THE UNHAPPY TOTAL KNEE REPLACEMENT. A COMPREHENSIVE REVIEW AND MANAGEMENT GUIDE

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.
Feature:
- Clearly explains the causes of failure of TKA and associated pain
- Presents state of the art clinical and radiological diagnostics and helpful algorithms
- Describes specific pathology-related treatment options including salvage and revision TKA strategies
- Includes a case series covering clinical scenarios frequently encountered in daily clinical practice
- Highlights pearls and pitfalls

Authors
Michael T. Hirschmann, MD, is head of Knee Surgery at Kantonsspital Baselland (Bruderholz, Liestal, Laufen). He trained at the University of Mainz in Germany, graduating in 2004. He then worked from 2004-2006 as registrar at the Departement of Surgery at University of Basel. His orthopaedic residency was spent at Bruderholz Hospital and Kantonsspital Baselland under the leadership of Professor Dr. Niklaus Friederich. He became a board certified specialist in Orthopaedic Surgery in 2011. He completed a 12 months clinical and research fellowship at the Imperial College London, UK under Prof. Justin Cobb and Prof. Andrew Amis. In addition, he spent a 3 months knee fellowship in Melbourne, Australia with John Bartlett. Michael went on several fellowships such as the ESSKA-APOSSM Travelling Fellowship 2012, the AGA European Arthroscopy Fellowship 2011 and the EFORT Visiting Fellowship 2010, which he spent with Dr. Timo Järvelä in Tampere, Finland. For his research he was awarded numerous awards such as the Swiss Quality Award 2013, the ESSKA Basic Science Poster Award 2012, 2nd AGA Poster Award 2013 and the EANM Young Investigator Award 2013. His research focus has been on diagnostics and treatment of knee injuries involving the cartilage, meniscus or ligaments, diagnostics and treatment of patients with OA and in particular on unhappy patients after knee arthroplasty surgery. Another major research focus lies on the evaluation and development of 3D imaging such as CT, MRI and SPECT/CT on orthopaedic purposes. He published numerous original articles and book chapters in these areas. Michael has been a member of ESSKA since 2007 and has been active in the ESSKA arthroscopy and cartilage committee. He is also a member of AAOS, ACL Study Group, AGA, DGOOC, DKG,EKA, EORS, GOTS and ISAKOS. In September 2012, he was appointed an Ass. Professor (PD) at the University of Basel, Switzerland.

Roland Becker is Head of the Centre for Orthopedics and Trauma Surgery, Klinikum Brandenburg (Municipal Hospital Brandenburg), Brandenburg, Germany. Dr. Becker graduated in medicine from the Medical Academy, Magdeburg, in 1992 and received his board certification in Orthopedics in 1998 and in Orthopedics and Trauma Surgery in 2006. He received his Habilitation and “venia legendi” for Orthopedics and Sports Traumatology in 2003 and was appointed Associate Professor at Otto von Guericke University, Magdeburg in 2011. Dr. Becker has held various leading positions in medical scientific societies, including as President of the Gesellschaft für Arthroskopie und Gelenkchirurgie (Society for Arthroscopy and Joint Surgery), a member of the Board of Directors of European Knee Associates (of ESSKA) and a member of the Knee Committee of the International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine (ISAKOS). Dr. Becker has published 68 articles in peer-reviewed journals and ten book chapters.

