Controversies in Orthopaedic Surgery of the Lower Limb

Preface
Contents
1: Total Hip Arthroplasty: Cemented or Uncemented?
1.1 Introduction
1.2 Cemented and Uncemented THA Design
1.2.1 The Cemented Cup
1.2.2 The Cemented Stems
1.2.3 The Uncemented Cups
1.2.4 The Uncemented Stems
1.3 Results of Cemented and Uncemented THA
1.3.1 Results According to Age
1.3.2 Periprosthetic Femoral Fractures
1.4 Conclusion
References
2: Hip Resurfacing Arthroplasty or Total Hip Arthroplasty?
2.1 Introduction
2.2 History of Hip Resurfacing
2.3 Indications for Hip Resurfacing
2.3.1 Gender
2.3.2 Surgical Expertise
2.3.3 Bone Stock
2.4 Hip Resurfacing Compared to Total Hip Arthroplasty
2.4.1 Safety
2.4.2 Revision
2.4.3 Patient-Reported Outcome Measures
2.4.4 Biomechanics
2.5 Monitoring Patients After Hip Resurfacing Arthroplasty
2.6 The Future of Hip Resurfacing Arthroplasty
2.7 Conclusion
References
3: Bilateral Total Hip Arthroplasty: One-Stage or Two-Stage
3.1 Introduction
3.2 Clinical Results
3.3 Mortality
3.4 Complication Rate
3.5 Surgical Technique
3.6 Cost Effectiveness
3.7 Conclusions
References
4: Approaches for Total Hip Arthroplasty
4.1 Background
4.2 The Posterior Approach
4.3 The Direct Lateral Approach
4.4 The Anterior Approach to the Hip
4.5 Less Common Approaches
4.6 Comparison of Different Approaches
4.6.1 Post-operative Pain and Function
4.6.2 Learning Curve
4.6.3 Revision Rate
4.6.4 Periprosthetic Fracture
4.6.5 Infection
4.6.6 Dislocation
4.6.7 Nerve Palsy
4.7 Complex and Revision Total Hip Arthroplasty
4.8 Hip Approaches for Indications Other Than Arthroplasty
4.9 Conclusion
References
5: Osteonecrosis of the Femoral Head: Core Decompression or Total Hip Arthroplasty?
5.1 Introduction
5.2 Basic Science
5.3 Diagnosis and Imaging
5.4 Core Decompression in Osteonecrosis of the Femoral Head
5.5 Total Hip Arthroplasty in Osteonecrosis of the Femoral Head
5.6 Osteonecrosis of the Femoral Head: Core Decompression or Total Hip Arthroplasty?
5.7 Conclusion
References
6: Controversies on the Surgical Treatment of Cartilage Defects of the Knee
6.1 Introduction
6.2 Arthroscopic Debridement
6.3 Microfracture (MFX) (Fig. 6.1)
6.4 Mosaicplasty (Osteochondral Autograft Transplantation) (Figs. 6.2 and 6.3)
6.5 Osteochondral Allograft Cartilage Transplantation
6.6 Autologous Chondrocyte Implantation (ACI) (Fig. 6.4)
6.6.1 Arthroscopic Gel-Type ACI
6.6.2 Third-Generation ACI (Novocart) After Failed Bone Marrow Stimulation (BMS)
6.6.3 Costal Chondrocyte-Derived Pellet-Type ACI
6.7 Matrix-Associated Chondrocyte Implantation (MACI) (Fig. 6.5)
6.7.1 MACI with Spheroid Technology
6.8 Acellular Scaffolds
6.8.1 Potential Indications
6.8.2 Cell-Free Scaffolds: Monotherapy
6.8.3 Synthetic Scaffold Plug
6.9 Mesenchymal Stem Cells (MSCs)
6.9.1 MSCs Implant
6.9.2 MSCs Plus MFX and Hyaluronic Acid (HA)
6.10 Autologous Collagen-Induced Chondrogenesis (ACIC)
6.11 Novel Autologous-Made Matrix
6.12 Comparative Studies
6.12.1 MFX vs Mosaicplasty
6.12.2 ACI vs MFX
6.12.3 ACI vs Osteochondral Allograft Cartilage Transplantation
6.12.4 Synthetic Biphasic Scaffolds vs MFX
6.12.5 Mosaicplasty: Patellofemoral vs Tibiofemoral Joints
6.12.6 Mosaicplasty vs MFX vs ACI vs MACI
6.13 Cost-Efficacy of Cartilage Therapies
6.14 Conclusions
References
7: Acute Anterior Cruciate Ligament Injuries: Repair or Reconstruction?
