Cementless versus Cemented Fixation in Total Knee Arthroplasty

2019 ◽  
Vol 32 (07) ◽  
pp. 596-599 ◽  
Author(s):  
Paraskevi Vivian Papas ◽  
Dominick Congiusta ◽  
Fred D. Cushner
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Cementless Fixation ◽  
Fixation Technique ◽  
Midterm Results ◽  
The Past ◽  
Total Knee ◽  
Changing Demographics ◽  
Standard Fixation ◽  
Revision Tka

AbstractDespite the success of total knee arthroplasty (TKA), more than 20,000 revision TKA procedures are performed annually. In an effort to decrease failures due to loosening in the past, cementless fixation of TKA was suggested. The preliminary results of cementless fixation for TKA proved to be discouraging, with midterm results linking the use of uncemented components to early aseptic loosening. While cemented TKA has remained the gold standard fixation technique, the changing demographics of the average TKA patient have led some surgeons to revisit cementless fixation as an option.

Removal of Well-Fixed Tibial Cone in Revision Total Knee Arthroplasty—A Uniquely Challenging Yet Necessary Scenario

2019 ◽  
Author(s):  
William F. Scully ◽  
Matthew E. Deren ◽  
Assem A. Sultan ◽  
Linsen T. Samuel ◽  
William Nageotte ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Loss ◽  
Knee Arthroplasty ◽  
Surgical Techniques ◽  
The United States ◽  
Revision Total Knee Arthroplasty ◽  
Midterm Results ◽  
Patient Reported ◽  
Total Knee ◽  
Revision Tka

AbstractThe number of revision total knee arthroplasties (TKA) performed in the United States continues to increase. While advancements in implant design and surgical technique have led to improved outcomes compared with historical data, these cases remain technically demanding with high rates of aseptic failure and worse patient reported outcome scores compared with primary total knee arthroplasty. One particular problem commonly encountered in revision knee arthroplasty is bone loss, particularly in the epiphyseal region, which negatively impacts the structural integrity of the implants. Various modular metaphyseal sleeves and cones in conjunction with stemmed implants have been designed to enhance metaphyseal fixation, corroborated by multiple studies demonstrating excellent midterm results involving cones, and sleeves. Commercially available revision systems that incorporate metaphyseal cones are currently widely utilized in revision TKA. For tibial defects, both symmetric and asymmetric cone options are available. Excellent midterm results have been reported with use of this device in the setting of severe proximal tibial bone loss in revision TKA surgery. With the enhanced fixation provided by various sleeve and cone augments, implant removal in the setting of recurrent infection or implant failure can be extremely challenging. Consequently, in this work, we sought to describe an algorithmic approach for removing a tibial cone in conjunction with the overlying tibial baseplate. A review of the literature has also been conducted for complex surgical techniques regarding removal of well-fixed implants in revision total knee arthroplasty.

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 Impact of Preoperative Opioid Use on Patient-Reported Outcomes after Revision Total Knee Arthroplasty: A Propensity Matched Analysis

2021 ◽  
Author(s):  
Eitan Ingall ◽  
Christian Klemt ◽  
Christopher M. Melnic ◽  
Wayne B. Cohen-Levy ◽  
Venkatsaiakhil Tirumala ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Propensity Score ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Opioid Use ◽  
Absolute Increase ◽  
Patient Reported ◽  
Total Knee ◽  
Opioid Users ◽  
Revision Tka

AbstractThis is a retrospective study. Prior studies have characterized the deleterious effects of narcotic use in patients undergoing primary total knee arthroplasty (TKA). While there is an increasing revision arthroplasty burden, data on the effect of narcotic use in the revision surgery setting remain limited. Our aim was to characterize the effect of active narcotic use at the time of revision TKA on patient-reported outcome measures (PROMs). A total of 330 consecutive patients who underwent revision TKA and completed both pre- and postoperative PROMs was identified. Due to differences in baseline characteristics, 99 opioid users were matched to 198 nonusers using the nearest-neighbor propensity score matching. Pre- and postoperative knee disability and osteoarthritis outcome score physical function (KOOS-PS), patient reported outcomes measurement information system short form (PROMIS SF) physical, PROMIS SF mental, and physical SF 10A scores were evaluated. Opioid use was identified by the medication reconciliation on the day of surgery. Propensity score–matched opioid users had significantly lower preoperative PROMs than the nonuser for KOOS-PS (45.2 vs. 53.8, p < 0.01), PROMIS SF physical (37.2 vs. 42.5, p < 0.01), PROMIS SF mental (44.2 vs. 51.3, p < 0.01), and physical SF 10A (34.1 vs. 36.8, p < 0.01). Postoperatively, opioid-users demonstrated significantly lower scores across all PROMs: KOOS-PS (59.2 vs. 67.2, p < 0.001), PROMIS SF physical (43.2 vs. 52.4, p < 0.001), PROMIS SF mental (47.5 vs. 58.9, p < 0.001), and physical SF 10A (40.5 vs. 49.4, p < 0.001). Propensity score–matched opioid-users demonstrated a significantly smaller absolute increase in scores for PROMIS SF Physical (p = 0.03) and Physical SF 10A (p < 0.01), as well as an increased hospital length of stay (p = 0.04). Patients who are actively taking opioids at the time of revision TKA report significantly lower preoperative and postoperative outcome scores. These patients are more likely to have longer hospital stays. The apparent negative effect on patient reported outcomes after revision TKA provides clinically useful data for surgeons in engaging patients in a preoperative counseling regarding narcotic use prior to revision TKA to optimize outcomes.

