دانلود کتاب Basics in Primary Knee Arthroplasty

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Foreword\nPreface\nContents\nAbout the Editors\n1: Anthropometry of the Native Knee\n 1.1 Introduction\n 1.2 Distal Femur\n 1.3 Patella\n 1.4 Proximal Tibia and Menisci\n 1.5 Ligamentous Structures\n 1.5.1 Anterior Cruciate Ligament (ACL)\n 1.5.2 Posterior Cruciate Ligament (PCL)\n 1.5.3 Medial Knee Structures\n 1.5.4 Lateral Knee Structures\n References\n2: Kinematics of the Native Knee\n 2.1 Introduction\n 2.2 Physiology\n 2.3 The Lower Limb Kinetic Chain\n 2.3.1 Tibiofemoral Kinematics\n 2.3.1.1 Sagittal Plane\n 2.3.1.2 Transverse Plane\n 2.3.2 Patellofemoral Kinematics\n 2.3.2.1 Patella Tracking\n 2.3.2.2 Patellar Height\n 2.3.2.3 Tibial Tubercle–Trochlear Groove Distance\n 2.3.3 Stability\n 2.4 Kinematics during Different Activities\n 2.4.1 Walking\n 2.4.2 Stair Climbing and Descent\n 2.4.3 Sitting Down and Standing from Seated\n 2.4.4 Squatting, Lunging, and Kneeling\n 2.4.5 Vertical Drop Jump\n 2.4.6 Sports\n 2.5 Inter-Individual, Gender, Age, and Ethnic Variations\n 2.5.1 Sexual Variations\n 2.5.2 Age Variations\n 2.5.3 Ethnic Variations Differences\n References\n3: Kinematics of the Knee After Partial and Total Knee Arthroplasty\n 3.1 Modalities for Studying Knee Kinematics After Arthroplasty\n 3.2 The Kinematics of Total Knee Replacements\n 3.2.1 Cruciate-Retaining TKA Designs\n 3.2.2 Posterior-Stabilized TKA Designs\n 3.2.3 Medial-Pivot Design\n 3.2.4 Lateral-Pivot Design\n 3.2.5 Bicruciate-Retaining TKA Designs\n 3.2.6 Fixed and Mobile-Bearing Designs in TKA\n 3.2.7 Highly Conforming Designs in TKA\n 3.3 The Kinematics of Unicondylar Knee Replacement\n 3.3.1 Introduction\n 3.3.2 The Kinematics of UKA\n 3.3.3 Mobile vs. Fixed-Bearing UKA\n 3.3.4 Medial vs. Lateral UKA\n 3.3.5 The Importance of the Anterior Cruciate Ligament in UKA\n References\n4: Loading of the Knee Joint After Total Knee Arthroplasty\n 4.1 Introduction\n 4.2 Technical Capabilities: How to Measure Knee Loading in Vivo?\n 4.2.1 Tibial Tray Design\n 4.2.2 Coordinate System and Nomenclature\n 4.3 In Vivo Loading in Activities of Daily Living\n 4.3.1 The Observed Peak Loads\n 4.3.1.1 Resultant Forces F\n 4.3.1.2 Shear Forces\n 4.3.1.3 Flexion–Extension Moments\n 4.3.1.4 Abduction–Adduction Moments\n 4.3.1.5 External–Internal Rotation Moments\n 4.3.2 Load Patterns\n 4.3.2.1 Two/One-Legged Stance\n 4.3.2.2 Knee Bend, Standing Up, and Sitting Down\n 4.3.2.3 Level Walking\n 4.3.2.4 Ascending/Descending Stairs\n 4.3.3 Force Directions\n 4.4 The Third Player: The Patellofemoral Joint Contact during High Knee Flexion\n 4.5 Mediolateral Force Distribution: Shifts across Activities and Is Driven by Tibiofemoral Alignment\n 4.5.1 Determination of Medial Force and Medial Force Ratio\n 4.5.2 Determination of Static Leg Alignment\n 4.5.3 Variation of the Medial Force Ration (MR) and Medial Femorotibial Force (Fmed)\n 4.5.4 Influence of Leg Alignment on MR and Fmed during Static One-Legged Stance [9]\n 4.5.5 Influence of Leg Alignment on MR and Fmed during Dynamic Limb Loading\n References\n5: The Optimal Indication for Unicompartmental Knee Arthroplasty\n 5.1 Introduction\n 5.2 Indication for UKA in Medial Femorotibial OA\n 5.3 Indication in Lateral Femorotibial OA\n 5.4 The Impact of Patellofemoral OA on the Indication for UKA\n 5.5 Contraindications\n References\n6: The Optimal Indication for Patellofemoral Arthroplasty\n 6.1 Introduction\n 6.2 Epidemiological Data\n 6.3 Etiology of Patellofemoral OA\n 6.3.1 Primary Patellofemoral OA\n 6.3.2 OA Secondary to Presence of Predisposing Factors for Patellofemoral