Table of contents
1.Anatomy and Biomechanics of the Natural Knee and After TKR
2.Biology of the Knee After Total Knee Replacement: Neglected Potential or Source of Failure?
3.There Is an Optimal Rotational Alignment in Total Knee Replacement: Femoral Rotation Does Matter!
4.There Is an Optimal Rotational Alignment in Total Knee Replacement: Tibial Rotation Does Matter!
5.Measured Resection and Gap Balancing Technique in TKR
6.How Can Preoperative Planning Prevent Occurrence of a Painful Total Knee Replacement?
7.Specific Orthopaedic Imaging Analysis Software: Clinical Benefit for TKR Revision Surgeon
8.Design, Shape, and Materials of Total Knee Replacement
9.Case Discussion to Chap. 8: Iliotibial Tract Syndrome After Cruciate-Substituting Guided Motion TKR
10.Importance of the Patellofemoral Joint for Total Knee Replacement
11.Avoiding Wound Complications in Total Knee Replacement
12.Material Failure of Total Knee Replacement
13.Patterns of Wear in Total Knee Replacement
14.Case Discussion to Chap. 12: Chronic Pain Due to Metallosis After TKR
15.Periprosthetic Fractures Following Total Knee Replacement
16.Malposition and Malorientation After Total Knee Replacement
17.The Problem of Under-or Oversizing of Total Knee Replacement
18.Case Discussion to Chap. 15: Stiff Knee Joint After TKR Due to Tight Flexion Gap in Oversized TKR
19.Case Discussion to Chap. 15: Lateral Oversizing of Tibial TKR Component Leading to Chronic Irritation of the Iliotibial Tract
20.Instability of Total Knee Replacement
21.Case Discussion to Chap. 16: Mid-Flexion Instability After TKR Due to Femoral Malrotation
22.Extensor Mechanism Deficiency in Total Knee Replacement
23.Causes and Diagnosis of Aseptic Loosening After Total Knee Replacement
24.Periprosthetic Joint Infection After TKR
25.Allergy and Hypersensitivity to Implant Materials
26.Stiffness After Total Knee Replacement
27.Case Discussion to Chap. 21: “Mechanical” Arthrofibrosis
28.Reducing the Impact of Psychological Factors on Outcome
29.Impingement After Total Knee Replacement
30.Chronic Regional Pain Syndrome (Algodystrophy) in Patients After Knee Replacement
31.Medical History and Physical Examination
32.Laboratory Analysis in the Assessment of Painful Total Knee Replacement
33.Diagnosis of Periprosthetic Joint Infection After Total Knee Replacement
34.What Do Radiographs Tell Us?
35.Determination of Component Orientation and Position in Patients After Total Knee Replacement
36.Magnetic Resonance Imaging in Total Knee Replacement
37.Nuclear Medicine Imaging (SPECT/CT) in the “Unhappy” Total Knee Replacement: A Potential for Better Diagnosis!
38.Fluoroscopy and Stress Radiographs Diagnosing Instability in Patients After Total Knee Replacement
39.The Diagnostic Value of Biopsy and Joint Aspiration in Periprosthetic Joint Infection
40.A Diagnostic Algorithm for Patients with Painful Total Knee Replacement: What to Do When
41.Case Discussion to Chap. 34: Persistent/Recurrent Pain After TKR Not Always TKR Related
42.Algorithm for the Management of Patients with Painful Total Knee Replacement
43.Management of Patients with Painful Total Knee Replacement: A Multimodal Approach
44.Pain After TKR: When Is a Conservative Treatment Beneficial?
45.Radiosynoviorthesis in Painful Total Knee Replacement
46.Physical Therapy for Persistent Pain After Total Knee Replacement
47.Intraoperative Landmarks in Revision Surgery
48.A Practical Approach to Biopsy, Joint Aspiration, and Diagnostic Arthroscopy
49.Arthroscopic Treatment of Patellofemoral Soft Tissue Impingement After Total Knee Replacement
50.Exposure for Revision Total Knee Replacement
51.Treatment of Aseptic Loosening
52.Treatment of Instability After Total Knee Replacement
53.Algorithm for Treating Infection After TKR
54.Case Discussion to Chap. 46: The Ultimate Challenge for the Orthopaedic Surgeon – Infection
55.Cementless Versus Cemented Revision Total Knee Replacement
56.The Optimal Cementing Technique in Total Knee Replacement
57.Use of Stems in Revision Total Knee Replacement
58.Ligament and Gap Balancing in Revision Total Knee Replacement
59.Complications After Revision TKR
60.Case Discussion to Chap. 51: Patellofemoral Problems After Total Knee Replacement
61.Joint Line Restoration in Revision Total Knee Replacement
62.Case Discussion to Chap. 52: Patellofemoral Pain After Cruciate Retaining Total Knee Replacement
63.Analysis and Treatment of Anterior Knee Pain After Total Knee Replacement
64.Case Discussion to Chap. 53: Persistent Anterior Knee Pain After Total Knee Replacement
65.Constrained Condylar Total Knee Replacement
66.Hinged Implants for Revision Total Knee Replacement
67.Management of Bone Loss in Revision Total Knee Replacement
68.Osteotomy of the Tibial Tubercle in Total Knee Replacement Revision Surgery
69.Extensor Apparatus Insufficiencies
70.Low-Grade Infection After Total Knee Replacement
71.Treatment of Infected Total Knee Replacement: Concept, Surgical Options and Antibiotic Therapy
72.Case Discussion to Chap. 60: Two-Stage Revision Total Knee Replacement and Significant Femorotibial Bone Loss
73.Navigated Revision Total Knee Replacement
74.Periprosthetic Fracture Treatment in Total Knee Replacement
75.Case Discussion to Chap. 62: Rare Femoral Periprosthetic Fracture After Complex TKR – Unusual Surgical Solutions
76.The Knee Arthroplasty Endgame: Four Options in the Face of Calamity
77.Case Discussion to Chap. 63: Desarthrodesis to a Total Knee Replacement: A Complication-Prone Procedure!