Operative Techniques in Orthopaedics RSS feed: Current Issue. Operative Techniques in Orthopaedics is an innovative, richly illustrated resource that keeps practitioners informed of significant advances in all areas of surgical management. Each issue of this atlas-style journal explores a single topic, often offering alternate approaches to the same procedure. Its current, definitive information keeps readers in the forefront of their specialty. Benefits to authors We also provide many author benefits, such as free PDFs, a liberal copyright policy, special discounts on Elsevier publications and much more. Please click here for more information on our author services . If you require any further information or help, please visit our support pages: http://support.elsevier.com http://www.optechorthopaedics.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Operative Techniques in Orthopaedics1048-6666224December 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.optechorthopaedics.com/article/PIIS1048666613000062/abstract?rss=yesEditorial Board10.1053/S1048-6666(13)00006-2Operative Techniques in Orthopaedics 22, 4 (2012)2012-12-01Operative Techniques in Orthopaedics2012-12-01224S1048-6666(12)X0005-3iihttp://www.optechorthopaedics.com/article/PIIS1048666613000074/abstract?rss=yesTable of Contents10.1053/S1048-6666(13)00007-4Operative Techniques in Orthopaedics 22, 4 (2012)2012-12-01Operative Techniques in Orthopaedics2012-12-01224S1048-6666(12)X0005-3iiiihttp://www.optechorthopaedics.com/article/PIIS1048666613000086/abstract?rss=yesContributors10.1053/S1048-6666(13)00008-6Operative Techniques in Orthopaedics 22, 4 (2012)2012-12-01Operative Techniques in Orthopaedics2012-12-01224S1048-6666(12)X0005-3iiiivhttp://www.optechorthopaedics.com/article/PIIS1048666612000912/abstract?rss=yes Total knee arthroplasty using prenavigation and patient-specific instrumentation is becoming increasingly popular. Some studies have demonstrated decreased operative times and improved implant alignment when using these techniques, and several major orthopedic device manufacturers now offer this technology in conjunction with their implant systems. Custom cutting guides are manufactured based on preoperative imaging and require careful surgical planning by the surgeon. This article will discuss our methods of presurgical planning and surgical technique using a commercially available system. Total Knee Replacement with Prenavigation and Custom Cutting BlocksWilliam J. Hozack, Michael R. Bloomfield, Navin Fernando10.1053/j.oto.2012.12.004Operative Techniques in Orthopaedics 22, 4 (2012)2012-12-01Operative Techniques in Orthopaedics2012-12-01224S1048-6666(12)X0005-3171175http://www.optechorthopaedics.com/article/PIIS1048666612000857/abstract?rss=yes Computer-assisted total knee arthroplasty (TKA) has been implemented to improve the accuracy of implant positioning and limb alignment. Studies have shown several benefits of computer-assisted TKA over conventional TKA. However, the technology is not without potential pitfalls. The following article is a technique guide for the use of computer-assisted navigation for TKA. Computer-Assisted Navigation—Total Knee ArthroplastyMichael J. O'Malley, Brian A. Klatt10.1053/j.oto.2012.11.001Operative Techniques in Orthopaedics 22, 4 (2012)2012-12-01Operative Techniques in Orthopaedics2012-12-01224S1048-6666(12)X0005-3176181http://www.optechorthopaedics.com/article/PIIS1048666612000882/abstract?rss=yes Unicompartmental knee arthroplasty (UKA) is becoming an increasingly more main stream option for arthritis management, but attaining durable outcomes is dependent on precise implantation of the components, accurate component and limb alignment, sound prosthesis design, and acceptable indications. Compared to conventional cutting guides, semi-autonomous robotic technologies have improved the precision of bone preparation and component alignment in UKA, enabling successful early functional results and with the expectation that they will enhance implant durability.Robotically Assisted Unicompartmental Knee ArthroplastyJess H. Lonner, Glenn J. Kerr10.1053/j.oto.2012.12.001Operative Techniques in Orthopaedics 22, 4 (2012)2012-12-01Operative Techniques in Orthopaedics2012-12-01224S1048-6666(12)X0005-3182188http://www.optechorthopaedics.com/article/PIIS1048666612000870/abstract?rss=yes The Oxford unicompartmental knee arthroplasty was developed for the treatment of anteromedial osteoarthritis of the knee. Following strict adherence to the clinical indications, this mobile-bearing device has shown >90% survivorship at 20 years and good to excellent clinical results after 10 years. The addition of small incision surgery to