The Adult Knee

 

As knee replacement surgeries continue to grow in number worldwide, the need for an authoritative and comprehensive reference in this key area is a must for today’s orthopaedic surgeon. The Adult Knee: Knee Arthroplasty, Second Edition, brings together the knowledge and expertise of internationally recognized experts in the field in one convenient volume.

• Covers knee biomechanics relevant to knee arthroplasty, alternatives to knee arthroplasty to alleviate arthritis, and primary total knee arthroplasty, including perioperative issues.
• Discusses complications including stiff knee, periprosthetic fractures, and instability, revision total knee arthroplasty, and management of infections in total knee replacement.

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Table of Contents:

 

1.              Cover

2.              Title Page

3.              Copyright

4.              Dedication

5.              Contributors

6.              Preface

7.              Contents

8.              SECTION 1 Historical Perspectives

9.              1 Total Knee Arthroplasty: Milestones

10.           INTERPOSITION ARTHROPLASTY

11.           HEMIARTHROPLASTY

12.           HINGED KNEE PROSTHESES

13.           RESURFACING KNEE PROSTHESES

14.           ANATOMIC APPROACH

15.           FUNCTIONAL APPROACH

16.           CEMENTLESS FIXATION

17.           MOBILE BEARING

18.           ALTERNATIVE MATERIALS IN TKA

19.           ADVANCES IN PERIOPERATIVE CARE

20.           FUTURE OUTLOOK

21.           2 Surgical Anatomy of the Knee

22.           INTRODUCTION

23.           EMBRYOLOGY

24.           BONES OF THE KNEE

25.           Femur

26.           Tibia

27.           Fibula

28.           Patella

29.           KNEE JOINT STRUCTURES

30.           Menisci

31.           Cruciate Ligaments

32.           Synovial Membrane and Cavity

33.           Knee Joint Bursae

34.           Capsule

35.           THREE LAYERS OF THE MEDIAL AND LATERAL KNEE

36.           Layers of the Medial Knee

37.           Layers of the Lateral Knee

38.           KNEE JOINT MUSCLES AND STABILITY

39.           Knee Flexors

40.           Knee Extensors

41.           Knee Joint Stabilization

42.           KNEE MOTION

43.           ARTERIES

44.           Geniculate Vessels and Knee Anastomoses

45.           VEINS

46.           NERVES

47.           Muscle and Knee Joint Innervation

48.           Cutaneous Innervation

49.           CONCLUSION

50.           3 Anesthesia for Total Knee Replacement

51.           INTRODUCTION

52.           PREOPERATIVE PHASE

53.           MULTIMODAL AGENTS

54.           Acetaminophen

55.           Nonsteroidal Anti-inflammatory Drugs

56.           Gabapentinoids

57.           INTRAOPERATIVE PHASE

58.           Anesthesia Techniques

59.           Dexamethasone

60.           Tranexamic Acid

61.           POSTOPERATIVE ANALGESIA

62.           Local Infiltration Analgesia

63.           Femoral Nerve Block

64.           Adductor Canal Nerve Block

65.           Interspace Between the Popliteal Artery and Posterior Capsule of the Knee Block

66.           Postoperative Multimodal Analgesia

67.           CONCLUSION

68.           SECTION 2 Basic Science

69.           4 Meniscus, Tendons, and Ligaments: Pathophysiology

70.           MEDIAL MENISCUS

71.           LATERAL MENISCUS

72.           MENISCUS STRUCTURE

73.           Vascular Supply

74.           Neurology

75.           Biomechanical Properties

76.           INJURIES

77.           DEGENERATIVE TEAR

78.           ACUTE TEAR

79.           RELATION OF TEAR LOCATION TO HEALING

80.           TENDON

81.           Normal Structure and Function

82.           Tendon Junctional Anatomy

83.           BIOMECHANICS

84.           INJURIES

85.           Patterns of Injury

86.           DEGENERATION

87.           TENDON HEALING AND REPAIR

88.           LIGAMENT

89.           Normal Structure and Function

90.           Biomechanics

91.           INJURIES

92.           Degenerative Tears

93.           Intra- Versus Extra-articular Ligament Injury

94.           5 Knee Arthritis: Pathology and Progression

95.           INTRODUCTION

96.           OSTEOARTHRITIS

97.           Epidemiology

98.           Symptoms

99.           Physical Exam and Diagnosis

100.         Imaging

101.         Pathophysiology and Progression

102.         RHEUMATOID ARTHRITIS

103.         Epidemiology

104.         Symptoms

105.         Physical Exam and Diagnosis

106.         Imaging

107.         Pathophysiology and Progression

108.         JUVENILE IDIOPATHIC ARTHRITIS

109.         SERONEGATIVE SPONDYLOARTHROPATHIES

110.         OTHER INFLAMMATORY ARTHROPATHIES

111.         CONCLUSION

112.         6 Lower Extremity Alignment

113.         ANATOMY AND BIOMECHANICS OF THE KNEE

114.         KNEE MOTION

115.         LOWER EXTREMITY AXES

116.         KNEE ALIGNMENT

117.         ASSESSING ALIGNMENT

118.         ANGULAR COMPONENTS OF CORONAL ALIGNMENT

119.         ANGULAR COMPONENTS OF SAGITTAL ALIGNMENT

120.         OSTEOTOMIES AND COMPONENT PLACEMENT

121.         Alignment Goals

122.         Tibial Osteotomy

123.         Distal Femur Osteotomy

124.         Anterior and Posterior Femoral Condylar Cuts

125.         ALIGNMENT STRATEGIES IN TKA

126.         CONCLUSION

127.         7 Knee Kinematics Following Total Knee Arthroplasty

128.         OVERVIEW OF KNEE KINEMATICS

129.         KINEMATIC ANALYSIS TECHNIQUES

130.         FLUOROSCOPIC ANALYSIS METHODS

131.         KNEE KINEMATICS

132.         Deep Knee Bend—Range of Motion

133.         Deep Knee Bend—Condylar Translation

134.         Deep Knee Bend—Axial Rotation

135.         Gait

136.         Chair Rise

137.         Ramp Activities

138.         HIGHLY VARIABLE KNEE KINEMATICS

139.         EFFECTS OF CONDYLAR TRANSLATION

140.         AXIAL ROTATION OF TKA AND NORMAL KNEES

141.         REDUCED RANGE OF MOTION AFTER TKA

142.         KNEE KINEMATICS AND PATIENT-SPECIFIC TKA

143.         8 Kinematics of the Normal Knee: In Vivo Investigation Using Advanced Imaging Technique

144.         INTRODUCTION

145.         IMAGING TECHNIQUE FOR ACCURATE MEASUREMENTS OF KNEE MOTION

146.         Tibiofemoral Kinematics and Relevant Coordinate Systems

147.         Dual Fluoroscopic Image System

148.         KNEE KINEMATICS DURING FUNCTIONAL ACTIVITIES

149.         Treadmill Gait

150.         Stair Step-Up

151.         Kinematics of the Knee During Weight-Bearing Deep Flexion

152.         SUMMARY

153.         9 Knee Biomechanics and Implant Design

154.         LESSONS FROM THE NATURAL KNEE JOINT

155.         Functional Considerations

156.         Structural Considerations

157.         KNEE REPLACEMENT DESIGN

158.         Design of Articular Surfaces

159.         Design of Fixation

160.         10 Biomechanical and Clinical Aspects of the Stable and Unstable Total Knee Arthroplasty

