The Unhappy Total Knee Replacement: A Comprehensive Review by Michael T. Hirschmann, Roland Becker

By Michael T. Hirschmann, Roland Becker

This booklet addresses the necessity for greater diagnostic and remedy directions for sufferers in whom overall knee arthroplasty (TKA) has had an unsatisfactory consequence. It opens by way of discussing the fundamentals of TKA and a number of the motives of failure and soreness. Diagnostic facets are thought of intimately, with awareness to advances in medical research, laboratory research and particularly, imaging strategies. furthermore, useful cutting-edge diagnostic algorithms are awarded. particular pathology-related cures, together with conservative methods and salvage and revision TKA suggestions, are then defined, with id of pitfalls and key issues. a chain of illustrative situations disguise scientific eventualities often encountered in day-by-day medical perform. The evidence-based, clinically concentrated suggestions supplied during this e-book, written via across the world well known specialists, will support surgeons achieve the simplest administration of those hard cases.

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Clin Orthop Relat Res. 2001;392:383. 13. Stiehl JB, Komistek RD, Dennis DA, Paxson RD, Hoff WA. Fluoroscopic analysis of kinematics after posterior-cruciate-retaining knee arthroplasty. J Bone Joint Surg Br. 1995;77(6):884–9. 14. Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br. 2002;84(1):50–3. 15. Taylor WR, Heller MO, Bergmann G, Duda GN. Tibio-femoral loading during human gait and stair climbing.

With both cruciates resected, the restraint must additionally apply to tibial posterior translation [6]. The ACL primarily restrains anterior tibial translation but controls tibial internal rotation as well. In case of ACL deficiency, the neutral position of the tibia to the femur is translated more anteriorly and rotated internally when compared to its position in an intact knee. In vivo assessment of the kinematics in normal and ACLdeficient knees showed less anteroposterior translation in the lateral compartment but increased translation in the medial compartment in the ACLdeficient knees.

2). The medial femoral condyle predominantly rotates and demonstrates minor translation during flexion. In contrast, the lateral condyle rolls and glides posteriorly on the tibial plateau. The different kinematic behaviour in the medial and lateral compartments lead to coupled internal rotation of the tibia in relation to the femur during flexion. The tibia performs a coupled internal rotation during knee flexion. 00 Fig. 2 Characteristic kinematics of knee flexion with a pivoting of the medial compartment and an interplay of rolling and gliding of the lateral compartment [3] Sagittal view A FE Axis B C FE Axis E a Longitudinal axis b Long axis c Transverse view Fig.

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