Prospective study of clinical and functional outcome of primary total knee replacement (tkr) in osteoarthritic knee.

Abstract

Introduction: Osteoarthritis is a degenerative joint disease that significantly impacts quality of life, particularly in older adults. Total knee replacement (TKR) has emerged as a definitive surgical intervention for end-stage osteoarthritis of the knee when conservative management fails. This study aimed to evaluate the clinical and functional outcomes of primary TKR in patients with osteoarthritic knees at the Department of Orthopaedics, Shri B M Patil Medical College and Research Centre, Vijayapura, Karnataka, India. Methodology: This prospective cohort study was conducted from April 2023 to December 2024, enrolling 33 patients who met the inclusion criteria of being over 50 years with incapacitating knee pain due to grade 3 or 4 osteoarthritis (Kellgren & Lawrence classification) after failure of non-operative therapy. All surgeries were performed using the anteromedial parapatellar approach with posterior-stabilized prosthesis design. Preoperative assessment included detailed clinical examination and radiological evaluation. Postoperatively, patients followed a structured rehabilitation protocol and were evaluated at regular intervals (day 5, 3 months, and 6 months) using the Knee Society Score (KSS). Results: The study included 33 patients with a predominant age group of over 60 years (42.4%), followed by 51-60 years (36.4%). Female patients constituted 60.6% of the study population, and right knee involvement (54.5%) was slightly more common than left. The mean duration of symptoms before surgery was 27.6 ± 26.1 months. Preoperatively, all patients (100%) had poor KSS scores (<60). By day 5 post-surgery, a slight improvement was noted with 6.1% of patients showing fair scores. At the 3- month follow-up, dramatic improvement was observed with 97% of patients achieving excellent scores and 6.1% showing good scores. At 6 months, all patients (100%) had excellent KSS scores, demonstrating optimal functional recovery. There was no statistically significant association between KSS scores at 3 months and either age (p=0.409) or gender (p=0.23). Conclusion: Primary TKR is a highly effective surgical intervention for osteoarthritic knees with predictable and excellent functional outcomes. The significant improvement in KSS scores from preoperative to 6-month follow-up indicates the procedure's success in alleviating pain and restoring function. The lack of significant association between outcomes and demographic factors suggests that TKR benefits patients regardless of age or gender when properly indicated and performed with appropriate surgical technique and rehabilitation protocols.