161.         INTRODUCTION

162.         FLEXION INSTABILITY

163.         Clinical Presentation

164.         Biomechanics of the Native Knee and Stable TKA

165.         EXTENSION INSTABILITY

166.         Clinical Presentation

167.         Biomechanics of the Native Knee and Stable TKA

168.         GENU RECURVATUM

169.         MID-FLEXION INSTABILITY

170.         Clinical Presentation

171.         Biomechanics of the Native Knee and Stable TKA

172.         SUMMARY

173.         11 Metals

174.         METALLIC BOND

175.         ALLOY MICROSTRUCTURE

176.         CORROSION OF ORTHOPEDIC METAL ALLOYS

177.         STAINLESS STEEL ALLOYS

178.         Alternative Stainless Steels

179.         COBALT–CHROMIUM ALLOYS

180.         TITANIUM ALLOYS

181.         Other Titanium Alloys

182.         OTHER ALLOYS AND SURFACE COATINGS

183.         CLINICAL CONCERNS REGARDING METAL IMPLANT DEGRADATION

184.         Metal Ion Release

185.         Metal Particle Distribution

186.         Metal Hypersensitivity Responses

187.         Metal-Induced Carcinogenesis

188.         STATUS OF METALS IN TKA

189.         CONCLUSION

190.         12 Polyethylene in Total Knee Arthroplasty

191.         MEDICAL GRADE POLYETHYLENE

192.         ARTICULAR SURFACE GEOMETRY

193.         METAL BACKING

194.         MOTION PATTERN

195.         WEAR PARTICLES

196.         STERILIZATION METHODS

197.         CROSS-LINKING METHODS

198.         CONCLUSION

199.         ACKNOWLEDGMENTS

200.         13 Damage of Implant Surfaces in Total Knee Arthroplasty

201.         INTRODUCTION

202.         TIBIAL INSERTS

203.         PATELLAR COMPONENTS

204.         ULTRAHIGH-MOLECULAR-WEIGHT POLYETHYLENE

205.         DAMAGE ON ARTICULATING AND NONARTICULATING SURFACES

206.         WEAR MECHANISMS

207.         WEAR APPEARANCE AND VOLUMETRIC MATERIAL LOSS

208.         OSTEOLYSIS IN TOTAL KNEE REPLACEMENTS

209.         FACTORS AFFECTING DAMAGE AND SOLUTIONS TO MINIMIZE WEAR

210.         Kinematics and Design

211.         Oxidation

212.         Mechanical Stress: Conformity and Polyethylene Thickness

213.         Modularity and Backside Wear

214.         Clinical Variables

215.         TECHNOLOGIES TO REDUCE BEARING SURFACE DAMAGE

216.         Highly Cross-Linked UHMWPEs and Thermal Treatment

217.         Antioxidant Stabilization of Cross-Linked UHMWPEs

218.         Surface Grafting of UHMWPE Using 2-Methacryloxyethyl Phosphorylcholine

219.         Ceramic and Ceramicized Femoral Components

220.         Other Technologies

221.         CONCLUSIONS AND FUTURE OUTLOOK

222.         14 Implant Fixation

223.         INTRODUCTION

224.         CEMENTED FIXATION

225.         Basic Science of Polymethylmethacrylate

226.         CEMENTLESS FIXATION

227.         Biology of Cementless Fixation

228.         STANDARD CONCEPTS IN ACHIEVING OSSEOINTEGRATION

229.         IMPLANT CONSIDERATIONS: LEARNING FROM OUR MISTAKES

230.         REVISION ARTHROPLASTY: ACHIEVING OSSEOINTEGRATION IN SETTING OF BONE LOSS

231.         CONCLUSION

232.         ACKNOWLEDGMENTS

233.         SECTION 3 Clinical Science

234.         15 Examination of the Knee Before and After Total Knee Replacement

235.         INTRODUCTION

236.         EXAMINATION OF THE KNEE BEFORE KNEE REPLACEMENT

237.         Inspection and Observation

238.         EXAMINATION OF THE KNEE AFTER KNEE REPLACEMENT

239.         Introduction

240.         CONCLUSION

241.         16 Imaging of the Native and Prosthetic Knee

242.         INTRODUCTION

243.         CONVENTIONAL RADIOGRAPHS

244.         Standard Views

245.         Additional Views

246.         COMPUTED TOMOGRAPHY

247.         NUCLEAR SCINTIGRAPHY

248.         ULTRASOUND

249.         Basic Principles

250.         Diagnostic Imaging

251.         Ultrasound-Guided Intervention

252.         BASIC PRINCIPLES OF MAGNETIC RESONANCE IMAGING

253.         MENISCI

254.         Normal Meniscal Anatomy and Imaging

255.         Meniscal Pathology

256.         LIGAMENTS

257.         Anterior Cruciate Ligament

258.         Posterior Cruciate Ligament

259.         Medial Collateral Ligament

260.         Fibular Collateral Ligament and Posterolateral Corner

261.         Knee Dislocation

262.         Extensor Mechanism

263.         ARTICULAR CARTILAGE

264.         Peripheral Nerves

265.         POSTOPERATIVE MRI

266.         Postoperative Meniscus

267.         Ligament Reconstruction

268.         Repair of the Articular Surfaces

269.         KNEE ARTHROPLASTY

270.         CONCLUSION

271.         17 Knee Rating Scales for Clinical Outcome

272.         KNEE RATING SCALES FOR CLINICAL OUTCOME

273.         Reliability, Validity, and Responsiveness

274.         Generic and Specific Measures

275.         KNEE RATING SCALES FOR ATHLETIC PATIENTS

276.         KNEE RATING SCALES FOR PATIENTS WITH DEGENERATIVE DISORDERS OF THE KNEE

277.         MEASURES OF ACTIVITY LEVEL FOR PATIENTS WITH DISORDERS OF THE KNEE

278.         KNEE OUTCOME SURVEY

279.         Instructions

280.         SECTION 4 Patellofemoral Disorders

281.         18 Etiology of Anterior Knee Pain in the Adult

282.         BACKGROUND

283.         ANATOMY

284.         BIOMECHANICS

285.         HISTORY

286.         PHYSICAL EXAMINATION

287.         IMAGING

288.         Plain X-Rays

289.         Magnetic Resonance Imaging

290.         Nuclear Imaging

291.         DIFFERENTIAL DIAGNOSIS

292.         Soft Tissue

293.         Bone, Joint, and Cartilage

294.         Nerve

295.         Other

296.         CONCLUSION

297.         19 Patellar Instability

298.         INTRODUCTION

299.         ANATOMY AND BIOMECHANICS OF THE PATELLOFEMORAL JOINT

300.         CLASSIFICATION OF PATELLAR INSTABILITY

