TKR in the Asian knee: a demanding procedure

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The lifestyles and religious practices of Asian cultures place special demands on the knee joints of people in this region. We examine specific considerations surgeons should employ when performing TKR on Asian knees.

Myung Chul Lee, a surgeon and professor based out of the Seoul National University Hospital, South Korea, took time to speak with AO Recon about his approach to TKR in the Asian knee, educational needs of surgeons in Asia, as well as where he would like to see future research focused. (Read interview with Myung Chul Lee)

TKR surgery can alleviate knee joint pain due to trauma and/or osteoarthritis and bring better quality of life to patients. If successful, it can improve biomechanics of the joint, realign soft tissues and mitigate structural and functional deficits [1]. 

It is currently the most common orthopedic procedure performed in the US [2], and its use doubled in this country between 1999 and 2008 [3]. According to Indian arthroscopic surgeon Bharat Mody, the rate of growth in TKRs in India is close to 30 percent per year, with predictions of more than 350,000 being performed annually by the end of 2020 [4].

Part 1 and 2 in this series of articles on TKR in the Asian knee looked at cultural and anatomical factors that contribute to the comparatively higher incidence of arthritic knees in the Asian population. Here we will examine some of the surgical implications, operative challenges, and device deficiencies that are applicable to Asian TKR patients.

 

 

A personal choice

From a surgeon’s perspective the decision to proceed with TKR surgery may seem like a straightforward choice for candidate patients suffering from knee pain. However, not everyone chooses to have surgery at the same functional status, or elects to have surgery at all [5].

Elderly Asian patients in some countries are more likely to seek surgical intervention in a more physically compromised state than Caucasians. When looking at preoperative TKR function of both Caucasian and Chinese patients in the same community, UK researchers discovered that mean Preoperative Knee Society Clinical Rating System scores were much lower for Asian patients than for Caucasians, 32.5 and 45.0 respectively. The authors hypothesized that cultural beliefs and social support may explain this [6].

However, this doesn’t necessarily mean that postoperative functional potential is going to be lower for those who undergo surgery when they have a lower ROM. A group of Singaporean doctors looked at 302 Asian TKR patients, assessing ROM both pre-and postoperatively. Those with a preoperative ROM of <110 degrees had poorer postoperative ROM than the group with ROM ≥ 110 degrees at the 6 and 24 month follow-ups. However, the lower functioning group showed a gain in ROM, while those with ROM ≥ 110 degrees lost range of motion after the procedure [7].

When faced with making a decision for or against TKR surgery, patients of different ethnicities and genders evaluate the decision using different criteria and elect for surgical intervention at varied stages of disability [8, 9, 10]. Asian patients generally desire to be able to participate in culturally relevant religious and lifestyle activities.

 

 

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  • Patient expectations
  • Implant design
  • Impact of morphologic differences
  • Interview with Myung Chul Lee
    • Incidence of osteoarthritis
    • Device issues
    • Patient satisfaction
    • Patella considerations
    • Femur considerations
    • Tibia considerations
    • Surgical creativity
    • Scientific research
    • Sufficient education?

Part 1 | The Asian knee through a cultural lens

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Part 2 | Anatomical variations in Asian knees: one size does not fit all

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Contributing experts

This series of articles was created with the support of the following specialists (in alphabetical order):

Myung-Chul Lee

Seoul National University Hospital
Seoul, South Korea

 

 

This issue was created by Word+Vision Media Productions, Switzerland

References

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