Table Of ContentE. Carlos Rodríguez-Merchán
Sam Oussedik Editors
Total Knee
Arthroplasty
A Comprehensive Guide
123
Total Knee Arthroplasty
E. Carlos Rodríguez-Merchán
Sam Oussedik
Editors
Total Knee Arthroplasty
A Comprehensive Guide
Editors
E. Carlos Rodríguez-Merchán Sam Oussedik
“La Paz” University Hospital-IdiPaz University College London Hospitals
Madrid London
Spain UK
ISBN 978-3-319-17553-9 ISBN 978-3-319-17554-6 (eBook)
DOI 10.1007/978-3-319-17554-6
Library of Congress Control Number: 2015941103
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2015
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Pref ace
The origins of total knee arthroplasty (TKA) lie in providing functional res-
toration through pain relief. Replacing rough, diseased joint surfaces with
prosthetic, smooth bearings has proven to be a very effective method of
obtaining symptomatic improvement. However, changing times have
increased the demands placed on these neo-articulations.
T hree phenomena can be identifi ed to help explain increases in rates of
knee arthroplasty observed worldwide. First, developed countries have an
ageing population as the wave of “baby-boomers” reach their seventh and
eighth decades. This increase in the demographic group in whom TKA might
be expected to be required has led to a commensurate rise in demand. Second,
today’s septuagenarians are no longer content to lead a sedentary lifestyle,
just as advanced age is no longer synonymous with senility and obsolescence.
Increased activity leads to greater symptoms and thus greater demand for
surgical solutions. Third, an increase in TKA is also noted in younger patients,
particularly in the United States. This phenomenon is thought to be linked to
increased rates of obesity and is no doubt a precursor to similar increases in
other developed economies.
T hus, the knee arthroplasty surgeon is under increasing pressure to deliver
durable symptomatic relief leading to functional gains for his patients. The
best way to achieve good results reproducibly will of course vary subtly from
surgeon to surgeon. However, certain inalienable principles hold true across
successful exponents of TKA, and we hope to have distilled some of this
wisdom into the following chapters.
W e have scoured the world for the best of the best in the fi eld of TKA. These
are high volume surgeons delivering high quality results, week in, week out,
but are also selected for their ability to communicate their ideas effectively.
From basic anatomy and physiology we build to primary arthroplasty leading
to principles of complex revision surgery.
Understanding the state of the art in knee arthroplasty will allow readers to
adopt and embed some of these principles into their practices. Perhaps just as
importantly, it might stimulate debate and research into how we might
improve yet further our patients’ outcomes.
Madrid , Spain E. Carlos Rodríguez-Merchán
London , UK Sam Oussedik
v
Contents
1 Anatomy, Physiology, and Biomechanics
of the Native Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Romain Gaillard , Bujar Shabani , Rosa Ballis ,
Philippe Neyret , and Sébastien Lustig
2 The Arthritic Knee: Etiology and Patterns of Disease. . . . . . . 27
E. Carlos Rodríguez-Merchán and Sam Oussedik
3 Infl ammatory Arthropathy of the Knee. . . . . . . . . . . . . . . . . . . 39
Alexander D. Liddle and E. Carlos Rodríguez-Merchán
4 Medicolegal Considerations – The Consent Process. . . . . . . . . 51
Ran Schwarzkopf and David I. S. Sweetnam
5 Patient Preparation for Total Knee Arthroplasty:
Reducing Blood Loss, Thromboprophylaxis
and Reducing Infection Risk. . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Luthfur Rahman and Sam Oussedik
6 Acute Pain Management in Total Knee Arthroplasty . . . . . . . 69
Antony J. R. Palmer and E. Carlos Rodríguez-Merchán
7 Outcome Measures in Total Knee Arthroplasty . . . . . . . . . . . . 79
Ayman Gabr , Rosamond Tansey , and Fares S. Haddad
8 Longevity: Characteristics of a Well-Functioning,
Long- Lasting Total Knee Arthroplasty . . . . . . . . . . . . . . . . . . . 89
Matthew T. Jennings , Paul L. Sousa ,
and Matthew P. Abdel
9 The Cost-Effectiveness of Knee Arthroplasty. . . . . . . . . . . . . . 101
Kartik Logishetty and Charles A. Willis-Owen
10 Surgical Technique of Total Knee Arthroplasty:
Basic Concepts Including Surgical Approaches,
Minimally Invasive Surgery and Simultaneous
Bilateral Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
David A. Parker and Vikram A. Mhaskar
vii
viii Contents
11 Technological Aids in Total Knee Arthroplasty:
