Techniques in Revision Hip and Knee Arthroplasty

1st Edition - May 8, 2014
Imprint: Saunders
Author: Giles R Scuderi
Language: English
Hardback ISBN:
9 7 8 - 1 - 4 5 5 7 - 2 3 6 8 - 3
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 3 2 3 6 6 - 6
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 3 1 5 1 0 - 4
eBook ISBN:
9 7 8 - 1 - 4 5 5 7 - 3 7 3 2 - 1

Techniques in Revision Hip and Knee Arthroplasty is the one authoritative volume that gives you an efficient, problem-based approach to revision arthroplasty of both the h… Read more

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Techniques in Revision Hip and Knee Arthroplasty is the one authoritative volume that gives you an efficient, problem-based approach to revision arthroplasty of both the hip and knee. Dr. Giles Scuderi and other leading experts from North America and Western Europe present their favored surgical procedures and post-surgical management strategies in this straightforward, heavily illustrated, video-intensive reference. It’s your one-stop, go-to guide for successful revision surgery for a myriad of complications, such as implant loosening, polyethylene wear, osteolysis, or infection of the hip and knee.

Title of Book
Instructions for online access
Cover image
Title page
Table of Contents
Copyright
Contributors
Preface
Section I. Evaluation of the Painful Total Knee Arthroplasty
Chapter 1. The Economics of Total Hip and Knee Arthroplasty
Introduction
Costs of Total Joint Arthroplasty
Costs of Revision Total Joint Arthroplasty
Implant Cost
New Payment Methodologies
Summary
Chapter 2. History and Physical Examination for the Painful Total Knee Arthroplasty
Algorithm
Introduction
Patient History
General Overview
The Chief Complaint
The Knee History
Past Medical and Surgical History
Medications
Social History
Review of Prior Records
Physical Examination
Outcome Measures
Summary
Chapter 3. Aspiration and Serology Testing
Introduction
Serologic Testing
Acute Postoperative Infection
Chronic Infection
Future Serologic Tests
Synovial Fluid Analysis
Joint Aspiration
Microbiology
Synovial White Blood Cell Count: Acute Postoperative Infection
Chronic Infection
Aspiration and Serology in Special Situations
Inflammatory Arthritis
Crystalline Arthropathy
Unicompartmental Knee Arthroplasty
Future Synovial Fluid Tests
Summary
Chapter 4. Imaging in the Failed Total Knee Arthroplasty
Introduction
Radiographic Assessment
Patellofemoral Evaluation
Loosening
Ligamentous Instability
Wear
Computed Tomography
Magnetic Resonance Imaging
Nuclear Medicine Scans
Bone Scan
Bone/Gallium Imaging
Indium-Labeled Leukocyte Imaging
Fluorodeoxyglucose Positron Emission Tomography
Summary
Chapter 5. An Algorithmic Approach to the Painful Total Knee Arthroplasty
Algorithm
Introduction
Differential Diagnosis
Clinical Evaluation
Physical Examination
Laboratory Tests
Imaging Studies
Treatment
Section II. Surgical Approaches
Chapter 6. Medial Arthrotomy
Chapter Preview
Chapter Synopsis
Important Points
Surgical Pearls
Surgical Pitfalls
Introduction
Indication and Contraindications
Pearl
Surgical Techniques
Patient Preparation
Skin Incision
Pearls
Arthrotomy
Pearls
Removal of the Prosthesis
Pearls
Postoperative Care
Complications
Summary
Chapter 7. Quadriceps Snip
Algorithm
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications
Contraindications
Equipment
Surgical Technique
Complications
Outcomes
Postoperative Care
Summary
Chapter 8. V-Y Quadriceps Turndown
Introduction
Surgical Technique
Rehabilitation
Surgical Outcome
Summary
Chapter 9. Tibial Tubercle Osteotomy
Algorithm
Chapter Preview
Chapter Synopsis
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Complications
Outcomes
Postoperative Care
Summary
Chapter 10. Exposures for Revision Knee Arthroplasty
Case 1: Exposure With a Quadriceps Snip
Case 2: Exposure With a Tibial Tubercle Osteotomy
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Knee Exposure With a Quadriceps Snip
Anatomy and Approaches
Examination and Imaging
Procedure: Revision Knee Exposure With a Quadriceps Snip
Knee Exposure With a Tibial Tubercle Osteotomy
Anatomy and Approaches
Examination and Imaging
Procedure: Tibial Tubercle Osteotomy
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Section III. Implant Removal
