Total Knee Replacement (TKR) is a complex yet highly rewarding procedure aimed at restoring mobility and relieving chronic pain in patients with severe knee arthritis or injury. Dr. Ulhas Sonar, a British-Indian orthopedic surgeon with global training, outlines a step-by-step guide to modern TKR, emphasizing precision, alignment, and patient-specific care.
Pre-operative Evaluation
The process begins with a thorough clinical examination, including assessment of skin condition, deformity correction, ligament stability, and range of motion. X-rays—ideally long-leg views—help assess bone quality and alignment.
- A popping sound or sensation at injury
- Swelling within hours
- Instability — “giving way” feeling when walking
Positioning & Preparation
Patients are positioned supine, and a strict sterile protocol is followed with double prep, antibiotics, and theater discipline to minimize infection risk.
Key Surgical Goals
The technical objectives include achieving proper alignment, restoring joint line, balancing ligaments, and ensuring smooth patella tracking.
The Surgical Technique
- Approach: Most commonly via the medial parapatellar approach.
- Femur First: Involves removing osteophytes, using intramedullary alignment, and making accurate femoral cuts.
- Tibia Preparation: Typically done using extramedullary referencing, ensuring proper slope and varus/valgus alignment.
- Trialing & Balancing: Components are trialed to check fit, gaps, and tracking before final fixation.
- Patella & Cementation: Patella is prepared, and components are cemented with careful handling.
Flexion & Extension Gap Management
Fine-tuning is done through balancing soft tissues and adjusting cuts. Scenarios like tight flexion or extension gaps are managed with augmentations or component adjustments.
Closure
The surgery concludes with layered closure in flexion, using appropriate dressings to support healing.
Conclusion:
TKR is a technical procedure, but with the right approach, attention to detail, and patient-specific planning, excellent outcomes are achievable. Dr. Ulhas Sonar’s systematic method ensures both new and experienced surgeons understand the balance between mechanics and clinical decision-making.
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