1 Patient Selection ............................................ 1
1.1 Social Conditions ....................................... 1
1.2 Economic Conditions ..................................... 1
1.3 Psychological Conditions ................................ 1
1.4 Indication .............................................. 2
1.4.1 Age .............................................. 2
1.4.2 Physical Conditions .............................. 3
1.4.3 Knee Joint Conditions ............................ 4
1.4.4 Surgeon's Experience ............................ 10
1.5 Contraindications ...................................... 10
Bibliography ................................................ 11
2 Implant Selection ........................................... 13
2.1 Material ............................................... 13
2.1.1 Metal ........................................... 13
2.1.2 Ceramic ......................................... 15
2.1.3 Polyethylene (Ultrahigh Molecular Weight
Polyethylene: UHMWPE,PE) ........................ 15
2.1.4 Bone Cement (Polymethylmethacrylate, PMMA) ...... 19
2.2 Design ................................................. 22
2.2.1 Introduction .................................... 22
2.2.2 Anatomy and Biomechanics ........................ 23
2.2.3 Factors to Be Considered in Implant Design ...... 24
2.3 Design of Each Component ............................... 38
2.3.1 Femur ........................................... 38
2.3.2 Tibia ........................................... 41
2.3.3 Spacer (Polyethylene) ........................... 45
2.3.4 Patella ......................................... 46
2.3.5 Size Matching ................................... 47
2.3.6 Options ......................................... 48
2.3.7 Design to Increase Knee Flexion ................. 51
2.4 Surgical Instruments ................................... 53
2.4.1 Surgical Instruments for Use in TKA ............. 53
2.4.2 Implant-Specific Surgical Instruments ........... 59
Bibliography ................................................ 60
3 Preparation for the Operation ............................... 67
3.1 Admission Checkup ..................................... 67
3.1.1 History Taking .................................. 67
3.1.2 Physical Examination ............................ 68
3.1.3 Preoperative Evaluation ......................... 68
3.2 Final Decision ......................................... 68
3.3 Outcome Study .......................................... 71
3.3.1 HSS Score ....................................... 71
3.3.2 Knee Society Score .............................. 73
3.3.3 Knee Society Total Knee Arthroplasty
Roentgenographic Evaluation System .............. 74
3.3.4 WOMAC Score (The Western Ontario and McMaster
Universities Osteoarthritis Index Score) ........ 76
3.3.5 SF-36 (36-Item Short-Form Health Survey) or
MOS (Medical Outcomes Study) .................... 77
3.3.6 Patellofemoral Scoring System ................... 78
3.3.7 Miscellaneous Methods ........................... 78
3.4 Patient Education ...................................... 79
3.5 Final Checkup for the Operation ........................ 79
3.5.1 Consent Form .................................... 79
3.5.2 Medical Preparation ............................. 80
3.5.3 Preparation for Anesthesia ...................... 80
3.5.4 Knee Joint Preparation .......................... 81
Bibliography ................................................ 81
4 Surgical Techniques ......................................... 83
4.1 Drape .................................................. 83
4.2 Surgical Approach ...................................... 83
4.2.1 Skin Incision ................................... 84
4.2.2 Arthrotomy ...................................... 86
4.2.3 Ancillary Procedures ............................ 89
4.3 Soft Tissue Procedure .................................. 92
4.3.1 Cruciate Ligament Treatment ..................... 92
4.3.2 Meniscectomy .................................... 92
4.3.3 Soft Tissue Release ............................. 93
4.3.4 Fat Pad Removal ................................. 94
4.3.5 Removal of Posterior Soft Tissues ............... 94
4.4 Osteotomy and Bone Preparation ......................... 95
4.4.1 Osteotomy ....................................... 95
4.4.2 Osteotomy of Each Bone and Preparation for
Fixation ....................................... 100
4.5 Balancing ............................................. 117
4.5.1 Flexion and Extension Gap Balancing ............ 117
4.5.2 Mediolateral Balancing ......................... 120
4.5.3 Patellofemoral Balancing ....................... 126
4.6 Fixation .............................................. 129
4.6.1 Fixation Methods ............................... 129
4.6.2 Cementing Techniques ........................... 129
4.7 Closure ............................................... 132
4.7.1 Hemostasis ..................................... 132
4.7.2 Hemovac Insertion .............................. 132
4.7.3 Suturing Technique ............................. 132
4.8 Miscellaneous Techniques .............................. 132
4.8.1 Methods for Increasing the ROM ................. 133
4.8.2 Techniques for the Mobile-Bearing Joint ........ 135
4.8.3 Techniques for the Posterior Cruciate-
Substituting Type .............................. 136
Bibliography ............................................... 137
5 TKA in Specific Conditions ................................. 143
5.1 Bone Defects .......................................... 143
5.1.1 Introduction ................................... 143
5.1.2 Classification ................................. 143
5.1.3 Diagnosis ...................................... 144
5.1.4 Principles and Methods of Treatment ............ 145
5.1.5 Surgical Methods of Each Bone .................. 152
5.2 Deformity ............................................. 159