Chapter 11. Implant Removal in Revision Total Knee Arthroplasty
Algorithm
Chapter Preview
Chapter Synopsis
Important Points
Surgical Pearls
Surgical Pitfalls
Introduction
Equipment
Surgical Technique
1 Start by Removing the Polyethylene Insert
2 Use a Thin, Flexible Sawblade to Undermine the Anterior Femur
3 Work Around the Distal Femoral Pegs, Box, and Posterior Femur Using Thin Osteotomes
4 Extract the Femoral Component and Assess Femoral Bone Loss
5 Expose the Proximal Tibia Without Damaging the Femoral Bone
6 Use a Thin, Flexible Sawblade to Undermine the Tibial Baseplate
7 Use a Thin Osteotome for the Posterior Area, Especially the Posterolateral Region
8 Use a “Stacked Osteotomes” Technique to Lift the Baseplate Off the Tibial Bone
9 In Case of a Well-Fixed Keel or Stem, Perform a Tibial Tubercle Osteotomy and Work Around the Stem Using Osteotomes
10 Extract the Tibial Component
11 Assess Patellar Thickness, Patellar Button Condition, and Compatibility
12 Use a Thin, Flexible Sawblade to Undermine and Extract the Patellar Component
Summary
Section IV. Principles of Revision Total Knee Arthroplasty
Chapter 12. Principles of Revision Total Knee Arthroplasty
Algorithm
Chapter Preview
Chapter Synopsis
Important Points
Surgical Pearls
Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Instruments
Implants
Surgical Technique
Step 1: The Skin Incision
Step 2: Perform the Arthrotomy
Step 3: Prosthetic Removal
Step 4: The Tibial Platform
Step 5: The Flexion Gap
Step 6: The Extension Gap
Step 7: Ligament Balancing
Step 8: Addressing the Bone Defects
Step 9: Intramedullary Stems
Step 10: The Tibial Polyethylene Insert
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Chapter 13. Revising the Failed Unicompartmental Knee Arthroplasty
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Indications
Contraindications to Revision
Equipment
Anatomy and Approaches
Examination and Imaging
Surgical Procedure
Step 1. Exposure of the Implant
Step 2. Assessment of the Implant and the Knee for Infection
Step 3. Resection In Situ
Femur
Tibia
Step 4. Final Preparation of the Bone Ends
Step 5. Insertion of the Definitive Total Knee Arthroplasty
Controversies
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Section V. Management of the Stiff Knee
Chapter 14. Manipulation
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Anatomy and Approaches
Examination and Imaging
Procedure
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Chapter 15. Nonrevision Surgery
Algorithm
Chapter Preview
Introduction
Indications and Contraindications
Manipulation Under Anesthesia
Aggressive Physical Therapy and Bracing
Arthroscopic Lysis of Adhesions
Open Lysis of Adhesions
Revision Surgery
Surgical Techniques
Manipulation Under Anesthesia
Arthroscopic Lysis of Adhesions
Open Lysis of Adhesions
Complications
Manipulation Under Anesthesia
Arthroscopic Lysis of Adhesions
Open Lysis of Adhesions
Outcomes
Manipulation Under Anesthesia
Arthroscopic Lysis of Adhesions
Open Lysis of Adhesions
Postoperative Care
Summary
Future Considerations
Chapter 16. Revision Total Knee Arthroplasty
Chapter Preview
Introduction
Causes
Evaluation
Indications and Contraindications
Surgical Technique
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Section VI. Management of Instability
Chapter 17. Balancing the Gaps
Algorithm
Introduction
Surgical Concepts
Tibial Reconstruction
Femoral Reconstruction
Gap Balancing
Role of Constraint
Summary
Chapter 18. Use of Constrained Implants
Algorithm
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Chapter 19. Management of Knee Instability: Use of Hinged Implants
Algorithm
Chapter Preview
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Step 1: Exposure
Step 2: Prosthesis and Hardware Removal
Step 3: Débridement of Bone and Soft Tissues
Step 4: Assessment of Bone Stock
Step 5: Assessment of Ligamentous Competence
Step 6: Implant Selection
Step 7: Preparation of Bone Stock for Prosthesis Implantation
Step 8: Assess and Balance Flexion and Extension Gaps
Step 9: Assess Patellar Tracking
Step 10: Implantation
Step 11: Closure
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Section VII. Management of Bone Defects
Chapter 20. Classification of Bone Defects
Introduction
Preoperative Assessment
Bone Loss Classification
Bone Loss Management
AORI Type I Defects
