Table Of ContentRevision Total
Knee Arthroplasty
Revision Total
Knee Arthroplasty
James V. Bono, MD
Associate Clinical Professor, Department of Orthopaedic Surgery,
Tufts University School of Medicine; Attending Orthopaedic Surgeon,
New England Baptist Hospital, Boston, Massachusetts
Richard D. Scott, MD
Professor of Orthopaedic Surgery, Harvard Medical School;
Chief, Joint Arthroplasty Service, New England Baptist and Brigham
and Women’s Hospitals, Boston, Massachusetts
Editors
Forewords by Chitranjan S. Ranawat, MD,
and Roderick H. Turner, MD
With 275 Illustrations in 365 Parts,82 in Full Color
James V.Bono,MD Richard D.Scott,MD
Associate Clinical Professor Professor ofOrthopaedic Surgery
Department ofOrthopaedic Surgery Harvard Medical School
Tufts University School ofMedicine and
and Chief
Attending Orthopaedic Surgeon Joint Arthroplasty Service
New England Baptist Hospital New England Baptist and Brigham and
Boston,MA 02120 Women’s Hospitals
USA Boston,MA 02120
USA
Library ofCongress Cataloging-in-Publication Data
Revision total knee arthroplasty / James V.Bono,Richard D.Scott,editors ;forewords by
Chitranjan S.Ranawat and Roderick H.Turner.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-387-22352-5 (alk.paper)
1. Total knee replacement—Reoperation. I. Bono,James V. II. Scott,Richard D.
(Richard David),1943–
[DNLM: 1. Arthroplasty,Replacement,Knee. 2. Knee–surgery. 3. Reoperation.WE
870 R45481 2005]
RD561.R4923 2005
617.5¢820592—dc22 2004058912
ISBN 0-387-22352-5 Printed on acid-free paper.
© 2005 Springer Science+Business Media,Inc.
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To my wife,Meg
To my children,Andrew,Olivia,Caroline,and Thomas
To my father for his guidance and inspiration
To Rod Turner for his pioneering work in revision
surgery
JVB
To my wife,Mary
To my sons,Jordan and Andrew
To our residents and fellows through the years
RDS
FOREWORD I
Revision Total Knee Arthroplasty, edited by Drs. James V. This book is especially useful as a compendium ofthe
Bono and Richard D.Scott,is a comprehensive review of editors’ personal philosophy, which has been tested and
revision arthroplasty.The book includes discussions on all forged by many years of concentrated practice.I hope all
aspects of this technically challenging surgery, including total knee surgeons will partake ofthe wisdom that these
detailed surgical techniques, exposure issues, allographs, surgeons have so willingly and capably dispensed in this
custom implants, alignment, and TKA after other failed book.
procedures.Invaluable pointers on technique,the authors’
personal experience,useful illustrations,and an in-depth Chitranjan S.Ranawat,MD
review of published literature further enhance the value Chairman,Department of Orthopedics
of this wide-ranging text.This volume is indispensible to Lenox Hill Hospital
any surgeon who performs knee arthroplasty, including
surgeons in practice,fellows,and senior residents.
vii
FOREWORD II
As senior editor of this excellent treatise on complicated Perhaps most important of all is the high regard
knee surgery,Dr.Richard D.Scott brings three decades of which Dr.Scott’s peers have for his judgment and techni-
experience in arthroplasty surgery to focus sharply on the cal ability. Many physicians, including a number of
title subject. Dr. Scott serves as Chief of the Implant orthopedic surgeons,have sought out Dr.Scott when they
Service at the two of the busiest orthopedic implant needed major joint replacement. He is truly a surgeon’s
services in the nation: New England Baptist Hospital surgeon.
and Brigham and Women’s Hospital.He is a proven edu- Dr.James V.Bono is some 18 years younger than Dr.
cator at all levels: medical student, resident, fellow, and Scott,but his career is following a similar pattern to that
postgraduate. ofthe senior author.His list ofpublications,chapters,and
In addition to lectures and surgical demonstrations in presentations would number well over 150. He was a
over a dozen different countries, Dr. Scott has authored pioneer,over a decade ago,in the use ofcomputer graph-
more than 200 scientific publications.These publications ics in medical presentations and digital templating in
include 35 book chapters in well-established orthopedic joint replacement surgery. These presentations by Dr.
texts. Bono are made with skill,clarity,and always come across
Working primarily with Dr.Thomas Thornhill,Dick with strong visual impact.
Scott has designed entire implant systems for primary Jim Bono was the lead author of a text entitled
and revision knee arthroplasty. These designers have Revision Total Hip Arthroplasty with Drs. McCarthy,
made many innovations,such as the use ofmodular tibial Bierbaum,Thornhill,and myself.
wedges for bone deficiency. They also have designed a I have read the current volume Revision Total Knee
total hip replacement system. Arthroplasty in its entirety and have found it to be thor-
Working with Drs.Insall,Dorr,and W.N.Scott,Dick ough,accurate,readable,and very helpful.I congratulate
Scott designed and published the Knee Society Clinical the skillful co-editors and all of the contributors for
Rating System, which is universally accepted as the gold putting together a classical and excellent orthopedic text.
standard knee rating system.