5.2.1 Intra-articular Deformity ...................... 160
5.2.2 Extra-articular Deformity ...................... 168
5.3 Ankylosis ............................................. 172
5.3.1 Indication ..................................... 173
5.3.2 Prognostic Factors ............................. 173
5.3.3 Surgical Techniques ............................ 174
5.4 Miscellaneous Conditions and Diseases ................. 176
5.4.1 Osteopenia ..................................... 176
5.4.2 Previous Knee Operation ........................ 178
5.4.3 AnkyloticHip ................................... 182
5.4.4 Miscellaneous Diseases ......................... 183
5.5 Tumor Prosthesis ...................................... 186
5.5.1 Indication ..................................... 186
5.5.2 Type and Composition ........................... 187
5.5.3 Surgical Techniques ............................ 187
5.5.4 Results ........................................ 189
Bibliography ............................................... 191
6 Unicompartmental Knee Arthroplasty ......................... 195
6.1 Unicompartmental Knee Arthroplasty .................... 195
6.1.1 Introduction ................................... 195
6.1.2 Implant ........................................ 196
6.1.3 Indications .................................... 198
6.1.4 Surgical Technique ............................. 200
6.1.5 Postoperative Care ............................. 205
6.1.6 Complications .................................. 205
6.1.7 Prognosis ...................................... 207
6.2 Patellofemoral Arthroplasty ........................... 208
6.2.1 Overview ....................................... 208
6.2.2 Design ......................................... 209
6.2.3 Indication ..................................... 209
6.2.4 Surgical Technique ............................. 210
6.2.5 Postoperative Care ............................. 210
6.2.6 Complications .................................. 211
6.2.7 Prognosis ...................................... 211
6.3 Bicompartmental Knee Arthroplasty ..................... 211
Bibliography ............................................... 212
7 Postoperative Management ................................... 215
7.1 Postoperative Care .................................... 215
7.1.1 Early Stage .................................... 216
7.1.2 Midterm Stage .................................. 218
7.1.3 Late Stage ..................................... 223
7.2 Education ............................................. 223
7.3 Follow-Up ............................................. 224
Bibliography ............................................... 225
8 Complications .............................................. 227
8.1 Systemic Complications ................................ 227
8.1.1 Deep Vein Thrombosis ........................... 227
8.1.2 Fat Embolism Syndrome .......................... 231
8.2 Knee Joint Complications .............................. 231
8.2.1 Pain ........................................... 231
8.2.2 Swelling ....................................... 234
8.2.3 Motion Limitation .............................. 234
8.2.4 Instability and Dislocation .................... 236
8.2.5 Vascular Complications ......................... 238
8.2.6 Nerve Palsy .................................... 239
8.2.7 Component Breakage ............................. 239
8.2.8 Complications of the Extensor Mechanism ........ 239
8.2.9 Hematoma and Wound Drainage .................... 243
8.2.10 Superficial Infection and Skin Necrosis ....... 243
8.2.11 Deep Infection ................................ 245
8.2.12 Aseptic Loosening ............................. 252
8.2.13 Wear .......................................... 253
8.2.14 Osteolysis .................................... 255
8.2.15 Heterotopic Ossification ...................... 257
8.2.16 Periprosthetic Fracture ....................... 257
8.3 Results ............................................... 268
Bibliography ............................................... 268
9 Revision Arthroplasty ...................................... 275
9.1 Introduction .......................................... 275
9.2 Revision for Aseptic Failure .......................... 276
9.2.1 Preoperative Checkup ........................... 276
9.2.2 Surgical Procedure ............................. 277
9.3 Revision of Unicompartmental Knee Arthroplasty (UK) ... 287
9.4 Revision of Infected TKA .............................. 287
9.4.1 One-Stage Revision TKA ......................... 288
9.4.2 Two-Stage Revision TKA ......................... 289
Bibliography ............................................... 294
10 Optional Techniques ........................................ 297
10.1 Introduction .......................................... 297
10.2 Computer Assisted Orthopedic Surgery .................. 297
10.2.1 Overview ....................................... 297
10.2.2 History ........................................ 298
10.2.3 Type ........................................... 298
10.2.4 Indication ..................................... 305
10.3 Result ................................................ 306
10.3.1 Future of CAOS ................................. 306
10.4 Minimally Invasive Surgery ............................ 307
10.4.1 Overview ....................................... 307
10.4.2 History ........................................ 307
10.4.3 Indication ..................................... 307
10.4.4 Surgical Technique ............................. 307
10.4.5 Postoperative Care ............................. 310
10.5 Result ................................................ 310
Bibliography .................................................. 311
About the Author .............................................. 315
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