Revision total knee arthroplasty due to bone cement and metal hypersensitivity

2017 ◽  
Vol 137 (2) ◽  
pp. 267-271 ◽  
Author(s):  
Ioannis P. Stathopoulos ◽  
Nicolaos Andrianopoulos ◽  
Dimitrios Paschaloglou ◽  
Ioannis Tsarouchas
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Cement ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Metal Hypersensitivity ◽  
Total Knee

scholarly journals Metal allergy in primary and revision total knee arthroplasty

2021 ◽  
Vol 2 (10) ◽  
pp. 785-795
Author(s):  
Hosam E. Matar ◽  
Patrick J. Porter ◽  
Martyn L. Porter
Keyword(s):  
Total Knee Arthroplasty ◽  
Informed Consent ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Screening Tests ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Metal Allergy ◽  
Metal Hypersensitivity ◽  
Total Knee

Aims Metal allergy in knee arthroplasty patients is a controversial topic. We aimed to conduct a scoping review to clarify the management of metal allergy in primary and revision total knee arthroplasty (TKA). Methods Studies were identified by searching electronic databases: Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Embase, from their inception to November 2020, for studies evaluating TKA patients with metal hypersensitivity/allergy. All studies reporting on diagnosing or managing metal hypersensitivity in TKA were included. Data were extracted and summarized based on study design, study population, interventions and outcomes. A practical guide is then formulated based on the available evidence. Results We included 38 heterogeneous studies (two randomized controlled trials, six comparative studies, 19 case series, and 11 case reports). The evidence indicates that metal hypersensitivity is a rare complication with some histopathological features leading to pain and dissatisfaction with no reliable screening tests preoperatively. Hypoallergenic implants are viable alternatives for patients with self-reported/confirmed metal hypersensitivity if declared preoperatively; however, concerns remain over their long-term outcomes with ceramic implants outperforming titanium nitride-coated implants and informed consent is paramount. For patients presenting with painful TKA, metal hypersensitivity is a diagnosis of exclusion where patch skin testing, lymphocyte transformation test, and synovial biopsies are useful adjuncts before revision surgery is undertaken to hypoallergenic implants with shared decision-making and informed consent. Conclusion Using the limited available evidence in the literature, we provide a practical approach to metal hypersensitivity in TKA patients. Future national/registry-based studies are needed to identify the scale of metal hypersensitivity, agreed diagnostic criteria, and management strategies. Cite this article: Bone Jt Open 2021;2(10):785–795.

scholarly journals Suitability of Metal Block Augmentation for Large Uncontained Bone Defect in Revision Total Knee Arthroplasty (TKA)

2019 ◽  
Vol 8 (3) ◽  
pp. 384 ◽  
Author(s):  
Kwan Kang ◽  
Trinh Tien ◽  
Myung Lee ◽  
Kwon-Yong Lee ◽  
Bongju Kim ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Cement ◽  
Bone Defect ◽  
Knee Arthroplasty ◽  
Strain Distribution ◽  
Stress Transfer ◽  
Bone Defects ◽  
Revision Total Knee Arthroplasty ◽  
Total Knee ◽  
Metal Block

This study was performed to determine whether metal block augmentation is suitable for large uncontained bone defect via evaluations of differences in biomechanical characteristics among the configurations of metal block augmentations for medium or large uncontained bone defects in revision total knee arthroplasty (TKA). Three-dimensional finite element (FE) models of the proximal tibia with revision TKA were developed and analyzed considering the configurations of the metal block augmentations for medium and large uncontained bone defects. To identify differences in biomechanical characteristics according to the configurations of metal block augmentations, the stress transfer, strain distribution, and peak von Mises stresses (PVMSs) were assessed. Large and medium uncontained bone defects had similar ranges of strain below the critical bone-damage strain for the metal block augmentations, but the strain distribution characteristics differed in response to the metal block-augmentation configurations. PVMSs exceeding the yield strength of the bone cement for the single metal block-augmentation configurations were, on average, 1.4 times higher than those for double metal block-augmentation configurations for both medium and large uncontained bone defects. These findings suggest that metal block augmentation may be suitable for large uncontained bone defects (≤20 mm), compared with the results obtained for metal block augmentation used in medium uncontained bone defects (≤10 mm). If possible, double metal block augmentation is recommended for both medium and large uncontained bone defects rather than single metal block augmentation. It is also recommended that the metal block augmentation should be customized to meet the contact characteristics with the cortical bone, thereby ensuring better stress transfer and reducing the risk of the bone resorption due to stress shielding and bone-cement failure.

scholarly journals Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jake von Hintze ◽  
Mika Niemeläinen ◽  
Harri Sintonen ◽  
Jyrki Nieminen ◽  
Antti Eskelinen
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Patient Reported ◽  
Total Knee ◽  
Revision Tka

Abstract Background The purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design. Methods Between January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs. Results The ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9–91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2 years (range, 0–12.7 years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose. Conclusion We found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen® RHK design can be regarded as a suitable option in complex revision TKA.

scholarly journals Cementing technique for total knee arthroplasty in cadavers using a pastry bone cement

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hans Bösebeck ◽  
Anna-Maria Holl ◽  
Peter Ochsner ◽  
Manuel Groth ◽  
Kevin Stippich ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Cement ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Pull Out ◽  
Ensure Patient Safety ◽  
Temperature Development ◽  
Total Knee ◽  
Primary Total Knee ◽  
Rule Out

Abstract Background In cemented primary total knee arthroplasty (TKA), aseptic loosening remains a major cause for failure. Cementing techniques and characteristics of a chosen cement play a key role for good fixation and implant survival. A pastry bone cement was developed to facilitate the cement preparation and to rule out most of preparation-associated application errors. The pastry bone cement was compared to a conventional polymethyl methacrylate cement in a TKA setting. Methods Standardized implantations of total knee endoprostheses were performed in bilateral knee cadavers to investigate handling properties, variables of cement application, working time, and temperature development. Mechanical aspects and cementation quality were assessed by pull-out trials and microscopic interface analysis. Results Both cements expressed similar characteristics during preparation and application, only the curing time of the pastry cement was about 3 min longer and the temperature peak was lower. Fractures of the conventional cement specimens differed from the pastry cement specimens in the tibial part, while no differences were found in the femoral part. Penetration depth of the pastry cement was similar (tibia) or deeper (femur) compared to the conventional cement. Conclusions The pastry cement facilitates the feasibility of cemented TKA. The pre-clinical tests indicate that the pastry bone cement fulfills the requirements for bone cement in the field of knee arthroplasty. A clinical trial is needed to further investigate the approach and ensure patient safety.

Revision Total Knee Arthroplasty

2007 ◽  
Vol 464 ◽  
pp. 146-150 ◽  
Author(s):  
Robert L Barrack ◽  
J Thomas McClure ◽  
Corey F Burak ◽  
John C Clohisy ◽  
Javad Parvizi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Total Knee
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