Instability\n 6.3.2.1 Dislocation\n 6.3.2.2 Extensor Mechanism Malalignment\n 6.3.2.3 Lack of Congruency between the Patella and the Trochlea\n 6.3.3 Posttraumatic Patellofemoral OA (9%)\n 6.3.4 Patellofemoral OA Secondary to Chondrocalcinosis or Other Rheumatic Diseases (9%)\n 6.4 Predisposing Factors for Patellofemoral Osteoarthritis\n 6.4.1 Trochlear Dysplasia\n 6.4.2 Dysplasia of the Patella\n 6.4.3 Other Factors\n 6.5 Therapeutic Consequences\n 6.5.1 Non-operative Treatment\n 6.5.2 Non-prosthetic Treatment\n 6.5.3 Patellofemoral Arthroplasty\n 6.5.3.1 Indication and Contraindications\n 6.5.3.2 Technical Considerations\n Patellofemoral Osteoarthritis without Dysplasia\n Patellofemoral Osteoarthritis with Dysplasia\n References\n7: The Optimal Indication for Combined Patellofemoral and Unicondylar Knee Arthroplasty\n 7.1 Introduction\n 7.2 Concepts of Combined Patellofemoral and Medial Unicondylar Knee Arthroplasty\n References\n8: The Optimal Indication for Total Knee Arthroplasty\n 8.1 Introduction\n 8.2 Indication for Total Knee Arthroplasty (TKA)\n 8.3 Prediction for Outcome after TKA\n References\n9: Partial Resurfacing Implants\n 9.1 Introduction\n 9.2 Knee Resurfacing Implant Types\n 9.2.1 HemiCAP® Implants\n 9.2.2 The Episealer® Implant\n 9.3 Indications for the Use of a Resurfacing Prosthesis\n 9.4 Surgical Techniques\n 9.4.1 HemiCAP®\n 9.4.2 Episealer®\n 9.5 Biological Response to Resurfacing Implants\n 9.6 Clinical Outcome\n 9.6.1 Case Series (Table 9.2)\n 9.6.2 Failure after Resurfacing Implant Treatment\n 9.7 Discussion\n References\n10: Patients’ Evaluation Prior to Knee Arthroplasty\n 10.1 Introduction\n 10.2 Patients’ Evaluation\n 10.2.1 Specific History of the Knee\n 10.2.2 General Medical History\n 10.2.2.1 Diabetes Mellitus (DM)\n 10.2.2.2 Anaemia\n 10.2.2.3 Cardiovascular Diseases\n 10.2.2.4 Chronic Renal Disease (CRD)\n 10.2.2.5 Neurological Diseases\n 10.2.2.6 Rheumatoid Arthritis (RA)\n 10.2.2.7 Malnutrition\n 10.2.2.8 Obesity\n 10.2.2.9 Smoking\n 10.2.2.10 Alcohol Misuse\n 10.2.2.11 Depression\n 10.2.2.12 Urinary Tract Infection\n 10.2.3 Clinical Examination\n 10.2.3.1 Inspection\n 10.2.3.2 Feel\n 10.2.3.3 Move\n 10.2.3.4 Specific Testing\n 10.2.4 Radiological Examination\n References\n11: Cardiovascular Comorbidity in Patients Scheduled for TKA\n 11.1 Introduction\n 11.2 Risk Indices\n 11.3 Cardiac Biomarkers\n 11.4 Noninvasive Testing of Cardiac Disease\n 11.4.1 Electrocardiography\n 11.4.2 Echocardiography\n 11.4.3 Noninvasive Testing of Ischemic Heart Disease\n 11.5 Perioperative Management in Patients on Antiplatelet Agents or Anticoagulation Therapy\n 11.5.1 Aspirin\n 11.5.2 Dual Antiplatelet Therapy (DAPT)\n 11.6 Perioperative Management in Patients on Anticoagulants\n 11.6.1 Chronic Heart Failure\n 11.6.2 Hypertension\n 11.6.3 Valve Disease\n 11.6.4 Aortic Stenosis\n 11.6.5 Secondary Mitral Regurgitation\n 11.6.6 Patients with Prosthetic Heart Valves\n 11.6.7 Prophylaxis of Infective Endocarditis\n 11.6.8 Arrhythmias\n 11.6.9 Perioperative Management of Patients with Pacemakers/Implantable Cardioverter Defibrillators\n 11.6.10 Stroke\n 11.6.11 Peripheral Artery Disease\n 11.7 Pulmonary Disease\n References\n12: Patient Expectations in Total Knee Arthroplasty\n 12.1 What Do Patients Expect from TKA?