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Artykuły w czasopismach na temat "Total Knee Replacement (TKR) Implant"
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Li, Xinyu, Changjiang Wang, Yuan Guo i Weiyi Chen. "An Approach to Developing Customized Total Knee Replacement Implants". Journal of Healthcare Engineering 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/9298061.
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Total knee replacement (TKR) has been performed for patients with end-stage knee joint arthritis to relieve pain and gain functions. Most knee replacement patients can gain satisfactory knee functions; however, the range of motion of the implanted knee is variable. There are many designs of TKR implants; it has been suggested by some researchers that customized implants could offer a better option for patients. Currently, the 3-dimensional knee model of a patient can be created from magnetic resonance imaging (MRI) or computed tomography (CT) data using image processing techniques. The knee models can be used for patient-specific implant design, biomechanical analysis, and creating bone cutting guide blocks. Researchers have developed patient-specific musculoskeletal lower limb model with total knee replacement, and the models can be used to predict muscle forces, joint forces on knee condyles, and wear of tibial polyethylene insert. These available techniques make it feasible to create customized implants for individual patients. Methods and a workflow of creating a customized total knee replacement implant for improving TKR kinematics and functions are discussed and presented in this paper.
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Rao, Nandan, Abhishek Shashikant Patil i Kunal Bansal. "Uncemented Total Knee Replacement- Rediscovering the Past". Journal of Clinical Orthopaedics 7, nr 1 (2022): 126–34. http://dx.doi.org/10.13107/jcorth.2022.v07i01.495.
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Total knee replacements (TKR) both cemented and uncemented were developed almost simultaneously in the 1980’s. Cemented TKR found favor among the surgeons due to its technical ease and early failure of uncemented TKR due to poor design. In the past two decades; however, interest has been generated in uncemented TKR both because of design improvements which, in turn, has led to better results, especially in young active, obese, and geriatric but active patients where cemented TKR’s have been found to have increased failure rates. Active research is ongoing to refine the designs of uncemented TKR and future holds promise for this re-emerging technique and implant. This review helps to summarize the reasons for increasing interest in uncemented TKR, the newer designs and their results and the future developments expected.
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Khan, Farooq Azam, Waqas Ali, Bilal Ahmad Abbas, Khalid Mehmood, Nisar Ahmed i Talha Qureshi. "Comparison of All-Polyethylene Tibial Versus Metal-Backed Tibial Component in Total Knee Replacement Surgery". Pakistan Journal of Medical and Health Sciences 17, nr 4 (6.05.2023): 245–58. http://dx.doi.org/10.53350/pjmhs2023174245.
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Introduction: Total knee replacement (TKR) is the most successful procedure in Orthopedics. The selection of an ideal implant relies on better survivorship, restoration of functional activities and cost-effectiveness. This study compared the effectiveness of all-polyethylene (AP) versus metal-backed tibial (MTB) implant in TKR patients in terms of objective and subjective patient related outcomes. Objectives: To compare the effectiveness of all-polyethylene tibial implants versus metal-backed tibial implants in total knee replacement patients in terms of improvement in the American Knee Society Score (AKSS). Methodology: It was a nonrandomized controlled trial done in the Orthopaedic Department of the Sharif Medical City Hospital, Lahore, after approval by the institutional ethical committee. Fifty patients of grade IV knee joint osteoarthritis for greater than six months were included by nonprobability convenient sampling technique. The patients were allocated equally into standard treatment and intervention groups; patients underwent TKR with MTB implants in the standard group and AP implants in the intervention group after taking informed written consent. The AKSS score was calculated pre-operatively, 3 months and 6 months after surgery by the team member not involved in surgical planning. Results: A statistically significant improvement was observed in pre-operative to post-operative knee scores (p-value = 0.004) and functional scores (p-value = 0.001) with TKR. When the means of knee scores were compared between AP and MTB implants, there was no significant difference between the two groups between pre-operative and post-operative knee scores and functional scores. Practical implication Conclusion: There is no significant difference in knee score between the all-polyethylene and metal-backed implants regarding pain and functional status. All-polyethylene implants are a better substitute for MTB implants due to their cost-effectiveness, particularly in countries with financial constraints. The most practical implication of the current study is health economics. In a developing country with a low per capita income, expensive implants can be swapped with low cost implants to bring the cost of the procedure down. Keywords: All-polyethylene tibial, Metal-backed tibial, Total knee replacement, American Knee Society Score, AKSS.
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Wilding, Christopher P., Martyn Snow i Lee Jeys. "Which factors affect the ability to kneel following total knee arthroplasty? An outpatient study of 100 postoperative knee replacements". Journal of Orthopaedic Surgery 27, nr 3 (1.09.2019): 230949901988551. http://dx.doi.org/10.1177/2309499019885510.
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Background: Kneeling is an important activity of daily living, holding social, religious and occupational value. Following total knee replacement (TKR), many patients report they are unable to kneel or have been advised not to kneel. Methods: We observed 100 consecutive knee replacements in 79 patients attending outpatient clinic at a minimum 5 months post-TKR. The patients were asked to fill out a questionnaire detailing whether they were able to kneel prior to their knee replacement and whether they thought they were able to kneel since their knee replacement. The patients were then asked to kneel on a padded examination couch and then onto a pillow on the floor for 15 s. Degree of flexion achievable was also recorded. Results: Of the knees with patella resurfacing, 78.6% were able to kneel compared to only 45.6% knees with native patellae. Two-tailed Fisher’s exact test showed this difference to be statistically significant ( p = 0.001). The χ 2 analysis showed that those patients with an achievable flexion of angle of greater than 100° were significantly more likely to be able to kneel than those with a flexion angle of less than 100° ( p = 0.0148). Comparing posterior cruciate ligament (PCL) retaining against PCL sacrificing implants, there was no statistically significant difference in kneeling ability ( p = 0.541). Conclusion: Kneeling remains an important function in patients undergoing TKR, with patella resurfacing significantly improving the likelihood of a patient being able to kneel.
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Khan, Haziq Dad, Sayed Sohail Akhtar, Waleed Ali, Adil Saidullah i Summar Fatima. "Outcome of Total Knee Replacement in Morbid Obese Patients". Pakistan Journal of Medical and Health Sciences 16, nr 12 (31.12.2022): 530–33. http://dx.doi.org/10.53350/pjmhs20221612530.
