Curbside Consultation in Knee Arthroplasty 49 Clinical Questions

Dedication

Acknowledgments

About the Editor

Contributing Authors

Foreword by Jorge Galante, MD

SECTION I: PREOPERATIVE QUESTIONS

Question 1 How Do You Decide When a Patient Is \u201cReady\u201d for a Total Knee

Replacement? Is There a Downside to Waiting Until They Have More

Severe Disease?

Carlos Lavernia, MD and Diego Cardona, MD

Question 2 Management of Unicompartmental Osteoarthritis of the Knee

Michael Archibeck, MD

Question 3 I Have a Patient With a Deformity of the Distal Femur and Arthritis

of the Knee. Should I Do an Osteotomy to Correct the Deformity at the

Time of Total Knee Arthroplasty?

Jess H. Lonner, MD

Question 4 If a Patient Has a Clearly Visible Calcified Vessel in the Posterior

Aspect of Their Knee on the Preoperative Radiograph, Should

I Use a Tourniquet? What About the Patient with a History of Prior

Bypass Grafts?

Raphael C. Y. Hau, MBBS, FRACS and Bassam A. Masri, MD, FRCSC

Question 5 Should My Patients Donate Blood Prior to Surgery?

Fred Cushner, MD

Question 6 When Do You Do a One-Stage Bilateral Total Knee Arthroplasty

as Opposed to Staging Them?

Steve Lyons, MD

Question 7 Should the Patella Be Routinely Resurfaced at the Time

of Total Knee Arthoplasty?

Javad Parvizi, MD, FRCS and Feridon Jaberi, MD

Question 8 I Have a Patient Who Is Very Concerned About Their Range of Motion.

Should I Use a High Flex Type Component?

Giles R. Scuderi, MD

Question 9 I Have a 43-year Old Male Who Needs a Total Knee: Should I Use

Highly Cross-linked Polyethylene as a Bearing Surface?

Markus A. Wimmer, PhD and Joshua J. Jacobs, MD

Question 10 I Think My Patient May Have a Charcot (Neuropathic) Knee. Is This

a Contraindication to Total Knee Arthroplasty?

R. Michael Meneghini, MD and Jeffery L. Pierson, MD

Question 11 I Am Considering Implementing a Teaching Class Prior to Surgery

for My Patients. Is This Beneficial? What Topics Should be Covered?

Regina Barden, RN, BSN and Kim Chandler, RN

SECTION II: INTRAOPERATIVE QUESTIONS

Question 12 If a Patient Has Had Prior Surgery, How Do I Decide Where

to Make the Skin Incision?

Brett Levine, MD, MS

Question 13 If I Am Doing a Total Knee Arthroplasty and the Patella Does

Not Seem to Track Well, What Should I Do?

Richard A. Berger, MD

Question 14 How Do You Determine Appropriate Femoral Component Rotation

at the Time of Surgery

Richard Illgen II, MD and Matthew Squire, MD, MS

Question 15 How Do I Determine Tibial Component Rotation in Total Knee

Arthroplasty?

David Manning, MD and Seann Carr, MD

Question 16 How Do I Perform a Lateral Release?

Mark D. Campbell, MD

Question 17 The Femoral Component Sizing Guide Is Measuring Between

Two Sizes. Should I Choose the Smaller or Larger Size?

Frank R. DiMaio, MD

Question 18 What Is Flexion Instability and How Do I Prevent It During Total

Knee Arthroplasty?

David J. Jacofsky, MD

Question 19 I Am Doing a Total Knee in a Patient With a Varus Deformity.

I Have Done My Standard Release and the Knee Is Still Tight

Medially. What Should I Do?

Gregg R. Klein, MD and Mark A. Hartzband, MD

Question 20 When Performing a Total Knee Arthroplasty in a Patient With

a Valgus Deformity, What Structures Do You Release First?

Keith R. Berend, MD

Question 21 If I Am Doing a Total Knee and It Is Too Tight in Extension,

But Otherwise Feels Well Balanced, What Should I Do?

Steven Stuchin, MD

Question 22 The Patella Measures 22 Millimeters Prior to Making My Osteotomy.

How Much Bone Should I Remove?

Hari P. Bezwada, MD and Robert E. Booth, Jr., MD

Question 23 What Should I Do If I Cut the MCL Intraoperatively?

Scott D. Ruhlman, MD; Shanon M. Sara; and Seth S. Leopold, MD

Question 24 When Do You Use Antibiotic-Loaded Cement?

Mohammad Namazian, DO and Paul E. Di Cesare, MD

Question 25 Do You Inject the Capsule With Anything at the End of the Case

in an Effort to Decrease Perioperative Pain?

Amanda Marshall, MD

SECTION III: POSTOPERATIVE QUESTIONS

Question 26 I Have a Patient Who Is 2 Weeks Postoperative From a Primary

Total Knee Arthroplasty and the Wound Is Draining. What Should

I Do?

Carl Deirmengian, MD

Question 27 What Is the Best Method for Preventing Thromboembolic Events

After Total Knee Arthroplasty?