AORI Type II Defects
AORI Type III Defects
Summary
Chapter 21. Management of Bone Defects Using Bone Graft
Algorithm
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indication and Contraindications
Equipment
Surgical Techniques
Small Contained Bone Defects
Large Bone Defects
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Chapter 22. Bone Graft
22A Impaction Bone Grafting
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Surgical Technique
Rationale
Rationale for Morselized Allograft in Bone Defects
Exposure
Bone Preparation
Component Sizing and Positioning
Prosthesis Insertion and Fixation
Bone Grafting Procedure
Outcomes
Summary
Future Considerations
22B Structural Bone Grafting
Algorithm
Chapter Preview
Chapter Synopsis
Important Points
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Anatomy and Approaches
Technical Aspects
Complications
Outcomes
Postoperative Care
Summary
Chapter 23. Prosthetic Augmentation
23A Metaphyseal Fixation
Introduction
Classification of Bone Loss and Reconstructive Options
Relative Indications and Contraindications
Surgical Technique
Bone Preparation and Metaphyseal Fixation Device Placement (Video 23A.I)
Complications
Postoperative Care
Case Examples
Case 1: Type IIB Tibial Defect and Type IIB Femoral Defect
Case 2: Type III Tibial Defect and Type III Femoral Defect
Outcomes
Summary
23B Case Presentation: Knee Megaprosthesis
Introduction
Surgical Technique
Clinical Results
Section VIII. Management of the Extensor Mechanism
Chapter 24. Patella Instability
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Clinical Presentation and Indications for Surgery
Equipment
Preoperative Planning
Anatomy and Approaches
Examination and Imaging
Physical Examination
Imaging
Surgical Procedure
Patella Instability
Limb Alignment
Postoperative Q Angle
Patellofemoral Offset
Soft Tissue Imbalance
Controversies
Tibial Tubercle Osteotomy
Mobile-Bearing Total Knee Arthroplasty Designs
Complications
Recurrent Instability
Avascular Necrosis of the Patella
Tibial Tubercle Osteotomy Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Chapter 25. Patellar Component Loosening
Algorithm
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Complications
Outcomes
Postoperative Care
Summary
Chapter 26. Patellar Bone Loss
26A Patellar Bone Grafting
Case 1
Case 2
Case 3
Chapter Preview
Introduction
Indications and Contraindications
Preoperative Evaluation
Surgical Techniques
Complications
Outcomes
Pearls and Pitfalls
Postoperative Care
Summary
26B Management of Patellar Bone Loss: Patella Augmentation
Introduction
Indications and Contraindications
Equipment
Surgical Technique
Step 1. Size Selection and Bone Preparation
Step 2. Trialing
Step 3. Securing the Augment
Step 4: Cementing
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Chapter 27. Acute and Chronic Patellar Tendon Ruptures After Total Knee Arthroplasty
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Indications
Contraindications
Physical Examination and Imaging
Allograft Options
Procedure for Extensor Mechanism Reconstruction (Video 27.1)
Examination of the Allograft
Anatomy and Exposure
Preparation of the Allograft
Preparation of the Host Tibia
Preparation of the Proximal Portion of the Allograft and Host
Closure
Postoperative Care
Outcomes
Summary
Chapter 28. Acute and Chronic Quadriceps Tendon Ruptures After Total Knee Arthroplasty
Chapter Preview
Introduction
Surgical Repair of Acute Rupture of the Quadriceps Tendon
Equipment
Surgical Technique
Surgical Tips
Postoperative Care
Surgical Repair of Chronic Rupture of the Quadriceps Tendon
Equipment
Surgical Technique
The Graft
The Procedure
Surgical Tips
Postoperative Care
Complications
Outcomes
Chapter 29. Periprosthetic Fractures
29A Classification of Periprosthetic Femur Fractures Occurring With Total Knee Arthroplasty
Introduction
Classification
29B Classification of Periprosthetic Tibial Fractures Occurring With Total Knee Arthroplasty
Introduction
Classification
29C Periprosthetic Fractures: Treatment Options After Total Knee Arthroplasty
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Femur Fractures
Tibia
Patella
Treatment Options: Fixation With a Locking Plate
Equipment
Surgical Technique
Anatomy
Imaging
Procedure
Controversies
Postoperative Care
Section IX. Management of Periprosthetic Fractures
