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New Technology and Surgical Technique in TKA

The critical determinants of successful, durable total knee arthroplasty (TKA) are correct positioning of the implanted components, acceptable alignment of the knee with weight-bearing, and restoration of normal stability during functional activities without the need for excessive muscular activation. Although the ideal values of component position, joint alignment, and knee stability remain topics of intense debate, there remains a general consensus that the success of surgeons…

TKA Balancing

Introduction Knee arthroplasty was in its infancy in India in the 90s, when I returned from overseas having done hundreds of fairly straightforward cases, to start practice in India. I was accosted with patients with profound knee deformities, and I was desperately in need of guidance! That’s when a colleague suggested I read Ken’s book. However, in the early “90s,” in the sprawling metropolis of Mumbai,…

Bone-Cutting Technique

Dr. Krackow was a stickler for precision, and he was relentlessly thinking about how to make his bone-cutting techniques more reproducible and precise. This chapter on bone-cutting technique and accuracy is inspired from much of the teaching and direction he provided to countless residents and fellows over the years. Saw Technique Accurate, safe, and efficient use of a power bone saw has become a basic task…

Surgical Procedure

Primary total knee arthroplasty (TKA) starts with the surgical approach and then moves to a step-wise approach, which includes bony preparation, osteophyte removal, soft tissue balancing, and implant placement. This chapter details an in-depth discussion of soft tissue balancing, and techniques related to the proper exposure of the knee. A generic discussion of different prostheses and instrumentation systems is also included. This material supplements the step-by-step…

Setting Up an Outpatient or Same-Day Discharge Total Knee Arthroplasty (TKA) Program

Introduction When the first edition of this book was released, primary total knee arthroplasty (TKA) was a procedure that had a mean length of stay of around 7 days. Dr. Krackow was a pioneer and advanced the issues pertaining to length of stay throughout his career. Advances in operative techniques, anesthesia, and perioperative analgesia have allowed same-day TKA to become a reality. Outpatient total joint arthroplasty…

Preoperative Planning From Medical Issues to Implants

There is no straightforward answer as to “when to pull the trigger” and offer surgery to a patient with severe knee disease. Surgeons would require a patient to report chronic knee pain and has functional impairment before they proceed with an arthroplasty. How bad is the pain? Is a patient impaired enough? Are the radiographs bad enough? Is the patient too young or too old? Is…

Assessment of Surgical Difficulty

Although surgery cannot be compared with war, Sun Tzu’s philosophies, as written in The Art of War , have been used often in other fields, such as business, politics, and sports. Perhaps some of his principles can be applied when approaching surgery in general and total knee arthroplasty (TKA) specifically. None of us ever wants to be in the uncomfortable position of being “knee deep” into…

Optimizing Important Comorbidities: Diabetes, Rheumatoid Arthritis, Peripheral Vascular Disease, and Cardiac Disease

The decision to recommend any surgery hinges on the severity of pathology and on the various risk factors the patient has while undergoing surgery. The risk–benefit analysis is an integral part of any surgeon’s thought process when offering surgery. Any surgical procedure can be classified into four categories ( Fig. 3.1 ) based on anticipated risk and benefit. In general, surgery is not recommended when the…

Modify What’s Modifiable: Smoking, Obesity, Opioid Dependence, and Nutritional Deficiencies

Introduction Total joint arthroplasties are some of the most commonly performed procedures in orthopedic surgery and have high success rates. These surgeries can greatly improve a patient’s quality of life. Even though these procedures generally have positive patient satisfaction rates, the prevalence of several modifiable risk factors can cause increased risk for postoperative complications. The risks associated with smoking, obesity, opioid use, and malnutrition will be…

Patient Considerations: Comorbidities and Optimization

Total knee arthroplasty (TKA) continues to be one of the most reliable methods for treating end-stage arthritis when nonoperative management has failed. Choosing which patients would benefit the most from this procedure is paramount to maximize subjective outcomes. Alternative surgical procedures to TKA may also be indicated, and they should be explored with the patient in select scenarios. This chapter focuses on the preoperative steps that…