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5. OITE > Hip & Knee 2016 > Flashcards

Hip & Knee 2016 Flashcards

1
Q
  1. According to the Paprosky classification for femoral deficiency following total hip arthroplasty, how much femoral diaphyseal bone must be present to obtain scratch-fit fixation with a fully porous coated stem for type IIIA deficiencies?
  2. 2 cm
  3. 4 cm
  4. 6 cm
  5. 8 cm
  6. 10 cm
A
  1. 4cm
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2
Q

20. A 66-year-old man has right hip pain after undergoing total hip arthroplasty 20 years ago. His erythrocyte sedimentation rate and C-reactive protein levels are within defined limits. Which molecule is mediating the issue shown in Figures 20a and 20b?

  1. Farnesyl transferase
  2. Matrix metalloproteinase-13
  3. Activating transcription factor 6
  4. Runt-related transcription factor 2
  5. Receptor activator of nuclear factor kappa
A
  1. Receptr activator of nuclear factor kappa.

RECOMMENDED READINGS

Ramage SC, Urban NH, Jiranek WA, Maiti A, Beckman MJ. Expression of RANKL in osteolytic membranes: association with fibroblastic cell markers. J Bone Joint Surg Am. 2007 Apr;89(4):841-8. PubMed PMID: 17403809.

Granchi D, Pellacani A, Spina M, Cenni E, Savarino LM, Baldini N, Giunti A. Serum levels of osteoprotegerin and receptor activator of nuclear factor-kappaB ligand as markers of periprosthetic osteolysis. J Bone Joint Surg Am. 2006 Jul;88(7):1501-9. PubMed PMID: 16818976.

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3
Q
  1. Figure 243 is the postsurgical radiograph of a 65-year-old woman who underwent an uncomplicated right total hip arthroplasty through a standard posterior approach. At the 2-week follow-up visit, she is having difficulty bearing weight. What is the best next step?
  2. Acetabular component revision
  3. Toe-touch weight bearing for 6 weeks
  4. Open reduction and internal fixation (ORIF) of the anterior column
  5. ORIF of the posterior column with acetabular component revision
  6. ORIF of both columns with acetabular component revision
A
  1. ORIF of the posterior column with acetabular component revision

RECOMMENDED READINGS

Laflamme GY, Belzile EL, Fernandes JC, Vendittoli PA, Hébert-Davies J. Periprosthetic fractures of the acetabulum during cup insertion: posterior column stability is crucial. J Arthroplasty. 2015 Feb;30(2):265- 9. doi: 10.1016/j.arth.2014.09.013. Epub 2014 Sep 28. PubMed PMID: 25307882.

Peterson CA, Lewallen DG. Periprosthetic fracture of the acetabulum after total hip arthroplasty. J Bone Joint Surg Am. 1996 Aug;78(8):1206-13. PubMed PMID: 8753713.

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4
Q
  1. A 67-year-old woman has experienced recurrent posterior hip dislocations that began 2 years after her index procedure was performed with the anterior approach. Her initial postsurgical course was uncomplicated and she progressed quickly to normal activities. She has been treated with bracing and physical therapy that included a comprehensive review of dislocation precautions after each dislocation occurred. Her C-reactive protein level and erythrocyte sedimentation rate are within defined limits. Radiographs reveal well-fixed femoral and acetabular components; the cup position abduction angle is 60 degrees with approximately 5 degrees of anteversion. What is the best next step?
  2. Revision of the acetabular component
  3. Revision arthroplasty of the femoral component
  4. Revision to a larger femoral head and liner
  5. Constrained liner use
  6. Trochanteric advancement
A
  1. Revision of the acetabular component

RECOMMENDED READINGS

Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978 Mar;60(2):217-20. PubMed PMID: 641088.

Soong M, Rubash HE, Macaulay W. Dislocation after total hip arthroplasty. J Am Acad Orthop Surg. 2004 Sep-Oct;12(5):314-21. Review. PubMed PMID: 15469226.

