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Erik Hansen · Klaus-Dieter Kühn Eds.
Essentials
of Cemented
Knee Arthroplasty
Essentials of Cemented Knee Arthroplasty
Erik Hansen • Klaus-Dieter Kühn
Editors
Essentials
of Cemented Knee
Arthroplasty
With forewords from Michael D.Ries (University of California, San
Francisco) and Patrick Sadoghi (Medical University of Graz, Austria)
Editors
Erik Hansen
Department of Orthopaedic Surgery
University of California San Francisco UCSF
San Francisco, CA
USA
Klaus-Dieter Kühn
Department of Orthopedic Surgery
Medical University of Graz
Graz, Austria
ISBN 978-3-662-63112-6 ISBN 978-3-662-63113-3 (eBook)
https://doi.org/10.1007/978-3-662-63113-3
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer-Verlag GmbH, DE,
part of Springer Nature 2022
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the
whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or
information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in
published maps and institutional afliations.
Cover illustration © Left gure: Hansen E., Kühn K.D.Essentials of cemented Knee Arthroplasty (2022).
Chapter 28 Zaid M.B., Vail T.P.Posterior Stabilized Total Knee Arthroplasty. Fig.28.2 left / Right gure ©
Heraeus Medical GmbH.
This Springer imprint is published by the registered company Springer-Verlag GmbH, DE part of Springer
Nature.
The registered company address is: Heidelberger Platz 3, 14197 Berlin, Germany
V
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Foreword
The nal surgical treatment of end-stage osteoarthritis (OA) of the knee joint is total
knee arthroplasty (TKA), with over 1 million cases performed annually worldwide,
including over 15.000 cases per year in Austria, and more than 350 of these implanted
by the Division of Knee Surgery at the Department of Orthopaedics and Trauma at
the Medical University of Graz.
Contemporary TKA has substantially evolved over the past 130 years, since the rst
prosthesis was implanted early in 1890 by Themistocles Gluck in a 17-year-old female
suffering from a tuberculous knee joint. The prosthesis was made of ivory in a hinged
design as Gluck was the rst surgeon who additionally experimented with bone cement
including copper amalgam, plaster of Paris, and stone putty, which hardened rapidly
after mixing. Whilst many of Gluck´s devices ultimately failed because of chronic
infection, we have to admit that today, 130 years later, we still face the same obstacles,
namely the best materials producing the lowest wear, the ideal alignment and biomechanics, the cementation technique (Gluck favoured osseointegration although his
implants could be well xed with “cement” alone), and the treatment of early or late
infection after TKA.
130 years later, we still face equal challenges such as revision surgery after failed
TKA (Gluck´s ivory prosthesis had to be removed), the adequate management of postoperative complications (some of his cases ended in stula formation), selection of the
ideal patient for surgery (Gluck already recognized outcome of surgeries after previous
infections) and improvement of rehabilitation or even fast-track approaches. All these
aspects are still in the focus of research worldwide, and various projects are currently
performed at our department in Graz, Austria.
In addition, various new technologies emerged over the past decades, such as robotics, patient-specic instrumentation, preoperative planning and computer-assisted surgery, which had signicant impact with respect to accuracy and reproducibility of our
results as knee surgeons. However, various level II studies performed at our own institution did not reveal signicant clinical benets for our patients operated on by highvolume surgeons and have, therefore, not been implemented in our daily practice.
In 2020, our approach in Graz consisted of systematic preoperative and postoperative patients´ assessment (including 100% of the assessed patients in level IV studies
and approx. 75% of the assessed patients in level II studies); a totally cemented, xed
TKA design using a cobalt-chromium-molybdenum (CoCrMo) alloy with or without
titanium-nitride coating; surgical helmet systems; an extension gap rst technique with
conventional (mechanical) or kinematic alignment; and patient-specic instrumentation in case of intramedullary pathologies.
We can be excited regarding the future of TKA and I sincerely hope that this book
feeds your interest on this ongoing scientic eld.