301.         HISTORY AND PHYSICAL EXAMINATION

302.         History

303.         Physical Examination

304.         RADIOGRAPHIC EVALUATION

305.         Plain Radiographs

306.         Computed Tomography

307.         Magnetic Resonance Imaging

308.         TREATMENT OF PATELLAR INSTABILITY

309.         Nonoperative Treatment

310.         Operative Management

311.         Lateral Retinacular Release

312.         Medial Patellofemoral Ligament Repair

313.         Medial Patellofemoral Ligament Reconstruction

314.         Tibial Tubercle Osteotomy

315.         Femoral Trochleoplasty

316.         CONCLUSION

317.         20 Cartilage Repair in the Patellofemoral Joint

318.         INTRODUCTION

319.         NONSURGICAL TREATMENT

320.         SURGICAL TREATMENT

321.         Chondroplasty

322.         Bone Marrow Stimulation

323.         Osteochondral Autograft Transplantation

324.         Autologous Chondrocyte Implantation/MACI

325.         Osteochondral Allograft Transplantation

326.         Particulated Cartilage Procedures

327.         Postoperative Rehabilitation

328.         Summary

329.         21 Patellofemoral Arthroplasty

330.         INTRODUCTION

331.         INDICATIONS AND CONTRAINDICATIONS

332.         PREOPERATIVE EVALUATION

333.         IMPLANT DESIGN

334.         SURGICAL TECHNIQUE

335.         POSTOPERATIVE COMPLICATIONS

336.         FUNCTIONAL OUTCOMES AND SURVIVORSHIP

337.         CONCLUSION

338.         SECTION 5 Alternatives to Arthroplasty for Knee Arthritis

339.         22 Oral and Topical Agents and Injectables

340.         INTRODUCTION

341.         ORAL MEDICATIONS

342.         Acetaminophen

343.         Nonsteroidal Anti-inflammatory Drugs

344.         Other Oral Medications

345.         TOPICAL TREATMENTS

346.         Topical NSAIDs

347.         Topical Salicylates and Topical Capsaicin

348.         CORTICOSTEROID INJECTIONS

349.         Pharmacology and Mechanism of Action

350.         Indications

351.         Adverse Effects

352.         Contraindications

353.         HYALURONIC ACID INJECTIONS

354.         Pharmacology and Mechanism of Action

355.         Indications

356.         Adverse Effects and Contraindications

357.         ORTHOBIOLOGICS

358.         Platelet-Rich Plasma

359.         Adverse Effects and Contraindications

360.         Stem Cells

361.         CONCLUSION

362.         23 Physical Therapy and Bracing

363.         KNEE BRACING

364.         Indications and Design

365.         Radiographic Studies

366.         Gait Analysis Studies

367.         Clinical Data

368.         Summary

369.         REHABILITATION AND TOTAL KNEE ARTHROPLASTY

370.         Preoperative Education

371.         Timing of Physical Therapy

372.         Goals of Acute Physical Therapy

373.         Long-Term Goals of Physical Therapy

374.         Future Developments in Rehabilitation After Knee Arthroplasty

375.         ACKNOWLEDGMENTS

376.         24 The Role of Arthroscopy in Treating Degenerative Joint Disease

377.         INTRODUCTION

378.         HISTORY OF ARTHROSCOPY IN KNEE OA

379.         CONTRAINDICATIONS

380.         PREOPERATIVE ASSESSMENT

381.         MANAGEMENT

382.         FUTURE TREATMENTS

383.         AUTHOR PREFERRED INDICATIONS

384.         AUTHOR’S PREFERRED TECHNIQUE

385.         SUMMARY

386.         25 Cartilage Restoration Procedures of the Knee

387.         INTRODUCTION

388.         OVERALL CARTILAGE INDICATIONS

389.         MICROFRACTURE

390.         Technique

391.         Outcomes

392.         OSTEOCHONDRAL ALLOGRAFT/AUTOGRAFT

393.         Osteochondral Allograft Technique

394.         OAT Technique

395.         OAT Outcomes

396.         Osteochondral Allograft Outcomes

397.         AUTOLOGOUS CHONDROCYTE IMPLANTATION

398.         Indications/Contraindications

399.         Surgical Approach/Initial Biopsy

400.         MENISCAL ALLOGRAFT TRANSPLANTATION

401.         MALALIGNMENT (DFO/HTO) AND MALTRACKING (TTO)

402.         CONCLUSION

403.         26 Femoral and Tibial Osteotomy for the Degenerative Knee

404.         INTRODUCTION

405.         PATIENT SELECTION

406.         History and Physical Examination

407.         Imaging

408.         PREOPERATIVE PLANNING

409.         HIGH TIBIAL OSTEOTOMIES

410.         Indications

411.         Degree of Correction

412.         Surgical Techniques

413.         Fixation

414.         Clinical Outcomes

415.         Complications

416.         DISTAL FEMORAL OSTEOTOMIES

417.         Indications

418.         Degree of Correction

419.         Surgical Technique

420.         Fixation

421.         Clinical Outcomes

422.         Complications

423.         Ilizarov Technique

424.         SUMMARY

425.         SECTION 6 Primary Total Knee Arthroplasty

426.         27 Economics of Total Knee Arthroplasty

427.         INTRODUCTION

428.         COST OF TOTAL KNEE ARTHROPLASTY

429.         Implant Costs

430.         Navigation Cost

431.         Computer-Assisted Navigation

432.         Robotic-Assisted Navigation

433.         ALTERNATIVE PAYMENT MODELS

434.         Bundled Payments for Care Improvement

435.         Revision TKA in APM

436.         Comprehensive Care for Joint Replacement

437.         BPCI Advanced

438.         CONCLUSION

439.         28 Indications for Total Knee Arthroplasty

440.         INTRODUCTION

441.         DEFINING INDICATIONS

442.         GOALS OF TOTAL KNEE ARTHROPLASTY

443.         PATIENT SELECTION

444.         Who Is a Candidate for Knee Arthroplasty

445.         When to Proceed with Knee Arthroplasty

446.         Outpatient Patient Selection

447.         Outcomes Prediction Tools

448.         Other Available Options