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Aim: The purpose of our study was to determine the outcomes of total knee replacement in morbidly obese patients. Methodology: This prospective analysis was carried out on 128 morbidly obese patients (BMI> 40 kg/m2) in the Department of Orthopedic Surgery, Federal Govt. Polyclinic Hospital (FGPC) Islamabad, Mardan Medical Complex, Mardan and Bacha Khan Medical Complex, Swabi for the duration from January, 2021 to June, 2022. Demographic details, anthropometric parameters, and radiological assessment were recorded. Pre and post-operative radiological assessments included alignment, implant position, and radiolucent lines presence around the implant were compared. Outcome of TKR such as pre and post-operative functional score, knee society score, age, diagnosis, gender, laterality, and type of prosthesis were assessed and compared. SPSS version 25 was used for data analysis. Results: Of the total 128 TKR in morbid obese patients, the incidence of unilateral and bilateral TKR was 10 (7.8%) and 118 (92.2%) respectively. The overall mean age of the patients was 62.00 ± 8.12 years. Out of 126 TKR patients, there were 11 (8.6%) males and 117 (91.4%) females. Out of 10 unilateral TKR groups, males and females were 4 (40%) and 6 (60%) respectively. In the bilateral TKR group, there were 7 (5.9%) males and 111 (94.1%) were females. The mean BMI was 42.84 ± 3.46 kg/m2 with a range of 40-60 kg/m2. Based on Knee Society Scores and Functional Scores, Pre-operative mean knee score and functional score was 26.4 and 48.8, p=0.01 compared to post-operative 83.7 and 74.2, p=0.07 respectively. A higher prevalence for post-operative radiolucent lines was 28% against pre-operative 9%, p=0.01 were observed. During follow-up, the complications rate was 17.2% (n=22). Post-TKR complications such as superficial wound infection, deep joint infection, and deep vein thrombosis was found in 12.5% (n=16), 1.6% (n=2), and 3.1% (n=4) respectively. Conclusion: Our study found that prior to total knee replacement, patients with BMI>40 kg/m2 should lose weight to maintain weight reduction criteria. Knee arthroplasty's growth rate and epidemiological changes in morbid obese patients were the particular issues regarding total knee replacement highlighted in the present study. Based on our study, morbidly obese patients could be suitable candidates for total knee replacement. Morbid obese patients should be counseled. Keywords: Total Knee Replacement, Unilateral, Bilateral, Morbid Obese Patients
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Sivarasu, Sudesh, i Lazar Mathew. "KINEMATIC ANALYSIS AND 3D FINITE ELEMENT ANALYSIS OF A MOBILE-BEARING ARTIFICIAL HIGH FLEXION KNEE". Biomedical Engineering: Applications, Basis and Communications 21, nr 04 (sierpień 2009): 279–85. http://dx.doi.org/10.4015/s1016237209001337.
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Total knee arthroplasty (TKA) has been the end-time surgical procedure for pain relief and movement restoration in cases of severe arthritis. The knee implant design plays a vital role in deciding the activity levels of a patient after total knee replacement (TKR). In about 90% of younger patients undergoing the knee replacement surgeries, the restriction is not from the subject but from the implant design. This paper discusses parameters affecting the activity levels after TKR. It also briefs the design aspects of a novel knee design that allows the normal high flexion activity even after TKR. The application of finite element modeling in medical applications has been evolving as the field of high importance especially in the development of medical devices. The TKA has been in existence for over six decades till now. The generic artificial knee implants used in the TKA have the restriction in its range of motion of about 90°. A new design allowing flexion extension range of over 120° was designed with a view to facilitate partial squatting and the same is used for the analysis purpose. The loading conditions of 10 times the body weight are considered. The finite element analyses of the designs were carried out based on standard biomaterial used in orthopedic implants. In this paper, we have discussed the results of analyses of an artificial knee with titanium (Ti) alloy. The results of the analyses were used in identifying areas of extreme stresses within the design and the spot prone for higher deformation. Based on these results, slight modification on the designs was carried out. The results are also verified whether the body is within the linear deformation levels. As the results obtained were very satisfactory, the models have been recommended for prototyping.
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Zadorožnijs, Sergejs, i Konstantīns Kalnbērzs. "Ignoring Digital Templating Leads to Prosthetic Overhang in Total Knee Replacement". Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. 72, nr 5 (1.10.2018): 279–84. http://dx.doi.org/10.2478/prolas-2018-0026.
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Abstract Published studies on the accuracy of digital templating in total knee replacement (TKR) have employed standard knee, but not hip-to-ankle radiographs. A retrospective study was conducted in our hospital on patients undergoing TKR due to osteoarthritis in a period of six consecutive months. Templating was performed using a calibrating 25 mm metallic ball and Agfa Orthopaedic Tools software by a surgeon not involved with the operation. The surgeon performing the templating was blinded to the size of the implants inserted. Postoperative knee anteroposterior and lateral radiographs were then checked for the presence of prosthetic overhang of ≥ 3 mm. In total, 132 Caucasian adults were included in the study. Femoral overhang occurred in 33%, whereas tibial overhang in only 6% of cases. The exclusion of prosthetic overhang cases significantly improved the accuracy of size detection; exact match for femur increased from 55% to 69%, and for tibia from 70% to 73%. All implants were predicted to within one size in all cases. Digital templating using a calibrating 25 mm metallic ball, Agfa Orthopaedic Tools software and hip-to-ankle and knee lateral radiographs is an accurate method of predicting the knee implant to within one size. Ignoring this procedure leads to prosthetic overhang.
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Maag, Chase, Ioan Cracaoanu, Jason Langhorn i Mark Heldreth. "Total knee replacement wear during simulated gait with mechanical and anatomic alignments". Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 235, nr 5 (31.01.2021): 515–22. http://dx.doi.org/10.1177/0954411921991269.
