Complex Primary TKA

Primary total knee arthroplasty (TKA) is a reliable procedure with reproducible long-term results. TKA for the treatment of knee arthritis has substantially increased over the past decade. This success is contingent upon accurate tibial and femoral bone resection and proper soft tissue balancing. Nevertheless, there are conditions related to the type of patient or local conditions of the knee that can make it a difficult procedure. The most common scenarios that make it difficult are discussed in this chapter. This chapter covers complex primary knee replacement topics, such as patella baja, post-traumatic arthritis, extra-articular deformities, and stiff knee. They comprise longer, more complex procedures that require extensive planning, and specialized implants and tools to achieve a good result. This chapter provides a framework for understanding how to evaluate, diagnose, and treat these problems. The chapter has intraoperative pictures, plain radiographic images and some simple yet elegant illustrations of different surgical techniques. TKA is challenging in patients who have deformity, bone loss, contracture, or multiple comorbidities, or have had prior surgery; therefore, it is necessary for surgeons to be aware of some general principles that may help minimize complications and improve outcomes. This chapter will provide orthopaedic surgeons with the best strategies to properly manage the more complicated forms of knee replacement they may encounter. Key points for each scenario will be provided at the end of this chapter which are very useful in day-to-day practice.