Revision total knee arthroplasty : a practical guide

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