Total Knee Replacement Analysis

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Introduction
Total knee replacement (TKR) is considered as an effective and successful end-stage surgical procedure for the relief of chronic knee pain and functional disability (Wylde et al. 2007). There should be radiographic evidence of joint damage, moderate to severe persistent pain that is not relieved by a course of non-surgical management and clinically significant functional limitation resulting in diminished quality of life (Gabr et al. 2011). In Singapore, there is no prevalence data on knee replacements (Leung et al. 2013), but Xu et al. (2008) reviewed the data of 1663 total knee replacements in a tertiary institute of Singapore, and revealed that 96% of the knee replacements were due to osteoarthritis. Osteoarthritis is a multifactorial
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Besides those advantages, it was mentioned that the advantages of a simultaneous bilateral TKR are that it ensures a single anaesthetic exposure, single postoperative course, a single rehabilitation period and enables a more efficient use of resources and increased patient satisfaction (Gurunathan, 2013).

Setting the Context

In setting a clear direction and structure to the essay, some assumptions has to be made to provide a realistic picture of the subject. A review by Stubbs et al. (2015) found that the factors associated with knee osteoarthritis were low physical activity, the non-white ethnicity, being female and increasing age. Thus, it is assumed that the lady is a Singaporean lady with bilateral osteoarthritic knees who lead a sedentary lifestyle. She was experiencing pain and limitation in function, and difficulty in carrying out her activities of daily living (ADLs). Hence, this led to her bilateral total knee replacement surgery done in order to relief her pain, improve her functional mobility and quality of life. Considering the time frame and considerations mentioned, it is highly likely that she underwent a simultaneous bilateral TKR.
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It is advised to follow up with the lady for 6 months as it is well known that maximum functional gain is achieved in the first 6 month following total knee replacement surgery (Unver et al. 2005, Kennedy et al. 2005). In managing the lady, any reversible risk factors that predisposed her to osteoarthritis such as obesity, smoking and physical inactivity must be managed and lifestyle modifications must be made accordingly, along with self-efficacy of her condition.

It is also important to assess and review her functional outcomes as well as performance outcomes from rehab using outcome measures such as Six Minute Walk test, Berg balance test, Functional Independent Measure, Modified Barthel Index and Dynamic Gait Index (Artz et al, 2015).

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