Total Knee Arthroplasty

This comprehensive reference on total knee arthroplasty describes all surgical techniques and prosthetic designs for primary and revision arthroplasty, discusses every aspect of patient selection, preoperative planning, and intraoperative and postoperative care.

Total knee arthroplasty (TKA) is commonly considered to be a reliable procedure, with high implant survival rates at 10 to 15 years of follow-up. The goal of total knee replacement surgery is to relieve pain and obtain better knee function. This is achieved by ensuring correct patient selection, pre-operative deformity, implant design and accurate surgical techniques. This book covers a range of techniques for the realisation of functional joint motion and stability. The first part of the book will describe fundamentals in total knee arthroplasty and alternative procedures. The second half will look at surgical techniques and considerations whilst the final chapters will address future trends and challenges in the field of knee surgery. This book will be an essential reference for academics, orthopaedic surgeons, and those training in medicine, physiatry and rheumatology.

This open access book describes and illustrates the surgical techniques, implants, and technologies used for the purpose of personalized implantation of hip and knee components. This new and flourishing treatment philosophy offers important benefits over conventional systematic techniques, including component positioning appropriate to individual anatomy, improved surgical reproducibility and prosthetic performance, and a reduction in complications. The techniques described in the book aim to reproduce patients’ native anatomy and physiological joint laxity, thereby improving the prosthetic hip/knee kinematics and functional outcomes in the quest of the forgotten joint. They include kinematically aligned total knee/total hip arthroplasty, partial knee replacement, and hip resurfacing. The relevance of available and emerging technological tools for these personalized approaches is also explained, with coverage of, for example, robotics, computer-assisted surgery, and augmented reality. Contributions from surgeons who are considered world leaders in diverse fields of this novel surgical philosophy make this open access book will invaluable to a wide readership, from trainees at all levels to consultants practicing lower limb surgery

More than 20 years have passed since the International Symposium on Total Knee Replacement was held in London in 1974. Prosthetic design and operative technique have been greatly improved since then, and there is now an accepted standard concept of total knee arthroplasty. Thirteen years after the London symposium, another international symposium on total knee replacement was held, this time in Nagoya, Japan, in 1987. Its ambitious objective was to push forward the frontiers of continuous investigation and improve ment of total knee replacement. The fruits of the individual efforts presented at the Nagoya symposium were published in a volume of proceedings entitled Total Knee Replacement. In the years since 1987, further investigations have been conducted in various parts of the world regarding prosthetic design, fixation, long-term radiological follow-up, biomechanical evaluation, and biomaterials research. In knee ligament reconstruc tion, rapid progress has been made in the past five years in clinical practice and fundamental research by means of arthroscopic surgery and tissue transplantation, and we have come close to establishing a standard treatment. Under these circumstances, an international symposium on knee joint reconstruc tion was planned for 1994, again to be held in Nagoya, to provide ample opportunity for exchanging information and sharing clinical experience from around the world.

This book addresses the need for improved diagnostic and treatment guidelines for patients in whom total knee arthroplasty (TKA) has had an unsatisfactory outcome. It opens by discussing the basics of TKA and the various causes of failure and pain. Diagnostic aspects are considered in detail, with attention to advances in clinical investigation, laboratory analysis and in particular, imaging techniques. In addition, helpful state of the art diagnostic algorithms are presented. Specific pathology-related treatment options, including conservative approaches and salvage and revision TKA strategies, are then explained, with identification of pitfalls and key points. A series of illustrative cases cover clinical scenarios frequently encountered in daily clinical practice. The evidence-based, clinically focused guidance provided in this book, written by internationally renowned experts, will assist surgeons in achieving the most effective management of these challenging cases.

This book focuses on the current clinical practice, outcome and the future development of Total Knee Arthroplasty (TKA) in surgical settings. A major objective of this work is to address “What is the optimal design and fixation of the implants we use for knee arthroplasty reconstruction? What are the gold standards? and, Can we do better?”. In an attempt to throw light on these questions, the authors evaluate data from clinical studies and assess various factors which may influence the long term outcome of TKA. Many variables such as age, severity, implant design and surgical techniques for appropriate component placement and soft tissue balancing are explored in great detail by expert surgeons in the field. Total Knee Arthroplasty: Long Term Outcomes will be a useful resource for recently qualified surgeons in search of an introduction to this topic and for more experienced surgeons seeking an in-depth critical review of current practices in TKA.

This book is published open access under a CC BY 4.0 license. White Paper on Joint Replacement This White Paper details the status of hip and knee arthroplasty care in Germany. Hip and knee replacements are amongst the most frequently performed procedures and usually become necessarily due to age-related wear of the joint, osteoarthritis and fractures of the femoral neck. In light of demographic change, demands with regard to standards of care and the procedures are likely to rise. Contents • This White Paper contains information on indications, procedures, health economic aspects and the healthcare system stakeholders involved. • It portrays current developments with regard to the prevalence of hip and knee arthroplasty, the healthcare situation and quality of care within the chain of medical care. • This book is complemented by a chapter assessing the current situation from an expert perspective with contributions from renowned experts in the fields of science, medical technology and medical practice. This book addresses people involved in shaping and representing the healthcare system from a variety of fields including medical professions, health insurances and health sciences as well as journalists and patient representatives.

Calipered kinematic alignment was proposed by Dr. Stephen M. Howell to enable the accurate and individualized placement of total knee components coincident within ± 0.5 mm of the patient’s pre-arthritic alignment. The aim was to restore the patient's native joint kinematics and thereby address the well documented 20% dissatisfaction when total knee replacement is performed using traditional, or mechanical alignment techniques. With Dr. Stefano A. Bini and Dr. G. Daxton Steele as co-editors, Dr. Howell has curated an international team of expert surgeons and engineers to discuss various aspects of the calipered knee alignment technique in short, concise, and well-illustrated chapters. Each author provides clear, practical guidance for adopting and implementing calipered kinematic alignment covering manual, patient-specific, navigated, and robotic techniques. Chapters on component design tailored explicitly for kinematic alignment and showing the close relationship between knee biomechanics and the kinematically aligned TKA help the surgeon manage complex challenges associated with deformity and post-operative complications. Following the introduction of the calipered kinematic alignment technique for total knee arthroplasty, many international studies have shown consistently better patient satisfaction than the traditional mechanical alignment technique. Better function and high long-term implant survival have catalyzed a paradigm shift in total knee replacement philosophy that is being embraced by orthopedic surgeons and innovative implant companies around the world with excellent results. Calipered Kinematically Aligned Knee Arthroplasty is the definitive textbook on the subject and features: Thorough explanations of how the calipered kinematic alignment technique for total knee arthroplasty accurately sets total knee components coincident with the patient’s pre-arthritic alignment and coaligned with the three rotational axes of the native knee. A personalized approach to total knee surgery designed to reconstitute the patient’s native biomechanics in contrast with mechanical alignment that place all patients in the same standard alignment regardless of their constitutional anatomy. Detailed and well-illustrated descriptions of manual, navigated, robotic and patient-specific guide techniques that confirm kinematic alignment with a caliper. Clinical photos, radiographs, and line art throughout the book as well as helpful online technique videos. Key focus topics such as managing complex deformities, the expected post-operative recovery, and future trends in kinematic alignment. The shared experience and knowledge of international pioneers in the field. An emphasis on a personalized surgical philosophy which enables same-day discharge, reduces pain and opioid use, and promotes quicker recovery, better function, and a more natural feeling knee.