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5
Q
  1. According to the American Academy of Orthopaedic Surgeons clinical practice guideline, Treatment of Osteoarthritis of the Knee, Evidence-Based Guideline, 2nd Edition, the most highly recommended intervention for the treatment of symptomatic knee osteoarthritis is
  2. tramadol.
  3. a valgus knee off-loader brace.
  4. a lateral wedge insole.
  5. a hyaluronic acid injection.
  6. glucosamine and chondroitin.
A
  1. tramadol.

Beaulieu AD, Peloso PM, Haraoui B, Bensen W, Thomson G, Wade J, Quigley P, Eisenhoffer J, Harsanyi Z, Darke AC. Once-daily, controlled-release tramadol and sustained-release diclofenac relieve chronic pain due to osteoarthritis: a randomized controlled trial. Pain Res Manag. 2008 Mar-Apr;13(2):103-10. PubMed PMID: 18443672.

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6
Q
  1. Soft-tissue releases are performed during total knee arthroplasty (TKA) for a patient with an 8-degree presurgical varus deformity. During the process of assessing flexion and extension gaps, it is noted that a lateral tendinous structure was inadvertently completely released when removing posterior lateral osteophytes. What is the best next step?
  2. Posterior stabilized TKA
  3. Allograft lateral collateral ligament reconstruction
  4. Constrained TKA
  5. Anterior-posterior stabilized polyethylene
  6. Medial retinacular reefing
A
  1. Posterior stabilized TKA

RECOMMENDED READINGS

Kesman TJ, Kaufman KR, Trousdale RT. Popliteus tendon resection during total knee arthroplasty: an observational report. Clin Orthop Relat Res. 2011 Jan;469(1):76-81. doi: 10.1007/s11999-010-1525-z. PubMed PMID: 20809169.

Ghosh KM, Hunt N, Blain A, Athwal KK, Longstaff L, Amis AA, Rushton S, Deehan DJ. Isolated popliteus tendon injury does not lead to abnormal laxity in posterior-stabilised total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2015 Jun;23(6):1763-9. doi: 10.1007/s00167-014-3488-1. Epub 2015 Jan 1. PubMed PMID: 25552404.

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7
Q
  1. A 68-year-old patient underwent a direct lateral total hip arthroplasty (THA) and now has a Trendelenburg gait. Which nerve most likely is dysfunctional?
  2. Inferior gluteal
  3. Superior gluteal
  4. Sciatic
  5. Pudendal
  6. Femoral
A
  1. Superior Gluteal
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8
Q
  1. A 76-year-old man underwent right total hip arthroplasty. He fell from a step ladder and is unable to bear weight on his right side. A radiographic evaluation reveals a Vancouver B2 periprosthetic femur fracture. What is the best next step?
  2. Place a hip abduction brace and allow partial weight bearing with reevaluation in 2 weeks
  3. Proceed with surgical treatment using cortical strut graft and plate and cerclage wire fixation of the fracture
  4. Revise the femoral component with a long-stem device and perform fracture stabilization using a plate and cerclage wire construct
  5. Revise the femoral component with a proximal femoral replacement construct
  6. Perform a staged procedure with fracture fixation followed by femoral revision once the fracture has healed
A
  1. Revise the femoral component with a long-stem device and perform fracture stabilization using a plate and cerclage wire construct

RECOMMENDED READINGS

Shah RP, Sheth NP, Gray C, Alosh H, Garino JP. Periprosthetic fractures around loose femoral components. J Am Acad Orthop Surg. 2014 Aug;22(8):482-90. doi: 10.5435/JAAOS-22-08-482. Review. PubMed PMID: 25063746.

Munro JT, Garbuz DS, Masri BA, Duncan CP. Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures. Clin Orthop Relat Res. 2014 Feb;472(2):590-8. doi: 10.1007/s11999-013-3087-3. PubMed PMID: 23719963.

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9
Q
  1. Placing the acetabular cup and femoral stem in the templated position shown in Figures 197a and 197b increases
  2. joint reactive force.
  3. force requirement for abductors.
  4. Increased lever arm for body weight.
  5. Increased lever arm for abductors.
  6. Increased polyethylene wear.
A
  1. Increased lever arm for abductors.

