eMedicine Specialties > Orthopedic Surgery > Knee

Total Knee Arthroplasty: Workup

Author: Simon H Palmer, MD, Consultant Surgeon, Department of Orthopedics and Trauma, Worthing and Southlands NHS trust, Sussex
Coauthor(s): Mervyn J Cross, MBBS, FRACS, Director of the Australian Institute of Musculoskeletal Research, Department of Orthopedic Surgery, North Sydney Orthopedic/Sports Medicine Center, Crows Nest, Australia
Contributor Information and Disclosures

Updated: Apr 14, 2009

Workup

Laboratory Studies

  • Preoperative laboratory evaluation should include the following: CBC (complete blood count), sedimentation rate, prothrombin time and activated partial thromboplastin time (PT/aPTT), urinalysis and culture, and urea and electrolytes.
    • Urinalysis is performed to exclude occult urinary tract infection
    • Routine preoperative evaluation of coagulation studies is not necessary except in patients with a history of bleeding, alcoholism, or previous liver disease.

Imaging Studies

  • Radiographic views for the assessment of the patient with knee arthritis include the following:
    • Standing AP view
    • Lateral view
    • Patellofemoral (skyline) view (see Image 7)
    • Long leg radiographs to assess malalignment - Helpful for preoperative planning
    • Standing radiographs with the knee in extension or in 45 degrees of flexion (Rosenberg view) - Can improve the sensitivity of detection of cartilage degeneration
  • Routine use of a chest roentgenography is not usually recommended as a screening tool. However, it is indicated in patients with cardiopulmonary disease or in patients with clinical signs identified in the preadmission clinic.

Other Tests

  • Electrocardiography is performed in elderly patients and in patients with a history of cardiac issues.
  • More sophisticated imaging modalities in the investigation of knee arthritis are of occasional benefit for the assessment of significant bone loss or bone infection and include the following:
    • Indium white blood cell scanning
    • Computed tomography scanning
    • Magnetic resonance imaging
    • Bone densitometry

Histologic Findings

Macroscopic examination shows a spectrum of changes in the articular cartilage, from softening and fibrillation to complete cartilage destruction, subchondral bone thickening, cysts, and osteophytes. Microscopic examination shows chondrocyte proliferation into embryonic and dedifferentiated forms in the deeper zones, fibrocartilage formation with capillary infiltration, loss of proteoglycan ground substance with altered staining characteristics, chondrocalcinosis, and synovial hyperplasia.

More on Total Knee Arthroplasty

Overview: Total Knee Arthroplasty
Workup: Total Knee Arthroplasty
Treatment: Total Knee Arthroplasty
Follow-up: Total Knee Arthroplasty
Multimedia: Total Knee Arthroplasty
References
Further Reading
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References

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  4. Chitnavis J, Sinsheimer JS, Clipsham K. Genetic influences in end-stage osteoarthritis. Sibling risks of hip and knee replacement for idiopathic osteoarthritis. J Bone Joint Surg Br. Jul 1997;79(4):660-4. [Medline].

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  6. Soderman P, Malchau H. Validity and reliability of Swedish WOMAC osteoarthritis index: a self-administered disease-specific questionnaire (WOMAC) versus generic instruments (SF-36 and NHP). Acta Orthop Scand. Feb 2000;71(1):39-46. [Medline].

  7. Rand JA, Ilstrup DM. Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties. J Bone Joint Surg [Am]. Mar 1991;73(3):397-409. [Medline].

  8. Ritter MA, Herbst SA, Keating EM. Long-term survival analysis of a posterior cruciate-retaining total condylar total knee arthroplasty. Clin Orthop. Dec 1994;(309):136-45. [Medline].

  9. Greene KA, Schurman JR 2nd. Quadriceps muscle function in primary total knee arthroplasty. J Arthroplasty. Oct 2008;23(7 Suppl):15-9. [Medline].

  10. [Best Evidence] Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br. Jan 2009;91(1):52-7. [Medline].

  11. [Best Evidence] Andersen LØ, Husted H, Otte KS, Kristensen BB, Kehlet H. A compression bandage improves local infiltration analgesia in total knee arthroplasty. Acta Orthop. Dec 2008;79(6):806-11. [Medline].

  12. [Best Evidence] Shum CF, Lo NN, Yeo SJ, Yang KY, Chong HC, Yeo SN. Continuous femoral nerve block in total knee arthroplasty: immediate and two-year outcomes. J Arthroplasty. Feb 2009;24(2):204-9. [Medline].

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  14. [Best Evidence] Harmer AR, Naylor JM, Crosbie J, Russell T. Land-based versus water-based rehabilitation following total knee replacement: a randomized, single-blind trial. Arthritis Rheum. Feb 15 2009;61(2):184-91. [Medline].

  15. Healy WL, Sharma S, Schwartz B, Iorio R. Athletic activity after total joint arthroplasty. J Bone Joint Surg Am. Oct 2008;90(10):2245-52. [Medline].

  16. Bradbury N, Borton D, Spoo G. Participation in sports after total knee replacement. Am J Sports Med. Jul-Aug 1998;26(4):530-5. [Medline].

  17. Buechel FF. Cementless meniscal bearing knee arthroplasty: 7- to 12-year outcome analysis. Orthopedics. Sep 1994;17(9):833-6. [Medline].

  18. March LM, Cross M, Tribe KL, Lapsley HM, Courtenay BG, Cross MJ, et al. Two knees or not two knees? Patient costs and outcomes following bilateral and unilateral total knee joint replacement surgery for OA. Osteoarthritis Cartilage. May 2004;12(5):400-8. [Medline].

  19. Meneghini RM, Hanssen AD. Cementless fixation in total knee arthroplasty: past, present, and future. J Knee Surg. Oct 2008;21(4):307-14. [Medline].

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Keywords

total knee arthroplasty, TKA, total knee replacement, knee replacement, knee replacement surgery, knee surgery, knee pain, osteoarthritis of the knee, total joint arthroplasty, artificial knee

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Contributor Information and Disclosures

Author

Simon H Palmer, MD, Consultant Surgeon, Department of Orthopedics and Trauma, Worthing and Southlands NHS trust, Sussex
Disclosure: Nothing to disclose.

Coauthor(s)

Mervyn J Cross, MBBS, FRACS, Director of the Australian Institute of Musculoskeletal Research, Department of Orthopedic Surgery, North Sydney Orthopedic/Sports Medicine Center, Crows Nest, Australia
Mervyn J Cross, MBBS, FRACS is a member of the following medical societies: American Orthopaedic Society for Sports Medicine, Australasian College of Sports Physicians, Australian Association of Surgeons, Australian Medical Association, Australian Orthopaedic Association, Hughston Society, and Royal Australasian College of Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas M DeBerardino, MD, Director, John A Feagin, Jr, Sports Medicine Fellowship at West Point, Associate Professor of Orthopedic Surgery, Uniformed Services University of the Health Sciences and Keller Army Community Hospital
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds None; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

 
 
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