7.1 Introduction
7.2 ACL Repair
7.2.1 Patient Factors Associated with Eligibility for ACL Repair
7.2.2 DIS (Dynamic Intraligamentary Stabilization)
7.2.3 SLA (Suture Ligament Augmentation)
7.2.4 Outcomes of ACL Repair
7.3 Acute ACL Ruptures: Repair or Reconstruction?
7.4 Conclusions
References
8: Anterior Cruciate Ligament Reconstruction: Isolated or Combined with an Extra-Articular Procedure?
8.1 Introduction
8.2 Lateral Extra-Articular Tenodesis (LET)
8.3 Anatomic Anterolateral Ligament Reconstruction (AALLR)
8.3.1 Single-Bundle Anatomic Reconstruction
8.3.2 Double-Bundle Anatomic Reconstruction
8.3.3 ACLR Combined Intra- and Extra-Articular Technique
8.4 ACL Reconstruction: Isolated vs Combined
8.4.1 Studies to Determine If the Combination ACLR + LEAP Can Improve Graft Survival
8.4.2 Studies Trying to Determine If the Combination ACLR + LEAP Can Improve Residual Rotational Instability
8.5 Indications for AALLR and LET
8.6 Complications of LEAPs
8.6.1 Difficulties with Grafting
8.6.2 Injury to LCL
8.6.3 Wound Hematoma
8.6.4 Persistent Lateral Pain
8.6.5 Discomfort Caused by Fixation Devices
8.6.6 Over-Constraint of the Lateral Compartment
8.6.7 Loss of Knee Mobility or Stiffness
8.6.8 Patellofemoral Crepitus
8.6.9 Osteoarthritis of the Lateral Compartment
8.6.10 Malposition of the Fixation Devices
8.6.11 Convergence of Tunnels
8.7 Conclusions
References
9: Optimal Technique in Knee Osteotomy
9.1 Introduction
9.2 Is High Tibial Osteotomy (HTO) the Best Option in All of My Varus Knees?
9.3 Should I Always Have a Vascular Surgeon Nearby When Starting My Osteotomy Cuts?
9.4 Why Intra-Articular Wear and Soft Tissue Management Are the Most Complex Issues in Knee Osteotomies?
9.5 How to Improve Accuracy: CAO (Computer-Assisted Osteotomy)/PSI (Patient-Specific Instrumentation)/Robots
9.6 Sagittal (Un)intentional Correction and Patellar Height in Knee Osteotomy
9.7 Is It Necessary to Fill the Osteotomy Gap in Opening Wedge High Tibial Osteotomy?
9.8 Conclusions
References
10: Upper Tibial Osteotomy or Unicompartmental Knee Arthroplasty for Medial Compartment Knee Osteoarthritis: Evidence-Based Indications for Treatment
10.1 Introduction
10.2 Factors Determining Treatment in Medial Compartment OA
10.2.1 Disease Severity
10.2.2 Disease Chronicity
10.2.3 Deformity Analysis
10.3 HTO and UKA in the Treatment of Medial Compartment OA
10.3.1 Upper Tibial Osteotomy
10.3.2 Unicompartmental Knee Arthroplasty
10.4 Comparison of HTO vs UKA
10.4.1 Pain and Functional Outcomes
10.4.2 Survival
10.5 Shared Decision Making in the Surgical Treatment of Medial Compartment OA
10.5.1 Summary
10.6 Conclusions
References
11: Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty
11.1 Introduction
11.2 Indications
11.3 Complications
11.4 Revision Rate
11.5 Functional Outcomes
11.6 Effect of Surgeon/Unit Volume
11.7 Cost-Effectiveness
11.8 Conclusion
References
12: Bilateral Simultaneous Versus Bilateral Staged Total Knee Arthroplasty and Unicompartmental Knee Arthroplasty
12.1 Introduction
12.2 Bilateral Total Knee Arthroplasty
12.3 Bilateral Unicompartmental Knee Arthroplasty
12.4 Conclusions
References
13: Late Acute Hematogenous Infection Following Total Knee Arthroplasty: Debridement, Antibiotics and Implant Retention (DAIR), One-Stage Revision or Two-Stage Revision?