\n 12.2 Measuring and Managing Expectations—Predicting Satisfaction\n References\n13: Basic Principles of Partial Knee Arthroplasty\n 13.1 Introduction—Anthropology and Partial Knee Arthroplasty\n 13.2 Indication\n 13.2.1 Medial Femorotibial Osteoarthritis\n 13.2.2 Lateral Femorotibial Osteoarthritis\n 13.3 Key Points of Examination\n 13.4 Surgical Planning\n 13.5 Technical Tips and Tricks\n 13.5.1 Medial UKA\n 13.5.2 Lateral UKA\n 13.5.3 Closure\n 13.5.4 Postoperative Regimen\n 13.6 Compartmental Arthroplasty\n 13.7 Postoperative Care\n References\n14: Principles of Total Knee Arthroplasty\n 14.1 Introduction\n 14.2 Patient Selection\n 14.3 Choice of Implant\n 14.4 Polyethylene\n 14.5 Informed Consent and Preoperative Patient Education\n 14.6 Preoperative Physiotherapy\n 14.7 Day of Surgery Preoperative Review\n 14.8 The Operating Theatre Environment\n 14.9 Anaesthesia\n 14.10 Theatre Setup and Draping\n 14.11 Arthrotomy and Exposure\n 14.12 Tibial Alignment and Resection\n 14.13 Distal Femoral Preparation\n 14.14 Overview of Final Femoral Preparation\n 14.15 Soft Tissue Balancing\n 14.16 Final Implantation\n 14.17 Haemostasis\n 14.18 Prior to Closure\n 14.19 Dressings\n 14.20 Immediate Medical Supervision\n 14.21 Enhanced Recovery\n 14.22 After Care\n 14.23 Postoperative Physiotherapy\n 14.24 Minimising Risk of Complications\n References\n15: UKA Component Design: What Do We Need to Know?\n 15.1 Introduction\n 15.2 Biomechanical Considerations\n 15.3 Fixed-Bearing Design\n 15.4 Mobile-Bearing Design\n 15.5 Cemented Versus Uncemented\n 15.6 All Polyethylene Versus Metal Backed\n 15.7 Customized Unicompartmental Knee Arthroplasty\n16: TKA Component Design: What Do Engineers Need to Know?\n 16.1 Introduction\n 16.2 Implant Design\n 16.2.1 Single Versus Multiple Femoral Radius Design\n 16.2.2 Fixed Versus Mobile Bearing Design\n 16.2.3 Cruciate-Retaining, Posterior-Stabilized, and Bicruciate-Retaining Design\n 16.2.4 Orientation of the Trochlea Groove\n 16.2.5 Symmetrical or Asymmetrical Tibial Trays\n 16.3 Implant Development—From the Idea to Clinical Application\n 16.3.1 Morphology Data\n 16.3.2 Materials\n 16.3.3 Collaboration\n 16.4 Development Method\n 16.5 Risk Management\n 16.6 Instrumentation—What Are the Most Important Aspects?\n 16.7 New Medical Device Regulation in Europe\n References\n17: Patellofemoral Arthroplasty: Onlay Versus Inlay Prostheses\n 17.1 Introduction\n 17.2 Indication\n 17.3 Contraindication\n 17.4 Inlay Prosthesis—Implant Design and Surgical Technique\n 17.5 Onlay Prosthesis—Implant Design and Surgical Technique\n 17.6 Postsurgical Rehabilitation\n 17.7 Clinical Outcome\n References\n18: Surgical 2D Planning of Total Knee Arthroplasty\n 18.1 Introduction\n 18.2 Radiographies\n 18.3 Digital Planning\n 18.3.1 Automatic Planning\n 18.3.2 Manual Planning\n 18.4 Accuracy of Planning\n References\n19: 3D Planning of Total Knee Arthroplasty: Why and How?\n 19.1 Introduction\n 19.2 How to Plan a TKA in 3D\n 19.2.1 Data Acquisition\n 19.2.2 Frame of References\n 19.2.3 Tutorial\n 19.2.3.1 Step 1: Femoral Frame of Reference\n 19.2.3.2 Step 2: Femoral Condyles\n 19.2.3.3 Step 3: Tibial Frame of Reference\n 19.2.3.4 Step 4: Tibial Condyles\n 19.3 What to Do with the Information Obtained in 3D Planning?\n 19.3.1 Coronal Lower Limb Alignment\n 19.3.2 Joint Line Angulation\n 19.3.3 Femoral Rotation\n 19.4 How 3D Planning Influences Knee Surgery? – The Knee Phenotype Concept\n References\n20: Optimal Setup of the Operating Room\n 20.1 Introduction\n 20.2 Operating Room Requirements\n 20.3 Setup of the Operating Room during Knee Arthroplasty\n References\n21: Pain Management in Total Knee Arthroplasty\n 21.1 Introduction\n 21.2 Preoperative Management\n 21.2.1 Preoperative Physiotherapy\n 21.2.2 Anesthesia\n 21.2.2.1 Preemptive Analgesia\n 21.2.2.2 General Versus Spinal Anesthesia\n 21.2.2.3 Peripheral Nerve Blocks\n 21.2.2.4 Peripheral Nerve Blocks Versus Intrathecal Morphine\n 21.2.3 Tourniquet Time\n 21.3 Postoperative