RECOMMENDED READINGS

Merle C, Waldstein W, Pegg E, Streit MR, Gotterbarm T, Aldinger PR, Murray DW, Gill HS. Femoral offset is underestimated on anteroposterior radiographs of the pelvis but accurately assessed on anteroposterior radiographs of the hip. J Bone Joint Surg Br. 2012 Apr;94(4):477-82. doi: 10.1302/0301-620X.94B4.28067. PubMed PMID: 22434462.

Charles MN, Bourne RB, Davey JR, Greenwald AS, Morrey BF, Rorabeck CH. Soft-tissue balancing of the hip: the role of femoral offset restoration. Instr Course Lect. 2005;54:131-41. Review. PubMed PMID: 15948440.

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10
Q
  1. A 53-year-old man underwent a successful total hip arthroplasty revision 2 years ago. Recently he started to experience recurrent dislocations after a traumatic fall. He underwent revision surgery for instability. Despite revising femoral and acetabular components and adequately restoring limb length, intraoperative instability persists. What is the best surgical option?
  2. Medialization of the acetabular cup
  3. Femoral component revision
  4. Increase in neck length
  5. Trochanteric advancement
  6. Use of an offset acetabular liner
A
  1. Trochanteric advancement

RECOMMENDED READINGS

Soong M, Rubash HE, Macaulay W. Dislocation after total hip arthroplasty. J AmAcad Orthop Surg. 2004 Sep-Oct;12(5):314-21. Review. PubMed PMID: 15469226.

Kaplan SJ, Thomas WH, Poss R. Trochanteric advancement for recurrent dislocation after total hip arthroplasty. J Arthroplasty. 1987;2(2):119-24. PubMed PMID: 3612137.

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11
Q
  1. A 62-year-old woman with rheumatoid arthritis underwent left total knee arthroplasty and continues to have pain and swelling. Her presurgical knee alignment was 25-degree valgus. Standard posterior stabilized implants and soft-tissue releases were used. One year after surgery, she has a 2+ effusion and 2+ lateral laxity at 90 degrees. Nonsurgical treatment options have failed. What is the most appropriate surgical option?
  2. Femur revision with a posterior medial augment
  3. Femur revision with a posterior lateral augment
  4. Femur revision with a distal augment
  5. Lateral retinacular release
  6. Medial soft-tissue reefing
A
  1. Femur revision with a posterior lateral augment

Favorito PJ, Mihalko WM, Krackow KA. Total knee arthroplasty in the valgus knee. J Am Acad Orthop Surg. 2002 Jan-Feb;10(1):16-24. Review. PubMed PMID: 11809047.

Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg Am. 2005 Sep;87 Suppl 1(Pt 2):271-84. PubMed PMID: 16140800

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12
Q
  1. Figure 177 is the radiograph of a 53-year-old woman who underwent left total hip arthroplasty 3 years ago and has had no issues with her hip since the surgery. Based on these radiographic findings, what is the best next step?
  2. Observation for 1 year
  3. Bone scan
  4. Hip aspiration
  5. Assess serum metal ion levels
  6. Assess erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels
A
  1. Assess erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels
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13
Q
  1. At which time is it safe for patients to return to driving after undergoing right total hip arthroplasty (THA)?
  2. 2 weeks
  3. 4 weeks
  4. 6 weeks
  5. 8 weeks
  6. 10 weeks
A
  1. 2 weeks

RECOMMENDED READINGS

Hernandez VH, Ong A, Orozco F, Madden AM, Post Z. When is it safe for patients to drive after right total hip arthroplasty? J Arthroplasty. 2015 Apr;30(4):627-30. doi: 10.1016/j.arth.2014.11.015. Epub 2014 Nov 26. PubMed PMID: 25499170.

Marecek GS, Schafer MF. Driving after orthopaedic surgery. J Am Acad Orthop Surg. 2013 Nov;21(11):696-706. doi: 10.5435/JAAOS-21-11-696. Review. PubMed PMID: 24187039.

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14
Q
  1. In patients with Paget disease, administration of which drug can help to minimize perioperative blood loss for patients undergoing elective joint arthroplasty?
  2. Pamidronate
  3. Methylprednisolone
  4. Glucosamine chondroitin
  5. Aminocaproic acid
  6. Fibrin sealer
A
  1. Pamidronate

RECOMMENDED READINGS

Lewallen DG. Hip arthroplasty in patients with Paget’s disease. Clin Orthop Relat Res. 1999 Dec;(369):243-50. Review. PubMed PMID: 10611879.

