The prevalence of implant failure has risen in conjunction with the
broadening of the indications for total knee replacement. The need for
revision total knee arthroplasty has increased at such a rapid rate that a
textbook devoted to this procedure is appropriate, timely, and necessary.
Although one might question how a single procedure could be the subject of an
entire book, the complexity of the issue becomes quickly apparent as the
reader proceeds through this informative text. The editors enlisted the help
of numerous experts to produce a work that completely covers this difficult
topic.
The text is organized into five sections, each dealing with a separate
facet of revision arthroplasty. The first section includes a useful
cataloguing of the indications for, and the contraindications to, revision. It
also includes a thorough discussion of the mechanisms of failure of knee
replacement. This section cleverly provides not only explanations for the
causes of failure but also insights into the principles of primary
arthroplasty that will minimize the incidence of failure.
An entire section is devoted to the planning of revision operations. This
section underscores the importance of preoperative considerations and contains
a plethora of useful information on the classification of bone defects, the
use of revision instruments, and the cost of knee arthroplasty. There is also
a particularly helpful comparison of the implant systems that are available
for use in revision procedures. The photographs and tables in Chapter 7,
"Selecting an Implant: A Comparison of Revision Implant Systems,"
alone make this book a valuable resource. The section on techniques used in
revision operations provides the reader with enough tools to tackle virtually
any problem. This section focuses on such topics as operative exposure,
methods of dealing with the extensor mechanism, removal of the prosthesis,
restoration of the joint line, allografts, and periprosthetic fractures, to
name just a few. Another entire section is devoted to the problem of infection
at the site of a total knee replacement. This section includes a number of
useful tips for the treatment of this devastating complication. The book
concludes with a discussion of the results of revision knee arthroplasty, with
reference to a number of the techniques described earlier in the text.
In summary, this very comprehensive text has few shortcomings. There is
some repetition, but this is difficult to avoid when a topic is covered in
such depth. This valuable contribution to the literature clearly belongs in
the library of any surgeon who performs total knee arthroplasty, whether
revision or primary.