Management\n 21.3.1 Oral Analgesics\n 21.3.2 Joint Infiltration Analgesia\n 21.3.3 Cryotherapy\n 21.3.4 Continuous Passive Motion\n 21.3.5 Neuromuscular Electrical Stimulation (NMES)\n 21.3.6 Transcutaneous Electrical Nerve Stimulation (TENS)\n References\n22: Optimal Positioning of the Patient\n 22.1 Introduction\n 22.2 Positioning of the Patient on the Operating Table\n 22.3 Positioning of the Surgeon in the OR\n References\n23: Pros and Cons of Using a Tourniquet\n 23.1 Introduction\n 23.1.1 Historical Perspectives [6–8]\n 23.2 Characteristics of Tourniquets in TKA\n 23.3 Cuff Pressure and Duration\n 23.3.1 Cementation\n 23.4 Possible Complications Related to the Use of a Tourniquet\n 23.4.1 Ischaemia Reperfusion Injury\n 23.4.2 Muscle Damage\n 23.4.3 Nerve Injuries\n 23.4.4 DVT and PE\n 23.5 Practical Recommendations\n References\n24: Pro and Cons of Tranexamic Acid (TXA) in Total Knee Arthroplasty\n 24.1 Background\n 24.2 Basic Pharmacokinetics\n 24.3 Modes of Administration\n 24.3.1 Intravenous Administration\n 24.3.1.1 Bolus Regimens\n 24.3.1.2 Continuous Regimens\n 24.3.2 Topical Administration\n 24.3.2.1 Intra-Articular Administration Regimens\n 24.3.2.2 Topical Wash Regimens\n 24.3.3 Oral Administration\n 24.3.4 Combined Administration\n 24.4 Efficacy\n 24.5 Risk of Thromboembolic Disease\n References\n25: Standard Approaches to the Knee\n 25.1 Introduction\n 25.2 Skin Incision\n 25.3 Arthrotomy\n 25.3.1 Midline Capsular Incision\n 25.3.2 Medial Parapatellar or Anteromedial Arthrotomy\n 25.3.3 Lateral Parapatellar Arthrotomy\n 25.4 Exposure of the Joint\n 25.5 Tissue-Sparing Arthrotomies\n 25.5.1 Subvastus Approach\n 25.5.2 Midvastus Approach\n References\n26: Is There an Optimal TKA Component Position?\n 26.1 Introduction\n 26.2 What Is the Evidence?\n 26.2.1 Optimal Coronal TKA Alignment\n 26.2.1.1 Coronal Alignment of Femoral Component\n 26.2.1.2 Coronal Alignment of Tibial Component\n 26.2.2 Optimal Sagittal TKA Alignment\n 26.2.2.1 Sagittal Alignment of Femoral Component\n 26.2.2.2 Sagittal Alignment of Tibial Component\n 26.2.3 Optimal Rotational TKA Alignment\n 26.2.3.1 Rotational Alignment of Femoral Component\n 26.2.3.2 Rotational Alignment of Tibial Component\n References\n27: Neutral Mechanical Alignment: The Gold Standard\n 27.1 Introduction\n 27.2 The Current Evidence for Restoration of Mechanical Alignment (Table 27.1)\n 27.3 Mechanical Alignment\n References\n28: The Anatomical Alignment Concept for Total Knee Arthroplasty\n 28.1 Basics for a Better Understanding\n 28.2 Coronal Alignment\n 28.3 Sagittal Alignment\n 28.4 Rotational Alignment\n 28.5 Clinical Outcome Anatomical Alignment Versus Mechanical Alignment\n References\n29: Kinematic Alignment in Total Knee Arthroplasty\n 29.1 Introduction\n 29.2 Kinematic Alignment\n 29.2.1 Biomechanical Rational for Kinematic Alignment\n 29.2.2 Concept of Kinematic Alignment\n 29.3 Surgical Technique\n 29.3.1 Tibia First Vs. Femur First Technique for KA TKA\n 29.3.2 Manual Surgical Technique: Femur First\n 29.3.3 Computer-Assisted Surgical Techniques.\n 29.4 Clinical Evidence Base\n 29.5 Indications and Limitations\n 29.5.1 Constitutional vs. Pathological Alignment and Biomechanical Aspects\n 29.6 Preoperative Planning and Analysis\n 29.7 Prosthetic Design Features for KA TKA\n References\n30: Measured Resection Technique: How Does it Work?