PatrickSadoghi
Medical University of Graz
Graz, Austria
Foreword
https://t.me/medicina_free
It is with great pleasure that I write the foreword to Essentials of Cemented Knee
Arthroplasty, edited by Erik Hansen and Klaus-Dieter Kühn. The US and European
editors have done a remarkable job of assembling international experts in the eld to
contribute timely and well-written chapters on a topic which is considered the “gold
standard” for total knee arthroplasty, but has evolved and developed over the past 50
years.
Cemented total knee arthroplasty remains one of the most clinically successful,
cost-effective treatments for degenerative or inammatory arthritis of the knee. It is
anticipated that the volume of procedures performed in the coming decades will grow
signicantly. However, even a small proportion of replacements which do not meet
expectations suggest that there is still room for improvement in the outcome of this
procedure for a substantial number of patients.
Essentials of Cemented Knee Arthroplasty is a very comprehensive “one-stop-shop”
book. It includes separate parts dedicated to surgical indications, surgical techniques,
clinical outcomes, partial and total knee implant options, implant design, and
PMMA.It goes further to discuss complications and management of failed total knee
arthroplasty. Other topics covering healthcare economics and new technology which
may inuence the future role of total knee arthroplasty have been included. In short,
there are few texts which are as all-encompassing and written by such a collection of
international experts.
There is a strong focus on the subject of polymethylmethacrylate (PMMA) with
many chapters highlighting tips and tricks of using bone cement during surgery. There
are also numerous chapters dedicated to related topics, including the pros and cons of
antibiotic-loaded bone cement (ALBC), antibiotic cement spacers for treatment of
periprosthetic joint infection, and use of bone cement in revision total knee arthroplasty.
While there are many textbooks focused on knee arthroplasty, what makes this textbook really standout is the compilation of international authors and perspectives on
the subject matter of knee arthroplasty. A quick preview of the Table of Contents
reveals novel contributions from international experts from all the major continents.
These varied perspectives add depth to the subject matter and makes the messages all
the more “universal”.
MichaelD.Ries
University of California, San Francisco
San Francisco, CA, USA
VII
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Preface
Who would’ve or could’ve imagined how different the world would be when we rst
embarked on this project over a year ago? Upon reection, a couple of things truly
stand out to me. For one, the COVID pandemic has reinforced that we are truly an
interconnected global community, whether it be in relation to the spread of the virus or,
more importantly, the concerted international effort to develop effective treatment
strategies including vaccines. Parallels can be drawn with the scope of this textbook.
We set out to draw together the world experts in the eld of knee arthroplasty, both
because we saw value in including the varied perspectives of individual authors from all
the major continents, but we also wanted a text that was relevant to the practice of knee
replacement surgery throughout the globe.
Additionally, the last several months have only reinforced the importance of reliance
on sound science and an evidence-based approach rather than personal opinion. Each of
the chapters included in this textbook is heavily referenced with the most relevant,
recent literature to ensure that the readers are provided accurate up-to-date information. As with the development of any novel therapeutics to prevent or treat the Corona
virus, there will undoubtedly be varied approaches and strategies. Similarly, in the eld
of knee arthroplasty, there are numerous philosophical differences in surgical techniques and optimal implant design, and we wanted to be inclusive of these important
differences. We included a part on healthcare economics to recognize that the practice
of medicine cannot be divorced from the larger issues of access, geographical differences, and increasingly constrained healthcare resources. There is also a novel part on
databases to highlight both national and international trends in the utilization of knee
arthroplasty, as well as provide macro-level data to complement other more commonly
used research methodologies. We also believed that incorporating a part on the use of
technology in the eld of arthroplasty was timely and relevant, as it is clear that the
eld is heading towards greater adoption of innovative technological solutions for
many current unsolved problems.
