Total Knee Replacement

269 Pages·1991·11.57 MB·English

by  David G. Murray (auth.)

Richard S. Laskin (Ed)
Total Knee
Replacement
With 228 Figures
Springer-Verlag
London Berlin Heidelberg New York
Paris Tokyo Hong Kong
Barcelona Budapest
Richard S. Laskin, MD
Professor of Orthopaedic Surgery,
Albert Einstein College of Medicine,
New York, and Chairman,
Department of Orthopaedic Surgery,
Long Island Jewish Medical Center,
New Hyde Park, New York 11042, USA
With the assistance of:
BarryC. Kleeman, MO, and Andrew Turtel, MO
Department of Orthopaedic Surgery,
Long Island Jewish Medical Center,
New Hyde Park, New York 11042, USA
ISBN-13: 978-1-4471-1827-5 e-ISBN-13: 978-1-4471-1825-1
001: 10.1007/978-1-4471-1825-1
British Library Cataloguing in Publication Data
Laskin, Richard S., 1940
Total Knee replacement.
1. Humans. Knees. Surgery
I. Title
617.582059
ISBN-13: 978-1-4471-1827-5
Library of Congress Cataloging-in Publication-Data
Total Knee replacement edited by Richard S. Laskin, with the assistance of Barry C. Kleeman and Andrew
Turtel
p. em. Includes index
ISBN-13: 978-1-4471-1827-5
1. Artificial knee. 2. Knee-Surgery. I. Laskin, RichardS., 1940- n. KleemanBarryC. m. TurtelAndrew.
[DNML: 1. Knee Prosthesis-methods. WE 870 T7162]
RD561.T669 1991
617.5'820592-dc20
DNLMlDLC 90-11336
for Library of Congress OP
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© Springer-Verlag London Limited 1991
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This book is dedicated:
To the memory of Dr Jo Miller whose keen insight, rational thinking, and good
friendship I will truly miss.
To my dear wife Judge Joyce Sparrow, my mother Trudy Klein Laskin, and my sons
Jonathan and Andrew.
To Mr A. Graham Apley and Dr Mark Lazansky, my first two orthopaedic teachers.
Each has remained a mentor and a friend to me over the past twenty-two years.
To Dr Richard Bryan who has encouraged me through the years to continue with my
investigations in total knee replacement.
To Dr John Insall whose concepts, ideas, and thoughts I feel have been the
my
cornerstone on which I have based so much of own work.
To Drs Ronald Rosenthal and George Mauler, who, through their own personal
example, convinced me that I should make Orthopaedic Surgery my life's work.
To all my colleagues in the Knee Society for helping enrich my knowledge of knee
replacement arthroplasty.
Foreword
Knee replacement can be regarded as the inevitable sequel to hip replacements, the
child so to speak, of a brilliant father. As with other children, there were growing pains
and a somewhat troubled adolescence, but the mature adult can now stand, proud and
unashamed, alongside its distinguished forebear. Total replacement of the knee is now
a highly successful operation which has enriched the lives of countless sufferers.
Clearly the time is ripe for a definitive work on the subject.
Richard Laskin, whose abiding interest and profound knowledge of knee replace
ment are well known, has gathered together a team of notable experts who, between
them, cover every aspect of the subject. The first section of this book deals with the
history of knee replacement, its indications, alternative procedures, biomechanics and
materials. Then follows a most important section by Laskin himself, on the surgical
technique, the details of which, as he points out in his preface, are more important
than differences between the various prostheses. The third section considers the
results of several different prostheses and discusses some problem areas.
This is a book which surgeons in the field of knee replacement have been waiting for;
those with experience will find it of absorbing interest and those who have more
recently embarked on the subject will find it an invaluable guide in their quest for
perfection. Dr Laskin is to be congratulated on his choice of collaborators and for
producing such a masterly compilation.
A. Graham Apley
Preface
Total knee replacement is one of the most successful operations to exist in the field of
orthopaedic surgery. Over the last twenty years it has become the mainstay in the
treatment of the patient with advanced arthritis of the knee. Its results have become
predictable and reproducible. I believe that it is now time to evaluate critically our
results and techniques and to use this knowledge to guide our thinking and
investigatory patterns for this new decade. It is for this reason that this, my second
total knee book was conceived. The contributors are all experts in the field on knee
joint surgery and among them have over three hundred years of pooled experience in
knee joint replacement.
The first three chapters of the book set the stage. Dr David Murray eloquently
describes the long, arduous and sometimes frustrating road we have travelled up to
the present. Beginning with prosthesis which were mere hinges he progresses through
the generations of constrained and then unconstrained prosthesis to the current state
of the art. Dr Richard Bochner offers a comprehensive insight into the options other
than total joint replacement that we can offer to the patient with advanced knee
arthritis. Finally, Dr Malcolm Pope and Mr Braden Fleming discuss the relevant
biomechanics of the knee and the choice of materials used in implant design.
The next section deals with surgical technique. With no disrespect for any knee
prosthesis designer, I feel that it is the technique, rather than the small nuances of any
one prosthesis that in the long run accounts for the success or failure of most total knee
replacements. I have written two chapters on "How I do a Knee Replacement". One
relates to the soft tissue technique, the other to the bony cuts. They are generic