Navigation, Patient-Specifi c Instrumentation,
and Robotics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Paul L. Sousa and Matthew P. Abdel
12 Prosthetic Kinematics: Cruciate Retaining Versus
Posterior Stabilized Versus Medial Pivot. . . . . . . . . . . . . . . . . . 137
Jason L. Blevins and Michael B. Cross
13 Alignment Targets in Total Knee Arthroplasty. . . . . . . . . . . . . 145
Sujith Konan , Stephen Howell , and Sam Oussedik
14 Primary Knee Arthroplasty:
The Patella-Resurfacing Options . . . . . . . . . . . . . . . . . . . . . . . . 161
Myles R. J. Coolican and Vikram A. Mhaskar
15 Unicompartmental Knee Arthroplasty . . . . . . . . . . . . . . . . . . . 173
Sebastien Parratte and Jean-Noel Argenson
16 Aseptic Failure in Total Knee Arthroplasty . . . . . . . . . . . . . . . 183
Rahul Patel
17 The Diagnosis of Prosthetic Joint Infection. . . . . . . . . . . . . . . . 197
Behrooz Haddad and Sam Oussedik
18 Total Knee Arthroplasty Associated Infections:
Treatment Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Jorge Manrique , Miguel M. Gomez , Antonia F. Chen ,
and Javad Parvizi
19 Periprosthetic Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Alexander D. Liddle and E. Carlos Rodríguez-Merchán
20 Aetiology of Patient Dissatisfaction Following
Total Knee Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Myles R. J. Coolican
21 Principles of Revision Total Knee Arthroplasty:
Incisions, Approaches, Implant Removal
and Debridement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Mohsin Khan , Gemma Green , Ayman Gabr ,
and Fares S. Haddad
22 Bone Loss in Revision Total Knee Arthroplasty. . . . . . . . . . . . 249
Rhidian Morgan-Jones
23 Revision Total Knee Arthroplasty: Surgical Technique
in Dealing with Instability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
E. Carlos Rodríguez-Merchán
24 Revision Total Knee Arthroplasty: Surgical Technique
in Dealing with Extensor Mechanism Failure. . . . . . . . . . . . . . 267
Simone Cerciello , Philippe Neyret , and Sébastien Lustig
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
1
Anatomy, Physiology, and
Biomechanics of the Native Knee
Romain Gaillard , Bujar Shabani , Rosa Ballis ,
Philippe Neyret , and Sébastien Lustig
1.1 Introduction (Anatomy (cid:129) C ancellous bone: structure of plates and
and Physiology of the Native arches of bone rods
Knee) [ 1 – 6 ] T he protein matrix is colonized by a num-
ber of cells:
1.1.1 Osteology (cid:129) Osteoclasts: belonging to the family of mono-
cytes/macrophages, responsible for bone
1.1.1.1 Bone Physiology resorption
and Histology [7 ] (cid:129) Osteoblasts: of mesenchymal origin, respon-
The bone is composed of: sible for bone formation, producing the pro-
(cid:129) P rotein matrix consisting essentially of type I tein components of the organic part
collagen fi bers (90 % of the organic part of the (cid:129) Osteocytes: derived from osteoblasts, after
bone), surrounded by a fundamental interfi bril- they become trapped in the mineral bone
lar substance (ground substance) rich in protein. matrix
(cid:129) A n inorganic part (70 % of the weight of the The periosteum covers the surface of the corti-
dry mater of the bone) consisting of crystal- cal bone.
lized calcium phosphate as hydroxyapatite. It The bone marrow and adipose tissue occupy
gives bone its rigidity and mechanical strength. the intramedullary canal of the long bones.
The bone architecture is lamellar and dif-
fers depending on its location: 1.1.1.2 Bone Architecture
(cid:129) Cortical bone: layers arranged concentrically The knee joint is composed of three bones: the
around the vascular Haversian canals femur, tibia, and patella.
The Patella [ 8 – 11 ]
R. Gaillard (cid:129) B. Shabani (cid:129) R. Ballis The patella is the largest sesamoid bone in the
P. Neyret (cid:129) S. Lustig (*)
human body. Its role is to transmit the forces of
Service de Chirurgie Orthopédique,
the extensor mechanism.
Albert Trillat Center, Groupement Hospitalier Nord;
Université Lyon 1 , 103 Grande rue de la Croix I t articulates with the femoral trochlea and
Rousse, Lyon , Rhône 69004 , France forms with it the patellofemoral compartment.
e-mail: [email protected];
It is roughly triangular in shape with its base
[email protected]; [email protected];
facing proximally, apex facing distally and two
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[email protected] surfaces (anterior and posterior).
© Springer International Publishing Switzerland 2015 1
E.C. Rodríguez-Merchán, S. Oussedik (eds.), Total Knee Arthroplasty: A Comprehensive Guide,
DOI 10.1007/978-3-319-17554-6_1