the Oxford technique along with rapid recovery protocols has resulted in quicker functional recovery with less morbidity and mortality, thus making the procedure truly minimally invasive compared with total knee replacement. The most recent evolutionary change to the Oxford technique has been the addition of new instrumentation (Oxford Microplasty) that allows for more reproducible execution of the operation, which might improve the long-term success of the surgery. This article outlines the Oxford surgical technique using the Oxford Microplasty instruments. Unicompartmental Knee Replacement With New Oxford InstrumentsMichael J. Morris, Benjamin M. Frye, Timothy E. Ekpo, Keith R. Berend10.1053/j.oto.2012.11.003Operative Techniques in Orthopaedics 22, 4 (2012)2012-12-01Operative Techniques in Orthopaedics2012-12-01224S1048-6666(12)X0005-3189195http://www.optechorthopaedics.com/article/PIIS1048666613000025/abstract?rss=yes Patellofemoral arthroplasty represents a modern surgical treatment for patients with isolated patellofemoral arthritis. This procedure is less invasive than total knee arthroplasty and preserves the patients' ligaments, menisci, and most of their native knee joint. Even though it raised much controversy in its early days due to poor results, newer-generation implants have led to lower complications rates and improved outcomes. This is mainly owing to the use of onlay implants, which truly replace the patellofemoral compartment. Thorough patient selection is crucial to optimize outcomes. Progression of arthritis in the tibiofemoral compartments currently constitutes the most frequently seen complication. Recent advances include the use of computer navigation and the combination of patellofemoral arthroplasty with other minimally invasive procedures to address more extensive disease of the knee joint. Patellofemoral ArthritisJoseph A. Karam, Carlos A. Higuera, Eric B. Smith, Peter F. Sharkey10.1053/j.oto.2013.01.001Operative Techniques in Orthopaedics 22, 4 (2012)2012-12-01Operative Techniques in Orthopaedics2012-12-01224S1048-6666(12)X0005-3196202http://www.optechorthopaedics.com/article/PIIS1048666612000900/abstract?rss=yes The rate of revision total knee revision arthroplasty (TKR) is increasing and will continue to increase. Addressing bone loss during TKRs continues to be a major challenge and is necessary to provide a stable construct. Current techniques for addressing bone loss include using cement, bone graft (structural or morselized), augments, custom-made implants, or metaphyseal filling implants. Metaphyseal filling implants include metaphyseal sleeves and tantalum cones, and they achieve stability by osteointegration with metaphyseal bone. The indications for using metaphyseal sleeves include addressing bone loss, adding stability to the prosthesis–bone construct, and providing long-term fixation of the implant to bone. Metaphyseal sleeves are implanted using a broach technique that prepares the metaphyseal bone and reduces bony gaps. The sleeves attach to stems by Morse taper instead of creating a cement interface, and sleeves are available for both tibial and femoral fixation. Care must be taken when broaching and placing implants to reduce the risk of fracture, and weight-bearing status will vary according to the procedure performed. By using the techniques described in this article for placing metaphyseal sleeves, stable TKR constructs may be achieved. Metaphyseal Sleeves in Revision Total Knee ArthroplastyAntonia F. Chen, Michael R. Pagnotto, Lawrence S. Crossett10.1053/j.oto.2012.12.003Operative Techniques in Orthopaedics 22, 4 (2012)2012-12-01Operative Techniques in Orthopaedics2012-12-01224S1048-6666(12)X0005-3203208http://www.optechorthopaedics.com/article/PIIS1048666612000894/abstract?rss=yes Porous tantalum cones show promise as a tool to allow for reconstruction of large tibial and femoral bone defects during revision total knee arthroplasty (TKA). They function as a metallic substitute for structural bone graft during revision surgery. They are designed for ingrowth into the metaphyseal or metadiaphyseal regions of host bone, and serve as a platform for the tibial or femoral prosthetic components that are united to the inner surface of the cones using bone cement. Porous tantalum cones come in various sizes and shapes and can be used with various knee revision arthroplasty systems, providing the surgeon with flexibility in reconstructive options. Small series with short-term follow-up have reported encouraging results using porous tantalum cones during revision TKA, which are summarized in this manuscript. In addition, we provide a comprehensive description for the technique of using