Essentials of Cemented Knee Arthroplasty

Foreword
Foreword
Preface
Acknowledgment
Contents
Contributors
I: History
1: The History of Total Knee Arthroplasty
1.1 Introduction
1.2 First Attempts
1.3 Early Attempts Using Metallic Prostheses to Treat Knee Arthritis
1.4 The Concept of Modern TKA
1.5 Patella
1.6 Mobile Bearing
1.7 The Evolution of Alignment Parameters: Anatomic Versus Kinematic Versus Restricted Kinematic
1.8 The Evolution of Femoral Component Design
1.9 The Evolution of Tibial Component Design
1.10 The Evolution of Polyethylene—The Growth of Mid-Level Constraint
1.11 The Evolution of Fixation in TKA
1.12 Conclusion
References
II: Indications
2: Osteoarthritis
2.1 Introduction
2.2 Risk Factors
2.3 Pathophysiology
2.4 Diagnostic Features
2.5 Treatment Options
2.5.1 Nonoperative Management
2.5.2 Surgical Intervention: Cemented Total Knee Arthroplasty
2.6 Conclusion
References
3: Osteoarthritis and Other Indications for Total Knee Arthroplasty: An East African Perspective
3.1 Osteoarthritis
3.1.1 Introduction
3.1.2 Risk Factors
3.1.3 Pathology
3.1.4 Clinical Features
3.1.5 Laboratory Findings
3.1.6 Radiologic Features
3.1.7 Management
3.1.8 Indications for Total Knee Arthroplasty
3.2 Total Knee Arthroplasty in East (and Sub-Saharan) Africa
References
4: Inflammatory Arthritis
4.1 Introduction
4.2 Case Example
4.3 Preoperative Considerations
4.3.1 General Medical Evaluation
4.3.2 Medications
4.3.2.1 Glucocorticoids
4.3.2.2 DMARDs
4.3.2.3 Biologics
4.3.2.4 SLE-Specific Considerations
4.3.3 Orthopedic Evaluation
4.4 Intraoperative Considerations
4.5 Postoperative Considerations
4.5.1 Medications
4.5.2 Complications
4.5.3 Implant Survivorship
4.6 Conclusion
References
5: Osteonecrosis
5.1 Introduction
5.2 Case Examples
5.2.1 Case Report #1
5.2.2 Case Report #2
5.3 Published Outcome Data
5.4 Conclusion
References
6: Post-Traumatic Arthritis
6.1 Introduction
6.2 Case Examples
6.2.1 Case 1: Femoral Nail
6.2.2 Case 2: Tibial Plateau Plate
6.3 Preoperative Evaluation
6.4 Intraoperative Considerations
6.5 Outcomes
6.6 Conclusion
References
7: Post-Septic Arthritis
7.1 Introduction
7.2 Definition and Diagnosis of Post-Septic Arthritis
7.3 Approach to Septic Arthritis Depending on the Stage of the Joint Disease
7.3.1 Acute Septic Arthritis on a Native Knee and Without Degenerative Disease
7.3.2 Quiescent/Cured Septic Arthritis
7.3.3 Evolutive Septic Arthritis with End Degenerative Disease
7.4 Importance of Antibiotic-Loaded Cement for TKA in Post-Septic Arthritis
7.5 TKA in Post-Septic Arthritis
7.5.1 Clinical Outcomes: One-Stage and Two-Stage
7.5.1.1 One-Stage TKA
7.5.1.2 Two-Stage TKA
7.5.2 Complication and Revision Rates of TKA
7.6 Special Considerations for TKA in Post-Septic Arthritis
References
8: Influence of Lifestyle and Risk Factors on the Development of Knee Arthritis and Outcomes Following Cemented Total Knee Arthroplasty: A US Perspective
8.1 Introduction
8.2 Patient and Lifestyle Risk Factors Associated with the Development of Knee Osteoarthritis
8.2.1 Patient Factors
8.2.1.1 Genetics
8.2.1.2 Gender Differences
8.2.1.3 Malalignment
8.2.1.4 Obesity
8.2.2 Lifestyle Factors
8.2.2.1 Nutrition and Dietary Patterns
8.2.2.2 Smoking and Alcohol
8.2.2.3 Exercise and Muscle Strength