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Total knee replacements (TKR) have historically been implanted perpendicular to the mechanical axis of the knee joint, with a commensurate external rotation of the femur in flexion relative to the posterior condylar axis (PCA). Although this mechanical alignment (MA) method has typically offered good long-term survivorship of implants, it may result in alignment of the implant that departs significantly from the native Joint Line (JL) in extension and flexion for a considerable portion of the patient population. There is a growing interest with surgeons to implant TKR components more closely aligned to the natural JL (Anatomic Alignment-AA) of the patient’s knee joint to reduce the need for soft tissue releases during surgery, potentially improving knee function and patient satisfaction. Using a previously-validated finite element model of the lower extremity, implant- and alignment-specific loading conditions were developed and applied in a wear experiment via a six-degree-of-freedom joint simulator. MA was defined as 0° Joint Line (JL), 0° varus hip-knee-ankle (HKA) angle, and 3° external femoral rotation. AA was defined as 5° varus JL, 3° varus HKA, and 0° femoral rotation. The experiment returned wear rates of 3.76 ± 0.51 mg/million cycles (Mcyc) and 2.59 ± 2.11 mg/Mcyc for ATTUNE® cruciate-retaining (CR) fixed bearing (FB) in MA and AA, respectively. For ATTUNE posterior-stabilized (PS) FB in AA, the wear rate was 0.97 ± 1.11 mg/Mcyc. For ATTUNE CR rotating platform (RP), the wear rates were 0.23 ± 0.19 mg/Mcyc, 0.48 ± 1.02 mg/Mcyc in MA and AA respectively. Using a two-way ANOVA, it was determined that there was no significantly difference in the wear rates between AA and MA ( p = 0.144) nor the wear rate of ATTUNE PS FB in AA significantly different from either ATTUNE CR FB or ATTUNE CR RP.
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Motwani, P., A. Jariwala i N. Valentine. "DOES NAVIGATION TOTAL KNEE REPLACEMENT REALLY MAKE A DIFFERENCE?" Journal of Musculoskeletal Research 16, nr 02 (czerwiec 2013): 1350007. http://dx.doi.org/10.1142/s0218957713500073.
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Background: Computer Navigation in Total Knee Replacement (TKR) has completed more than a decade since its inception. From that time, numerous studies have been done to see its effect on the variables of surgery and its outcome. Some studies have shown that it is definitely beneficial while others have negated its superiority over conventional techniques. This is an early outcome study on the results of navigation TKR in terms of alignment and clinical outcome at three years post-operatively. Methods: In the present study, 128 patients who had undergone navigation TKR (128 TKR) between January 2006 and November 2009 were included. The navigation system used was orthoPilot®. Patients were assessed post-operatively at one and three year using knee society score (KSS) and knee function score (KFS). All patients completed one year follow-up and 55 patients completed three year follow-up. From 128 patients, 40 navigated TKR patients operated between November 2007 and 2009 and were compared with 40 patients operated by conventional TKR operated between July 2007 and December 2008. Results: The mean KSS at 1 year post-operatively was 85.60 and at 3 years was 85.87. The mean KFS at 1 year post-operatively was 69.30 and at 3 years was 68.00. There was no statistically significant difference between navigation TKR and conventional TKR in terms of anatomical femoro-tibial alignment, femoral component alignment in coronal and sagittal plane and tibial component alignment in coronal plane. However, there was statistically significant difference between tibial component alignment in sagittal plane (p = 0.000) between both the groups. Conclusion: Computer navigation TKR affords a possibility to place both the femoral and tibial component very precisely without the risk of any greater axis deviation from ideal value. It helps in reducing the outliers in alignment of the limb and that of component and that improves the overall implant survival for a long time post-operatively.
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Cristofolini, L., S. Affatato, P. Erani, W. Leardini, D. Tigani i M. Viceconti. "Long-term implant—bone fixation of the femoral component in total knee replacement". Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 222, nr 3 (1.03.2008): 319–31. http://dx.doi.org/10.1243/09544119jeim328.
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Success of total knee replacement (TKR) depends on the prosthetic design. Aseptic loosening of the femoral component is a significant failure mode that has received little attention. Despite the clinical relevance of failures, no protocol is available to test long-term implant—bone fixation of TKR in vitro. The scope of this work was to develop and validate a protocol to assess pre-clinically the fixation of TKR femoral components. An in vitro protocol was designed to apply a simplified but relevant loading profile using a 6-degrees-of-freedom knee simulator for 1 000 000 cycles. Implant—bone inducible micromotions and permanent migrations were measured at three locations throughout the test. After test completion, fatigue damage in the cement was quantified. The developed protocol was successfully applied to a commercial TKR. Additional tests were performed to exclude artefacts due to swelling or creep of the composite femur models. The components migrated distally; they tilted towards valgus in the frontal plane and in extension in the sagittal plane. The migration patterns were consistent with clinical roentgen-stereophotogrammetric recordings with TKR. Additional indicators were proposed that could quantify the tendency to loosen/stabilize. The type and amount of damage found in the cement, as well as the migration patterns, were consistent with clinical experience with the specific TKR investigated. The proposed pre-clinical test yielded repeatable results, which were consistent with the clinical literature. Therefore, its relevance and reliability was proved.
Rozprawy doktorskie na temat "Total Knee Replacement (TKR) Implant"
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Bučková, Katrin. "Pokročilá technologie výroby kloubních implantátů metodou EBM". Master's thesis, Vysoké učení technické v Brně. Fakulta strojního inženýrství, 2020. http://www.nusl.cz/ntk/nusl-433499.
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Tato práce se zabývá pokročilou technologií výroby personalizovaných kloubních implantátů metodou EBM za použití titanové slitiny Ti6Al4V-ELI a navrhuje nový unikátní design kolenního implantátu společně s metodologií jeho inserce, přičemž tato řešení jsou součástí patentové přihlášky č. PV 2020-459. Toto neinvazivní řešení náhrady kolenního kloubu je šetrnější k pacientovi, maximálně chrání jeho zdravé tkáně a kosti, navíc se dá předpokládat vyšší životnost implantátu ve srovnání s tradičními dostupnými řešeními. Byla uskutečněna výroba vzorků z materiálu Ti6Al4V-ELI metodou EBM, proveden rozbor jejich materiálových, mechanických, technologických a únavových vlastností. Dále byly popsány pokročilé metody zobrazování, úpravy a tvorby kloubních ploch a použity k vyvinutí nového designu personalizovaného kloubního implantátu společně s inovační technologií jeho inserce a nástroji potřebnými k její úspěšné realizaci. Toto nové řešení bylo úspěšně ověřeno mnoha testy i výrobou Ti6Al4V-ELI a CoCrMo prototypů implantátů metodou EBM. Proveditelnost a použití v praxi bylo konzultováno a schváleno odborníky v této oblasti.
