Revision total knee arthroplasty : a practical guide

Description

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. 6.9) 6.7 Removal of Revision Components 6.8 Removal of Metaphyseal Sleeves References 7 Principles of Surgical Reconstruction: Back to the Beginning… 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 Ligaments’ 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 Demonstration (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. 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 PJIs—Single 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: An 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 Revision–Why? 19.2 Wear 19.3 Loosening 19.4 Stiffness 19.5 Infection 19.6 Instability 19.7 Pain 19.8 Workman’s 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