8.2.2.4 Occupation
8.3 Patient Risk Factors for Adverse Outcome Following Cemented TKA
8.3.1 Aseptic Loosening
8.3.1.1 Obesity
8.3.1.2 Malalignment
8.3.1.3 Activity Level
8.3.2 Function and Patient Satisfaction
8.3.2.1 Functional Outcomes
8.3.2.2 Patient Satisfaction
References
9: Lifestyle and Risk Factors for Knee Arthroplasty: A South African Perspective
9.1 Introduction
9.2 Return to Work and Return to Sports
9.3 Malnutrition
9.4 Undernutrition
9.5 Overnutrition
9.5.1 Associated Risks
9.5.2 Functional Outcomes
9.5.3 Preoperative Optimization
9.6 Rehabilitation TKA
References
10: The Microbiome of the Joint
10.1 Microbiome Overview
10.2 Clinical Significance of Microbiome
10.3 Microbiome in “Sterile” Compartments
10.4 Chronic Colonization of the Native Joint
10.5 Colonization of Native/Implanted Joint Without Evidence of Disease
10.6 Implications for PJI
References
III: Radiographs and Outcomes
11: Radiographic Analysis of Knee Arthritis
11.1 Introduction
11.2 Plain Radiographs
11.2.1 Technique
11.3 Radiographic Grading
11.4 Radiographic Assessment of Non-Osteoarthritic Arthritis
11.5 Correlation of OA Severity and TKA Outcomes
11.6 Radiographic Evaluation of TKA
11.7 Cross-Sectional and Advanced Imaging
11.7.1 Computed Tomography
11.7.2 Magnetic Resonance Imaging
11.7.3 Nuclear Medicine
References
12: Patient-Reported Outcomes in Total Knee Arthroplasty
12.1 Introduction
12.2 General Health Outcome Measures
12.2.1 Medical Outcomes Study Short-Form (SF-36 and SF-12)
12.2.2 EuroQOL 5-Dimension Score (EQ-5D)
12.2.3 The Patient-Reported Outcomes Measurement Information System (PROMIS)
12.2.4 Press Ganey
12.2.5 Prediction Model for Patient Satisfaction (PMPS)
12.3 Joint-Specific Outcome Measures
12.3.1 Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
12.3.2 Knee Injury and Osteoarthritis Outcome Score (KOOS)
12.3.3 Oxford Knee Score (OKS)
12.3.4 Knee Society Score
References
IV: Treatment
13: Fixation in Joint Arthroplasty
13.1 Clinical History
13.2 Clinical Outcome
13.3 Fixation Method
13.3.1 Cement Type
13.3.2 Cementing Technique
13.4 What Have We Learned?
References
14: Medial Unicompartmental Knee Arthroplasty
14.1 Introduction
14.2 Patient Selection
14.3 Implant Development
14.4 Implant Design
14.5 Surgical Technique
14.6 New Technology in UKA
14.7 Postoperative Rehabilitation
References
15: Lateral Unicompartmental Knee Arthroplasty
15.1 Introduction
15.2 Case Example
15.3 Evaluation, Indications, and Contraindications
15.4 Surgical Technique
15.4.1 Positioning and Lateral Exposure
15.4.2 Tibial Preparation
15.4.3 Femoral Preparation
15.4.4 Balancing the Flexion and Extension Gaps
15.4.5 Cementation and Component Fixation
15.4.6 Closure
15.5 Discussion of Current Literature
References
16: Lateral Unicompartmental Knee Arthroplasty: A French Perspective
16.1 Introduction
16.2 Case Example
16.3 Anatomy
16.4 Indications and Preoperative Investigations
16.5 Kinematics of a Native Knee and After UKA
16.6 Surgical Technique
16.6.1 Tibial Cut
16.6.2 Femoral Cuts
16.6.3 Implant Positioning
16.6.4 Common Mistakes and Operating Difficulties
16.7 Results and Revision
References
17: Patellofemoral Arthroplasty
17.1 Introduction
17.2 Clinical Evaluation
17.2.1 Patient History
17.2.2 Physical Examination