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Fisher, Emily Kay. "SYSTEMATIC REVIEW OF OUTCOMES OF TOTAL JOINT REPLACEMENT CLASS PARTICIPATION". Kent State University Honors College / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ksuhonors1367924351.
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Freisinger, Gregory Martin. "Varus-Valgus Knee Laxity and Biomechanical Function in Patients with Severe Osteoarthritis and after Total Knee Arthroplasty". The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1429805221.
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Blodgett, Nicole Petsas. "Predictors of time to return to work following a planned medical event: total knee replacement as an exemplar". Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/1828.
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Little is known about time to return to work (TRTW) following planned medical events. This study was a secondary analysis (n=94) to determine predictors of time to return to work following a total knee replacement for osteoarthritis. Significant predictors of delayed TRTW following a knee replacement: 1) use of workplace modifications (in 6wks vs 5 wks) and 2) poor physical function (in 7wks vs 6 wks). These findings have large implications for workers undergoing knee replacement, orthopedic clinicians, and occupational health nurses.
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Rivière, Charles. "Kinematic alignment technique for total knee replacement : rational, current evidence, potential concerns". Thesis, Aix-Marseille, 2016. http://www.theses.fr/2016AIXM4103.
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La pose d’une prothèse totale de genou (PTG) se fait selon la technique d’alignement mécanique (AM) qui corrige les déformations constitutionnelles du membre pour créer un membre rectiligne. La survie à long terme des implants est excellente mais les résultats fonctionnels sont décevants avec notamment de nombreux symptômes résiduels. Une nouvelle technique chirurgicale, l’alignement cinématique (AC), vise à rétablir l’anatomie constitutionnelle pré-arthrosique du genou, et permet une amélioration des résultats fonctionnels des PTG. Cette technique est actuellement réalisée avec des implants destinés à un positionnement mécanique, et qui ont un design trochléen ne reproduisant pas l'anatomie trochléaire native. Ceci pourrait affecter la biomécanique de l’articulation patello-fémorale et donc rendre les résultats fonctionnels des PTG cinématiques non optimal. Ce travail vise à démontrer 1) les limitations de la technique mécanique, 2) la fiabilité de la technique cinématique pour le positionnement de l’implant fémoral, et 3) que les implants actuels ne permettent pas une restauration de l’anatomie trochléenne des patientsThe conventional technique for TKA, namely mechanical alignment (MA), does not preserve the constitutional limb anatomy but systematically creates a straight limb. Excellent long-term implant survivorship has been reported, but functional outcomes are disappointing. To solve this problem, an alternative technique for TKA, namely kinematic alignment (KA), has recently been promoted and aims at restoring the constitutional (pre-arthritic) knee anatomy and laxity. Mid-term outcomes have shown excellent functional outcomes with this new KA technique. However, KA technique is currently done with TKA implants designed to be mechanically inserted. Their trochlea design does not reproduce the native trochlear anatomy, which could lead to increased rate of patellar complications with KA TKA. This work aims at demonstrating technical limitations of MA technique, good reproducibility of KA technique, and inappropriateness of current implant to restore patient trochlea anatomy
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Ehrman, James D. "X-Ray Photoelectron Spectroscopy Studies of Orthopedic Materials". University of Akron / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=akron1248115447.
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Renault, Jean-Baptiste. "Contributions mécaniques et numériques pour le développement de modèles individualisés os/implant : application à l'optimisation de l'arthroplastie totale du genou". Thesis, Aix-Marseille, 2019. http://www.theses.fr/2019AIXM0636.
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La gonarthrose est une maladie handicapante qui touche l’ensemble des structures articulaires du genou. Elle est favorisée par un défaut d’alignement du genou sur l’axe mécanique du membre inférieur, ce défaut cause un déséquilibre de la répartition des charges entre la partie médiale et la partie latérale de l’articulation. Lorsque la gonarthrose est trop avancée, une opération chirurgicale, l’arthroplastie totale de genou (ATG), permet le remplacement de l’articulation native par une prothèse totale de genou (PTG). Il n’y a pas de consensus clinique sur le meilleur positionnement des implants de la PTG, les principales causes d’échecs sont le descellement aseptique de l’implant tibial et les douleurs inexpliquées. Ces causes s'expliquent en partie par la perturbation du chargement mécanique de l’os induite par l’implantation d’une prothèse. Ce travail propose une méthode pour déterminer un positionnement des implants spécifique au patient pour limiter ces risques d’échec. Des méthodes automatiques, opérateur-indépendantes, d’association de repères anatomiques aux os du genou ont été développées et évaluées, elles permettent une implantation virtuelle automatique des implants. Nous avons montré que le défaut d’alignement conditionne les propriétés micromécaniques et micro-architecturales de l’os situé sous l’implant. Des modèles éléments-finis patients spécifiques ont été automatiquement construis. Pour chaque patient plusieurs stratégies chirurgicales de positionnement des implants ont été simulées et ont montré que le positionnement et les propriétés mécaniques de l’os trabéculaire influencent les phénomènes à l’origine d’une partie des échecs de PTGGonarthrosis is a widespread disabling disease which affects all joint structures of the knee. It is worsened by a non-alignment of the knee on the mechanical axis of the lower limb, this malalignment causes an imbalance in the distribution of loads between the medial and lateral part of the joint. When the gonarthrosis is too advanced, Total Knee Arthroplasty (TKA), allows the replacement of the native joint with a Total Knee Replacement (TKR) prosthesis. There is no clinical consensus on the best positioning of TKR implants, the main causes of failure are aseptic loosening of the tibial implant and unexplained pain. These causes are partly explained by the disruption of the mechanical loading of the bone induced by the implantation of a prosthesis. This work proposes a method to determine a patient-specific implant positioning to limit these risks of failure. During this thesis, operator-independent methods were developed and evaluated to automatically construct anatomical coordinate system on the knee bones, allowing automatic and parametric virtual implantation of implants. Using microindentation and µ-CT imaging, we showed that malalignment affects the micromechanical and micro-architectural properties of the bone under the implant. Patient-specific finite-element models were automatically built. For each patient, several surgical strategies for implant positioning were simulated. These simulations have shown that the positioning and mechanicals properties of trabecular bone influence the phenomena which cause a large part of TKR failure. The work carried out led to a numerical and mechanical method for optimizing the positioning of each patient's tibial implant
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Srinivas, Gunti Ranga. "Applications of Advanced CAE Methodologies to Orthopaedic Implant and Vehicle Occupant cum Pedestrian Safety Countermeasure Design". Thesis, 2017. http://etd.iisc.ac.in/handle/2005/4270.