13.1 Introduction
13.2 Incidence of Late Acute Hematogenous PJI After TKA
13.3 Arthroscopic DAIR
13.4 Open DAIR
13.5 One-Stage Revision
13.6 Two-Stage Revision
13.7 Comparative Studies: DAIR, One-Stage Revision or Two-Stage Revision?
13.8 Conclusions
References
14: Management of Distal Femoral Periprosthetic Fractures: Plate, Intramedullary Nail or Arthroplasty?
14.1 Introduction
14.2 Basic Concepts
14.2.1 Risk Factors
14.2.2 Local Stressors and Notching
14.3 Classification Systems
14.4 Treatment
14.4.1 Intramedullary Fixation
14.4.2 Locking Plate Fixation
14.4.3 Results of Fixation
14.5 Primary Endoprosthetic Replacement
14.6 Conclusion
References
15: Total Knee Arthroplasty in Patients with a History of Metal Allergy: Conventional Implant or Hypoallergenic Implant?
15.1 Introduction
15.2 Diagnosis of Metal Allergy: What Tests Should Be Done? Are They Reliable?
15.3 The Clinical Impact of Metal Allergy on the Outcomes of TKA
15.4 Should We Implant a Conventional Primary TKA or a Hypoallergenic TKA?
15.4.1 TKA Using Alternative Materials
15.4.2 Surface Coatings
15.4.3 Comparison of Outcomes of Conventional and Hypoallergenic Implants
15.5 Is There a Justification to Use Primary Hypoallergenic TKA in Patients with Metal Allergy?
15.6 TKA Failure Due to Metal Allergy: Should We Perform a “Hypoallergenic” Revision TKA
15.7 Conclusions
References
16: Ankle Arthroplasty Versus Arthrodesis: Making the Right Choice
16.1 Introduction: Background and Current Practice
16.2 Ankle Arthrodesis Versus Total Ankle Arthroplasty—Is There Really a Gold Standard?
16.3 Key Considerations for Choosing Between Ankle Arthrodesis and Total Ankle Arthroplasty
16.3.1 Does Range of Motion Matter?
16.3.2 Post-operative Rehabilitation
16.3.3 Long-Term Concurrent Joint Osteoarthritis
16.3.4 Revision Surgery
16.4 Factors Influencing Decision to Perform Either Ankle Arthrodesis or Total Ankle Arthroplasty
16.4.1 Patient Demographics
16.4.2 Relative Demographics and Co-morbidities
16.4.3 Lifestyle Factors
16.4.4 Local Pathology
16.4.5 Bilateral Ankle Disease
16.4.6 Cost Effectiveness
16.4.7 Patient and Surgeon Expectations
16.5 Making the Right Choice
16.6 Conclusions
References
17: Achilles Tendon Ruptures: Nonoperative Treatment, Open Repair or Percutaneous Repair?
17.1 Introduction
17.2 Nonoperative Treatment
17.2.1 Nonoperative Treatment and Early Active Rehabilitation
17.2.2 Nonoperative Treatment Versus Open Surgical Treatment
17.3 Surgical Treatment
17.3.1 Suturing Techniques
17.3.2 Surgical Approaches
17.3.2.1 Open Surgery Versus Minimally Invasive Surgery
17.3.2.2 Open Surgery Versus Percutaneous Surgery
17.3.2.3 Surgical Technique Preferred by the Authors of This Chapter
17.4 Conclusion
References
18: Biomarkers in Osteoarthritis: Their Role in Predicting the Progression of the Disease and Their Ability to Assess the Efficacy of Existing Treatment
18.1 Introduction
18.2 The Role of Biomarkers in the Clarification of the Pathogenetic Mechanisms of OA
18.3 The Role of Biomarkers in the Prediction of OA Occurrence and Detection of Early Development of OA
18.4 The Role of Biomarkers in the Prediction of Radiographic Severity in Symptomatic OA
18.5 Biomarkers Associated with the Progression of OA
18.6 OA-Related SF Biomarkers Are Specifically Linked to Indicators of Activated Macrophages and Neutrophils: Therapeutic Targeting of a Subset of Individuals at High Risk for OA Progression
18.7 The Role of Biomarkers to Differentiate Between OA Patients and Other Problems
18.8 Associations Between Serum Muscle Biomarkers and Sarcopenia in OA
18.9 Biomarker Differences Between Genders
18.10 Impact of Exercise on Molecular Biomarkers Related to Cartilage and Inflammation
18.11 Conclusions
References