17.2.3 Imaging
17.3 Patellofemoral Arthroplasty
17.3.1 Contraindications to Patellofemoral Arthroplasty (Leadbetter et al. 2005)
17.3.2 Design Features
17.3.3 Surgical Technique
17.3.4 Clinical Results
17.4 Complications
References
18: Bicompartmental Knee Arthroplasty
18.1 Introduction
18.2 Case Example
18.3 Classification
18.4 Indications
18.5 Implant Options and Surgical Technique
18.6 Results
References
19: Total Knee Arthroplasty
19.1 Introduction
19.2 Case Example
19.3 Surgical Technique
19.4 Gap Balancing Versus Measured Resection
19.4.1 Gap Balancing
19.4.2 Measured Resection
19.4.3 Comparison of Outcomes
19.5 Mechanical Versus Kinematic Alignment
19.5.1 Mechanical Alignment
19.5.2 Kinematic Alignment
19.5.3 Comparison of Outcomes
19.6 Unicompartmental, Bicompartmental, and Tricompartmental Knee Arthroplasty
References
20: Patellar Resurfacing in Cemented Total Knee Arthroplasty
20.1 Introduction
20.2 Case Example and Surgical Technique
20.3 History of Controversy
20.4 Natural History of the Patellofemoral Joint and Patterns of Wear
20.5 Indications for Resurfacing or Not Resurfacing
20.6 Risks of Patellar Non-resurfacing and Outcomes of Secondary Resurfacing
20.7 Risks of Patellar Resurfacing
20.8 Comparison Studies of Resurfacing
20.8.1 Randomized Controlled Trials
20.8.2 Registry Data
20.8.3 Bilateral Comparisons
20.9 Cost-Effectiveness
20.10 Technique for Cemented Patella Resurfacing
20.11 Conclusion
References
21: Patella Replacement in Knee Arthroplasty: A Japanese Perspective
21.1 Introduction
21.2 Patellofemoral Contact Stress in TKA
21.2.1 Factors Correlated with Patellofemoral Contact Stress after TKA
21.2.2 Effect of Patellar Morphology on Postoperative Patellofemoral Contact Stress
21.2.3 Effect of Component Geometry on Postoperative Patellofemoral Contact Stress
21.3 Complications Associated with the Patellofemoral Joint in TKA
21.3.1 Patellar Fracture
21.3.2 Osteonecrosis of the Patella
21.3.3 Patellar Clunk Syndrome and Crepitus
21.3.4 Anterior Knee Pain after TKA
21.4 Surgical Technique and Strategies that Can Reduce Anterior Knee Pain
References
22: Knee Arthroplasty: An Asian Perspective
22.1 Introduction
22.1.1 Demographics of Knee OA in Western Versus Asian Populations
22.1.2 TKA in Western Versus Asian Countries
22.1.3 Predictors of Knee OA and Knee Arthroplasty
22.1.4 Unicompartmental and Patellofemoral Arthroplasty
22.2 Ethnic Differences in Knee Morphology
22.2.1 Asian Versus Western Knee Anatomy
22.2.2 Lower Extremity Axial Alignment in Asian Versus Caucasian Adults
22.2.3 Differences in Distal Femoral Morphology
22.2.4 Differences in Proximal Tibial Morphology
22.2.5 Differences in Patella Morphology and Others
22.3 Prevailing Knee Arthroplasty Techniques
22.3.1 Special Considerations in Asian Knee Arthroplasty
22.3.2 UKA Utility in Asia
22.4 Cementless TKA
22.4.1 Background of Cementless TKA
22.4.2 Cementless Versus Cemented TKA
22.5 Patellofemoral Arthroplasty and Background and Utility of Patellar Resurfacing
References
V: Clinical Care Pathways
23: Preoperative Optimization in Total Joint Arthroplasty
23.1 Introduction
23.1.1 Scope of the Problem—Periprosthetic Joint Infections
23.1.2 Modifiable Versus Non-modifiable Risk Factors