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In the present work, experimental and numerical investigations into the load-displacement responses of a human lumbar Truncated Vertebral Unit (TVU) under quasi-static and impact loading conditions have been carried out for aiding in the design of orthopaedic implants and countermeasures for vehicle occupant and pedestrian safety. TVU samples obtained from the lumbar spinal column of an adult human male cadaver were initially subjected to quasi-static compressive tests. Impact tests were then conducted on a similar TVU sample in a drop-weight testing device instrumented with a piezoelectric load cell and a high-speed data acquisition system. An explicit nonlinear finite element model of the TVU was developed for predicting the experimental quasi-static and impact dynamic responses. Using the validated modelling approach mentioned, insights have been generated on adjoining vertebral stresses due to disc arthroplasty, and single and multi-level disc fusions as well as posterior fusions with and without posterior instrumentation. The numerical study is further extended to another crucial orthopaedic domain i.e. the assessment of the performance of variants of TKR (Total Knee Replacement) implants under ISO-specified dynamic gait cycle. In the latter investigation, a detailed and realistic finite element model of a representative human knee complex was developed by capturing relevant tissues such as femoral and tibial bones, medial and lateral collateral ligaments, and the components of a typical TKR implant including femoral component, tibial tray and UHMWPE (Ultra High Molecular Weight Polyethylene) insert. Substantive contribution has been made in the current research work towards assessment of vehicle occupant and pedestrian safety by applying the previously mentioned advanced finite element modelling approaches for representing complex vehicle structures, anthropomorphic test devices (commonly called as “dummies”), and pedestrian leg-forms. To this end, keeping in mind computational efficiency and need for optimization, a truncated finite element modelling approach capable of predicting the occupant response for a passenger car subject to a full-frontal US-NCAP test has been developed. Using the modelling tools mentioned and a nonlinear explicit LS-DYNA solver, it has been shown that meeting pedestrian safety standards need not be an isolated exercise of designing the front bumper of a vehicle only but can be combined with meeting NCAP occupant safety requirements leading to weight reduction of the front structure of a vehicle with gages of parts such as front rails in addition to bumper parts being included as design variables. For the first time, with the help of a comparative study carried out with a Hybrid 3 dummy and detailed biomechanical models of human lower extremity, the susceptibility of knees with TKR implants to periprosthetic injuries during frontal collisions has been demonstrated pointing out to a need for higher knee-protection countermeasures in vehicles.
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BURGER, ANDREAS. "Feasibility Assessment of Compliant Polymers in TKR". Thesis, 2009. http://hdl.handle.net/1974/2578.
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Total knee joint replacements (TKRs) are a commonly used treatment when joint pain becomes a major issue and the function of activities of daily living is impaired. TKRs may last for up to 20 years; however, younger and physically more active patients are receiving TKRs, necessitating increased prosthesis life-time. There has been considerable interest in more cartilage-like materials for the tibial inlay of a TKR. Compliant, rubbery polymers may be a first step towards such a material.
In this thesis, finite element analysis (FEA) was utilized to assess the feasibility of polycarbonate urethane (PCU) in a TKR application. Mechanical characterisation of PCU55D and PCU80A was performed in order to better understand the deformation behaviour of these materials. Mechanical test data was then used to tune and validate a hyperelastic material model. In a last step, the material model was applied to a static FE knee model which was used to simulate five discrete loading cases: three gait cycle events, stair climbing and squatting. Contact pressure, contact area and von Mises stress of the PCU inlay were compared to literature and to a standard ultra-high molecular weight polyethylene (UHMWPE) inlay.
The contact area of the articulating implant surfaces was on average 345% greater in PCU than in UHMWPE and contact pressure was on average 77% lower in PCU than in UHMWPE. The difference between TKRs simulated with a PCU tibial inlay and those simulated with a UHMWPE inlay increased with increasing flexion angle. The contact pressures measured in TKRs simulated with a PCU tibial inlay were well below values that are expected to cause damage to the polymer, possibly reducing the risk of wear. The contact areas found in TKRs simulated with a PCU tibial inlay were close to what has been reported for the natural knee.
Considering the low contact pressures even at high flexion angles, where initial congruency is limited, it may be feasible to design less conforming knee prostheses that still exhibit low contact pressures, allowing for a greater range of motion. The reported results strongly indicate that compliant polymers may offer an opportunity to improve current TKRs.Thesis (Master, Mechanical and Materials Engineering) -- Queen's University, 2009-08-11 14:59:50.801
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Ku, Ivan, i 古奕方. "A Study of the Correlation between Total Knee Replacement and Implant Size". Thesis, 2017. http://ndltd.ncl.edu.tw/handle/pmpscc.
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碩士東海大學
工業工程與經營資訊學系
105
Total Knee Replacement is an effective method for the treatment of severe osteoarthritis disease. The Taiwan National Health Insurance statistics show there are around 20,000 patients accepted the operation each year. The preoperative planning of TKR is to measure the size of patients’ knee by x-ray or computer tomography, etc. But, both of them are not able to accurately predict the size of patients' knees. This study implements gender, height, weight, age and the size of knee joint supplies to predict the size of a patient’s knee. Thereafter, it can reduce the size of supplies and the cost of medical expenses. The results show that there is a linear relationship among gender, height, weight, age and patitnts’ size. The linear regression model is capable of appling to predict the size of TKR.
Części książek na temat "Total Knee Replacement (TKR) Implant"
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Gotman, Irena. "Biomechanical and Tribological Aspects of Orthopaedic Implants". W Springer Tracts in Mechanical Engineering, 25–44. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-60124-9_2.