449.         SETTING EXPECTATIONS

450.         Surgeon Expectations

451.         Patient Expectations

452.         PREOPERATIVE ASSESSMENT

453.         History

454.         Physical Examination

455.         Radiograph Evaluation

456.         SPECIFIC CONSIDERATIONS

457.         Age

458.         Body Mass Index

459.         Diabetes Mellitus

460.         Malnutrition

461.         Osteonecrosis

462.         Hemophilia

463.         Ipsilateral Hip Arthrodesis

464.         Paget Disease (“Osteitis Deformans”)

465.         Posttraumatic Arthritis

466.         Neurologic Dysfunction

467.         Workers’ Compensation

468.         CONTRAINDICATIONS TO TOTAL KNEE ARTHROPLASTY

469.         Active Infection

470.         Incompetent Extensor Mechanism

471.         Neuropathic Arthropathy

472.         Knee Arthrodesis

473.         Prohibitive Medical Comorbidities

474.         Peripheral Vascular Disease

475.         Unrealistic Patient Expectations

476.         CONCLUSION

477.         29 Preoperative Planning for Primary Total Knee Arthroplasty

478.         INTRODUCTION

479.         PATIENT SELECTION

480.         PATIENT EXPECTATIONS

481.         PATIENT ASSESSMENT

482.         History

483.         Physical Examination

484.         Radiographic Analysis

485.         CONTRAINDICATIONS AND ALTERNATIVES TO TOTAL KNEE ARTHROPLASTY

486.         Contraindications

487.         SPECIFIC PATIENT-RELATED CONSIDERATIONS

488.         Age

489.         Weight

490.         Diabetes Mellitus

491.         Osteonecrosis

492.         Hemophilic Arthropathy

493.         Ipsilateral Hip Fusion

494.         Paget Disease

495.         Posttraumatic Arthritis

496.         Neurologic Dysfunction

497.         Workers’ Compensation

498.         CONCLUSION

499.         30 Principles of Implantation—Flexion/Extension

500.         INTRODUCTION

501.         PREOPERATIVE EVALUATION

502.         INTRAOPERATIVE ASSESSMENT

503.         ACHIEVING A SAGITTALLY BALANCED KNEE

504.         THE INTERPLAY BETWEEN FLEXION AND EXTENSION GAPS: WHICH GAP TO BALANCE FIRST?

505.         MANAGING THE TIGHT EXTENSION GAP AND STEPWISE APPROACH TO FLEXION CONTRACTURES

506.         MANAGING THE FLEXION GAP

507.         ALGORITHMIC APPROACH FOR INTRAOPERATIVE SAGITTAL BALANCING

508.         MID-FLEXION INSTABILITY: BALANCING THE FORGOTTEN GAP

509.         CONCLUSION

510.         31 Principles of Implantation: Measured Resection

511.         INTRODUCTION

512.         SURGICAL TECHNIQUE

513.         Transepicondylar Axis

514.         Anteroposterior Axis

515.         Posterior Condylar Axis

516.         ADVANTAGES

517.         DISADVANTAGES

518.         CLINICAL STUDIES

519.         SUMMARY

520.         32 Principles of Instrumentation and Component Alignment

521.         INTRODUCTION

522.         NORMAL ANATOMY

523.         BIOMECHANICS

524.         THEORIES OF AXIAL IMPLANT ALIGNMENT

525.         Mechanical Alignment

526.         Anatomical Alignment

527.         Kinematic Alignment

528.         MECHANICAL ALIGNMENT

529.         Outcomes

530.         Instrumentation

531.         KINEMATIC ALIGNMENT

532.         Outcomes

533.         Instrumentation

534.         ROTATION

535.         Femoral Component Rotation

536.         Tibial Component Rotation

537.         PATELLAR ALIGNMENT

538.         NEW TECHNOLOGIES

539.         CONCLUSION

540.         33 Patient Specific Instrumentation

541.         BACKGROUND

542.         ALIGNMENT

543.         Kinematic Alignment

544.         Mechanical Alignment

545.         Hip–Knee–Ankle Angle

546.         Coronal Alignment

547.         Sagittal Alignment

548.         TEMPLATING AND PREOPERATIVE PLANNING

549.         MANUFACTURER

550.         CT VERSUS MRI

551.         Intraoperative Adjustments and Abandonment

552.         CLINICAL OUTCOMES

553.         PERIOPERATIVE BLOOD LOSS

554.         ECONOMIC EVALUATION

555.         Operative Time

556.         Cost Considerations

557.         FUTURE DIRECTIONS

558.         34 Computer Guidance

559.         INTRODUCTION

560.         COMPUTER NAVIGATION SYSTEMS

561.         IMAGE-BASED COMPUTER NAVIGATION

562.         IMAGELESS COMPUTER NAVIGATION

563.         Kinematic Registration

564.         Surface Registration

565.         Optical Navigation Systems

566.         Accelerometer-Based Systems

567.         ROBOTIC-ASSISTED KNEE ARTHROPLASTY

568.         CLINICAL OUTCOMES

569.         Computer Navigation

570.         Robotic-Assisted Knee Arthroplasty

571.         35 Robotic Applications for Total Knee Arthroplasty

572.         INTRODUCTION

573.         ROBOTIC ARM–ASSISTED TOTAL KNEE ARTHROPLASTY (MAKO—STRYKER ORTHOPEDICS)

574.         General Overview

575.         Indications

576.         Preoperative Planning

577.         Patient Setup

578.         Surgical Exposure

579.         Tracker Array Placement

580.         Bone Registration

581.         Pose Capture

582.         BONE CUTS PER MEASURED RESECTION TECHNIQUE

583.         BONE CUTS PER TIBIAL CUT FIRST TECHNIQUE

584.         BONE CUTS PER TIBIAL CUT AND DISTAL FEMUR CUT FIRST TECHNIQUE

585.         BONE CUTS PER FEMORAL CUTS FIRST TECHNIQUE

586.         IMPLANTATION

587.         EARLY CLINICAL RESULTS

588.         SUMMARY

589.         36a Posterior Cruciate Ligament Retention in Total Knee Replacement

590.         POSTERIOR CRUCIATE LIGAMENT ANATOMY

591.         KNEE KINEMATICS PERTAINING TO THE POSTERIOR CRUCIATE LIGAMENT

592.         EVOLUTION OF THE CRUCIATE-RETAINING TOTAL KNEE REPLACEMENT

593.         CURRENT CONTROVERSIES IN POSTERIOR CRUCIATE LIGAMENT–RETAINING AND POSTERIOR CRUCIATE LIGAMENT–SUBSTITUTING TOTAL KNEE REPLACEMENT

