Revision knee arthroplasty including reconstruction of the lateral collateral ligament by allograft: a case report.

A 53-year-old woman presented with an unstable and painful total knee arthroplasty 6 months after the index procedure. Disruption of both collateral ligaments as a young adult and the subsequent development of traumatic arthritis required repeated surgical and extensive conservative treatment before a prosthesis was implanted. Examination disclosed marked instability of the lateral collateral ligament (LCL) and loosening of the tibial and the femoral components.

Retrieval analysis of femoral zirconium components in total knee arthroplasty: preliminary results.

Safety of oxidized zirconium (OxZr) in total knee arthroplasty (TKA) has been supported by biomechanical, clinical, and radiologic data. Retrieved OxZr femoral components and corresponding polyethylene (PE) inserts were examined to rule out patterns leading to early failure. Sixteen retrieved TKA with an OxZr femoral component were included.

Is minimally invasive surgery-total knee arthroplasty truly less invasive than standard total knee arthroplasty? A quantitative evaluation.

With recent technical advancements, the number of operative manipulations in the knee joint by minimally invasive surgery-total knee arthroplasty (MIS-TKA) is now considered to be the same as that using standard TKA (S-TKA). The question still remains, however, if MIS-TKA improves recovery compared to S-TKA. We compared MIS-TKA and S-TKA patients' physical activity as measured by an accelerometer.

Varus gonarthrosis predisposes to varus malalignment in TKA.

Postoperative alignment is a predictor for long-term survival of total knee arthroplasty (TKA). The purpose of this study was to evaluate whether or not preoperative deformities predispose to intraoperative malposition of TKA components. A retrospective radiographic analysis of 53 primary TKA cases was performed.

The mini-incision mid-vastus approach for total knee arthroplasty.

Objective: Rapid functional recovery and improved range of motion after total knee arthroplasty (TKA) without compromising implant position.

Indications: Osteoarthritis of the knee requiring TKA.

Contraindications: Preoperative flexion < 80 degrees.

The classic: modular total knee-replacement arthroplasty. A review of eighty-nine patients. 1976.

Fifty-eight osteoarthritic and thirty-one rheumatoid patients underwent modular total knee-replacement arthroplasty. The major indication for the operation was relief of pain. Contraindications to this resurfacing arthroplasty included varus-valgus instability of over 20 degrees, combined varus-valgus instability with flexion contracture of over 40 degrees, marked recurvatum, and predominant patellofemoral symptoms.

The classic: total condylar knee replacement in patients who have rheumatoid arthritis. A ten-year follow-up study. 1990.

Eighty knee replacements with a total condylar prosthesis in patients who had rheumatoid arthritis were followed for ten years. At ten years, nineteen knees needed revision and sixty-one prostheses were still functioning. The major reasons for revision were loosening of the tibial component or late bacteremic seeding from another site.

Intramedullary arthrodesis of the knee in the treatment of sepsis after TKR.

Infection is a devastating complication following total knee replacement (TKR). In the majority of cases, single- or two-stage revision has excellent results in eradicating infection and restoring function. Rarely, recurrent infection requires alternative treatments such as resection, amputation, or arthrodesis.

A mini-midvastus capsular approach with patellar displacement decreases the prevalence of patella baja.

Our aim in this study was to evaluate the prevalence of patella baja after total knee arthroplasty (TKA) using 2 different surgical techniques. Postoperative changes in patella height were measured on serial radiographs of 74 TKAs implanted using a mini-midvastus capsular approach without patella eversion (group 1) and 57 TKAs implanted using a standard medial parapatellar capsular approach with patella eversion (group 2). Preoperative and postoperative Knee Society scores, operative data, and complications were compared.

The effect of a high-flex implant on postoperative flexion after primary total knee arthroplasty.

Compared to a statistically similar cohort, patients implanted with a high-flex poster-stabilized prosthesis achieved greater return of flexion than that with a standard posterior stabilized implant. In addition, patients with a high flexion arc preoperatively retained this high arc of flexion after surgery. Finally, there was an increase in the range of flexion seen after surgery in both groups of patients, but larger in the group in which the modified high-flexion implant was used.

Ten-year results of the first 100 Genesis II total knee replacement procedures.

The first 100 consecutive Genesis II (Smith & Nephew; Memphis, Tenn) total knee replacements (TKR) procedures performed in 97 patients by the senior investigators (RBB, RSL) had a Kaplan-Meier survivorship of 96% +/- 2% at 12 years with any reoperation as the endpoint. Significant improvements in health-related quality-of-life outcome measures were noted. There were no revisions for implant-related factors (ie, polyethylene wear, osteolysis, or aseptic loosening).

What would you do? Challenges in knee surgery.

