Foreword I
Foreword II
Foreword III
Preface
Contents
About the Authors
1 Philosophy of Primary Total Knee Arthroplasty: Back to the Beginning
1.1 Introduction
1.2 Stability in TKA
1.3 Balanced Soft Tissue Envelope
1.4 Gap Balanced Approach (Figs. 1.2, 1.3, 1.4, 1.5, 1.6 and 1.7)
1.5 What About Tibial Slope?
1.6 Balancing the Knee in Extension
1.7 Balancing the Knee in Flexion
1.8 A Word of Caution
1.9 Mobile Versus Fixed Bearings
1.10 PCL-Retention and Gap Balancing
1.11 Patella Resurfacing
References
2 Complex Primary Total Knee Arthroplasty
2.1 Introduction
2.2 So, What Makes a Complex TKA?
2.3 Surgical Approach
2.4 Chronic Fixed Flexion Deformity
2.5 Previous Periarticular Fractures
2.6 Previous Offloading Osteotomies for OA
2.7 Revising Partial Knees
2.8 Previous Patellectomy
2.9 Patella Baja and Alta
2.10 Previous Septic Arthritis
2.11 Primary Hinged TKA
2.12 What About Patient Specific Instrumentation (PSI)?
References
3 Assessment of Painful Total Knee Arthroplasty
3.1 Introduction
3.2 Clinic Assessment
References
4 Indications for Revision Total Knee Arthroplasty
4.1 Introduction
4.2 Our Series
4.3 Polyethylene Wear
4.4 Fixation and Aseptic Loosening (Figs. 4.3, 4.4, 4.5 and 4.6)
4.5 Instability (Figs. 4.7, 4.8 and 4.9)
4.6 Stiffness
References
5 Challenges of Surgical Exposure
5.1 Introduction
5.2 Tibial Crest Osteotomy
5.2.1 Our Technique
References
6 Removal of Well-Fixed Components
6.1 Introduction
6.2 Prerequisites for Implant Removal
6.3 Removal of Cemented Primary TKA
6.4 Removal of an All-Poly Tibial Component
6.5 Patella Removal
6.6 Cementless Primary (Fig.ย 6.9)
6.7 Removal of Revision Components
6.8 Removal of Metaphyseal Sleeves
References
7 Principles of Surgical Reconstruction: Back to the Beginningโฆ Again
7.1 Introduction
7.2 Philosophy of rTKA
7.3 Our Approach to Condylar Revisions
7.4 Flexion First Approach
7.5 Caution
7.6 What About Collateral Ligamentsโ Attenuation?
7.7 Augments and Bone Loss
7.8 How Do We Restore Posterior Femoral Offset?
7.9 Constraint and the Balanced Approach
7.10 Patellofemoral Joint
7.11 Case Demonstrationย (Figs. 7.1, 7.2, 7.3, 7.4, 7.5, 7.6, 7.7 and 7.8)
References
8 Fixation in Revision Total Knee Arthroplasty
8.1 Introduction
8.2 Philosophy of Fixation Techniques
8.3 Metaphyseal Fixation
8.4 What About Metaphyseal Cones?
8.5 What About a Short-Cemented Stem Construct?
8.6 Our Indications for Metaphyseal Sleeves
8.7 Practical Advantages of Sleeves
8.8 Cemented Sleeves
8.9 Complications
8.10 Our Series of Sleeves in rTKA
8.11 Overview of Metaphyseal Sleeves in the Literature
References
9 Kinematics of Constrained Condylar Revision Implants: A Practical Perspective
9.1 Introduction
9.2 What is Constraint?
9.3 Constraint and Kinematics
9.4 In First Principles, Why Have a Cam-Post Mechanism and Why in Revision Surgery?
9.5 What About Fixed-Bearings in Revision Surgery?
9.6 What About Mobile-Bearing VVC Articulation?
9.7 Impact of Constraint on Patellofemoral Joint (PFJ)
References
10 Rotating-Hinge Implants
10.1 Introduction
10.2 When to Use Hinges?
10.3 What About Fixed-Hinges?
10.4 Where Should the Hinge Mechanism Be?
10.5 Patellofemoral Issues with Hinges
10.6 Practical Perspective on Hinge Kinematics
10.7 What is An Ideal Hinge Design?
10.8 Hinges in Megaprostheses
10.9 Our Series of Rotating Hinges
References
11 Salvage Revision Total Knee Arthroplasty