594.         Rollback and Kinematics

595.         Wear and Loosening

596.         Range of Motion

597.         Proprioception

598.         Stability

599.         AUTHORS’ ARGUMENTS FOR POSTERIOR CRUCIATE LIGAMENT RETENTION

600.         Balancing Flexion and Extension Gaps

601.         Bone Sparing

602.         Patellar Clunk and Post Dislocation

603.         Ease of Management of Supracondylar Femur Fractures

604.         Avoidance of Peg Wear and Fracture

605.         Survivorship

606.         SURGICAL TECHNIQUE

607.         CONCLUSION

608.         ACKNOWLEDGMENTS

609.         36b Posterior Stabilization in Total Knee Arthroplasty

610.         HISTORICAL PERSPECTIVE

611.         KINEMATICS

612.         Specific Design Features

613.         High Flexion Designs

614.         INDICATIONS

615.         SURGICAL TECHNIQUE

616.         CLINICAL OUTCOMES

617.         PATIENT-REPORTED OUTCOME MEASURES

618.         SURVIVORSHIP

619.         Registry Data

620.         SPECIFIC COMPLICATIONS

621.         Tibial Post Wear

622.         Patellar Clunk

623.         SUMMARY

624.         36c Medial Pivot Knee

625.         PERSONAL STATEMENT

626.         INTRODUCTION

627.         KINEMATICS

628.         Evolution of Knee Motion Measurements

629.         Movement of Condyles

630.         Movement of Contact Area

631.         IMPLANT DESIGN

632.         Rationale

633.         Polyethylene

634.         Femoral Component

635.         SURGICAL TECHNIQUE

636.         CASES

637.         RESULTS

638.         Survivorship Studies

639.         Comparison Studies

640.         Radiographic Evaluation

641.         COMPLICATIONS

642.         CONCLUSION

643.         36d Ultracongruent Total Knee Arthroplasty

644.         INTRODUCTION

645.         INDICATIONS AND SURGICAL TECHNIQUE

646.         OUTCOMES

647.         36e Mobile-Bearing Knee Replacement

648.         HISTORY AND DEVELOPMENT OF MOBILE BEARINGS

649.         EVOLUTION OF THE NEW JERSEY LOW CONTACT STRESS MOBILE-BEARING KNEE

650.         Early Results

651.         BIOMECHANICAL CONSIDERATIONS

652.         Component Surface Geometry

653.         Wear Properties

654.         FIXATION OF MOBILE BEARINGS

655.         CLINICAL APPLICATION OF MOBILE BEARINGS

656.         Unicompartmental Knee Replacement

657.         Bicompartmental Knee Replacement

658.         Rotating Bearing Patella Replacement

659.         SURVIVORSHIP

660.         POSTERIOR-STABILIZED LOW CONTACT STRESS MOBILE-BEARING KNEE

661.         REVISION TOTAL KNEE REPLACEMENT

662.         Rotation

663.         Fixation

664.         36f Bicruciate Retaining in Total Knee Arthroplasty

665.         INTRODUCTION

666.         HISTORY

667.         KINEMATICS

668.         CLINICAL OUTCOMES

669.         COMPLICATIONS

670.         SUMMARY

671.         37 Cement Fixation for Total Knee Arthroplasty

672.         38 Cementless Total Knee Arthroplasty

673.         INTRODUCTION

674.         EARLY CEMENTLESS DESIGNS: LEARNING FROM HISTORICAL FAILURES

675.         EARLY CEMENTLESS DESIGNS: SUCCESS STORIES

676.         MODERN CEMENTLESS TKA DESIGNS: IMPROVED BIOMATERIALS AND DESIGNS

677.         MODERN CEMENTLESS TKA: EARLY CLINICAL PERFORMANCE

678.         SURGICAL CONSIDERATIONS AND PREFERRED TECHNIQUE

679.         Clinical and Perioperative Considerations

680.         CONCLUSIONS

681.         39 Surgical Exposures in Total Knee Arthroplasty

682.         INTRODUCTION

683.         SKIN INCISION AND SOFT-TISSUE HANDLING

684.         MEDIAL PARAPATELLAR APPROACH

685.         Surgical Technique

686.         MIDVASTUS APPROACH

687.         SUBVASTUS APPROACH

688.         MEDIAL TRIVECTOR-RETAINING APPROACH

689.         LATERAL PARAPATELLAR APPROACH

690.         DIFFICULT EXPOSURES: SPECIALIZED TECHNIQUES

691.         MODIFICATIONS TO THE MEDIAL PARAPATELLAR APPROACH IN CHALLENGING EXPOSURES

692.         QUADRICEPS SNIP OR RECTUS SNIP

693.         TIBIAL TUBERCLE OSTEOTOMY

694.         V-Y QUADRICEPSPLASTY OR QUADRICEPS TURNDOWN

695.         COMPARISON OF REVISION APPROACHES

696.         ALTERNATIVE TECHNIQUES

697.         CONCLUSION

698.         40 Unicompartmental Knee Arthroplasty

699.         INTRODUCTION

700.         INDICATIONS AND PATIENT SELECTION

701.         Anteromedial Osteoarthritis

702.         Avascular Osteonecrosis

703.         Obesity

704.         Age

705.         Patellofemoral Osteoarthritis

706.         Chondrocalcinosis

707.         Lateral Posttraumatic Arthritis

708.         Absolute Contraindication

709.         Extra-articular Deformity

710.         The Ideal Patient

711.         IMPLANT DESIGNS

712.         Mobile- Versus Fixed-Bearing UKA

713.         Cemented Versus Cementless

714.         All-Polyethylene Versus Metal-Backed

715.         KINEMATICS OF THE NATIVE KNEE AND UKA

716.         PREOPERATIVE PREPARATION

717.         Physical Examination Criteria

718.         Imaging

719.         Patient Expectations

720.         SURGICAL POSITIONING

721.         THE SURGICAL STEPS FOR MEDIAL UNICOMPARTMENTAL KNEE ARTHROPLASTY

722.         Main Principles in Medial UKA

723.         Operative Technique

724.         THE SURGICAL STEPS FOR LATERAL UNICOMPARTMENTAL KNEE ARTHROPLASTY

725.         Anatomy

726.         Indications

727.         Specificity of Preoperative Planning for Lateral UKA

728.         Approach

729.         First Step: Tibial Cut

730.         Second Step: Femoral Cuts

731.         Third Step: Positioning of the Implant

732.         Common Surgical Errors Leading to Failure in Lateral UKA

733.         Conclusion

734.         RESULTS AND SURVIVAL OF UKA

735.         Results of Medial UKA for Osteoarthritis

736.         Results of Medial UKA in Young Patients

737.         Results of Medial UKA in Old Patients (Older Than 75 years)

738.         Results of Lateral UKA

739.         Results of UKA for Avascular Osteonecrosis of the Knee

740.         FAILURES AND REVISION OF UKA

741.         Introduction

742.         Progression of Osteoarthritis in the Other Compartments

743.         Aseptic Loosening

744.         Bearing Dislocation in Mobile-Bearing Implants

745.         Periprosthetic Fracture

746.         Infection

747.         Stiffness

748.         Unexplained Pain

749.         Preoperative Evaluation

750.         Revision Strategies

751.         Results of Revision UKA

752.         Conclusion

753.         PROCESS OPTIMIZATION IN PERIOPERATIVE MANAGEMENT

754.         Perioperative Management

755.         Rehabilitation and Postoperative Care

756.         Conclusion

757.         41 Robotic Application of Unicompartmental Knee Arthroplasty

758.         INTRODUCTION

759.         MAKO SYSTEM

760.         Registration and Planning Procedure

761.         Plan Execution

762.         Accuracy and Reproducibility

763.         Clinical Outcomes

764.         NAVIO SYSTEM

765.         Registration and Planning Procedure

766.         Plan Execution

767.         Accuracy and Reproducibility

768.         Clinical Outcomes

769.         PEARLS AND PITFALLS

770.         Bone Preservation

771.         Complications

772.         Image-Based and Imageless

773.         Learning Curve and Operation Time

774.         Cost-Effectiveness

775.         CONCLUSION

776.         42 Osseous Deficiencies in Total Knee Replacement

777.         BACKGROUND

778.         PREOPERATIVE ASSESSMENT

779.         IMPLANT REMOVAL

780.         BONE DEFECT CLASSIFICATION

781.         Massachusetts General Hospital Classification

782.         University of Pennsylvania Classification

783.         Huff and Sculco Classification

784.         Anderson Orthopaedic Research Institute Classification

785.         SURGICAL RECONSTRUCTION

786.         AORI Type 1 Defect (“Intact” Metaphysis)

787.         Cement and Screws

788.         Particulate Graft

789.         AORI Type 2 Defect (“Damaged” Metaphysis)

790.         AORI Type 3 Defect (“Deficient” Metaphysis)

791.         Constrained Condylar and Hinged Devices

792.         Endoprostheses and Allograft-Prosthesis Composites

793.         Extensor Mechanism Deficiency

794.         RESULTS

795.         Bulk Allograft

796.         Metal Augments

797.         Porous Metaphyseal Sleeves and Cones

798.         Stems

799.         Constraint

800.         AORI EXPERIENCE

801.         CONCLUSION

802.         43 The Varus Knee: Considerations for Alignment and Balance

803.         TYPES OF VARUS DEFORMITY

804.         CAUSES OF VARUS DEFORMITY

805.         PREOPERATIVE EVALUATION AND RELEVANT ANATOMY

806.         TREATMENT OF INTRA-ARTICULAR VARUS DEFORMITY

807.         SOFT-TISSUE RELEASES IN THE VARUS KNEE

808.         POSTOPERATIVE PROTOCOL

809.         RESULTS OF SOFT-TISSUE RELEASES IN THE VARUS KNEE

810.         CONCLUSION

811.         44 The Valgus Knee: Considerations for Alignment and Balance

812.         PREOPERATIVE EVALUATION

813.         History and Physical Examination

814.         Radiographic Examination

815.         Templating

816.         Implant Considerations

817.         Patient Positioning

818.         Surgical Technique

819.         SPECIAL CONSIDERATIONS IN THE VALGUS KNEE

820.         Distal Femoral Resection

821.         Evaluation of the Flexion and Extension Gaps

822.         Lateral Ligament Release for Fixed Valgus Deformity

823.         Postoperative Course

824.         Complications

825.         Discussion

826.         ACKNOWLEDGMENTS

827.         45 Managing Fixed Flexion Before and After Total Knee Arthroplasty: Maximizing Range of Motion