To enumerate Dr.Scott’s lectureships and professional Roderick H.Turner,MD
presentations for any given year would take several pages. Clinical Professor,Orthopaedic Surgery
A legion of postgraduate fellows from the United States Tufts University School of Medicine
and elsewhere have come to study with him at both the Honorary Trustee
Brigham and Baptist Hospitals. New England Baptist Hospital
ix
PREFACE
Revision Total Knee Arthroplastywas proposed as a “how- the ensuing chapters.Management ofthe extensor mech-
to”text for the diagnosis and management of the failed anism is included as a separate entity.
total knee arthroplasty,with step-by-step descriptions of Part III draws attention to the wide dimension of
surgical techniques of revision total knee arthroplasty. complicating issues that frequently occur in revision knee
The text was intended to be a practical reference for stu- surgery. These chapters address the topics of infection,
dents,residents,fellows,and attending surgeons engaged periprosthetic fracture,and stiffness and discuss the com-
in the treatment and follow-up of patients who have plexities of total knee arthroplasty after failed high tibial
undergone knee replacement surgery. osteotomy,after fractures about the knee,and after prior
In Part I, the need for reoperation after total knee unicompartmental and hinged knee replacement. The
arthroplasty is summarized from the prospective of one topics of insert exchange, aseptic synovitis, and the eco-
surgeon’s practice and brings to light Dr. Scott’s vast nomics of revision total knee arthroplasty are discussed
experience in total knee arthroplasty. This is comple- individually. The final chapter discusses the role of
mented nicely by Dr. Thornhill’s chapter on the painful arthrodesis as a salvage procedure.
total knee arthroplasty, where it is emphasized that the We feel fortunate to have received the support of so
etiology of the patient’s pain must be elucidated prior to many well-known master surgeons who have contributed
embarking on revision surgery. Part I also includes the to the text.We are grateful to all ofthem and are honored
definitive treatise on ultra-high molecular weight poly- to have been able to present their combined experience in
ethylene in knee arthroplasty as well as a compendium the ensuing pages.
of the radiological evaluation of the failed total knee We are especially grateful to Dr.Ranawat for writing
arthroplasty. the foreword and acknowledge the profound personal
Part II emphasizes general principles of revision impact he has had on our understanding ofjoint replace-
surgery, including management of skin, surgical expo- ment surgery through his commitment to patient care,
sure, and removal of femoral and tibial implants at the teaching,and musculoskeletal research.
time of revision. The fundamental aspects of revision
total knee arthroplasty,alignment,management of bone James V.Bono,MD
defects,and use of constrained implants are discussed in Richard D.Scott,MD
xi
CONTENTS
Foreword I by Chitranjan S.Ranawat . . . . . . . . . . . . . . . . . . vii
Foreword II by Roderick H.Turner . . . . . . . . . . . . . . . . . . . . ix
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Part I Diagnosis and Evaluation
Chapter 1 Reoperation After Total Knee Arthroplasty . . . . . . . . . . . . . . 3
Richard D.Scott
Chapter 2 Ultra-High Molecular Weight Polyethylene in Total
Knee Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
A.Seth Greenwald and Christine S.Heim
Chapter 3 The Painful Total Knee Arthroplasty . . . . . . . . . . . . . . . . . . . 24
Nigel M.Azer and Thomas S.Thornhill
Chapter 4 Radiological Evaluation ofTotal Knee Arthroplasty . . . . . . . 36
David A.Feiock,Joel S.Newman,and Arthur H.Newberg
Part II General Principles of Revision Surgery
Chapter 5 Skin Exposure Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Ginger E.Holt and Douglas A.Dennis
Chapter 6 Exposure Options for Revision Total Knee Arthroplasty . . . 63
Gerard A.Engh
xiii
xiv Contents
Chapter 7 Removal ofthe Femoral and Tibial Components for
Revision Total Knee Arthroplasty . . . . . . . . . . . . . . . . . . . . . 76
Daniel J.Berry
Chapter 8 Allograft in Revision Total Knee Arthroplasty . . . . . . . . . . . . 81
J.Craig Morrison and Donald T.Reilly
Chapter 9 Modular Augments in Revision Total Knee Arthroplasty . . . 97
J.Bohannon Mason
Chapter 10 Custom Implants in Revision Total Knee Arthroplasty . . . . . 105
J.Craig Morrison,David K.DeBoer,and Michael J.Christie
Chapter 11 Femoral Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
James Huddleston,Reuben Gobezie,and Harry Rubash
Chapter 12 Tibial Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
James V.Bono
Chapter 13 Use ofStems in Revision Total Knee Arthroplasty . . . . . . . . 137
Thomas K.Fehring
Chapter 14 Restoration ofStability,Maintaining Joint Line,Gap
Balancing,and Constraint Selection . . . . . . . . . . . . . . . . . . . 145
Brian McDermott
Chapter 15 Management ofthe Extensor Mechanism During Revision
Total Knee Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Richard S.Laskin and Burak Beksaç
Part III Special Considerations
Chapter 16 Infection in Total Knee Arthroplasty . . . . . . . . . . . . . . . . . . . 167
Carl Deirmengian,Samir Mehta,and Jess H.Lonner
Chapter 17 Periprosthetic Fractures After Total Knee Arthroplasty . . . . 183
Michael E.Ayers,Richard Iorio,and William L.Healy
Chapter 18 Total Knee Arthroplasty After Failed High
Tibial Osteotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Michael C.Dixon and Richard D.Scott
Chapter 19 Total Knee Arthroplasty Following Prior
Unicompartmental Replacement . . . . . . . . . . . . . . . . . . . . . . 206
William P.Barrett
Chapter 20 Hinge Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
David W.Manning,Peter P.Chiang,and Andrew A.Freiberg
Chapter 21 Total Knee Arthroplasty After Fractures About the Knee . . . 237
Russell E.Windsor and William L.Walter