Midterm results of a new personalized knee implant for total knee arthroplasty: implant survivorship and patient-reported outcome after five years’ follow-up

2021 ◽  
Author(s):  
Cristina Dauder Gallego ◽  
Irene Blanca Moreno Fenoll ◽  
José Luis Patiño Contreras ◽  
Francisco Javier Moreno Coronas ◽  
María del Carmen Torrejón de la Cal ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcome ◽  
Midterm Results ◽  
Implant Survivorship ◽  
Patient Reported ◽  
Total Knee

Midterm Results of All-Polyethylene Tibial Components in Primary Total Knee Arthroplasty

2009 ◽  
Vol 24 (4) ◽  
pp. 620-624 ◽  
Author(s):  
David F. Dalury ◽  
Donald L. Pomeroy ◽  
Ricardo A. Gonzales ◽  
Thomas A. Gruen ◽  
Mary Jo Adams ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Midterm Results ◽  
Total Knee ◽  
Primary Total Knee

Isolated tibial insert exchange in revision total knee arthroplasty

2021 ◽  
Vol 103-B (6) ◽  
pp. 1103-1110
Author(s):  
Matthew W. Tetreault ◽  
Jeremy T. Hines ◽  
Daniel J. Berry ◽  
Mark W. Pagnano ◽  
Robert T. Trousdale ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Polyethylene Wear ◽  
Revision Total Knee Arthroplasty ◽  
Common Reason ◽  
Original Diagnosis ◽  
Tibial Insert ◽  
Total Knee ◽  
Component Loosening ◽  
Revision Tka

Aims This study aimed to determine outcomes of isolated tibial insert exchange (ITIE) during revision total knee arthroplasty (TKA). Methods From 1985 to 2016, 270 ITIEs were performed at one institution for instability (55%, n = 148), polyethylene wear (39%, n = 105), insert fracture/dissociation (5%, n = 14), or stiffness (1%, n = 3). Patients with component loosening, implant malposition, infection, and extensor mechanism problems were excluded. Results Survivorship free of any re-revision was 68% at ten years. For the indication of insert wear, survivorship free of any re-revision at ten years was 74%. Re-revisions were more frequent for index diagnoses other than wear (hazard ratio (HR) 1.9; p = 0.013), with ten-year survivorships of 69% for instability and 37% for insert fracture/dissociation. Following ITIE for wear, the most common reason for re-revision was aseptic loosening (33%, n = 7). For other indications, the most common reason for re-revision was recurrence of the original diagnosis. Mean Knee Society Scores improved from 54 (0 to 94) preoperatively to 77 (38 to 94) at ten years. Conclusion After ITIE, the risk and reasons for re-revision correlated with preoperative indications. The best results were for polyethylene wear. For other diagnoses, the re-revision rate was higher and the failure mode was most commonly recurrence of the original indication for the revision TKA. Cite this article: Bone Joint J 2021;103-B(6):1103–1110.

scholarly journals Patients' Perception of Bone and Tissue Excision, and the Size and Weight of Prostheses at Total Knee Arthroplasty

2017 ◽  
Vol 03 (03) ◽  
pp. e110-e112
Author(s):  
Benjamin Rossi ◽  
Narlaka Jayasekera ◽  
Fionnuala Kelly ◽  
Keith Eyres
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Postoperative Recovery ◽  
Patient Perception ◽  
Femoral Bone ◽  
Bone Resection ◽  
Orthopaedic Literature ◽  
Total Knee ◽  
A Prospective Study ◽  
Revision Tka

AbstractThe aim of this study is to ascertain patients' perception of the amount of bone and tissue excision and size and weight of their implanted prostheses at total knee arthroplasty (TKA). To our knowledge, no prior study in the English orthopaedic literature has analyzed these parameters against patient perception of TKA. In a prospective study of eight consecutive TKA (six primary and two single-stage revision TKA procedures) by a single surgeon, patients estimated the weight of their implanted knee. We assessed actual weights of their implants and bone cement. Patients estimated the size of their prostheses by sketching the tibial and femoral bone cuts upon a printout of an anteroposterior and lateral radiographs of their preoperative knee. We utilized an articulated plastic model knee for patient reference. Our study shows almost half a kilogram of weight is added postoperatively to the surgical site as a result of tissue excision, explanted material, and implanted prosthesis and cement. All patients overestimated the weight of their implanted prostheses and extent of bone excision. Thus, even ‘well-informed’ patients overestimate their bone resection and weight of implanted prosthesis at TKA. We postulate such misconceptions among TKA patients are common, and may impact negatively upon patient perception of TKA, their postoperative recovery and outcome.

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