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AbstractOrthopaedic and dental implant treatments have allowed to enhance the quality of life of millions of patients. Total hip/knee arthroplasty is a surgical replacement of the hip/knee joint with an artificial prosthesis. The aim of joint replacement surgery is to relieve pain improve function, often for sufferers of osteoarthritis, which affects around a third of people aged over fifty. Nowadays, total hip and knee replacement (THR) surgeries are considered routine procedures with generally excellent outcomes. Given the increasing life expectancy of the world population, however, many patients will require revision or removal of the artificial joint during their lifetime. The most common cause of failure of hip and knee replacements is mechanical instability secondary to wear of the articulating components. Thus, tribological and biomechanical aspects of joint arthroplasty are of specific interest in addressing the needs of younger, more active patients. The most significant improvements in the longevity of artificial joints have been achieved through the introduction of more wear resistant bearing surfaces. These innovations, however, brought about new tribocorrosion phenomena, such as fretting corrosion at the modular junctions of hip implants. Stiffness mismatch between the prosthesis components, non-physiological stress transfer and uneven implant-bone stress distribution are all involved in premature failure of hip arthroplasty. The development of more durable hip and knee prostheses requires a comprehensive understanding of biomechanics and tribocorrosion of implant materials. Some of these insights can also be applied to the design and development of dental implants.
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Bobak, Peter, i Peter V. Giannoudis. "Total Knee Replacement (TKR)". W Practical Procedures in Elective Orthopaedic Surgery, 183–92. London: Springer London, 2011. http://dx.doi.org/10.1007/978-0-85729-814-0_24.
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Sandeep Kumar, Y., K. V. S. Rajeswara Rao, Sunil R. Yalamalle, S. M. Venugopal i Sandeep Krishna. "Effect of Slicing Thickness and Increment on the Design of Patient Specific Implant for Total Knee Replacement (TKR) Using Magnetic Resonance Imaging (MRI)—A Case Study". W Intelligent Manufacturing and Energy Sustainability, 411–19. Singapore: Springer Singapore, 2020. http://dx.doi.org/10.1007/978-981-15-1616-0_40.
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Ries, Michael D. "51 Complications After Revision TKR". W The Unhappy Total Knee Replacement, 611–22. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-08099-4_59.
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Testa, Enrique A., i Michael T. Hirschmann. "Case Discussion to Chap. 34: Persistent/Recurrent Pain After TKR Not Always TKR Related". W The Unhappy Total Knee Replacement, 435–41. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-08099-4_41.
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Parvizi, Javad. "19 Periprosthetic Joint Infection After TKR". W The Unhappy Total Knee Replacement, 239–42. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-08099-4_24.
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Aggarwal, Ajay, i Javad Parvizi. "46 Algorithm for Treating Infection After TKR". W The Unhappy Total Knee Replacement, 547–57. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-08099-4_53.
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Christen, Sebastian, i Michael T. Hirschmann. "Case Discussion to Chap. 15: Stiff Knee Joint After TKR Due to Tight Flexion Gap in Oversized TKR". W The Unhappy Total Knee Replacement, 185–88. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-08099-4_18.
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Daines, Brian K., i Douglas A. Dennis. "5 Measured Resection and Gap Balancing Technique in TKR". W The Unhappy Total Knee Replacement, 47–57. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-08099-4_5.
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Walmsley, Phil, Michael T. Hirschmann, Roland Becker i Ivan J. Brenckel. "37 Pain After TKR: When Is a Conservative Treatment Beneficial?" W The Unhappy Total Knee Replacement, 465–70. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-08099-4_44.
Pełny tekst źródłaStreszczenia konferencji na temat "Total Knee Replacement (TKR) Implant"
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Mane, Amit M., Chadd W. Clary, Amber N. Reeve, Lorin P. Maletsky i Kevin A. Dodd. "Change in Knee Passive Envelope of Motion With Total Knee Replacement Design". W ASME 2008 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2008. http://dx.doi.org/10.1115/sbc2008-192565.
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Many researchers have studied the tibial passive motion, the boundaries of which are defined by various knee ligamentious and bony constraints [1, 2, 3]. The technique has been used in clinical practices and experimental research to assess injury and predict likely surgical outcomes [1, 2]. After total knee replacement surgery (TKR), the implants’ design features and altered ligamentious tension provide the joint constraint and stability. Therefore, the change in passive envelope of motion from the natural condition could be used to observe the altered constraints and stability achieved in TKR knees. The objective of this study was to assess the change in passive envelope of motion after TKR with two implant designs: cruciate retaining and posterior stabilized.
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Park, Pan Gi, i Leszek J. Sudak. "Interaction Between Bone Cement Cracking and Non-Slip Implant Interfaces". W ASME 2007 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2007. http://dx.doi.org/10.1115/sbc2007-175920.
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According to National Hospital Discharge Survey 2003, approximately 217,000 and 402,000 patients in the U.S. underwent Total Hip Replacement (THR) and Total Knee Replacement (TKR) operations, respectively and $24.7 billion dollars were spent in hospitalization related to these replacement surgeries. In addition, there were 36,000 revision hip replacements and 33,000 revision knee replacements. To decrease the revision surgeries and increase the performance of the implants, many researchers have provided new techniques for better implant fixation and mechanisms of debonding around implants. With respect to fixation, performance of cemented prosthesis is reported to be better than those of cementless ones. Moreover, surgery with cemented implants has been among the most popular and widely performed.
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Martelli, Sandra, Maurilio Marcacci, Randy Ellis i Stefano Zaffagnini. "A Model of the Artificial Knee for Computer Assisted Functional Planning in Total Knee Replacement". W ASME 1996 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 1996. http://dx.doi.org/10.1115/imece1996-1279.
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Abstract Long term results of Total Knee Replacement (TKR) are highly dependent on the balance and positioning of the implant. The preoperative planning for a correct TKR positioning is based on the ideal adaptation of shape and kinematics of the prosthesis to the individual features of the patient.