Wegrzyn J, Pibarot V, Chapurlat R, Carret JP, Béjui-Hugues J, Guyen O. Cementless total hip arthroplasty in Paget’s disease of bone: a retrospective review. Int Orthop. 2010 Dec;34(8):1103-9. doi: 10.1007/ s00264-009-0853-7. Epub 2009 Aug 11. PubMed PMID: 19669762.

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15
Q
  1. Figures 144a and 144b are the radiographs of a 77-year-old patient who fell on the right hip, which resulted in a periprosthetic fracture. Which construct design can best fix the fracture?
  2. Cables alone
  3. Plate with cables
  4. Plates with cables and screws
  5. Stem revision with fracture fixation with a screw-and-cable construct
  6. Stem revision with fracture fixation using strut graft(s) and a cerclage cable construct
A
  1. Stem revision with fracture fixation with a screw-and-cable construct
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16
Q
  1. Figure 127a is the radiograph of a patient who is being seen for revision total hip arthroplasty for infection. Video 127b is the CT scan sequence obtained following removal of the components. Using the Paprosky classification for acetabular bone deficiency, how should this deficiency be classified?
  2. IIA
  3. IIB
  4. IIC
  5. IIIA
  6. IIIB
A
  1. IIIB
17
Q
  1. For patients who develop stiffness with decreased flexion following total knee arthroplasty (TKA), the recommended time frame from date of initial injury for manipulation under anesthesia is within
  2. 1 month.
  3. 3 months.
  4. 6 months.
  5. 9 months.
  6. 12 months.
A
  1. 3 months
18
Q
A
19
Q
  1. A 72-year-old woman underwent total hip arthroplasty (THA) with a metal-on-metal construct 4 years ago and is now experiencing the insidious onset of groin pain on the affected hip and pain with hip flexion. Radiographs reveal a 40-degree abduction angle of the acetabular component with appropriate anteversion and a well-positioned stem with minimal lucency adjacent to the proximal portion of the stem in Gruen zones 1 and 7. Further evaluation should include
  2. CT scan of the hip and pelvis.
  3. metal artifact reduction sequence (MARS) MRI.
  4. sterile aspiration of the hip for culture and sensitivity.
  5. technetium-99 bone scan imaging.
  6. indium-111 imaging.
A
  1. metal artifact reduction sequence (MARS) MRI.

Question 242

RECOMMENDED READINGS

Kwon YM, Lombardi AV, Jacobs JJ, Fehring TK, Lewis CG, Cabanela ME. Risk stratification algorithm for management of patients with metal-on-metal hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and the Hip Society. J Bone Joint Surg Am. 2014 Jan 1;96(1):e4. doi: 10.2106/JBJS.M.00160. PubMed PMID: 24382732.

Jacobs JJ, Urban RM, Hallab NJ, Skipor AK, Fischer A, Wimmer MA. Metal-on-metal bearing surfaces. J Am Acad Orthop Surg. 2009 Feb;17(2):69-76. PubMed PMID: 19202120.