23.1.3 Currently Available Guidelines on Surgical Site Infections
23.2 Patient-Modifiable Risk Factors and Current Evidence
23.2.1 Diabetes
23.2.2 Obesity
23.2.3 Malnutrition
23.2.4 Smoking
23.2.5 Vitamin D
23.2.6 Staphylococcus Aureus Screening
23.2.7 Inflammatory Arthropathies
23.2.8 Urinary Tract Infections
23.2.9 Poor Oral Health
23.2.10 Antibiotic Prophylaxis
23.3 Conclusion
References
24: Outpatient Total Knee Arthroplasty
24.1 Introduction
24.2 Outpatient Total Knee Arthroplasty
24.3 Clinical Outcomes
24.4 Conclusion
References
25: Perioperative Pain Management in Total Knee Arthroplasty
25.1 Introduction
25.2 Multimodal Analgesia
25.3 The Pain Pathway
25.4 Preoperative Analgesia
25.5 Intraoperative Periarticular Injection
25.6 Intraoperative Medications
25.7 Postoperative Analgesia
25.7.1 Gabapentinoids
25.7.2 Nonsteroidal Anti-Inflammatory Drugs
25.7.3 Opioids
25.7.4 Intravenous Opioids Via Patient-Controlled Analgesia
References
VI: Implant Design
26: Loosening of Total Knee Arthroplasty: An Australian Perspective
26.1 Introduction
26.2 Illustrative Cases
26.2.1 Patient 1
26.2.2 Patient 2
26.3 Overview of the Australian Registry
26.3.1 Revision
26.3.2 Implant Design and Bearing Mobility
26.3.3 Patella
26.3.4 Fixation
26.3.5 Patient Age, Gender, and BMI
26.4 Other National Joint Registries (UK and Scandinavia)
26.5 Loosening: The Most Common Cause of Failure
26.5.1 Implant Type (Cemented vs. Uncemented)
26.5.2 Implant Design/Constraint/Bearing
26.5.3 Osteolysis and Wear
26.5.4 Malalignment
26.5.5 Cement and Cementing Technique
26.5.6 Patient-Related Factors for Loosening
26.6 Clinical Presentation, Diagnosis, and Treatment
References
27: Cemented, Cruciate-Retaining Total Knee Arthroplasty: The Evolution of a Technique
27.1 Introduction
27.2 Case Example
27.3 Surgical Technique
27.3.1 General
27.3.2 Positioning
27.3.3 Exposure
27.3.4 Patella First
27.3.5 Femur Second
27.3.6 Tibia Third
27.3.7 Balancing
27.3.8 Cementation
27.3.9 Insert Trialing
27.3.10 Closure
27.4 Postoperative Care
27.5 CR Knees: Why Retain the Cruciate?
27.6 Design Features of CR Knees
27.7 Balancing the PCL
27.8 Tibial Slope
27.9 Indications/Contraindications
27.10 Clinical Results: CR Versus PS
References
28: Posterior Stabilized Total Knee Arthroplasty
28.1 Introduction
28.2 Case Example
28.3 Surgical Technique
28.3.1 Positioning
28.3.2 Exposure
28.3.3 Distal Femoral Preparation
28.3.4 Tibial Preparation
28.3.5 Extension Gap Balancing
28.3.6 Femoral Sizing and Rotation
28.3.7 Patellar Preparation
28.3.8 Trialing and Tibial Sizing
28.3.9 Cementation and Final Component Placement
28.3.10 Closure
28.4 Literature Review
References
29: Bicruciate-Retaining Total Knee Arthroplasty
29.1 Introduction
29.2 Illustrative Cases
29.2.1 Case 1
29.2.2 Case 2
29.3 Results
29.4 Discussion
References
30: Fixed- Versus Mobile-Bearing Total Knee Arthroplasty
30.1 Introduction
30.2 Case Example
30.3 Kinematics of the Native Knee and Total Knee Arthroplasty
30.4 Fears Associated with Mobile-Bearing TKA
30.5 Benefits of a Mobile-Bearing Design
30.6 Clinical Outcomes After Mobile Versus Fixed-Bearing TKA
References
31: All-Polyethylene Tibial Components in Primary Total Knee Arthroplasty: Why It Works and Why I Do Not Use It Anymore?