828.         Introduction

829.         NATIVE KNEE JOINT MOTION AND KINEMATICS

830.         Anatomic Features of the Native Knee

831.         Knee Joint Range of Motion and Classification

832.         FIXED FLEXION BEFORE TOTAL KNEE ARTHROPLASTY

833.         Etiology of Preoperative Fixed Flexion Deformities

834.         Dealing With Stiffness Before TKA: What are the Options?

835.         INTRAOPERATIVE MANAGEMENT OF FIXED FLEXION DURING TKA

836.         Surgical Technique

837.         Implant Factors

838.         POSTOPERATIVE CONSIDERATIONS FOR STIFFNESS AFTER TKA

839.         Prevalence and Causes of Postoperative Stiffness

840.         Outcomes and Predictors for Postoperative Range of Motion

841.         MANAGEMENT OF FIXED FLEXION AFTER TKA

842.         Medication Effects on Stiffness After TKA

843.         Rehabilitation and Manipulation

844.         Surgical Interventions

845.         CONCLUSION

846.         46 Managing Osteotomies and Extra-articular Deformity and Retained Hardware in Total Knee Arthroplasty

847.         INTRODUCTION

848.         FEMORAL DEFORMITY

849.         TIBIAL DEFORMITY

850.         RETAINED HARDWARE

851.         PREOPERATIVE PLANNING

852.         SURGICAL TECHNIQUE, INTRA-ARTICULAR CORRECTION

853.         SURGICAL TECHNIQUE, EXTRA-ARTICULAR CORRECTION

854.         CONCLUSION

855.         47 Total Knee Replacement in Special Situations

856.         INTRODUCTION

857.         PAGET DISEASE OF BONE

858.         POLIOMYELITIS

859.         PARKINSON DISEASE

860.         NEUROPATHIC ARTHRITIS

861.         HEMOPHILIA

862.         DIABETES MELLITUS

863.         INFLAMMATORY ARTHROPATHIES

864.         POSTTRAUMATIC ARTHRITIS

865.         ARTHROPLASTY AFTER HIGH TIBIAL OSTEOTOMY

866.         ARTHROPLASTY AFTER PRIOR ARTHRODESIS OR ANKYLOSIS

867.         GENU RECURVATUM

868.         CUSTOM COMPONENTS

869.         DWARFISM

870.         OSTEOGENESIS IMPERFECTA

871.         CONCLUSION

872.         SECTION 7 Perioperative Management in Total Knee Replacement

873.         48 Preoperative and Perioperative Medical Management

874.         SCOPE OF PROBLEM

875.         PATIENT MODIFIABLE RISK FACTORS

876.         Diabetes Mellitus

877.         Obesity

878.         Malnutrition

879.         Smoking

880.         Vitamin D

881.         Staphylococcus Aureus Screening

882.         Inflammatory Arthropathies

883.         Urinary Tract Infection

884.         Poor Oral Health

885.         PERIOPERATIVE MODIFIABLE RISK FACTORS

886.         Surgical Site Preparation and Irrigant Options

887.         Antibiotic Prophylaxis

888.         Operating Room Environment

889.         Avoidance of Aggressive Anticoagulation

890.         CONCLUSION

891.         49 Pathways for the Episode of Care

892.         INTRODUCTION

893.         VALUE AND CLINICAL PATHWAYS

894.         DEVELOPING PATHWAYS

895.         THE EPISODE OF CARE

896.         Preoperative Period

897.         Acute Care Period

898.         Post–Acute Care Period

899.         OUTCOMES

900.         TECHNOLOGY

901.         LIMITATIONS

902.         CONCLUSION

903.         50 Preventing Thromboembolism in Total Knee Arthroplasty

904.         PATHOGENESIS

905.         EPIDEMIOLOGY

906.         RISK STRATIFICATION

907.         VTE PROPHYLAXIS AFTER TKA

908.         Aspirin

909.         Vitamin K Antagonists

910.         Heparin and Low-Molecular-Weight Heparins

911.         Fondaparinux

912.         Factor Xa Inhibitors

913.         Dabigatran

914.         Mechanical Methods

915.         IVC Filters

916.         DURATION OF PROPHYLAXIS

917.         RECOMMENDATIONS

918.         51 Blood Management

919.         INTRODUCTION

920.         PREOPERATIVE

921.         Vitamin Deficiency

922.         Erythropoietin

923.         Management of Outpatient Medications

924.         Preoperative Autologous Donation

925.         Acute Normovolemic Hemodilution

926.         INTRAOPERATIVE

927.         Tourniquet

928.         Hypotensive Epidural Anesthesia

929.         Periarticular Injections

930.         Antifibrinolytic Agents

931.         Cell Salvage

932.         Surgical Accessories

933.         POSTOPERATIVE

934.         Autologous Reinfusion Drains

935.         Allogeneic Blood Transfusion

936.         Conclusions

937.         52 Outpatient Total Knee Arthroplasty

938.         INTRODUCTION

939.         SURGICAL FACILITY

940.         PATIENT SELECTION

941.         PREOPERATIVE EDUCATION

942.         PERIOPERATIVE PAIN MANAGEMENT

943.         Multimodal Pain Management

944.         Epidural and Regional Anesthesia

945.         Periarticular Injections

946.         SURGICAL APPROACH

947.         BLOOD MANAGEMENT

948.         POSTOPERATIVE CARE

949.         OUTCOMES

950.         CONCLUSION

951.         SECTION 8 Complications of Total Knee Replacement

952.         53 Intraoperative Complications During Total Knee Arthroplasty

953.         INTRODUCTION

954.         INTRAOPERATIVE FRACTURE

955.         INTRAOPERATIVE FRACTURE: FEMUR

956.         CLASSIFICATION

957.         Anatomy

958.         Prevention

959.         Management

960.         INTRAOPERATIVE FRACTURE: TIBIA

961.         Classification

962.         Anatomy

963.         Prevention

964.         Management

965.         INTRAOPERATIVE FRACTURE: PATELLA

966.         Classification

967.         Anatomy

968.         Prevention

969.         Management

970.         EXTENSOR MECHANISM INJURY

971.         Anatomy

972.         Prevention

973.         Management

974.         COLLATERAL LIGAMENT INJURY

975.         Anatomy

976.         Prevention

977.         Management

978.         VASCULAR INJURY

979.         Anatomy

980.         Prevention

981.         Management

982.         Nerve Injury

983.         Anatomy

984.         Prevention

985.         Management

986.         CONCLUSION

987.         54 The Stiff Total Knee

988.         INTRODUCTION

989.         EPIDEMIOLOGY

990.         ETIOLOGIES

991.         Intrinsic Causes

992.         Infection

993.         Overstuffing

994.         Implant Design

995.         EXTRINSIC CAUSES

996.         Arthrofibrosis

997.         Complex Regional Pain Syndrome

998.         Heterotopic Ossification

999.         SURGICAL MANAGEMENT

1000.      SURGICAL EXPOSURE

1001.      Assessing Flexion and Extension at Surgery

1002.      POSTOPERATIVE TKA STIFFNESS TREATMENT

1003.      Physical Therapy

1004.      Manipulation Under Anesthesia

1005.      Revision Surgery

1006.      CONCLUSION

1007.      55 Preventing Wound Complications After Total Knee Arthroplasty

1008.      VASCULAR SUPPLY TO THE KNEE

1009.      PREVENTION OF WOUND COMPLICATIONS

1010.      Systemic Factors

1011.      Local Factors

1012.      Surgical Technique Factors

1013.      Postoperative Factors

1014.      TREATMENT

1015.      TECHNIQUE OF TISSUE EXPANSION

1016.      TREATMENT OF A POSTOPERATIVE DRAINING WOUND

1017.      DEEP TISSUE HEMATOMA

1018.      SUPERFICIAL SOFT TISSUE NECROSIS

1019.      FULL-THICKNESS SOFT TISSUE NECROSIS

1020.      CONCLUSION

1021.      56 Extensor Mechanism Complications After Total Knee Arthroplasty

1022.      PATELLOFEMORAL INSTABILITY

1023.      PATELLAR COMPONENT LOOSENING

1024.      PATELLAR COMPONENT WEAR

1025.      PATELLOFEMORAL CREPITUS/CLUNK

1026.      EXTENSOR MECHANISM DISRUPTION

1027.      Quadriceps Rupture

1028.      Patella Fracture

1029.      Patellar Tendon Rupture

1030.      RESURFACED VERSUS NONRESURFACED PATELLA

1031.      PREVENTATIVE TECHNIQUE

1032.      CONCLUSION

1033.      57 Periprosthetic Fractures

1034.      INTRODUCTION

1035.      DISTAL FEMORAL PERIPROSTHETIC FRACTURES

1036.      Classification

1037.      Nonoperative Management

1038.      Fixation (Retrograde Nailing or Plating)

1039.      Polyaxial Versus Monoaxial Locking Plates

1040.      Nail Plate Combinations

1041.      Other Fixation Methods

1042.      Revision Arthroplasty

1043.      Distal Femoral Replacement

1044.      Interprosthetic—UCS Type D Fractures

1045.      Timing of Surgery

1046.      TIBIAL PERIPROSTHETIC FRACTURES

1047.      Classification

1048.      Treatment

1049.      PATELLAR PERIPROSTHETIC FRACTURES

1050.      Classification

1051.      Treatment

1052.      CONCLUSION

1053.      58 Instability After Total Knee Arthroplasty

1054.      Introduction

1055.      TIBIOFEMORAL INSTABILITY

1056.      Flexion Instability

1057.      Etiology

1058.      Evaluation

1059.      Treatment and Outcomes

1060.      MEDIAL-LATERAL INSTABILITY

1061.      Etiology

1062.      Evaluation

1063.      Treatment and Outcomes

1064.      GLOBAL INSTABILITY

1065.      Etiology

1066.      Evaluation

1067.      Treatment and Outcomes

1068.      CONCLUSION

1069.      59 Patellofemoral Problems in Total Knee Arthroplasty

1070.      PATELLOFEMORAL JOINT IN PRIMARY TOTAL KNEE ARTHROPLASTY

1071.      The Tight Lateral Retinaculum

1072.      Resection of the Patellofemoral Joint

1073.      Femoral Component

1074.      Tibial Component in Primary Total Knee Arthroplasty

1075.      Patellar Component

1076.      Conclusion

1077.      REVISION TOTAL KNEE ARTHROPLASTY FOR PATELLAR MALTRACKING

1078.      Assessment of Patellofemoral Maltracking

1079.      Extensor Mechanism Disruption

1080.      CONCLUSION

1081.      60 Persistent Effusions and Recurrent Hemarthrosis After Total Knee Arthroplasty