\n 30.1 Basics for a Better Understanding\n 30.2 Bone Cuts\n 30.3 Measured Resection Technique\n 30.3.1 Anatomical Landmarks\n 30.3.1.1 Transepicondylar Axis (TEA)\n 30.3.1.2 Posterior Condylar Axis\n 30.3.1.3 Anterior-Posterior Axis\n 30.3.1.4 Akagi Line\n 30.3.1.5 Anterior Tibial Border\n 30.3.2 Bone Cuts\n 30.3.2.1 Tibial Cut\n 30.3.2.2 Femoral Cuts\n Distal Femoral Cut\n 4-in-1 Femoral Cuts (Anterior, Posterior, Oblique)\n 30.3.3 Pros and Cons of the Measured Resection Technique\n References\n31: Ligament Balancing Technique: How Does It Work\n 31.1 Introduction\n 31.2 Surgical Technique\n 31.2.1 Extension Gap First Technique\n 31.2.2 Flexion Gap First\n 31.3 Discussion\n References\n32: Posterior Femoral Referencing in Total Knee Arthroplasty\n 32.1 Introduction\n 32.2 Morphometry of the Distal Femur\n 32.3 Relation of the Posterior Condylar Line to Other Landmarks for Femoral Component Placement\n 32.4 Femoral Component Placement Referenced to the Posterior Condyles\n References\n33: Anterior Femoral Referencing in Total Knee Arthroplasty\n 33.1 Introduction\n 33.2 Principles of Anterior Femoral Referencing in TKA\n 33.3 Surgical Technique of Anterior Femoral Referencing in TKA\n 33.4 Impact of External Femoral Rotation\n 33.5 Typical Clinical Scenarios\n 33.6 Influence of AR on Outcome in TKA\n References\n34: Tibial Component Rotation in Total Knee Arthroplasty\n 34.1 Implications of Component Rotation on Tibiofemoral Kinematics\n 34.1.1 Internal Rotation of the Tibial Component\n 34.1.2 External Rotation of the Tibial Component\n 34.2 Bony Landmarks of the Proximal Tibia\n 34.2.1 Tibial Tuberosity (Fig. 34.1)\n 34.2.2 Posterior Tibial Condylar Axis (Fig. 34.2)\n 34.2.3 Transtibial Axis (Fig. 34.3)\n 34.2.4 Anterior Surface of the Tibia (Fig. 34.4)\n 34.2.5 Patellar Tendon to PCL Axis (Akagi’s Line) (Fig. 34.5)\n 34.2.6 Other Extra-Articular References\n 34.3 Surgical Techniques Used to Determine Rotational Alignment\n 34.3.1 Single Point/Single Axis\n 34.3.2 Range of Motion/Self-Adjustment Method\n 34.3.3 Navigation\n 34.3.4 Symmetric Versus Asymmetric Tibial Baseplates (Fig. 34.6a, b)\n 34.3.5 Rotating Platform TKA\n References\n35: Patient-Specific Instrumentation in TKA\n 35.1 Introduction\n 35.2 Preoperative Considerations\n 35.3 Perioperative Considerations\n 35.4 Postoperative Considerations\n 35.5 Clinical Outcome\n 35.6 Discussion\n References\n36: Patient-Specific Partial and Total Knee Arthroplasty: An Update\n 36.1 Introduction\n 36.2 Patient-Specific UKA\n 36.2.1 Surgical Technique of Patient-Specific Medial UKA\n 36.2.2 Surgical Technique of Patient-Specific Lateral UKA\n 36.3 Bicompartmental Patient-Specific Knee Arthroplasty (BKA)\n 36.3.1 Surgical Technique of Bicompartmental Arthroplasty\n 36.4 Patient-Specific TKA\n 36.4.1 Surgical Technique\n 36.5 Discussion\n References\n37: Navigation in Total Knee Arthroplasty\n 37.1 Introduction\n 37.2 What Is Computer-Assisted Surgery (CAS)?\n 37.3 Basic Concepts of Navigation\n 37.4 Why Navigation (CAS) in TKA?\n 37.5 Why Navigation Is Useful for Young Surgeons?\n 37.6 (CAS) Navigation in TKA: Surgical Technique\n 37.7 The Future of CAS\n References\n38: Optimal Sizing of the Femoral, Tibial, and Patellofemoral Components in TKA\n 38.1 Introduction\n 38.2 Is Oversizing Frequent in TKA?\n 38.3 Does Oversizing Influences Outcomes in TKA?\n 38.4 Why Oversizing Is So Frequent in TKA?\n 38.4.1 Manufacturing Limitations\n 38.4.2 Anatomic Variability\n 38.4.3 Influence of Implants Orientation on Sizing\n 38.5 Why Oversizing Is Painful in TKA?