31.1 Introduction
31.2 Case Example
31.3 Background
31.4 Surgical Technique
31.5 Implant Cost
31.6 Clinical Outcomes
References
32: Cementless Total Knee Arthroplasty
32.1 Introduction
32.2 Cementless TKA Designs
32.2.1 Early Cementless TKA Designs
32.2.2 Second-Generation Cementless TKA Designs
32.3 Surgical Technique
32.4 Results
References
33: Custom/Patient-Specific Total Knee Arthroplasty
33.1 Introduction
33.2 Case Study
33.3 Discussion
References
34: Alternative Bearings in Total Knee Arthroplasty
34.1 Introduction
34.2 Case Example
34.3 Surgical Technique
34.4 Ceramic Bearings
34.5 Metal Allergy
34.6 Wear Properties
34.7 Clinical Outcomes
References
35: Contemporary Rotating Hinged Prostheses in Primary Total Knee Arthroplasty
35.1 Introduction
35.2 Case Example
35.3 Surgical Technique
35.3.1 Exposure
35.3.2 Tibial Preparation
35.3.3 Femoral Preparation
35.3.4 Patellar Preparation
35.3.5 Trialing
35.3.6 Final Implant Placement
35.4 Indications for Rotating Hinges in Primary TKA
35.5 Clinical Outcomes
35.5.1 Short- and Mid-Term Outcomes
35.5.2 Long-Term Outcomes
35.6 Complications
35.6.1 Early Perioperative Complications
35.6.2 Delayed Complications
References
36: Patellar Component
36.1 Introduction
36.2 Case Example
36.3 Surgical Technique
36.4 Relevant Literature
References
VII: Databases Afterwards Database
37: International Registries – A Comparison of Outcomes
37.1 Introduction
37.2 Registries
37.2.1 History
37.2.2 Collaboration
37.2.3 Data Collected
37.2.4 Weaknesses
37.3 Registries and Their Respective Sizes
37.4 Outcomes Reporting
37.4.1 Outcomes Based on Patient Characteristics
37.4.1.1 Effect of Age
37.4.2 Outcomes Based on Method of Fixation
37.4.3 Reasons for Revision
37.4.4 Notable Trends
37.4.5 Patient-Reported Outcome Measures
References
38: USA AJRR – Total Knee Arthroplasty: Lessons Learned
38.1 Introduction
38.2 Primary TKA
38.3 Primary Unicompartmental Knee Arthroplasty (UKA) and Patellofemoral Arthroplasty (PFA)
38.4 Epidemiology Revision TKA from AJRR
38.5 Future Directions
References
39: US National Databases – Total Knee Arthroplasty: Lessons Learned
39.1 Introduction
39.2 Available Databases
39.3 Unicompartmental Knee Arthroplasty (UKA)
39.3.1 Prevalence
39.3.2 Outcomes and Risk Factors
39.3.3 Surgical Technique
39.3.4 UKA vs. TKA
39.4 Primary and Revision Total Knee Arthroplasty
39.4.1 General Outcomes
39.4.1.1 Race and Gender
39.4.1.2 Region
39.4.1.3 Age
39.4.2 Comorbidities
39.4.2.1 Smoking and Malnutrition
39.4.2.2 Opioid Use Disorder and Associated Adverse Events
39.4.2.3 Disease
39.4.2.4 Immunosuppression
39.4.2.5 Obesity
39.4.3 Surgical Technique
39.4.3.1 Computer Navigation
39.4.3.2 Bilateral TKAs, Staged TKAs, Combined THA/TKA, and Inpatient vs. Outpatient Surgery
39.4.3.3 Cemented vs. Cementless
39.4.4 Infection
39.4.5 Postoperative Care
39.4.6 Preventing Venous Thromboembolic Events
39.4.7 Future Trends in TKA
References
40: Arthroplasty Register Data: Outcomes of Knee Arthroplasty in Younger Patients
40.1 Introduction
40.2 Trends in the Demography of Knee Arthroplasty Patients
40.3 What Is “Outcome”?
40.4 Implant Survival
40.4.1 TKA and UKA in the Young Patient
40.4.2 Cemented Compared with Cementless Fixation
40.5 Patient-Reported Outcomes
References
VIII: Economics
41: Economics of Surgical Treatment of Knee Arthritis – A US Perspective
41.1 Introduction
41.2 Economic Burden of Knee Arthritis
41.2.1 Non-TKA Treatments
41.2.2 Health-Related Quality of Life and Societal Benefits of TKA
41.3 Economic Considerations of TKA
41.3.1 Preoperative Considerations and Patient Selection
41.3.2 Postoperative and Discharge Considerations
41.3.3 Revision TKA
41.4 Reimbursement
41.4.1 Payment Models
