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Medicine - Orthopedics | The Unhappy Total Knee Replacement - A Comprehensive Review and Management Guide

The Unhappy Total Knee Replacement

A Comprehensive Review and Management Guide

Hirschmann, Michael, Becker, Roland (Eds.)

2015, XV, 825 p. 509 illus., 339 illus. in color.

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  • 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

Owing to improved understanding of biomechanics and tribology and advances in implant design and treatment technique, total knee arthroplasty (TKA) is considered a very successful treatment for osteoarthritic knees. Nevertheless, a significant minority of patients are unhappy with the outcome, complaining of pain, instability, swelling, or reduced range of motion. This book addresses the need for improved diagnostic and treatment guidelines for this challenging group of patients.

The book 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. Furthermore, state of the art diagnostic algorithms are presented that will assist in identifying the source of the problem in individual cases. Specific pathology-related treatment options, including conservative approaches and salvage and revision TKA strategies, are then explained, with identification of the pitfalls and key points of each treatment. Future perspectives are briefly considered, and a series of cases are presented that 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 ensuring that patients with an unsatisfactory result of TKA receive the most effective management. The book will also be helpful for general practitioners, physiotherapists, industry technicians, and engineers.

Content Level » Professional/practitioner

Keywords » Arthroscopy - Diagnostic Algorithm - Infection - Revision arthroplasty - Total knee replacement

Related subjects » Internal Medicine - Medicine - Orthopedics - Physical Medicine & Rehabilitation

Table of contents 

Basics of total knee replacement: Anatomy and biomechanics of the knee after total knee arthroplasty.- Biology of the knee after TKA- the neglected potential or source of failure?- There is an optimal axial alignment in TKA- rotation does matter!- There is an optimal alignment of the TKA- tibial rotation does matter!- Gap balancing in total knee arthroplasty- the US perspective.- Design, shape, and materials of total knee arthroplasty - What works well, what does not.- Patellofemoral complications and mal-tracing in TKA are influenced by what?- Image analysis- new ways to improve the diagnosis in patients after TKR.- How can preoperative planing prevent occurrence of a painful TKA? Causes of pain after TKA: Avoiding Wound Complications in Total Knee Arthroplasty- Failure of the TKA implant.- Periprosthetic fractures following total knee replacement- an epidemic problem on the rise!- Malposition and malorientation of TKA.- The problem of under- or oversizing of TKA.- Instability of TKA.- Extensor mechanism deficiency in TKA.- Causes and diagnosis of aseptic loosening after TKA.- Infection after TKA.- Allergy and hypersensitivity to implant materials in patients with TKA: an allergological approach.- Stiffness after total knee arthroplasty.- The unhappy TKA: Reducing the impact of psychological factors on outcome.- Impingement after TKA.  Diagnostics: Medical History and physical examination.- Laboratory analysis in the assessment of painful total knee arthroplasty.- What do the radiographs tell us?- CT determination of component orientation and position in patients after TKA.- Magnetic resonance imaging in knee arthroplasty.- The diagnostic value of SPECT/CT in the ‘unhappy’ total knee arthroplasty- a potential for better diagnosis!- FDG-PET in patients with total knee arthroplasty - what is the evidence?- Fluoroscopy and stress radiographs diagnosing laxity/instability in patients after TKA.- Biopsy, joint puncture, diagnostic arthroscopy.- A diagnostic algorithm for patients with painful total knee arthroplasty – what to do when?- Algorithm for the management of patients with painful total knee arthroplasty Treatment principles - Conservative treatment: Management of patients with painful total knee arthroplasty: A multimodal approach.- Pain after TKA- when is a conservative treatment possible?- Radiosynovectomy.- Physical therapy, alternative treatment options, braces/orthotics.- Treatment principles -Surgical treatment: General Principles.- Exposure for revision TKA.- Intraoperative landmarks in revision surgery- when to choose what?- Arthroscopic treatment of patellofemoral soft tissue impingement after posterior stabilized total knee arthroplasty.- Arthroscopic or open treatment of stiff knees after TKA.- Treatment of aseptic loosening.- Treatment of Instability after TK.- Cementless versus cemented revision TKA.- Use of stems in revision TKA.- Ligament and gap balancing in revision TKA.- Unusual causes of failure and unexpected complications.- My algorithm treating infection after TKA.- My special case of infection after total knee arthroplasty.- Joint line restoration in revision surgery.- Treatment of patellofemoral pain after TKA.- Hinged implants for revision TKA.- The management of bone loss in revision TKA.- My experience with diagnosis and treatment of extensor apparatus insufficiencies.- Low-grade infection after total knee arthroplasty.- Treatment of infection after TKA- one stage versus two stage.- Navigated revision arthroplasty- what is the benefit?- Periprosthetic fracture treatment in TKA.- Salvage procedures in revision TKA.- Future developments and perspectives. Case discussion.

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