\n References\n39: Optimal Implant Fixation in Knee Arthroplasty: Cemented Versus Cementless Knee Arthroplasty\n 39.1 Introduction\n 39.2 Cemented Fixation\n 39.2.1 Surface Preparation\n 39.2.2 Cementing Technique\n 39.2.3 Cement Type\n 39.2.4 Surface Versus Full Cementation\n 39.2.5 Implant Surface and Design Properties\n 39.2.6 Antibiotic-Loaded Cement\n 39.3 Cementless Fixation\n 39.3.1 Initial Stability and Osteointegration\n 39.3.2 Bearing Type\n 39.3.3 Patient Age\n 39.3.4 Obesity\n 39.3.5 Cementless Patellar Implants\n 39.3.6 Inflammatory Arthritis\n 39.3.7 Hybrid Fixation\n 39.3.8 Surface Coating\n 39.3.8.1 Hydroxyapatite\n 39.3.8.2 Porous Tantalum\n 39.3.8.3 Other Surface Coatings\n 39.3.9 Clinical Outcomes and Survivorship of Cementless TKA\n 39.4 Cemented Unicondylar Knee Arthroplasty\n 39.5 Cementless Unicondylar Knee Arthroplasty\n References\n40: Wound Closure in Total Knee Arthroplasty\n 40.1 Introduction\n 40.2 Risk Factors for Wound Complications\n 40.3 Optimal Wound Closure\n 40.4 Technical Tips and Tricks\n 40.4.1 Closure of the Capsule\n 40.4.2 Closure of Subcutaneous Layer\n 40.4.3 Skin Closure and Wound Dressing\n References\n41: Pros and Cons of Drains for Wound Drainage in Total Knee Arthroplasty\n 41.1 Introduction\n 41.2 Wound Healing, Hematoma\n 41.3 Post-operative Function and Duration of Hospital Stay\n 41.4 Blood Loss and Transfusion Rate\n 41.4.1 Effect of Drain Clamping\n 41.4.2 Use of Tranexamic Acid (TXA)\n 41.4.3 Thromboembolic Events\n 41.4.4 Periprosthetic Joint Infection (PJI)\n References\n42: Pain Management After Total Knee Arthroplasty\n 42.1 Introduction\n 42.2 Preoperative Patient Education\n 42.3 Oral or Parenteral Systemic Analgesia\n 42.3.1 Postoperative Conventional NSAIDs (Nonsteroidal Anti-inflammatory Drugs, ­COX-2-Selective Inhibitors and Paracetamol)\n 42.3.2 Opioids\n 42.3.3 Intravenous Patient-Controlled Analgesia (PCA)\n 42.4 Continuous Epidural Analgesia (CEA)\n 42.5 Peripheral Nerve Blocks (PNB)\n 42.6 Periarticular/Intra-articular Infiltration Analgesia and Continuous Intra-articular Analgesia\n 42.7 Comparison of LIA and PNB and Combining Techniques\n 42.8 Corticosteroids\n 42.9 Gabapentinoids\n References\n43: How to Handle Complications in Unicompartmental Knee Arthroplasty\n 43.1 Introduction\n 43.2 Medial Unicondylar Knee Arthroplasty\n 43.3 Lateral Unicondylar Knee Arthroplasty\n 43.4 Patellofemoral Arthroplasty\n References\n44: How to Handle Complications During TKA?\n 44.1 Introduction\n 44.2 Intraoperative Complications\n 44.2.1 Surgical Approach\n 44.2.2 Exposure of the Knee Joint\n 44.3 Femoral and Tibial Preparation\n 44.3.1 Vascular Injuries\n 44.3.2 Nerve Injuries\n 44.3.3 Ligament Injuries During Preparation of Femur and Tibia\n 44.3.4 Periprosthetic Fractures\n 44.4 Insertion of Implants and Wound Closure\n 44.4.1 Cementing with Use of a Tourniquet\n 44.4.2 The Final Steps\n References\n45: Deformity Correction in Total Knee Arthroplasty\n 45.1 Introduction\n 45.2 Surgical Planning\n 45.3 Varus Deformity\n 45.3.1 Surgical Technique for Varus Deformity\n 45.3.2 Knee Deformity of Less Than 10°\n 45.3.3 Knee Deformity Between 10° and 20°\n 45.3.4 Knee Deformity of over 20°\n 45.4 Valgus Deformity\n 45.4.1 Surgical Technique for Valgus Knees\n 45.5 Flexion Deformity\n 45.6 Hyperextension Deformity\n 45.6.1 Pathoanatomy\n 45.6.2 Surgical Technique\n 45.6.3 Computer-Assisted and Robotic-Assisted Technique\n References\n46: Total Knee Arthroplasty for Fracture Treatment\n 46.1 Introduction\n 46.2 AO-Classification\n 46.3 Indication for Total Knee Arthroplasty\n 46.4 Distal Femoral Fracture\n 46.5 Proximal Tibial Fracture\n 46.6 Outcome\n References\n47: Thromboembolic Prophylaxis After Partial or Total Knee Arthroplasty\n 47.1 Introduction\n 47.2 Mechanical VTE Prophylaxis\n 47.3 Pharmacologic VTE Prophylaxis\n 47.3.1 Warfarin\n 47.3.2 Low-Molecular-Weight Heparin\n 47.3.3 Aspirin\n 47.3.4 Rivaroxaban\n 47.3.5 Dabigatran\n 47.3.6 Apixaban\n References\n48: How to Avoid Typical Complications After Total Knee Arthroplasty?