20
Q
  1. Which artery provides the main blood supply to the structure marked by the X in Figure 191 during a left knee arthroscopy?
  2. Descending geniculate artery
  3. Middle geniculate artery
  4. Anterior tibial recurrent artery
  5. Superior geniculate artery
  6. Inferior geniculate artery
A
  1. Middle Geniculate Artery (ACL)
21
Q
  1. During total hip arthroplasty (THA), which anatomic structure is crucial when defining the acetabular quadrants for safe screw placement within the acetabular component?
  2. Anterior superior iliac spine
  3. Anterior inferior iliac spine
  4. Obturator foramen
  5. Iliopectineal eminence
  6. Greater sciatic notch
A
  1. Anteriorsuperior Illiac Spine
22
Q
  1. Total hip arthroplasty is planned for a 68-year-old woman who has had ongoing treatment with etanercept to address rheumatoid arthritis. Appropriate management of this medication to minimize adverse effects during surgery involves instructing the patient to
  2. discontinue using the medication 1 week prior to and 2 weeks after surgery to minimize risk for infection.
  3. discontinue using the medication 4 weeks prior to and 4 weeks after surgery to minimize risk for infection.
  4. discontinue using the medication 2 weeks prior to and 2 weeks after surgery to minimize risk for component loosening.
  5. continue using the medication during the perioperative period because it will not affect the outcome.
  6. increase the medication dosage to prevent stress-induced worsening of the patient’s polyarticular symptoms.
A
  1. discontinue using the medication 1 week prior to and 2 weeks after surgery to minimize risk for infection.
23
Q
  1. The patient seen in Video 258 is undergoing a direct anterior approach to total hip arthroplasty. During this approach, blood vessels are encountered. Which artery is identified?
  2. Ascending branch of the highest genicular
  3. Ascending branch of the lateral femoral circumflex
  4. Ascending branch of the medial femoral circumflex
  5. Descending branch of the lateral femoral circumflex
  6. Transverse branch of the lateral femoral circumflex
A
  1. Ascending branch of the lateral femoral circumflex
24
Q

30. A 75-year-old woman underwent a total knee arthroplasty (TKA). A nerve blockade was performed to manage her perioperative pain. During her postoperative visit 2 hours after surgery, she has numbness over the medial aspect of her leg, is able to extend and flex her knee, and can perform a straight-leg raise. Which type of preoperative nerve block was most likely administered?

  1. Femoral nerve
  2. Adductor canal
  3. Obturator nerve
  4. Sciatic nerve
  5. Peroneal nerve
A
  1. Adductor Canal
25
Q
  1. A 68-year-old woman fell and sustained the injury shown in Figures 76a and 76b. An intraoperative cell count of hip synovial fluid yields 5500 total nucleated cells and 11 cells/hpf on 7 fields. What is the best next step?
  2. Femur open reduction and internal fixation (ORIF) with plate and cables/screws
  3. Femur ORIF with a revision femoral component
  4. Femur ORIF with antibiotic spacer placement
  5. Femur ORIF with a head and liner exchange
  6. Intravenous (IV) antibiotics with femur ORIF
A
  1. Femur ORIF with antibiotic spacer placement

RECOMMENDED READINGS

Preston S, Somerville L, Lanting B, Howard J. Are Nucleated Cell Counts Useful in the Diagnosis of Infection in Periprosthetic Fracture? Clin Orthop Relat Res. 2015 Jul;473(7):2238-43. doi: 10.1007/ s11999-015-4162-8. PubMed PMID: 25631172.

Della Valle C, Parvizi J, Bauer TW, Dicesare PE, Evans RP, Segreti J, Spangehl M, Watters WC 3rd, Keith M, Turkelson CM, Wies JL, Sluka P, Hitchcock K; American Academy of Orthopaedic Surgeons. Diagnosis of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg. 2010 Dec;18(12):760-70. PubMed PMID: 21119142.

26
Q
  1. A 64-year-old man with rheumatoid arthritis underwent an uncomplicated total knee arthroplasty (TKA). He subsequently fell and underwent repair of his patellar tendon 2 weeks after the initial surgery. He now has left knee pain, instability with ambulation, and an inability to straighten his knee. Figure 206 is the radiograph taken 9 months after his most recent surgery. What is the best next step?
  2. Long-leg cast for 6 weeks
  3. Knee arthrodesis and casting
  4. Quadriceps V-Y advancement and patellar tendon repair
  5. Patellar tendon reconstruction with a hamstring autograft
  6. Reconstruction of the extensor mechanism with an allograft
A
  1. Reconstruction of the extensor mechanism with an allograft

RECOMMENDED READINGS

Crossett LS, Sinha RK, Sechriest VF, Rubash HE. Reconstruction of a ruptured patellar tendon with achilles tendon allograft following total knee arthroplasty. J Bone Joint Surg Am. 2002 Aug;84-A(8):1354-61. PubMed PMID: 12177265.

