Total Knee Arthroplasty- A Review of Emerging Trends in Patient Management and Surgical Practices

Abstract

Background: Osteoarthritis is a chronic, multifactorial, degenerative disorder commonly seen in elderly with predominance for females above the age of 45yrs with largely unknown etiology. With the rising demand for TKA in the foreseeable future, our aim is to assess the emerging trends in patient management and surgical practices for TKA. Material and Methods: A narrative review of current literature analyzing the patient characteristics, current practices in peri-operative management, methods to control blow loss, pain management and recent advances in TKA. Results: Literature describes that the prevalence of osteoarthritis of knee along with average BMI and associated comorbidities are on the rise. Emphasis is being laid on blood preservation, including iron therapy, erythropoietin tranexamic acid, low pressure tourniquet, acute normovolemic hemodilution. Multimodal analgesia including pre-emptive analgesia, peri articular injections, peripheral nerve blocks play a major role in pain management. The use of artificial intelligence, Robotics, 3D printing and Computer assisted navigation in TKA in recent years shows a promising future. Conclusion: Favorable outcomes have been observed with various blood preservation and pain management techniques. TKA remains the forefront of evolution of scientific innovation that have a great potential for refining the TKA alignment and biomechanical outcome to subsequently reduce the incidence of TKA revision and improve patient’s satisfaction. However, further Level 1 studies are required to assess the long-term outcomes.