In closing, I want to express my deepest gratitude to my co-editor Professor Kühn,
Barbara Krampitz (the heart and soul of the book), as well as all of the individual
authors who graciously contributed to this textbook. Despite COVID-19’s disruption
to family life, our clinical practices, and social norms in general, you all demonstrated
remarkable resilience and an unwavering commitment to furthering knowledge in the
eld of arthroplasty when you were being simultaneously pulled in numerous disparate
directions. I have been heartened by this international collaborative effort and am
hopeful that the same spirit will get us through this current pandemic.
Humbly and respectfully,
Erik Hansen, MD
University of California, San Francisco
ErikHansen
San Francisco, CA, USA
Acknowledgment
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First of all, I wish to extend my very special thanks to Dr. Barbara Krampitz for the
arduous work associated with the making of this book, especially for all organizing
steps with Erik, contributors, Springer, colleagues, computer specialists, and translators.
Naturally, my special thanks go to all contributors worldwide for providing their
exceptional expertise and knowledge.
I also owe great thanks to Doctor E.Hansen (University of San Francisco (UCFS);
California USA) for his reliable and exceptional cooperation. Erik has supervised most
authors from the USA with greatest professionalism, and our constructive exchange
has been decisive for the success of this book.
Furthermore, I would like to extend my thanks to all who provided scientic help
and fruitful discussions, in particular Christof Berberich, who contributed two chapters (ALBC– discussing fear of resistance; infection risk-adjusted antibiotic prophylaxis strategies in arthroplasty– low-dose single vs. high-dose dual ALBC) and provided
thoughts on the initial table of contents which gave momentum to the book design. I
would also like to thank Lothar Kiontke who provided loads of inspiration as well.
The motivated willingness of Dr. E.Lieb to support this extensive book in every
phase of its creation and exibility besides writing her doctoral thesis was amazing.
She deserves extraordinary thanks. In addition, she has contributed signicantly to the
article Collaboration with Professor Dr. Morlock, University of Hamburg.
Since the book includes various contributions from many different countries, it was
often necessary to contact the authors directly. This would not have been possible without B.Webb (USA), Dr. E.Lieb (F), A.Peyer (SA), M.Zaijer (B, NL), R.Gossens (B),
S.Tye (AUS), Dr. C.Berberich (S), L.Kiontke (USA), S.Chua (SG), T.Furokawa,
C.Hirai, and Y.Sasaki (J), Dr. B.Krampitz (ETH), and I.Martinez Kardeskog (S). A
book of such scope requires the critical review of impartial experts. The main participants we would like to thank are: S.Ubong, P. Vidal, B. Webb, N. Pezic, C. Abt,
D.Kratzmeier, A.Mensendieck, Dr. A.Holl, and O.Vornkahl.
For the correspondence and translation from Japanese, we thank V.Aue (7
alealibris. de) (independent translator Japanese–English/Japanese–German) and Dr.
H.Dürr (LahnPharma) (translation from German to English).
Furthermore, I would like to thank M.Zimni for the creation of the book cover and
other graphics, and A.Lenzen, D.Kraplow, and Y.Bell of Springer for managing the
publication of the book.
As a freelance editor, Karin Dembowsky has devotedly edited the book, checked it
for conclusiveness, and put the nishing touches on it.
The support of the IT department was invaluable. J.Matuliauskas was always on
hand to manage the valuable articles, illustrations, and tables.
Last but not least, I would like to thank Professor Patrick Sadoghi (Medical University of Graz) for writing a foreword. He emphasizes the relevance of such a book from
the current research approaches of the Medical University Hospital of Graz, Austria.
I also would like to thank Professor Andreas Leithner (Medical University of Graz,
Head and Chair of the Department of Orthopedic Surgery) for the opportunity and
freedom to create the present book.
www.