Chapter 30. Periprosthetic Fractures Associated With Total Knee Arthroplasty
Algorithm
Chapter Preview
Chapter Synopsis
Key Points, Pearls, and Pitfalls
Introduction
Indications and Contraindications
Preoperative Considerations
Equipment
Surgical Technique
Set-up
Surgical Approaches
Femur
Tibia
Treatment Options
Femur
Tibia
Patella
Complications
Outcomes
Postoperative Care
Summary
Chapter 31. Classification and Treatment of Patella Fractures
Algorithm
Chapter Preview
Surgical Pearls and Pitfalls
Introduction
Indications and Contraindications
Examination and Imaging
Equipment
Surgical Techniques
Anatomy and Approaches
Open Reduction and Internal Fixation
Wiring Techniques
Partial Patellectomy
Total Patellectomy
Revision of the Patellar Component
Controversies
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Section X. Management of the Infected Total Knee Arthroplasty
Chapter 32. Overview of the Microbiology
Introduction
Biofilm
Organism Profile
Emergence of Antibiotic Resistance
Classification
Microbiologic Management of Periprosthetic Joint Infection
Conclusion
Chapter 33. Two-Stage Revision
33A Articulating Spacer in Two-Stage Revisions
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Examination and Imaging
Anatomy and Approaches
Surgical Procedure
Step 1. Removal of Insert
Step 2. Femoral Component Removal
Step 3. Tibial Component Removal
Step 4. Patellar Component Removal
Step 5. Débridement and Preservation
Step 6. Assessment of Bone Loss and Component Size
Step 7. Tibial Component Thickness
Step 8. Loading Cement in Molds
Step 9. Débridement Completion and Lavage
Step 10. Inserting Implants
Step 11. Unresurfaced Patella
Step 12. Closure
Controversies
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
33B Static Spacer in Two-Stage Revisions
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Indications
Contraindications
Materials
Cement
Antibiotics
Surgical Techniques
Approach
Canal Preparation
Endoskeleton Preparation
Antibiotic Choice
Cement Preparation
Spacer Construction
Endoskeleton
Cement Block
Soft Tissue Closure
Spacer Removal
Controversies
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Chapter 34. Irrigation and Débridement With Component Retention for Acute Periprosthetic Total Knee Arthroplasty Infections
Chapter Preview
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Chapter 35. One-Stage Revision
Case 1
Case 2
Chapter Preview
Introduction
Indications and Contraindications
Equipment
Surgical Technique
Preoperative Radiologic Planning
Anatomy and Approach
Procedure
Complications and Revisions
Outcomes
Postoperative Care
Summary
Future Considerations
Section XI. Wound Complications
Chapter 36. Wound Management
Chapter Preview
Introduction
Indications and Contraindications
Multiple Prior Skin Incisions
Prior Burns, Irradiation, or “Road Rash” Abrasions About the Knee
Prior Soft Tissue Flaps
Postoperative Wound Ischemia and Soft Tissue Necrosis
Postoperative Wound Drainage and Hematoma
Surgical Techniques
Anatomy and Approaches
Procedure
Controversies
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Chapter 37. Soft Tissue Coverage
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Anatomy
Examination and Imaging
Procedures
Anterolateral Fasciocutaneous Perforator Thigh Flap
Medial or Lateral Gastrocnemius Rotational Muscle Flaps
Free Muscle Flaps
Controversies
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Section XII. Preoperative Evaluation of the Failed Total Hip Arthroplasty
Chapter 38. Evaluation of the Failed Total Hip Arthroplasty: History and Physical Examination
Algorithm
Chapter Preview
Introduction
Indication and Contraindications
Equipment
Evaluation Techniques
Step 1. History
Step 2. Physical Examination
Step 3. Plain Radiography
Step 4. Evaluate for Infection
Step 5. Consider Evidence for Common Failure Modes
Step 6. Consider Common Soft Tissue Irritation Diagnoses
Step 7. Consider Extrinsic Sources of Pain
Step 8. Check Markers of Inflammation and Infection
Step 9. Focus on Metal-on-Metal Bearing Surfaces
Step 10. Perform a Bone Scan
Complications
Summary
Future Considerations
Chapter 39. Mechanisms of Failure: Indications for Revision Total Hip Arthroplasty
Chapter Preview
Introduction
Indications for Revision Surgery
Instability
Periprosthetic Infection