41.4.2 Limitations of New Payment Models
41.4.3 Gainsharing
41.5 Big Data in TKA
41.6 TKA Implants
41.7 Cemented TKA
41.7.1 Cementing Technique
41.7.2 Antibiotics in Bone Cement
41.8 Surgeons and the Economic Future of TKA
References
42: Conceptualizing the Problem of Cost in Cemented Total Knee Arthroplasty
42.1 Introduction
42.2 Methods for Assessing Cost in TKA
42.3 Comparing Costs of Cemented and Non-cemented TKA
42.4 Cost Considerations in Special Populations
42.5 The Importance of Incorporating Value Measurement
References
IX: Cementing Technique
43: Polymethylmethacrylate Cements for Endoprosthetics
43.1 Introduction
43.2 History
43.3 Cement Viscosity
43.4 Flow Behavior and Intrusion
43.5 Doughing Time and Intrusion
43.6 PMMA Cement When Loaded with Antibiotics Serves as an Active Drug Carrier Reducing Infection Rates and Mortality
43.7 Malnutrition as an Underestimated Risk Factor for Deep Wound Infection
43.8 Metabolization of Antibiotics
43.9 Manual Admixing of Anti-microbials
References
44: The Principles of Total Knee Arthroplasty Cementing Technique – A Japanese Perspective
44.1 Introduction
44.2 Factors Involved in TKA Long-Term Results
44.2.1 Types of Loosening
44.2.2 Special Characteristics of Bone Cements
44.2.3 Concept of Contamination
44.2.4 Cement Types and Curing
44.2.5 Preparation of Cement – Mixing
44.2.6 Strength of Cement Fixation
44.2.7 Using a Tourniquet while Cementing
44.2.8 Preparation of the Cement Bone Bed
44.2.9 Cement Coating
44.2.9.1 Implant
44.2.9.2 Bone
44.2.10 Cementing Technique
44.2.10.1 Tibia
44.2.10.2 Femur
44.2.10.3 Cement Pressurization and Cement Removal
44.2.10.4 Patella
44.3 Discussion
References
45: Influence of Cement Storage Temperature on Its Viscosity and Penetration Depth in the Tibia During Total Knee Arthroplasty
45.1 Introduction
45.2 Materials and Methods
45.3 Results
45.4 Discussion
References
46: Antibiotic-Loaded Bone Cement: Pro
46.1 Introduction
46.2 Historical Context
46.3 Current Consensus
46.4 Products and Regulations
46.5 Evidence
46.5.1 Retrospective
46.5.2 Randomized Controlled
46.5.3 Systematic Reviews and Meta-analyses
46.5.4 Registry
46.6 Cost-Effectiveness
46.7 Safety
46.8 Alternative Local Therapy
References
47: Antibiotic-Loaded Bone Cement: Con
47.1 Introduction
47.2 Decreased Mechanical Strength
47.3 Antibiotic Resistance
47.4 Acute Renal Failure
47.5 Infection Risk
47.6 Allergic Reactions
47.7 Indications
References
48: Enhancement of Release Profile of Antibiotic from Antibiotic-Loaded Poly(methyl methacrylate) Bone Cement for Anchoring of Total Joint Arthroplasties: A State-of-the-Art Review
48.1 Introduction
48.2 Baseline Release Profile Characteristics
48.3 Enhancement Methods
48.3.1 Additive(s) to Cement Powder
48.3.2 Additive to Cement Liquid
48.3.3 Direct Impregnation of Antibiotic
48.3.4 Method of Mixing Antibiotic Powder and Cement Powder
48.3.5 Method of Mixing Blended Cement Powder and Cement Liquid
48.3.6 Application of Ultrasound
48.3.7 Alteration of Surface Pattern
48.3.8 Timing of Addition of Antibiotic Powder to Cement Powder
48.3.9 State of Antibiotic upon Addition to Cement Liquid
48.3.10 Combination Technique
48.4 Overview
References
49: Tourniquet Use in Cemented Total Knee Arthroplasty
49.1 Introduction
49.2 Blood Loss
49.3 Visualization
49.4 Cementation
49.5 Pain and Clinical Outcomes
49.6 Complications Related to Tourniquet Use
49.7 Authors’ Current Protocol
References
X: Complications
50: Perioperative Thromboembolic Events
50.1 Introduction
50.2 Clinical Manifestations and Pathophysiology
50.3 Diagnosis and Epidemiology
50.4 Prevention
50.5 Treatment
References
51: Current State of the Art for Prophylactic Treatment of Thromboembolic Events After TKA
