Topics
Myths and Misconceptions in Arthroplasty
Despite rapid advances in implant design, navigation, and perioperative protocols, arthroplasty surgery remains surrounded by persistent misconceptions — many of which influence both surgeon behavior and patient expectations. Understanding and debunking these myths is essential for evidence-based orthopaedic care.
Robotic Assisted UKA
Robotic unicompartmental knee arthroplasty (R-UKA) is an evolution of traditional unicompartmental knee replacement, developed to improve component accuracy, reduce outliers, and enhance short-term recovery. It is indicated for isolated medial or lateral compartment osteoarthritis (Kellgren–Lawrence grade IV) when the remaining compartments are intact. Approximately 20% of knee OA cases are unicompartmental — most involve the medial side.
Patellofemoral Arthroplasty
Ligament Balancing in TKA
• The basic aim is to get both extension and flexion gaps rectangular, equal and balanced. This balanced tension is important for implant stability and long-term survival. • Two popular knee replacement techniques currently practiced are: “measured resection” which depends on tibial and femoral bone cuts through resection guide and “balanced resection” which depends on optimising ligament tensioning. Both affect ligament balancing during the operation. • A stepwise approach for sequential ligament releases, according to the type of deformity, is essential to good outcomes.
Revision Knee Arthroplasty
Revision TKA is a complex reconstructive procedure performed to address implant failure due to infection, aseptic loosening, instability, periprosthetic fracture, or stiffness. Proper diagnosis requires a combination of clinical, radiographic, and laboratory evaluation to identify the cause of failure. Management aims to restore joint stability, mechanical alignment, and bone stock while minimizing complications. Modern evidence supports the use of modular stemmed and constrained implants to improve fixation, with either cemented or press-fit stems achieving comparable alignment outcomes. Prevention of periprosthetic joint infection (PJI) remains crucial, and intraosseous antibiotic prophylaxis provides superior local drug concentrations and lower infection rates compared to traditional intravenous administration.
Dislocation & Instability
Despite advances in implant design, surgical technique, and perioperative protocols, instability continues to challenge both surgeons and patients.Hip dislocation remains one of the most feared complications following total hip arthroplasty (THA), associated with higher morbidity, increased healthcare costs, and up to 25% of all revision procedures.
Periprosthetic Hip Fractures
Vancouver B2 fractures—those with a loose stem but adequate bone stock—remain the most debated subtype in terms of optimal management, with recent meta-analyses redefining treatment algorithms.Periprosthetic femoral fractures (PPF) represent one of the most challenging complications after total hip arthroplasty (THA). Their incidence is rising sharply worldwide, driven by increasing THA volumes, aging populations, and poor bone health, particularly osteoporosis.
Revision Hip Arthroplasty
Revision Total Hip Arthroplasty (rTHA) addresses failure or complications of primary hip arthroplasty, including aseptic loosening, periprosthetic fracture, infection, and instability. As primary THA volumes increase globally, rTHA has become more common. Outcomes depend on etiology, implant selection, and restoration of biomechanics rather than mere component replacements.
Periprosthetic Joint Infection (PJI)
Periprosthetic Joint Infection (PJI) is one of the most devastating complications of arthroplasty. Although uncommon (≈1–2%), it is a leading cause of revision surgery and implant failure. Biofilm formation on implant surfaces makes eradication difficult and often necessitates complex surgical management.
Preoperative Planning for TKA
Digital templating for TKA assists in predicting implant sizes and alignment, aiming to optimize motion and minimize stiffness or loosening. However, its impact on postoperative function and alignment remains limited.