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Khandaker, Morshed, Sadegh Nikfarjam, Karim Kari, Onur Can Kalay, Fatih Karpat, Helga Progri, Ariful Bhuiyan, Erik Clary i Amgad Haleem. "Laser Microgrooving and Nanofiber Membrane Application for Total Knee Replacement Implants Using a Caprine Model". W ASME 2021 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2021. http://dx.doi.org/10.1115/imece2021-73597.
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Abstract Aseptic loosening is a well-recognized phenomenon in cementless total knee replacement (TKR) and often carries severe consequences for the patient. We recently developed and tested in vitro a novel strategy for enhancing osseointegration and acute mechanical stability of orthopedic implants that employ laser-induced microgroove (LIM) and nanofiber membrane (NFM) applications at the bone-implant interface. We report herein investigation of the approach with results from a pilot study employing three skeletally mature female Spanish cross goats (∼4y, 35–45kg) receiving cementless TKR with a commercially available implant system (Biomedrix® Canine Total Knee). Pre-operative radiographs were taken to ensure limb normality and to select the appropriately sized implants for each goat. With the animal under general anesthesia and the limb properly prepped for aseptic surgery, the stifle was approached, and osteotomies of the proximal tibia and distal femur performed in preparation for implantation of the tibial (TT) and femoral (FT) trays. For one goat, the arthroplasty implant surfaces were unaltered from the manufacturer’s mirror-polished (MP) condition. For the other two goats, the TT bone-contact surface was laser-micro grooved (150 μm depth, 200 μm width, 200 μm spacing) prior to sterilization and then implanted with (LIM/NFM) or without (LIM) an intermediate (surface-applied) polycaprolactone (PCL) nanofiber mesh (50 × 50mm, electrospun, aligned, unidirectional, 10 μm thickness). Following surgery, animals received appropriate analgesic therapy and rehabilitative care to maximize animal comfort, function, and quality of life while limiting the risk of major complications. Post-operative monitoring included assessment of mentation, vital signs, pain level, digestive function (weight, appetite, rumen contractions, feed intake, fecal output), and limb status (usage, range of motion, muscular volume). By the study’s end (12 wks), all animals had recovered a pre-surgery range of motion in the operated knee and exhibited typical bony changes on radiographic follow-up. At necropsy following humane euthanasia, no gross instability of TKR components was observed. Histomorphometric analysis of explanted bone-TT constructs showed the increased new bone surface area in the LIM-NFM sample (0.49 mm2) compared with the MP sample (0.03 mm2), suggesting that microgrooves and/or PCL nanofiber coating may improve the clinical performance of the implant. A finite element analysis (FEA) model was developed to explore the impact of surface micro grooving to the mechanical stimuli at the bone-implant interface to supplement the in vivo studies. The three-dimensional geometry of the tibia was scanned using computed tomography and imported into a proprietary (MIMICS®) software to construct the solid models for finite element micro-strain analyses.
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Khandaker, Morshed, Onur Can Kalay, Fatih Karpat, Amgad Haleem, Wendy Williams, Kari E. Boyce, Erik Clary i Kshitijkumar Agrawal. "The Effect of Micro Grooving on Goat Total Knee Replacement: A Finite Element Study". W ASME 2020 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2020. http://dx.doi.org/10.1115/imece2020-24136.
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Abstract A method to improve the mechanical fixation of a total knee replacement (TKR) implant is clinically important and is the purpose of this study. More than one million joint replacement procedures are performed in people each year in the United States, and experts predict the number to increase six-fold by the year 2030. Whether cemented or uncemented, joint prostheses may destabilize over time and necessitate revision. Approximately 40,000 hip arthroplasty surgeries have to be revised each year and the rate is expected to increase by approximately 140% (and by 600% for total knee replacement) over the next 25 years. In veterinary surgery, joint replacement has a long history and the phenomenon of surgical revision is also well recognized. For the betterment of both people and animals, improving the longevity of arthroplasty devices is of the utmost clinical importance, and towards that end, several strategies are under investigation. One approach that we explore in the present research is to improve the biomechanical performance of cemented implant systems by altering the implant surface architecture in a way that facilitates its cement bonding capacity. Beginning with the Charnley system, early femoral stems were polished smooth, but a number of subsequent designs have featured a roughened surface — created with bead or grit blasting — to improve cement bonding. Failure at the implant-cement interface remains an issue with these newer designs, leading us to explore in this present research an alternate, novel approach to surface alteration — specifically, laser microgrooving. This study used various microgrooves architectures that is feasible using a laser micromachining process on a tibia tray (TT) for the goat TKR. Developing the laser microgrooving (LM) procedure, we hypothesized feasibility in producing parallel microgrooves of precise dimensions and spacing on both flat and round metallic surfaces. We further hypothesized that laser microgrooving would increase surface area and roughness of the cement interface of test metallic implants and that such would translate into an improved acute mechanical performance as assessed in vitro under both static and cyclic loads. The objective was to develop a computational model to determine the effect of LIM on the tibial tray to the mechanical stimuli distributions from implant to bone using the finite element method. This study designed goat TT 3D solid model from a computer topography (CT) images, out of which three different laser microgrooves were engraved on TT sample by varying depth, height and space between two adjacent grooves. The simulation test results concluded that microgrooves acchitecures positively influence microstrain behavior around the implant/bone interfaces. There is a higher amount of strain observed for microgroove implant/bone samples compared to non-groove implant/bone samples. Thus, the laser-induced microgrooves have the potential to be used clinically in TKR components.
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Halloran, Jason P., i Paul J. Rullkoetter. "A Total Knee Replacement Model for Evaluation of Joint Mechanics". W ASME 2001 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2001. http://dx.doi.org/10.1115/imece2001/bed-23087.
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Abstract The success of current total knee replacement (TKR) devices is contingent on the kinematics and contact mechanics during in vivo physiological activity. A great deal of research has gone into determining parameters important to proper long-term joint function. Indicators of potential wear performance in ultra-high molecular weight polyethylene (UHMWPE) total joint replacement components include contact stress and area due to articulations, and tibio-femoral and patello-femoral kinematics. All have been used to compare implant designs and serve as a basis for differentiation of systems.
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Sathyamoorthy, Mohan. "Biomechanics of the Total Knee Replacement: Theoretical and Computational Modeling of Biomechanical Response to the Tibial Insert". W ASME 1997 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 1997. http://dx.doi.org/10.1115/imece1997-0208.