51.1 Introduction
51.2 Current Recommendation
51.3 Why Aspirin?
51.4 Effectiveness of Aspirin After TKA
51.5 Cost-Effectiveness Ratio of Aspirin After TKA
51.6 Side-Effects of Aspirin After TKA
51.7 Indication of Aspirin After TKA
51.8 Dose and Duration of Aspirin After TKA
51.9 Conclusion
References
52: Aseptic Loosening – A US Perspective
52.1 Introduction
52.2 Case Example
52.3 Pathophysiology
52.4 History and Physical Exam
52.5 Imaging
52.5.1 Plain Radiographs
52.5.2 Bone Scintigraphy
52.5.3 Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)
52.5.4 Positron Emission Tomography-Computed Tomography (PET-CT)
52.6 Risk Factors
52.6.1 Body Mass Index
52.6.2 Diabetes Mellitus
52.6.3 Mobile-Bearing TKA
52.6.4 High-Viscosity Cement
52.7 Revision TKA Clinical Outcomes
52.8 Case Example Continued
References
53: Management of Extensor Mechanism Disruption After Total Knee Arthroplasty
53.1 Introduction
53.2 Case Example
53.3 Incidence, Etiology, and Risk Factors
53.4 Diagnosis and Treatment Options
53.5 Patellar Tendon Rupture
53.5.1 Nonoperative Management
53.5.2 Semitendinosus Tendon Autograft
53.5.3 Medial Myofascial Gastrocnemius Rotational Flap
53.5.4 Achilles Tendon Allograft
53.5.5 Extensor Mechanism Allograft
53.5.6 Synthetic Mesh
53.6 Patella Fracture
53.7 Quadriceps Tendon Rupture
53.8 Rehabilitation Protocol Following Extensor Mechanism Reconstruction
53.9 Outcome of Extensor Mechanism Disruption After TKA
53.10 Authors’ Preferred Approach
53.11 Prevention
References
54: Periprosthetic Fractures
54.1 Introduction
54.2 Case Study
54.2.1 History of Present Illness
54.2.2 Preoperative Planning
54.2.3 Surgical Procedure and Tips and Tricks
54.3 Risk Factors
54.4 Classification of Periprosthetic TKA Fractures
54.4.1 Periprosthetic Femur Fracture Classification Systems
54.4.2 Periprosthetic Tibia Fracture Classification
54.5 Surgical Techniques
54.5.1 Periprosthetic Femur Fractures
54.5.1.1 Intramedullary Fixation
54.5.1.2 Plate Fixation
54.5.1.3 Results of Intramedullary Nailing Versus Plate Fixation
54.5.2 Periprosthetic Tibia Fractures
54.5.2.1 Plate Fixation
54.5.2.2 Intramedullary Fixation
54.5.2.3 Intramedullary Nailing Versus Plate Fixation
54.5.3 Revision Arthroplasty
54.5.3.1 Periprosthetic Femur Fractures
54.5.3.2 Periprosthetic Tibia Fractures
References
55: Infection
55.1 Introduction
55.2 Prevention
55.3 Definition
55.4 Diagnosis
55.5 Treatment
55.5.1 Irrigation and Debridement with Polyethylene Exchange (DAIR)
55.5.2 Single-Stage Revision TKA
55.5.3 Two-Stage Revision TKA
55.5.4 Salvage Options: Arthrodesis and Amputation
References
XI: Management – Revision
56: Systematic Evaluation of Painful Total Knee Arthroplasty
56.1 Introduction
56.2 Clinical History
56.3 Physical Examination
56.4 Radiographic Evaluation
56.5 Laboratory Studies
56.6 Preoperative Counseling
References
57: Periprosthetic Joint Infection: Consensus and Guidelines
57.1 Introduction
57.2 Diagnosis
57.3 Prevention
57.3.1 Risk Factors
57.3.2 Perioperative Antibiotics
57.3.3 Antibiotic Cement
57.3.4 Irrigation Solutions
57.4 Treatment
References
58: Local Delivery of Antibiotics
58.1 Introduction
58.2 Local Delivery of Prophylactic Antibiotics
58.2.1 Intravenous Regional Administration
58.2.2 Intraosseous Regional Administration (IORA)
58.2.3 Other Methods of Delivering Local Antibiotics for Prophylaxis
58.3 Technique of Intraosseous Regional Administration
58.3.1 Indications and Contraindications
58.3.2 Procedure
58.3.3 Injection Solution
58.3.4 Keys to a Good Technique
58.4 Local Antibiotic Delivery When Treating Established PJI to Supplement Debridement and Implant Retention
58.4.1 Antibiotic-Loaded PMMA Beads
58.4.2 Calcium Sulfate Beads
58.4.3 Intra-articular Infusion
58.4.4 Topical Vancomycin
References
59: Antibiotic-Loaded Bone Cement in Total Knee Arthroplasty
59.1 Introduction
59.2 Evidence
59.3 Indications for Antibiotic-Loaded Bone Cement
59.4 Industrially Manufactured Versus “Homemade” Preparations of ALBC
59.4.1 Relevant Tips/Tricks of “Homemade” ALBC Articulating Spacers: Authors’ Preferred Technique
59.4.2 Technical Tips for Mixing ALBC (. Fig. 59.4)
59.4.3 Antibiotic Elution from “Homemade” High-Dose ALBC Spacers
59.4.4 Potential Complications of High-Dose ALBC Spacers
References
60: Antibiotic Spacers for Prosthetic Joint Infections Following Total Knee Arthroplasty
60.1 Introduction
60.2 Time-Based Classification of Prosthetic Joint Infections
60.3 Antibiotics, Elution Characteristics, and Systemic Toxicity
60.4 Types of Spacers
60.4.1 Static Spacers
60.4.2 Articulating Cement Spacers
60.4.3 Functional Prosthetic Spacers
60.5 Fate of Spacers and Options for Failed Spacers
References
61: Does Antibiotic-Loaded Bone Cement Trigger Widespread Antibiotic Resistance Affecting Prosthetic Joint Infection Treatment?