\n 48.1 Introduction\n 48.2 Arthrofibrosis\n 48.3 Nerve Injuries\n 48.4 Vascular Injuries\n References\n49: Infection Prophylaxis in TKA\n 49.1 Preoperative Risk Factors\n 49.1.1 Diabetes Mellitus\n 49.1.2 Nutritional Deficiencies\n 49.1.3 Obesity\n 49.1.4 Smoking\n 49.1.5 Inflammatory Arthritis\n 49.1.6 MSSA and MRSA Colonization\n 49.2 Intraoperative Prevention of Infection\n 49.2.1 Skin Preparation and Draping\n 49.2.2 Surgical Gloves and Gowns\n 49.2.3 Antimicrobials\n 49.2.4 Operating Room Traffic\n 49.2.5 Wound Irrigation\n 49.2.6 Wound Closure and Dressings\n 49.2.7 Longer Surgical Time\n 49.3 Postoperative Risk Factors\n 49.3.1 Indwelling Catheters\n 49.3.2 Closed Suction Drains\n 49.3.3 Blood Transfusions\n 49.3.4 Dental Procedures\n References\n50: Rehabilitation After Total Knee Arthroplasty\n 50.1 Introduction\n 50.1.1 Patients’ Individual Goals After TKA\n 50.1.2 Treatment Evaluation\n 50.2 Preoperative Treatments and Exercises\n 50.3 Postoperative Treatment and Exercises\n 50.3.1 Multimodal Rehabilitation Programs\n 50.3.2 Active Physical Therapy Programs\n 50.3.3 Continuous Passive Motion\n 50.3.4 Cryotherapy\n 50.3.5 Ergometer Cycling\n 50.3.6 Manual Lymphatic Drainage\n 50.3.7 Neuromuscular Electrical Stimulation\n 50.4 Additional Measures\n 50.5 Rehabilitation Programs\n 50.5.1 Standard Rehabilitation Program\n 50.5.2 Fast-Track Program\n References\n51: How to Assess Outcome After Partial or Total Knee Arthroplasty—Measuring Results that Really Matter!\n 51.1 Health Outcome Measurement\n 51.2 Outcomes of Interest\n 51.3 Current Strategies for Standardization\n 51.3.1 Core Outcome Set (COS)\n 51.3.2 ICHOM Standard Set\n 51.3.3 What Outcomes Should Be Considered?\n 51.3.4 Traditional Outcomes\n 51.3.5 Clinician-Based Outcomes\n 51.4 Range of Motion (ROM)\n 51.5 Joint Stability\n 51.6 Imaging\n 51.7 Patient-Reported Outcomes\n 51.7.1 Generic PROMs\n 51.7.2 Short Form 36 Health Survey (SF-36)\n 51.7.3 Short Form 12 Health Survey (SF-12)\n 51.7.4 European Quality of Life (EuroQoL EQ-5D)\n 51.7.5 Disease-Specific PROM\n 51.7.6 Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC)\n 51.7.7 Oxford Knee Score (OKS)\n 51.7.8 Knee Injury and Osteoarthritis Outcome Score (KOOS)\n 51.7.9 Knee Society Clinical Rating System (KSS)\n 51.7.10 University of California at Los Angeles (UCLA) Activity Rating Scale\n 51.8 Single-Item Satisfaction Outcome Measure\n 51.9 Expectations and Their Fulfillment\n 51.10 New Developments\n 51.11 Performance-Based Outcomes\n 51.11.1 The 30-s Chair-Stand Test (30s CST)\n 51.11.2 The 40-m Fast-Paced Walk Test (40m FPWT)\n 51.11.3 Stair-Climbing Test (x-step SCT)\n 51.11.4 The Six-Minute Walk Test (6MWT)\n 51.11.5 The Timed Up-and-Go Test (TUG)\n 51.12 Activity Measurement\n 51.13 Measurement Properties and Practical Issues\n 51.13.1 Consensus-Based Measurement Properties\n 51.13.2 Practical Issues\n 51.14 Interpretation of Outcomes\n References\n52: Function After Unicondylar Knee Arthroplasty—What Could You Expect?\n 52.1 Introduction\n 52.2 Range of Motion\n 52.3 Return to Sports\n 52.4 Patient-Reported Outcome\n 52.5 Gait Analysis\n 52.6 Limitations\n 52.7 Author’s Investigations\n References\n53: Outcome After Total Knee Arthroplasty—What Can Be Expected?\n 53.1 Introduction\n 53.2 How to Define a ‘Successful’ TKA?\n 53.3 Relation Between Functional Abilities and Expectations After Knee Replacement?\n 53.4 Are ‘Young’ Patients a Specific Group When Managing Expectations?\n 53.5 Defining the Reasons for Dissatisfaction\n 53.6 Indication Criteria for Surgery?