11.1 Introduction
11.2 Options for Salvage
11.3 Massive Endoprostheses
11.4 Issues Related to Massive Endoprostheses
11.5 Fixation of Massive Endoprostheses
11.6 Extensor Mechanism and Massive Endoprostheses
11.7 Soft Tissue Coverage
11.8 What About Ipsilateral THA?
11.9 Subtotal Femoral Replacements
11.10 Total Femoral Replacements
11.11 Contraindications of Salvage Endoprostheses
11.12 What About Concurrent Extensor Mechanism Failure?
11.13 Implant-Arthrodesis
11.14 Amputation
11.15 Our Recent Experience in Salvage Endoprostheses (Fig.ย 11.9, 11.10, 11.11 and 11.12)
References
12 Managing Infection in Revision Total Knee Arthroplasty: A Practical Perspective
12.1 Introduction
12.2 PJI Classifications
12.3 Practical Approach to Diagnosing PJI
12.4 How Would Identifying an Organism Change the Management of Chronic PJI?
12.5 Culture Negative PJIs
12.6 Operative Strategies
12.7 When to Do a DAIR?
12.8 DAIR and Revision Implants
12.9 Duration of Antibiotics Following DAIR
12.10 Outcomes of DAIR for Acute PJI
12.11 Chronic PJIsโSingle or Two-Stage?
12.12 Operative Technique
12.13 Why Do We Use a Definitive Prosthesis as an Articulating Spacer?
12.14 Why Do We Use a Fusion Nail as a Static Spacer?
12.15 What to Do with Sinuses?
12.16 Why Do 1st Stages Fail?
12.17 Can We Use Press-Fit Metaphyseal Sleeves at Time of Reconstruction?
12.18 Our Case Series on Chronic PJI
References
13 Orthoplastics and Revision Knee Arthroplasty
13.1 Introduction
13.2 Why Do We Get Compromised Soft Tissues Around the Knee?
13.3 Managing Compromised Soft Tissues
13.4 When Do We Need Free Flaps?
13.5 When Should We Flap an Infected Knee with Tissue Defects?
References
14 Managing Chronic Patella Dislocations in Revision Knee Arthroplasty: Surgical Technique
14.1 Introduction
14.2 Historical Perspective
14.3 Rationale
14.4 Surgical Technique
14.5 What About Blood Supply and Risk of Avascular Necrosis?
14.6 Literature Overview
References
15 Extensor Mechanism Failure and Allograft Reconstruction
15.1 Introduction
15.2 Why Do Extensor Mechanisms Fail After TKA?
15.3 Management Options
15.4 Managing Failed Acute Repairs or Chronic Salvage Failures
15.4.1 Surgical Technique
15.5 Outcomes of Allograft Reconstructions
References
16 Periprosthetic Knee Fractures: Anย Arthroplasty Perspective
16.1 Introduction
16.2 Principles of Management
16.3 Our Experience in DFRs for Acute Comminuted Periprosthetic Fractures
References
17 Mortality in Revision Knee Arthroplasty
17.1 Introduction
17.2 The Scale of the Problem
17.3 Our Series on Mortality in Septic Versus Aseptic rTKA
17.4 rTKA Mortality in the Literature
17.5 Practical Implications
References
18 Starting Out in Revision Knee Arthroplasty
18.1 Training, Mentoring and Support
18.2 Clinical Networks
References
19 A Lifetime of Revision Knee Arthroplasty
19.1 RevisionโWhy?
19.2 Wear
19.3 Loosening
19.4 Stiffness
19.5 Infection
19.6 Instability
19.7 Pain
19.8 Workmanโs Compensation Knee
19.9 Perceived Pain
19.10 The Flat on Flat Knee
19.11 Drug Seekers
19.12 Conclusion
References
20 A Lifetime of Revision Knee Arthroplasty
20.1 Introduction
20.2 It is All About Planning
20.3 Frame Principle
20.4 Choice of Constraint
20.5 Fixation
20.6 Infection
20.7 Megaprostheses
20.8 Learning Never Stops
20.9 Personal Series
20.10 Future of Revision Knee Arthroplasty
20.11 Conclusion
Index