Osteolysis and Aseptic Loosening
Periprosthetic Fracture
Adverse Local Tissue Reaction
Failure of Ceramic Bearings
Summary
Future Considerations
Chapter 40. Magnetic Resonance Imaging of the Painful Total Hip Arthroplasty
Introduction
Imaging Techniques
Imaging for Postoperative Complications
Particle Disease
Proliferative Synovitis
Osteolysis
Infection
Fracture
Tendon Injuries
Nerve Impingement
Summary
Chapter 41. Radiographic Evaluation of the Symptomatic Total Hip Arthroplasty
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Introduction
Radiographic Evaluation
Component Position
Radiographic Osseous Changes
Acetabulum
Femur
Special Circumstances: Infection
Radionuclide Imaging
Summary
Section XIII. Assessment of Bone Loss
Chapter 42. Acetabular Bone Loss: Case Presentations
Case 1
Case 2
Case 3
Introduction
Indications for Revision
Surgical Techniques
Postoperative Care
Summary
Chapter 43. Acetabular Bone Loss Classification
Introduction
Indications for Revision
Imaging
Acetabular Bone Loss Classification Systems
Paprosky Classification
American Academy of Orthopaedic Surgeons Classification
Gross Classification
Summary
Chapter 44. Recommended Acetabular Reconstruction Options
Algorithm
Introduction
Surgical Techniques
Liner Exchange With or Without Bone Grafting
Cementless Components
Cementless Component With Metallic Augmentation
Cementless Acetabular Component With a Bulk Structural Allograft
Impaction Grafting
Acetabular Cage and Cup–Cage Constructs
Summary
Chapter 45. Surgical Techniques: Socket Removal
Introduction
Indications and Contraindications
Surgical Techniques
Approach
Cemented Acetabular Component
Cementless Acetabular Components
Outcomes
Summary
Section XIV. Femoral Bone Loss
Chapter 46. Femoral Bone Loss Classification
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indication and Contraindications
Imaging and Templating
Imaging
Templating
Classification Systems
Chandler and Penenberg
Endo-Klinik
Engh and Glassman
Paprosky
Mallory
Gross
American Academy of Orthopaedic Surgeons Committee on the Hip
Controversies
Summary
Future Considerations
Chapter 47. Femoral Component Removal
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Approach
Examination and Imaging
Procedure
Controversies
Complications
Postoperative Care
Summary
Chapter 48. Femoral Reconstruction Options in Revision Hip Arthroplasty
Algorithm
Introduction
Indications for Revision
Classification of Femoral Bone Loss
Paprosky Classification
Surgical Techniques
Cemented Fixation
Proximally Porous-Coated Stems
Extensively Porous-Coated, Cylindrical Stems
Fluted, Tapered Stems
Impaction Bone Grafting and Cemented Fixation
Allograft-Prosthetic Composites
Proximal Femoral Replacement
Our Preferred Technique
Summary
Section XV. Surgical Approaches
Chapter 49. Posterolateral Approach to the Hip
Chapter Preview
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Surgical Technique
Complications
Postoperative Care
Summary
Chapter 50. Direct Lateral Approach to the Hip
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Technique
Anatomy
Procedure
Postoperative Care
Complications and Outcomes
Summary
Chapter 51. Direct Anterior Approach to Revision Total Hip Arthroplasty
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Technique
Preoperative Planning
Anatomy and Approach
Procedure
Acetabular Reconstruction
Femoral Reconstruction
Closure
Complications
Postoperative Care
Summary
Future Considerations
Chapter 52. Extended Trochanteric Osteotomy for Femoral Revision
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Technique
Complications
Outcomes
Postoperative Care
Summary
Chapter 53. Exposure for Revision Total Hip Arthroplasty
Case 1: Extended Trochanteric Osteotomy
Extended Trochanteric Osteotomy
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Anatomy and Approaches
Examination and Imaging
Procedure
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Case 2: Anterolateral Approach with a Cortical Window
Anterolateral Approach With a Cortical Window
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Anatomy and Approaches
Examination and Imaging
Procedure
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Section XVI. The Acetabulum
Chapter 54. Management of Cavitary Defects
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Anatomy and Approaches