1082.      PART

1. PERSISTENT EFFUSIONS AFTER TOTAL KNEE ARTHROPLASTY

1083.      Introduction

1084.      Definition

1085.      Epidemiology

1086.      Etiology of Persistent Effusion

1087.      Clinical Picture

1088.      Diagnostic Workup

1089.      Treatment

1090.      PART

2. RECURRENT HEMARTHROSIS AFTER TOTAL KNEE ARTHROPLASTY

1091.      Incidence and Causation

1092.      Clinical Diagnosis

1093.      Radiographs and Laboratory Investigations

1094.      Diagnostic Joint Aspiration

1095.      The Next Steps: Conservative Management Versus Advanced Imaging

1096.      Surgical and Radiographic Synovectomy

1097.      CONCLUSION

1098.      61 Metal Allergy and Management

1099.      INTRODUCTION

1100.      ALLERGIC REACTIONS TO METAL IMPLANTS

1101.      CLINICAL PRESENTATION

1102.      PATCH TESTING

1103.      LYMPHOCYTE TRANSFORMATION TEST

1104.      CLINICAL MANAGEMENT

1105.      SECTION 9 Revision Total Knee Arthroplasty

1106.      62 Evaluation of the Symptomatic Total Knee Replacement

1107.      HISTORY

1108.      PHYSICAL EXAMINATION

1109.      RADIOGRAPHIC EXAMINATION

1110.      NUCLEAR MEDICINE EXAMINATION

1111.      COMPUTED TOMOGRAPHY

1112.      MAGNETIC RESONANCE IMAGING

1113.      LABORATORY EVALUATION

1114.      TOTAL KNEE REPLACEMENT FAILURES

1115.      63 Preoperative Planning for Revision Total Knee Arthroplasty

1116.      PREOPERATIVE EVALUATION

1117.      Patient History and Physical Examination

1118.      Radiographs

1119.      STEP-BY-STEP PREOPERATIVE CONSIDERATIONS

1120.      Skin

1121.      Peripheral Vascular Supply

1122.      Neurologic Status

1123.      Exposure

1124.      Implant Removal

1125.      Bone Defects and Templating

1126.      Flexion–Extension Gap Balancing and Joint Line Restoration

1127.      Stability and Ligament Defects

1128.      Extensor Mechanism

1129.      Closure

1130.      POSTOPERATIVE ISSUES

1131.      Venous Thromboembolic Disease

1132.      Medical Issues

1133.      Pain Management

1134.      Dismissal Plan

1135.      64 Surgical Approaches in Revision

1136.      INTRODUCTION

1137.      SKIN INCISIONS

1138.      MEDIAL PARAPATELLAR APPROACH

1139.      MEDIAL PEEL

1140.      QUADRICEPS SNIP

1141.      V-Y QUADRICEPS TURNDOWN

1142.      EXTENSIVE FEMORAL PEEL

1143.      MEDIAL EPICONDYLAR OSTEOTOMY

1144.      THE “BANANA PEEL” EXPOSURE

1145.      TIBIAL TUBERCLE OSTEOTOMY

1146.      SUMMARY

1147.      65 Implant Removal in Revision Total Knee Arthroplasty

1148.      EXPOSURE

1149.      TOOLS

1150.      Component-Specific Tools

1151.      Hand and Power Tools

1152.      REMOVAL OF COMPONENTS

1153.      Femoral Component

1154.      Tibial Component

1155.      Patellar Component

1156.      REMOVAL OF CEMENT

1157.      CONCLUSION

1158.      66 Implant Selection in Revision Total Knee Arthroplasty

1159.      INTRODUCTION

1160.      PREOPERATIVE CLINICAL ASSESSMENT

1161.      Preoperative Assessment of the Existing Implant Design

1162.      INDICATIONS FOR REVISION TKA

1163.      Instability

1164.      Bone Loss

1165.      Infection

1166.      PRINCIPLES OF IMPLANT SELECTION IN REVISION TKA

1167.      General Principles

1168.      Single-Component Revision

1169.      LEVELS OF CONSTRAINT IN REVISION TKA

1170.      Posterior Cruciate–Retaining Revision TKA

1171.      Posterior Cruciate–Substituting Revision TKA

1172.      Varus/Valgus Constrained TKA

1173.      Linked Hinge Constrained TKA

1174.      AUGMENTATION IN REVISION TKA

1175.      Augments for Bone Loss

1176.      Stem Fixation

1177.      CONCLUSIONS

1178.      IMPLANT SELECTION SUMMARY

1179.      Cruciate-Retaining Components

1180.      Posterior-Stabilized Components

1181.      Unlinked Varus/Valgus Implants

1182.      Linked (Hinged) Implants

1183.      Stem Augmentation

1184.      Modular Augments

1185.      67 Stems in Revision Total Knee Arthroplasty

1186.      INTRODUCTION

1187.      PREOPERATIVE PLANNING

1188.      OPERATIVE TECHNIQUE

1189.      RESULTS

1190.      CONCLUSION

1191.      68 Hinged Knee and Megaprosthesis

1192.      INTRODUCTION

1193.      EVOLUTION AND CLINICAL RESULTS OF HINGED KNEE PROSTHESES

1194.      Fixed-Hinge Designs

1195.      Rotating Hinge

1196.      INDICATIONS FOR HINGED KNEE ARTHROPLASTY

1197.      Fixed-Hinged Knee Arthroplasty

1198.      Rotating-Hinged Total Knee Arthroplasty

1199.      CONCLUSION

1200.      69 Management of Bony Defects in Revision Total Knee Joint Replacement

1201.      CLASSIFICATIONS

1202.      PATHOGENESIS OF BONE DEFECTS IN TOTAL KNEE REPLACEMENT

1203.      Mechanical Bone Loss

1204.      Stress Shielding