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Abstract Degenerative bone disease is a condition that often affects the articulating joints in the body by compromising the normal range of movement in those areas. As the condition progresses, the patient experiences a more painful and reduced level of mobility, often requiring joint replacement therapy. As the use of orthopaedic implants has become commonplace, the need to adequately understand and characterize the body’s biomechanical response to such implants is necessary to assist patients in achieving a more complete recovery, and more importantly, to optimize the design of biocompatible implants. The total knee replacement (TKR), a modular assembly comprising of femoral, tibial, and patellar components, has demonstrated great benefit to patients in terms of pain management and restoration of mobility. However, with reported disadvantages including stem loosening and bone fracture [1], correlating three dimensional stress concentrations to bone resorption may be an effective predictor of potential bone fracture site in TKR patients. The relationship between stress adaptive theories, stress concentrations predicted by computational modeling, and bone resorption has previously not been studied in great detail. This paper develops a continuum relationship that relates stress adaptive bone remodeling in response to stress concentrations, and presents a basic finite element model to quantify stress concentrations to help verify the proposed relationship. Results could eventually be used recursively to optimize TKR implant design and performance.
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DesJardins, John, Lisa Gustafson, Lisa Benson i Martine LaBerge. "Fiberscopic Visualization of Total Knee Replacement Contact Kinematics During In Vitro Simulation". W World Tribology Congress III. ASMEDC, 2005. http://dx.doi.org/10.1115/wtc2005-63699.
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Optimization of total knee replacement (TKR) design and wear behavior requires the study of bearing contact mechanics. In this study, a novel fiberscopic imaging method was developed and combined with dynamic TKR simulation to visually quantify dynamic TKR contact areas in vitro. Contact areas between transparent TKR tibial inserts and metallic femoral components were captured using opaque lubricant media and a fiberscopic high-speed video camera within the simulator. Walking and stair descent loading patterns were characterized. Centroid location and contact pathways were calculated to determine pathway velocity and cross-shear characteristics. Overall, contact velocities ranging from 0 to 233mm/sec and crossing angles ranging from near 0 to 90 degrees were found during this study. These results provide a basis for wear testing and cross-shear modeling of TKR materials, leading to more accurate predictions of wear behavior in these implants.
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Baldwin, Mark A., Chadd W. Clary, Lorin P. Maletsky i Paul J. Rullkoetter. "Specimen-Specific Verification of Predicted TKR Mechanics During Simulated Deep Flexion Loading Conditions". W ASME 2008 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2008. http://dx.doi.org/10.1115/sbc2008-192948.
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Verified computational models of total knee replacement serve as the primary design-phase tool for parametric analysis of implant geometry. Previously, dynamic finite element models of the Kansas Knee Simulator (KKS) were developed and tibiofemoral (TF) and patellofemoral (PF) kinematic predictions were verified by comparison with experimental measurements [1,2]. In this prior work, the implants were mounted in metallic fixtures to assess the ability of the model to accurately predict the TF and PF kinematics without the additional complexity of variable cadaver specimens and soft-tissue constraint. The next step in the systematic model verification procedure was to verify kinematic predictions with multiple specimen-specific models. Specifically, the objectives of the present study were: 1) to develop an explicit finite element (FE) model of the KKS capable of recreating experimental loading protocols for a deep knee bend activity and 2) to verify predicted six degree-of-freedom (DOF) TF and PF kinematics of two cruciate retaining (CR) and two posterior stabilized (PS) implanted specimen-specific models with deformable, wrapping soft tissue constraint.
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Lundberg, Hannah J., Kharma C. Foucher, Thomas P. Andriacchi i Markus A. Wimmer. "Comparison of Numerically Modeled Knee Joint Contact Forces to Instrumented Total Knee Prosthesis Forces". W ASME 2009 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2009. http://dx.doi.org/10.1115/sbc2009-206791.
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Total knee replacement (TKR) surgery decreases pain and increases functional mobility for patients with joint disease. As primary TKRs are implanted in patients who are younger, heavier, and more active (1), increases in wear and TKR revision rates are expected. Preclinical analysis of TKRs with mathematical models and experimental tests require accurate in vivo kinetic and kinematic input data. Kinematics can be obtained with gait analysis, but in vivo force data are just beginning to become available from instrumented TKRs from only a few patients (2). Patient gait is highly variable both within and between individuals and can be influenced by a variety of factors including the progression and history of joint disease, surgical procedure, and TKR design. Variation in patient gait and activities results in subsequent contact force and polyethylene wear variability. A validated mathematical model which calculates contact forces for alternate input data could add valuable insight for preclinical testing. A problem facing mathematical modeling is that there are too many unknowns to directly solve for contact forces. In order to approach this problem, we have developed a knee mathematical model that allows parametric variation of muscle activation levels (3) and calculates a solution space of physically possible contact forces.
Raporty organizacyjne na temat "Total Knee Replacement (TKR) Implant"
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Howell, Stephen M. Kinematic Total Knee Replacement (TKR). Touch Surgery Simulations, marzec 2015. http://dx.doi.org/10.18556/touchsurgery/2015.s0045.
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Gandhi, Naline, Amatullah Sana Qadeer, Ananda Meher, Jennifer Rachel, Abhilash Patra, Jebamalar John, Aiswarya Anilkumar, Ambarish Dutta, Sarit Kumar Rout i Lipika Nanda. A systematic review of cost effectiveness of total knee replacement vs non-surgical management among 40 years and above population with knee osteoarthritis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, wrzesień 2022. http://dx.doi.org/10.37766/inplasy2022.9.0044.
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Review question / Objective: Clinically, knee is the most common site of OA, followed by the hand and hip. The main research question is what are different costing methodologies used and its quality in studies related to cost effectiveness of TKR compared to non-surgical treatment procedures. Based on this review question, the following objectives are proposed: 1. To assess different methodologies, scope and quality of studies related to cost effectiveness of TKR compared to non-surgical management. 2. To synthesize evidence of TKR cost and compare the variations across different countries. Information sources: All sources with information on TKR, economic evaluations and non-surgical management namely journals, handbooks, internet sources, published conference abstracts, thesis, and electronic databases will be searched extensively.