Examination and Imaging
Procedure
Step 1. Acetabular Exposure and Evaluation
Step 2. Reaming the Acetabulum
Step 3. Impaction of the Acetabular Component
Controversies
Complications
Postoperative Care
Summary
Future Considerations
Chapter 55. Management of Segmental and Column Defects
Case 1
Case 2
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Equipment
Surgical Techniques
Method
Procedure
Step 1. Approach
Step 2. Evaluation of the Acetabular Cavity
Step 3. Assessment of the Defect
Step 4. Acetabular Reaming Before Implantation
Step 5. Fixation
Complications
Postoperative Care
Chapter 56. Management of Protrusio Defects
Case 1
Case 2
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Anatomy and Approaches
Examination and Imaging
Procedure
Step 1. Approach
Step 2. Acetabular Cavity Assessment
Step 3. Defect Repair
Step 4. Component Implantation
Complications
Postoperative Care
Summary
Future Considerations
Chapter 57. Landmarks to Determine the Anatomic Hip Center of Rotation
Introduction
Surgical Technique
Goals of Acetabular Placement
Planning and Landmark Identification
Summary
Chapter 58. Acetabular Reconstruction With a Jumbo Socket
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Technique
Examination and Imaging
Procedure
Step 1. Positioning and Set-up
Step 2. Incision and Approach
Step 3. Implant Extraction
Step 4. Classification of Defect
Step 5. Landmarks and Reaming
Step 6. Trialing
Step 7. Acetabular Placement and Liner
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Chapter 59. Acetabular Reconstruction
59A Options for Acetabular Revision
Algorithm
Introduction
Surgical Techniques
Examination and Imaging
Anatomy and Approaches
Anterolateral Approach
Acetabular Exposure
Closure
Complications
Postoperative Care
59B Surgical Techniques: Metal Augments
Algorithm
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Evaluation for Plating
Augments
Acetabular Reconstruction
Outcomes
Summary
Future Considerations
Section XVII. Revision of The Femur
Chapter 60. Cemented Femoral Revision in Total Hip Arthroplasty
Case 1: Cemented Femoral Revision
Case 2: Cement-In-Cement Technique
Case 3: Impaction Allografting
Algorithm
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Technique: Removal of Well-Fixed Implants
Technique: Cemented Femoral Revision
Technique: Cement-in-Cement Revision
Technique: Impaction Allografting
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Section XVIII. Modular Cementless Fixation
Chapter 61. Femoral Revision Arthroplasty With a Modular Cementless Prosthesis
Case 1
Case 2
Case 3
Introduction
Indications and Contraindications
Equipment
Outcomes
Short-Term Results
Long-Term Results
Complications
Summary
Chapter 62. Proximal Porous-Coated Modular Stems: Surgical Technique
Introduction
Equipment
Stem Options
Sleeve Sizes
Surgical Technique
Preoperative Planning (Box 62.1)
Approach
Removal of the Femoral Component
Femoral Preparation
Distal Reaming
Proximal Reaming
Milling for the Spout
Sleeve and Stem Trialing
Final Sleeve and Stem Insertion
Femoral Head Assembly and Reduction
Postoperative Care
Summary
Section XIX. Management of Femoral Bone Loss in Revision Total Hip Arthroplasty
Chapter 63. Case Presentations: Extensively Porous-Coated, Cylindrical Stems
Case 1
Case 2
Chapter 64. Surgical Techniques: Extensively Porous-Coated, Cylindrical Stems
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Anatomy and Approaches
Examination and Imaging
Procedure
Controversies
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Chapter 65. Modular, Fluted, Tapered, Grit-Blasted Titanium Stems for Femoral Revision
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Anatomy and Approaches
Preoperative Planning
Positioning
Surgical Exposure
Procedure
Step 1. Exposure and Removal of Previous Components
Step 2. Evaluation of Bone Defects
Step 3. Preparation of the Area of Primary Fixation
Step 4. Trials and Preparation of Proximal Femur
Step 5. Implant Insertion and Closure
Controversies
Complications
Outcomes
Postoperative Care
Summary
Future Considerations
Chapter 66. Megaprosthesis of the Hip
Introduction
Indications and Contraindications
Equipment
Surgical Technique
Anatomy and Approach
Examination and Imaging
Procedure
Complications
Outcomes
Postoperative Care
Summary