Evaluation and management of 4 challenging knee case scenarios were discussed in an interactive session with a moderator and 5 experts in knee reconstruction. Case-based discussion included total knee arthroplasty in the presence of femoral deformity, deficient patellar bone, and patella baja, and treatment of infected total knee arthroplasty.

Surgical exposure for total knee arthroplasty: for everything there is a season.

The author has used a mini midvastus lesser-invasive knee approach for 5 years for patients undergoing a primary total knee arthroplasty. The approach involves a modified capsular and muscular incision, displacement but not eversion of the patella, and avoidance of anterior dislocation of the tibia before bony resections. This has resulted in a more rapid return of flexion and functional ability with a lesser amount of postoperative pain as compared with previous larger median parapatellar approaches with patellar eversion.

Computer-assisted navigation in TKA: where we are and where we are going.

When compared to standard intramedullary and extramedullary referencing systems, computer-assisted navigation systems have been shown in multiple randomized studies to increase the accuracy of bone resections in total knee arthroplasty. Accuracy to within 1 degrees in the coronal plane resections can routinely be obtained. Recent modifications of the software programs address the problem of proper soft tissue balance.

VenaFlow plus Lovenox vs VenaFlow plus aspirin for thromboembolic disease prophylaxis in total knee arthroplasty.

Two hundred seventy-five patients undergoing unilateral total knee arthroplasty were prospectively randomized to receive spinal epidural anesthesia (SEA), a VenaFlow calf compression device, and enoxaparin (group A) or SEA, VenaFlow, and aspirin (group B). Aspirin was started on the day of surgery, whereas enoxaparin was started 48 hours after surgery. Anticoagulants were continued for 4 weeks after surgery.

What would you do? Case challenges in knee surgery.

Six cases representing a variety of orthopedic issues were presented to a panel of senior surgeons. These included the following: (1) developmental patella baja with degenerative arthritis, (2) high valgus knee with attenuated medial collateral ligament, (3) degenerative arthritis with near-ankylosis, (4) depressed tibial plateau fracture with degenerative arthritis, (5) degenerative arthritis with laterally dislocating patella, and (6) degenerative arthritis with distal femoral malunion.

Mini-incision: occasionally desirable, rarely necessary in opposition.

Using a mini mid vastus limited incision for primary total knee arthroplasty, the authors noted the ability to decrease postoperative pain while speeding up the rate of recovery of motion and of return of function. By specific flexion and extension of the knee, the surgical window could be mobilized to visualize the articular surfaces at various stages during the surgery. Radiographic evaluation revealed that component position and limb alignment were excellent despite the use of the more limited incision.

The use of standard posterior stabilized implants in revision total knee arthroplasty.

Unlabelled: In primary knee replacement, posterior-stabilized prostheses often are used but we wondered if by balancing the flexion and extension spaces satisfactory coronal and AP stability could be achieved without a more constrained implant. We retrospectively reviewed 61 patients who had a unilateral revision knee replacement 58 of whom had a posterior stabilized implant. The initial indication for the revision had been coronal instability in 42% and a loose tibial component in 44%.

Minimally invasive total knee arthroplasty: the results justify its use.

Unlabelled: A mini-midvastus capsular incision was used in a feasibility study of 100 patients having primary total knee arthroplasty. Patients with marked limitation of motion were excluded from the study. Patients were followed up for a minimum of 2 years after surgery.

What would you do? Case challenges in knee surgery.

These knee arthroplasty cases were presented to a panel of surgeon and they represent classic clinical problems: (1) indications for unicompartmental arthroplasty; (2) total knee arthroplasty after a high tibial osteotomy complicated by infection and extensor mechanism rupture; (3) neuropathic arthropathy; (4) posttraumatic osteoarthritis with extraarticular deformity; (5) degenerative arthritis in the young patient; (6) osteoarthritis with a valgus deformity, fixed flexion contracture, degenerative scoliosis, and leg length discrepancy.

Choosing your implant: cemented, tricompartmental, and posterior stabilized.

Cemented, posterior-stabilized, tricompartmental implants have yielded excellent relief of pain and are applicable to almost all clinical situations. The complications and revision rates after routine patellar resurfacing are less than those seen without such resurfacing. Cine fluoroscopic studies have shown that they restore a more normal kinematic pattern than do posterior cruciate ligament-retaining implants and have a low rate of radiographic and/or clinical loosening when followed up through 15 years after surgery.

Total knee replacement using the Genesis II prosthesis: a 5-year follow up study of the first 100 consecutive cases.

One hundred consecutive patients with osteoarthritis undergoing knee replacement using a prosthesis with asymmetrical posterior condyles and an asymmetrical tibial base plate (Genesis II) were followed for a minimum of 5 years after surgery. Mean flexion was 118 degrees. Seventy nine percent of the patients could ascend and descend stairs in a reciprocal manner.