various types of cones to address large tibial and femoral bone defects during revision TKA. Use of Porous Tantalum Cones in Revision Total Knee ArthroplastyRyan E. Moore, Matthew S. Austin10.1053/j.oto.2012.12.002Operative Techniques in Orthopaedics 22, 4 (2012)2012-12-01Operative Techniques in Orthopaedics2012-12-01224S1048-6666(12)X0005-3209221http://www.optechorthopaedics.com/article/PIIS1048666612000845/abstract?rss=yes As the number of primary total knee arthroplasties increase, revision procedures with massive bone defects will also increase. Although multiple reconstructive options have been recommended, porous tantalum metaphyseal cones have the advantage of improved biological fixation because of their high porosity, interconnected pore space, and a modulus of elasticity similar to that of cancellous bone. Such features allow tantalum cones to fill bone defects while tolerating physiological loads. Indications for porous tantalum metaphyseal cones include patients with large contained or uncontained osseous defects that are typically categorized as Anderson Orthopaedic Research Institute type 2B or greater. The surgical technique is simpler than structural allograft reconstructions with decreased preparation time, resulting in a possible decrease in infection rates. The modularity of porous tantalum metaphyseal cones allows the surgeon to choose a size and position that best fits the individual defect encountered. Moreover, tantalum cones can be used with any revision system. Short-term clinical follow-up indicates that porous tantalum metaphyseal cones effectively provide structural support with the potential for long-term biological fixation and durable reconstructions. Reconstruction of Complex Distal Femur and Proximal Tibia Defects Using Tantalum ConesMatthew P. Abdel, Arlen D. Hanssen10.1053/j.oto.2012.10.001Operative Techniques in Orthopaedics 22, 4 (2012)2012-12-01Operative Techniques in Orthopaedics2012-12-01224S1048-6666(12)X0005-3222227http://www.optechorthopaedics.com/article/PIIS1048666612000924/abstract?rss=yes Dealing with extensive bone loss is one of the more difficult challenges in revision total knee arthroplasty. Occasionally, osteolysis, bone destruction due to infection, or fracture cause destruction that precludes the use of standard revision components. In this scenario, megaprosthetic reconstruction may be considered. Used for years in oncologic reconstructions, modular endoprostheses allow any amount of bone to be substituted. In the knee, either distal femoral or proximal tibial replacements can be performed. Rehabilitation of a distal femoral replacement parallels that of knee revision, whereas proximal tibial rehabilitation is somewhat different owing to the reconstruction of the extensor mechanism. Although somewhat different from that arthroplasty, the technique for bony resection and megaprosthetic reconstruction is applicable to arthroplasty surgeons or general orthopedic surgeons with revision arthroplasty experience. This reconstructive technique should be within the armamentarium of any surgeon who performs complex revision arthroplasty surgery. Coping with Extensive Bone Loss: The Use of Megaprosthetic Replacements for Difficult Knee RevisionsCharles L. Lupo, Richard L. McGough10.1053/j.oto.2012.12.005Operative Techniques in Orthopaedics 22, 4 (2012)2012-12-01Operative Techniques in Orthopaedics2012-12-01224S1048-6666(12)X0005-3228235http://www.optechorthopaedics.com/article/PIIS1048666612000869/abstract?rss=yes Infection after total knee arthroplasty is a devastating complication with multiple treatment options. Irrigation and debridement with a polyethylene liner exchange can be used for knees with an acute postoperative or acute hematogenous infection; however, the literature suggests a failure rate of approximately 50%, with some larger and more recent series suggesting success rates that are even lower. For a chronically infected total knee arthroplasty, options include a 1-stage or a 2-stage exchange with pros and cons to both approaches; however, a thorough debridement is key for both techniques. Resection arthroplasty, fusion, and above-the-knee amputation are options for patients with recurrent infection and/or who are not candidates for further attempts at knee reconstruction. Finally, other adjunct treatments, including chronic antibiotic suppression and multiple methods of antibiotic delivery, are described. Treatment of the Infected Total KneeAntonia F. Chen, Craig J. Della Valle, Nalini Rao, Javad Parvizi10.1053/j.oto.2012.11.002Operative Techniques in Orthopaedics 22, 4 (2012)2012-12-01Operative Techniques in Orthopaedics2012-12-01224S1048-6666(12)X0005-3236246