61.1 Introduction
61.2 Differences in Classification of “Susceptible” or “Resistant” Bacteria After Systemic or Local Administration of Antibiotics
61.3 Only Bacterial Strains with a Priorly Acquired High-Level Antibiotic Resistance May Survive and Get Selected in the Presence of ALBC
61.4 Clinical Implications if Using (Single or Dual) ALBC
References
62: Infection Risk-Adjusted Antibiotic Prophylaxis Strategies in Arthroplasty: Low-Dose Single vs. High-Dose Dual Antibiotic-Loaded Bone Cement
62.1 Introduction
62.2 Risk Factors for Infection and the Idea of a Risk-Tailored Antibiotic Prophylaxis
62.3 Results
62.3.1 PJI Risk Classification at the University Hospital Gregorio Maranon, Madrid
62.3.2 Outcome Analysis with High-Dose Antibiotic Cement in High-Risk Patients to Reduce PJI
References
63: Revision Total Knee Arthroplasty Stems: Cemented Versus Cementless
63.1 Introduction
63.2 Case Example
63.3 The Challenge of the Revision Knee
63.4 Optimal Stem Fixation
63.4.1 Cementless Stems
63.4.2 Cemented Stems
63.5 Clinical Outcomes
63.6 Author’s Preferred Technique
References
64: Metaphyseal Fixation: Sleeves and Cones
64.1 Introduction
64.2 Case Example
64.3 Surgical Technique
64.4 Discussion and Literature Review
References
XII: Technology
65: Custom Cutting Blocks
65.1 Introduction
65.2 History of Custom Cutting Blocks
65.3 Modern PSI Design Rationale
65.4 Authors’ Preferred Surgical Technique
65.5 Results of Patient-Specific Instrumentation
References
66: Navigation in Total Knee Arthroplasty
66.1 Introduction and History
66.2 Uses/Indications
66.3 Contraindications
66.4 Types of Devices/Preoperative Planning
66.5 Surgical Technique and Intraoperative Calibration
66.6 Complications
66.7 Results
66.8 Economic Value
References
67: Robot-Assisted Total Knee Arthroplasty
67.1 Introduction
67.2 Robotic TKA Systems
67.2.1 TSolution-One® (ROBODOC) Surgical System (Think Surgical Inc., Fremont, CA)
67.2.2 MAKO (Stryker, Fort Lauderdale, FL)
67.2.3 NAVIO/CORI (Smith and Nephew, Memphis, TN)
67.2.4 ROSA® Knee Robot (Zimmer Biomet, Warsaw, IN)
67.2.5 Omnibot (Corin, Tampa, FL)
67.3 Outcomes of Robotic-Assisted TKA
67.3.1 Radiographic Outcomes
67.3.2 Clinical Outcomes
67.4 Disadvantages of Robotic-Assisted TKA
67.5 The Future
References
68: The Role of Tibial Force Sensors in Total Knee Arthroplasty
68.1 Introduction
68.2 Verasense™
68.3 eLIBRA®
68.4 Benefits of Sensor-Guided TKA
68.4.1 Improved Outcomes
68.4.2 In Situ Adjustments
68.4.3 Balancing Revision Cases
68.4.4 Surgical Training
68.5 Robotic and Sensor-Assisted Surgery Synergy
References
69: Accelerometers
69.1 Introduction
69.2 Case Examples
69.3 What Are Handheld Accelerometers?
69.4 How Are Handheld Accelerometer Systems Used?
69.5 Benefits of Accelerometers in TKA
69.6 Clinical and Radiographic Outcomes of TKA Using Accelerometer Technology
69.7 Future Directions for the Use of Accelerometers in TKA
References
Index