title: The difficult primary total knee arthroplasty: a review.
abstract: Primary total knee arthroplasty (TKA) is a reliable procedure with reproducible long-term results. 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 review. These include patients with many previous operations and incisions, and those with severe coronal deformities, genu recurvatum, a stiff knee, extra-articular deformities and those who have previously undergone osteotomy around the knee and those with chronic dislocation of the patella. Each condition is analysed according to the characteristics of the patient, the pre-operative planning and the reported outcomes. When approaching the difficult primary TKA surgeons should use a systematic approach, which begins with the review of the existing literature for each specific clinical situation.
authors.affiliation: IFCA Institute, via del Pergolino 4, Florence 50139, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Baldini
authors.affiliation: IFCA Institute, via del Pergolino 4, Florence 50139, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Castellani
authors.affiliation: Humanitas Clinical and Research Center, via Manzoni 56 Rozzano, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Traverso
authors.affiliation: IFCA Institute, via del Pergolino 4, Florence 50139, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Balatri
authors.affiliation: IFCA Institute, via del Pergolino 4, Florence 50139, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Balato
authors.affiliation: "Sapienza" University of Rome, via F. Faggiana 1668 Latina, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Franceschini
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D006801:Humans; D016916:Joint Deformities, Acquired / Q000150:complications / Q000601:surgery; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000150:complications* / Q000601:surgery*; D010027:Osteotomy; D031222:Patellar Dislocation / Q000150:complications / Q000601:surgery; D011300:Preoperative Care; D012086:Reoperation; D016896:Treatment Outcome
keywords: Total knee arthroplasty; difficult primary; knee deformity; stiffness