Burnett RS, Berger RA, Della Valle CJ, Sporer SM, Jacobs JJ, Paprosky WG, Rosenberg AG. Extensor mechanism allograft reconstruction after total knee arthroplasty. J Bone Joint Surg Am. 2005 Sep;87 Suppl 1(Pt 2):175-94. PubMed PMID: 16140793.

27
Q

44. The patient in Figure 44 is being seen for knee arthroplasty. During the trialing of components, the knee is found to be tight in flexion on the lateral side and balanced in extension. To further balance the knee, which structure should be released to help balance the medial and lateral gaps in flexion?

  1. Iliotibial band
  2. Popliteus
  3. Lateral collateral ligament (LCL)
  4. Posterior cruciate ligament
  5. Posterior oblique ligament
A
  1. Popliteus

RECOMMENDED READINGS

Elkus M, Ranawat CS, Rasquinha VJ, Babhulkar S, Rossi R, Ranawat AS. Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Joint Surg Am. 2004 Dec;86-A(12):2671-6. PubMed PMID: 15590852.

Peters CL, Jimenez C, Erickson J, Anderson MB, Pelt CE. Lessons learned from selective soft-tissue release for gap balancing in primary total knee arthroplasty: an analysis of 1216 consecutive total knee arthroplasties: AAOS exhibit selection. J Bone Joint Surg Am. 2013 Oct 16;95(20):e152. doi: 10.2106/ JBJS.L.01686. PubMed PMID: 24132367.

28
Q
  1. A 52-year-old man underwent left total knee arthroplasty (TKA) 1 year ago and has reported persistent pain since his surgery. His postsurgical course was notable for persistent wound drainage for more than 14 days after the surgery; the drainage eventually resolved with oral antibiotics. He has not experienced a recurrence, but notes that his knee feels warm, especially at night. He denies fevers, chills, or sweats. An examination reveals his range of motion in extension is 10 degrees through 95 degrees of flexion. No instability is noted, and the skin is without erythema. A moderate-size effusion is present. Radiographs reveal circumferential radiolucent lines adjacent to each of the components. Further evaluation should include
  2. metal artifact reduction sequence MRI.
  3. a CT scan.
  4. a bone scan.
  5. laboratory studies (complete blood count, erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]).
  6. allergy skin testing.
A
  1. laboratory studies (complete blood count, erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]).

RECOMMENDED READINGS

Garvin KL, Konigsberg BS. Infection following total knee arthroplasty: prevention and management. J Bone Joint Surg Am. 2011 Jun 15;93(12):1167-75. Review. PubMed PMID: 21776555.

Gonzalez MH, Mekhail AO. The failed total knee arthroplasty: evaluation and etiology. J Am Acad Orthop Surg. 2004 Nov-Dec;12(6):436-46. Review. PubMed PMID: 15615509.

29
Q

5. Figures 5a and 5b are the anteroposterior (AP) radiographs of a 56-year-old woman who had right total knee arthroplasty (TKA) 5 years ago. She now has pain only with activity. An examination reveals she has a well-healed midline skin incision without erythema or drainage. Her knee range of motion is 0 to 125 degrees. She has a stable examination to varus/valgus stress and less than 1 cm of anterior-posterior translation in 90 degrees of flexion. She underwent knee aspiration and had a cell count of 875 with 20% neutrophils. Her C-reactive protein (CRP) level is within defined limits. What is the most likely cause for her knee arthroplasty failure?

  1. Septic loosening

2 Aseptic loosening

  1. Polyethylene wear
  2. Instability
  3. Malalignment
A
  1. Aseptic loosening

RECOMMENDED READINGS

Schroer WC, Berend KR, Lombardi AV, Barnes CL, Bolognesi MP, Berend ME, Ritter MA, Nunley RM. Why are total knees failing today? Etiology of total knee revision in 2010 and 2011. J Arthroplasty. 2013 Sep;28(8 Suppl):116-9. doi: 10.1016/j.arth.2013.04.056. Epub 2013 Aug 15. PubMed PMID: 23954423.

Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today–has anything changed after 10 years? J Arthroplasty. 2014 Sep;29(9):1774-8. doi: 10.1016/j. arth.2013.07.024. Epub 2014 Jul 5. PubMed PMID: 25007726.

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