chapters, applicable to almost any total knee prosthesis that the surgeon chooses to
implant. The surgical tips and ideas are a potpourri of those that have been described
by my colleagues in the Knee Society, as well as some that I probably conceived
personally.
In the third section there is a description of the long term results of many of the most
widely used implants. Drs John Insall, Kelly Vince, Giles Scuderi and Russ Windsor
draw upon the extensive and ground breaking work done at the Hospital for Special
Surgery for three chapters covering the cemented Total Condylar and Insall-Burstein
Posterior Stabilized prostheses. The "fathers" of the uncemented total knee, Drs
Kenneth Krackow and David Hungerford, describe the long term results with their
PCA prosthesis. Professor Stock reports on the long term experience of his group in
Braunsweig, using unicompartmental prostheses with localized arthritis of the knee.
Finally, I have included a long term evaluation of the Tricon-M uncemented
prosthesis, and a description of its successor, the Genesis uncemented total knee, the
implants that I have been using when performing uncemented total knee replacement
surgery.
x Preface
The fourth section covers the problem areas in total knee replacement. Dr Hugh
Cameron describes the Canadian experience with patellar problems in total knee
replacement. Dr Edward Habermann evaluates the problem with infection and the
current concepts of its treatment. Dr Thomas Sculco presents an algorithmic approach
to evaluating the patient who has had a total knee replacement, but who still continues
to have knee pain. Dr Leif Ryd of Sweden gives an in-depth analysis of the problem of
his seminal work with the problem of subsidence and its causes. His Swedish
colleague Dr Anders Wigren writes of his extensive experience in treating rheumatoid
patients, and of their special problems. Bone loss from the tibia or femur occurs often in
the patient with advanced arthritis. The chapter on bone loss describes how bone loss
is handled by three different surgeons: Dr Thomas Sculco from the Hospital for Special
Surgery, Drs Springorum, De Nicola and Lowe from the University of Heidelberg, and
myself.
The material in this book should act both as a source of ideas and a springboard for
further thought and investigation in the field of total knee replacement. It should
enable all of us to progress and advance in the 1990s, further reflning and perfecting
this excellent surgical procedure.
New York, May 1990 Richard S. Laskin
Acknowledgements
I would like to thank the administrative and nursing staff of the Department of
Orthopaedic Surgery at Long Island Jewish Medical Center for their unceasing help
and assistance in the preparation of this book. I would also like to thank all the
orthopaedic residents in my Department and my colleagues Dr Ronald Rosenthal,
Dr John Handelsman, Dr Cathleen Raggio, and Dr Richard Bochner for their guidance,
patient understanding, and professional advice. Finally I would like to thank Drs Barry
Kleeman and Andrew Turtel. After working long hard hours as senior orthopaedic
residents they somehow always found the extra hours to assist me with the reviewing,
editing, and the layout of the book.
Richard S. Laskin
Contents
Section I The Basics
Chapter 1 History of Total Knee Replacement
David G. Murray ................................. 3
Chapter 2 Indications and Alternatives to Total Knee Replacement
Richard Bochner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 17
Chapter 3 Knee Biomechanics and Materials
Malcolm H. Pope and Braden C. Fleming . . . . . . . . . . . . . . . .. 25
Section II The Surgical Technique of Total Knee Replacement
Chapter 4 Soft Tissue Techniques in Total Knee Replacement
Richard S. Laskin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 41
Chapter 5 Bone Resection Techniques in Total Knee Replacement
Richard S. Laskin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 55
Section III The Results of Total Knee Replacement
Chapter 6 Long term Results of the Cemented Total Condylar Knee
Giles R. Scuderi, John N. Insall and Russell E. Windsor 77
Chapter 7 The Total Condylar Knee Prosthesis
Kelly G. Vince and John N. Insall ...................... 85
Chapter 8 The Posterior Stabilized Knee Prosthesis
Kelly G. Vince ................................... 113
Chapter 9 Experience with the Sledge Prosthesis
D. Stock, R. Fabiasiak and A. Niezgoda . . . . . . . . . . . . . . . . .. 151
Chapter 10 Uncemented Total Knee Replacement: The Tricon-M and Genesis
Prosthesis
Richard S. Laskin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 161
Chapter 11 Results of Uncemented Total Knee Arthroplasty using the PCA
System
Kenneth A. Krackow, David S. Hungerford and Robert V. Kenna 183
xiv Contents
Section IV Problem Areas in Total Knee Replacement
Chapter 12 The Painful Total Knee Replacement
Thomas P. Scuko . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 195
Chapter 13 The Patella in Total Knee Arthroplasty
Hugh U. Cameron ................................ 199
Chapter 14 Subsidence
Leif Ryd ....................................... 211
Chapter 15 The Management of Bone Loss in Total Knee Replacement
Thomas P. Scuko, Hans W. Springorum, Ugo De Nicola, Walter
J. Lowe and Richard S. Laskin ........................ 225
Chapter 16 The Infected Total Knee Arthroplasty
Edward T. Habermann ............................. 241
Chapter 17 Special Considerations in Arthroplasty of the Rheumatoid Knee
Joint
Anders Wigren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 253
Subject Index ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 265