Section XX. Special Considerations
Chapter 67. Conversion of Prior Surgery to Total Hip Arthroplasty
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Preoperative Planning
Approaches
Acetabular Reconstruction
Femoral Reconstruction: Childhood Osteotomy or Hip Dysplasia
Femoral Reconstruction: Failed Treatment of Hip Fracture
Femoral Reconstruction: Hip Fusion Takedown
Assessing Hip Function and Leg Length Discrepancies
Postoperative Care
Outcomes
Prior Osteotomy
Failed Fixation of a Hip Fracture
Conversion of Hip Arthrodesis
Summary
Chapter 68. Instability After Total Hip Arthroplasty
Chapter Preview
Chapter Synopsis
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Algorithm
Introduction
Indications and Contraindications
Surgical Technique
Postoperative Care
Summary
Chapter 69. Management of Wear and Osteolysis
Algorithms
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Preoperative Considerations
Femoral Treatment
Acetabular Treatment
Equipment
Surgical Techniques
Anatomy and Approaches
Examination and Imaging
Procedure
Outcomes
Postoperative Care
Summary and Future Considerations
Chapter 70. Management of Thigh Pain in Cementless Arthroplasty
Introduction
Indications and Contraindications
Equipment
Surgical Techniques
Anatomy and Approaches
Examination and Imaging
Procedure
Step 1. Exposure
Step 2. Graft Placement
Step 3. Securing the Graft
Step 4. Closure
Controversies
Complications
Outcomes
Summary
Future Considerations
Chapter 71. Periprosthetic Femoral Fractures Associated With Total Hip Arthroplasty
Algorithms
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications and Contraindications
Equipment
Surgical Technique
Preoperative Considerations
Exposure
Fracture-Specific Care
Vancouver Type A Fracture
Vancouver Type B1 Fracture
Vancouver Type B2 or B3 Fracture
Vancouver Type C Fracture
Complications
Outcomes
Postoperative Care
Summary
Chapter 72. Revision Arthroplasty for Periprosthetic Femoral Fracture
Introduction
Surgical Technique
Examination and Imaging
Preoperative Planning
Step 1. Prophylactic Cable
Step 2. Proximal Exposure
Step 3. Acetabular Assessment
Step 4. Femoral Preparation
Step 5. Proximal Preparation: Intact Segment
Step 6. Proximal Preparation: Fractured Segment or Femoral Window
Step 7. Femoral Version
Step 8. Stability of the Proximal Femur
Procedure
Acetabular Side
Femoral Side
Postoperative Care
Outcomes
Fracture
Fracture Union
Subsidence and Loosening
Dislocation
Chapter 73. Revision of Articular Bearing Complications
73A Revision of Metal-on-Metal Bearing Surfaces in Hip Arthroplasty
Chapter Preview
Chapter Synopsis
Important Points
Clinical/Surgical Pearls
Clinical/Surgical Pitfalls
Introduction
Indications for Revision
Malpositioning, Fractures, and Loosening
Adverse Reactions to Metal Debris
Examination and Imaging
Surgical Technique
Complications
Outcomes
Postoperative Care
Summary
73B Ceramic-on-Ceramic Bearing Surfaces
Introduction
Ceramic-on-Ceramic Squeaking
Mechanisms and Indications
Surgical Technique
Outcomes
Ceramic Bearing Surface Fracture
Mechanisms and Indications
Surgical Technique
Outcomes
Summary
Section XXI. Management of the Infected Total Hip Arthroplasty
Chapter 74. History and Diagnostic Testing
Introduction
Examination and Imaging
Outpatient Laboratory Data
Radiologic Studies
Intraoperative and Perioperative Data
Diagnostic Criteria
Summary
Chapter 75. Single-Stage Revision Total Hip Arthroplasty
Case 1: Permanent Temporary Spacer
Case 2: Early Single-Stage Revision
Algorithm
Introduction
Indications and Contraindications
Classification of Periprosthetic Infection
Examination and Imaging
Surgical Technique
Preoperative Planning
Approach
Procedure
Intraoperative Testing and Débridement
Reconstruction
Postoperative Care
Outcomes
Summary
Chapter 76. Two-Stage Revision Total Hip Arthroplasty
Introduction
Indications and Contraindications
Equipment and Personnel
Surgical Technique
Component Removal and Débridement
Cement Spacer
Antibiotic Treatment and Laboratory Monitoring
Second-Stage Reconstruction
Postoperative Care
Outcomes
Summary
Index

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Techniques in Revision Hip and Knee Arthroplasty

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Giles R Scuderi

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