1205.      Osteolysis

1206.      Infection

1207.      TREATMENT

1208.      Options

1209.      Techniques

1210.      RESULTS OF TREATMENT

1211.      Cement

1212.      Metal Augments

1213.      Morselized Allograft

1214.      Structural Allograft

1215.      Metaphyseal Fixation Devices

1216.      Megaprostheses

1217.      CONCLUSION

1218.      70 Cementless Revision Total Knee Arthroplasty

1219.      GRAFTING TECHNIQUE

1220.      BONE PREPARATION TECHNIQUE

1221.      Tibial Preparation

1222.      Femoral Preparation

1223.      Graft Preparation and Placement

1224.      CLINICAL EXPERIENCE

1225.      71 Management of the Patella in Revision Total Knee Arthroplasty

1226.      SURGICAL CONSIDERATIONS

1227.      TREATMENT OPTIONS AFTER PATELLAR COMPONENT REMOVAL

1228.      Adequate Remaining Patellar Bone Stock

1229.      The Bone-Deficient Patella

1230.      Techniques Without Patellar Component Implantation

1231.      TECHNIQUES WITH PATELLAR COMPONENT IMPLANTATION

1232.      Screw or Wire With Cement Augmentation

1233.      Transcortical Wiring

1234.      Structural Bone Grafting of the Patella

1235.      Three-Pegged Porous Metal Monoblock Patella

1236.      Porous Metal Augmentation Baseplate

1237.      DISCUSSION

1238.      SECTION 10 Management of the Infected Total Knee Replacement

1239.      72 Prevalence, Prevention, and Economic Implications of Infection After Total Knee Arthroplasty

1240.      INTRODUCTION

1241.      PREVALENCE

1242.      PREVENTION

1243.      Preoperative Prevention

1244.      Intraoperative Prevention

1245.      Postoperative Prevention

1246.      ECONOMIC IMPLICATIONS

1247.      CONCLUSION

1248.      73 Diagnosing Infection

1249.      CASE

1250.      DEFINITION

1251.      BACKGROUND

1252.      RISK FACTORS

1253.      HISTORY AND PHYSICAL EXAMINATION

1254.      IMAGING MODALITIES PLAIN RADIOGRAPHY

1255.      RADIOACTIVE ISOTOPE SCANNING (SCINTIGRAPHY)—BONE SCAN

1256.      LABORATORY STUDIES SEROLOGICAL TESTS

1257.      INTERLEUKIN-6 (IL-6)

1258.      D-Dimer

1259.      JOINT ASPIRATION

1260.      α-Defensin

1261.      LEUKOCYTE ESTERASE

1262.      Synovial CRP

1263.      INTRAOPERATIVE ANALYSIS

1264.      MOLECULAR-BASED TESTING

1265.      FUTURE TESTS AND BIOMARKERS

1266.      CONCLUSION

1267.      74 Microbes and Antibiotics

1268.      MICROBIOLOGY OF PERIPROSTHETIC KNEE INFECTIONS

1269.      Early Periprosthetic Infections

1270.      Delayed Periprosthetic Infections

1271.      Late Periprosthetic Infections

1272.      MICROBIOLOGIC DIAGNOSIS

1273.      Culture-based Diagnostics

1274.      Molecular Diagnostics

1275.      SYSTEMIC ANTIMICROBIAL TREATMENT

1276.      Empiric Antibiotics

1277.      Definitive Antibiotic Selection

1278.      Duration of Antibiotic Treatment

1279.      Suppressive Antimicrobial Therapy

1280.      SUMMARY

1281.      75 Débridement and Implant Retention and Nonsurgical Options for Implant Salvage

1282.      INTRODUCTION

1283.      OPEN IRRIGATION AND DÉBRIDEMENT

1284.      ARTHROSCOPIC IRRIGATION AND DÉBRIDEMENT

1285.      LONG-TERM ANTIBIOTIC SUPPRESSION

1286.      SERIAL ASPIRATIONS

1287.      CONCLUSION

1288.      76 Reimplantation After Infection

1289.      INTRODUCTION

1290.      PREOPERATIVE PATIENT OPTIMIZATION

1291.      Inflammatory Arthropathy

1292.      Diabetes

1293.      Body Mass Index

1294.      Malnutrition

1295.      Smoking

1296.      Other Contributing Factors

1297.      CONFIRMING INFECTION ERADICATION: PREOPERATIVE WORKUP

1298.      Serologic Testing

1299.      Synovial Fluid Testing

1300.      TIMING FOR SECOND-STAGE REVISION

1301.      INTRAOPERATIVE CONSIDERATIONS

1302.      Intraoperative Tests for Infection

1303.      Surgical Exposure in Reimplantation

1304.      Débridement

1305.      POSTOPERATIVE CONSIDERATIONS

1306.      SUMMARY

1307.      77 Soft-Tissue Coverage for Infected Total Knee Arthroplasty

1308.      PATIENT FACTORS

1309.      MAKING COVERAGE DECISIONS

1310.      CLOSURE BY PRIMARY AND SECONDARY INTENTION

1311.      FLAPS

1312.      Local Flaps

1313.      CONCLUSION

1314.      78 Salvage Procedures: Knee Arthrodesis, Resection Arthroplasty, Amputation

1315.      INTRODUCTION

1316.      INDICATIONS

1317.      Primary Arthrodesis

1318.      Secondary Arthrodesis

1319.      Amputation

1320.      TECHNIQUE

1321.      External Fixation

1322.      Double Plate Fixation (Nichols)

1323.      Intramedullary Nail Fixation (Stiehl)

1324.      Intramedullary Nail (Neff)

1325.      Intramedullary Nail (Wichita)

1326.      Amputation

1327.      RESULTS

1328.      DISCUSSION

1329.      Index