Klaus-DieterKühn
Medical University of Graz
Graz, Austria
IX
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Contents
I History
1 The History of Total Knee Arthroplasty ............................................................................... 3
Ioannis Gkiatas, Thomas P. Sculco, and Peter K. Sculco
II Indications
2 Osteoarthritis ....................................................................................................................................... 17
Benjamin J. Levens, Eli Kamara, and Erik Hansen
3 Osteoarthritis and Other Indications for Total Knee Arthroplasty:
An East African Perspective
Seid Mohammed Yasin
4 Inammatory Arthritis ................................................................................................................... 33
Zachary K. Christopher, Jaymeson R. Arthur, and Mark J. Spangehl
........................................................................................................ 23
5 Osteonecrosis ....................................................................................................................................... 49
Hytham S. Salem, Brandon H. Naylor, Kevin K. Mathew, and Michael A. Mont
6 Post-Traumatic Arthritis ................................................................................................................ 57
Colin T. Penrose and Michael P. Bolognesi
7 Post-Septic Arthritis ......................................................................................................................... 67
Matan Ozery, Isaac Schultz, Tejbir S. Pannu, Jesus M. Villa,
and Carlos A. Higuera
8 Inuence of Lifestyle and Risk Factors on the Development
of Knee Arthritis and Outcomes Following Cemented Total Knee
Arthroplasty: A US Perspective
Jonathan Dattilo and William Hamilton
9 Lifestyle and Risk Factors for Knee Arthroplasty:
A South African Perspective
Zia Maharaj and Jurek Rafal Tomasz Pietrzak
10 The Microbiome of the Joint ....................................................................................................... 101
Samuel J. Clarkson, Karan Goswami, and Javad Parvizi
................................................................................................ 75
....................................................................................................... 89
III Radiographs and Outcomes
11 Radiographic Analysis of Knee Arthritis............................................................................. 111
Musa B. Zaid and Jeffrey Barry
12 Patient-Reported Outcomes in Total Knee Arthroplasty ......................................... 123
Anas Saleh and Denis Nam
X
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Contents
IV Treatment
13 Fixation in Joint Arthroplasty .................................................................................................... 137
Michael Morlock, Sarah Fischer, and Elke Lieb
14 Medial Unicompartmental Knee Arthroplasty ............................................................... 143
Asim Khan and Fares Haddad
15 Lateral Unicompartmental Knee Arthroplasty .............................................................. 155
Neel R. Patel, Keith R. Berend, and Adolph V. Lombardi Jr.
16 Lateral Unicompartmental Knee Arthroplasty: A French Perspective ........... 173
Axel Schmidt, Christophe Jacquet, Matthieu Ollivier, and Jean- Noël Argenson
17 Patellofemoral Arthroplasty ...................................................................................................... 187
Simon Garceau, William J. Long, and Ran Schwarzkopf
18 Bicompartmental Knee Arthroplasty ................................................................................... 199
Michael D. Ries
19 Total Knee Arthroplasty ................................................................................................................ 209
Alex Lencioni and Craig A. Hogan
20 Patellar Resurfacing in Cemented Total Knee Arthroplasty .................................. 221
Sachin Allahabadi and Derek Ward
21 Patella Replacement in Knee Arthroplasty: A Japanese Perspective .............. 233
Atsushi Takahashi
22 Knee Arthroplasty: An Asian Perspective .......................................................................... 245
Wilson Wang, Bryan T. H. Koh, and Vikaesh Moorthy
V Clinical Care Pathways
23 Preoperative Optimization in Total Joint Arthroplasty ............................................ 263
Vignesh K. Alamanda and Bryan D. Springer
24 Outpatient Total Knee Arthroplasty ...................................................................................... 269
Joshua A. Greenspoon, Charles P. Hannon, and Craig Della Valle
25 Perioperative Pain Management in Total Knee Arthroplasty ............................... 275
Matthew A. Harb, John P. Taliaferro, and James A. Browne
VI Implant Design
26 Loosening of Total Knee Arthroplasty: An Australian Perspective ................... 289
Ruben A. Mazzucchelli and Piers J. Yates
27 Cemented, Cruciate-Retaining Total Knee Arthroplasty:
The Evolution of a Technique
Stefano A. Bini and Giulio Santi
..................................................................................................... 301
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