Jay R. Lieberman, MD

Question 28 In the Recovery Room My Patient Does Not Have a Distal Pulse

in the Operative Leg. What Should I Do?

Kevin B. Fricka, MD

Question 29 My Patient Has a Foot-Drop After Surgery. What Should I Do?

Mark F. Schinsky, MD and William Macaulay, MD

Question 30 What Criteria Do You Use for a Manipulation Under Anesthesia?

Harpal Singh Khanuja, MD

Question 31 I Have a Patient Who Fell 3 Months Postoperatively and Fractured

Their Patella. Should I Try and Fix It?

Craig J. Della Valle, MD and Daniel J. Berry, MD

Question 32 I Have a Patient Who Tripped and Fell 3 Months After a Total

Knee Arthroplasty and Has a Supracondylar Femur Fracture.

What Is the Optimal Method of Treatment?

Mark Dumonski, MD and Walter Virkus, MD

Question 33 How Do You Manage Acute Extensor Mechanism Disruptions?

Cory L. Calendine, MD and Kevin B. Fricka, MD

SECTION IV: REVISION QUESTIONS

Question 34 How Do You Evaluate the Patient With a Painful Total Knee

Arthroplasty?

Michael J. Archibeck, MD

Question 35 What Is the Best Test for Diagnosing Periprosthetic Infection?

Craig J. Della Valle, MD

Question 36 If I Am Doing a Revision Total Knee and Can\u2019t Seem to Get Adequate

Exposure, What Should I Do?

Craig J. Della Valle, MD

Question 37 When Doing a Revision Total Knee, Do You Start Reconstructing

the Femur or Tibia First?

David G. Nazarian, MD

Question 38 Should I Use Stems on All of My Revision Total Knee Components?

Steven H. Weeden, MD and Wayne Paprosky, MD

Question 39 If I Use a Stem at the Time of a Revision Total Knee Arthroplasty,

Should I Press-Fit the Stem or Cement It?

Craig J. Della Valle, MD and Aaron G. Rosenberg, MD

Question 40 When Do You Use an Offset Stem During Revision Total Knee

Replacement?

Scott M. Sporer, MD, MS

Question 41 How Do You Handle Massive Bone Loss at the Time of Revision

Total Knee Arthroplasty?

Allan E. Gross, MD, FRCSC, O.Ont

Question 42 How Do I Decide If I Should Retain the Patellar Component

at the Time Of Revision Total Knee Arthroplasty?

Thomas E. Brown, MD; Khaled Saleh, MD, MSc, FRCSC;

Quan Jun Cui, MD, MS; and William Mihalko, MD, PhD

Question 43 How Do You Manage the Patient With Severe Patellar Bone Loss

at the Time of Revision Total Knee Arthroplasty? Kevin J. Bozic, MD, MBA and Michael D. Ries, MD

Question 44 How Do You Assess Joint Line Position at the Time of Revision

Total Knee Arthroplasty? What Are the Clinical Consequences

If It Is Elevated? Richard S. Laskin MD

Question 45 When Should I Use a Constrained Condylar Insert as Opposed

to a Posterior Stabilized Insert?

Kelly G. Vince, MD, FRCS

Question 46 How Should I Manage the Patient With Chronic Extensor Mechanism

Deficiency Associated with a Total Knee Arthroplasty?

R. Stephen J. Burnett, BSc, MD, FRCS(C), Dipl. ABOS

and Robert L. Barrack, MD

Question 47 Do You Use Static or an Articulating Spacer for Resection

Arthroplasty Prior to Reimplantation?

Alexander Siegmeth, FRCS (Tr & Orth) and Donald Garbuz, MD, FRCSC

Question 48 What Are Your Indications for a Knee Fusion?

Andrew A. Freiberg, MD

Question 49 How Do You Manage the Patient with an Unexpectedly Positive

Culture at the Time of a Revision Total Knee Arthroplasty?

Patrick M. Morgan, MD and John C. Clohisy, MD

Index

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Biography

Craig J. Della Valle, MD is an Adult Reconstructive Surgeon who focuses on Total Hip and Knee Arthroplasty at Rush University Medical Center in Chicago, IL. He specializes in complex primary and revision surgery as well as unicompartmental arthroplasty of the knee and hip resurfacing. Dr. Della Valle completed his residency at the Hospital for Joint Diseases in New York City and his fellowship in adult reconstructive surgery at Rush. In addition to his clinical duties, he is involved in numerous clinical research projects. Dr. Della Valle serves as an Associate Professor of Orthopaedic Surgery at Rush University Medical Center.

“Personal experience is a priceless asset in the hands of the talented surgeon. This book harnesses that knowledge and uses it as a learning tool for the practicing orthopedic surgeon. There are 49 such questions each put together in the form of a chapter written in an informal style, with only a minimal and essential list of references and a great deal of personal know-how. Dr. Della Valle and his collaborators have done an excellent job in making available a practical tool of widespread relevance. It certainly belongs in every total knee replacement surgeon’s library.”