\n 53.7 How to Increase Patient Expectations and Improve Outcome?\n References\n54: Function After Small Knee Implants\n 54.1 Introduction\n 54.2 Unicompartmental Knee Arthroplasty\n 54.3 Patellofemoral Arthroplasty\n 54.4 Bicompartmental Knee Arthroplasty\n 54.5 What is the Functional Outcome?\n 54.6 Functional Outcome After UKA\n 54.6.1 Influence of Type of Implant on Functional Outcome\n 54.6.2 Influence of Component Alignment on Functional Outcome\n 54.6.3 Influence of Patient Factors on Functional Outcome\n 54.6.3.1 Patient Characteristics in the Preoperative Period\n 54.6.3.2 Patient Characteristics in the Postoperative Period\n 54.7 Influence of Type of Rehabilitation on Functional Outcome\n 54.8 Lateral UKA\n 54.9 Functional Outcome After Patellofemoral Arthroplasty\n 54.10 Functional Outcome After Bicompartmental Knee Arthroplasty\n References\n55: Sports After Partial or Total Knee Arthroplasty\n 55.1 Introduction\n 55.2 Sports After Partial Knee Arthroplasty\n 55.3 Sports After Total Knee Arthroplasty\n 55.4 Comparison Partial Versus Total Knee Arthroplasty\n 55.5 Concerns of Sports Activity in Patients Following UKA/ TKA\n 55.6 Recommendations\n References\n56: The Immune Response to Metal in Total Knee Arthroplasty\n 56.1 Introduction\n 56.2 Prevalence of Type I Hypersensitivity to Metals\n 56.3 Mechanism of Metal Sensitivity\n 56.3.1 The Immunological Basis of Allergy\n 56.3.2 The Immunology of Type IV Hypersensitivity\n 56.4 Diagnostics\n 56.4.1 Patch Test\n 56.4.2 Tests for Metal Hypersensitivity\n 56.4.2.1 Lymphocyte Transformation Test\n 56.4.2.2 Modified Lymphocyte Stimulation Test (mLST)\n 56.4.2.3 Leucocyte Migration Inhibition Test\n 56.4.2.4 Other Investigations\n 56.5 Clinical Presentation\n 56.6 Alternative Implants\n References\n57: Does Digital Support Influence Outcome After Total Knee Arthroplasty?\n 57.1 Introduction\n 57.2 Learning and Teaching CAS-TKA\n 57.3 Pros and Cons of CAS-TKA\n 57.3.1 Blood Loss and Blood Transfusion Requirements\n 57.3.2 Embolism\n 57.3.3 Fractures Around the Pin Sites\n 57.3.4 Costs and Operative Time\n 57.3.5 Effect on Alignment and Component Placement\n 57.3.5.1 Accuracy and Outliers\n 57.3.5.2 Coronal Alignment\n 57.3.5.3 Sagittal Alignment\n 57.3.5.4 Rotational Alignment\n 57.3.6 Joint Line Level, Mediolateral and Sagittal Stability\n 57.4 Clinical Outcomes\n 57.4.1 Long-Term Results\n 57.5 Robotics in TKA\n References\n58: Registries—How Important Are They?\n 58.1 Introduction\n 58.2 History\n 58.3 Geological Aspects\n 58.4 International Associations\n 58.4.1 Nordic Arthroplasty Register Association (NARA)\n 58.4.2 Network of Orthopaedic Registries of Europe (NORE)\n 58.4.3 International Society of Registries (ISAR)\n 58.5 Quality Characteristics of Registries\n 58.6 Data Capturing\n 58.7 Classification of Data\n 58.8 Report of Data\n 58.9 How Should An Optimal Registry Be Performed?\n 58.10 Discussion\n References\n59: Most Common Scores for Patients’ Evaluation\n 59.1 Introduction\n 59.2 Outcome Measures\n 59.2.1 Performance-Based Scores\n 59.2.2 Disease-Specific Scores\n 59.2.2.1 PROM\n Oxford Knee Score (OKS)\n Knee Injury and Osteoarthritis Outcome Score (KOOS)\n Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)\n Hospital for Special Surgery (HSS)\n 59.2.2.2 Hybrid Scores\n Knee Society Clinical Rating System (KSS)\n 59.2.2.3 Generic Scores\n Visual Analogue Scale (Pain)\n EuroQol 5 Dimension Health Outcome Survey (EQ-5D)\n Short Form 36 Health Survey (SF-36)\n Short Form 12 Health Survey (SF-12)\n Veterans RAND 12-Item Health Survey (VR-12)\n 59.3 How to Use Scores in Clinical Practice?\n 59.4 Discussion\n References