Intraoperative Proximal Tibia Periprosthetic Fractures in Primary Total Knee Arthroplasty

2020 ◽  
Author(s):  
Christopher W. Damsgaard ◽  
Bishoy V. Gad ◽  
Olivia J. Bono ◽  
Marie C. Anderson ◽  
Jonathon M. Brown ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Proximal Tibia ◽  
Rare Complication ◽  
Weight Bearing ◽  
Control Group ◽  
Polyethylene Insert ◽  
Tibia Fractures ◽  
Total Knee

AbstractIntraoperative fracture of the proximal tibia is a rare complication of total knee arthroplasty (TKA) with few studies available reporting risk factors or prognosis. A review of our prospective joint registry was performed to determine the incidence and associated risk factors of intraoperative tibia fractures during primary TKA; 14,966 TKAs of all manufacturers were performed with 9 intraoperative tibia fractures. All fractures occurred in a single TKA design. There were 8,155 TKAs of this design performed with a fracture incidence of 0.110%. All but one fracture occurred on the medial tibial plateau, and all but one occurred during preparation of the tibia with keel punching. A control group of 75 patients (80 knees) with the same TKA design were randomly selected. Baseplates size 3 or smaller were less likely to experience an intraoperative fracture (odds ratio [OR]: 0.864, 95% confidence interval [CI]: 0.785–0.951), as were knees with a polyethylene insert thickness of 13 mm or larger (OR: 0.882, 95% CI: 0.812–0.957). Fractures were treated with a variety of different methods, but every patient had at least one screw placed and most (67%) had postoperative weight-bearing restrictions. At final follow-up, there were no cases of nonunion, component subsidence, or need for reoperation. Intraoperative tibia fractures are a rare complication of this TKA design at 0.11%. Knees with baseplates of size ≤3 and polyethylene thickness ≥13 mm were less likely to experience intraoperative fracture. These findings may be related to the depth of tibial resection, requiring the use of a thicker polyethylene insert, and a change in the keel width in implants size 4 or larger. No fracture patients required reoperation.

scholarly journals Unusually High Rate of Early Failure of Tibial Component in ATTUNE Total Knee Arthroplasty System at Implant–Cement Interface

2017 ◽  
Vol 30 (05) ◽  
pp. 435-439 ◽  
Author(s):  
Anton Khlopas ◽  
Morad Chughtai ◽  
Connor Cole ◽  
Chukwuweike Gwam ◽  
Steven Harwin ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Rare Complication ◽  
Weight Bearing ◽  
High Rate ◽  
Radiographic Evaluation ◽  
Rotating Platform ◽  
Cement Interface ◽  
Total Knee

AbstractA novel design total knee arthroplasty (TKA) system has been introduced to improve patient outcomes and increase longevity. However, we have encountered a high rate of debonding of tibial implant–cement interface. In addition, multiple reports have been filed in Manufacturer and User Facility Device Experience database (MAUDE) with the same mechanism of failure. Therefore, we evaluated: clinical, radiographic, and intraoperative findings of patients who received this system and required a revision surgery, and findings from MAUDE database compiled to this date. We reviewed three hospital databases for patients who had revision TKA for tibial loosening at the implant–cement interface. This yielded 15 cases with a mean age of 61 years (range, 47–84). All patients received a novel knee system at another institution. Radiographic analysis was performed by treating orthopaedist. The MAUDE database was reviewed for reports of aseptic failure. Patients presented with pain on weight bearing, effusion, and decreased range of motion (ROM) within 2 years after surgery. Radiographic evaluation demonstrated loosening of the tibial components in 2 of 15 knees. This included cruciate retaining, posterior stabilized, fixed bearing, and rotating platform bearing designs. Intraoperative findings demonstrated gross loosening of the tibial component at the implant–cement interface. Femoral and patellar components were well fixed. There were 21 reports of tibial loosening at the implant–cement interface in MAUDE database in the past 2 months alone. Numerous other tibial failures were reported; however, the mechanisms of failures were not specified. Tibial component loosening is a rare complication of cemented TKA at short-term follow-up. Several possible reasons include increased constraint, reduced cement pockets, and reduced keel rotational stabilizers. The tibial component, which has greater torsional loads, has lower surface roughness than femoral component. We believe that this complication is underreported due to failure of radiographs to assess loosening. In addition, MAUDE database reporting is not consistent and competing companies cannot provide data on the revised components. In patients who have negative workup for a painful joint, one must consider the diagnosis of debonding.

scholarly journals Risk Factors of Early Periprosthetic Femoral Fracture After Total Knee Arthroplasty

2021 ◽  
Author(s):  
Chaturong Pornrattanamaneewong ◽  
Akraporn Sitthitheerarut ◽  
Pakpoom Ruangsomboon ◽  
Keerati Chareancholvanich ◽  
Rapeepat Narkbunnam
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femoral Fracture ◽  
Control Group ◽  
Periprosthetic Femoral Fracture ◽  
Radiographic Outcomes ◽  
Total Knee ◽  
Independent Risk Factors ◽  
Preoperative Deformity

Abstract BackgroundPeriprosthetic femoral fracture (PFF) is a serious complication after total knee arthroplasty (TKA). However, the risk factors of PFF in the early postoperative setting are not well documented. This study determines the risk factors of early PFF after primary TKA.MethodsThis study recruited 24 patients who had early PFF within postoperative 3 months and 96 control patients. Demographic data (age, gender, weight, height, body mass index, Deyo-Charlson comorbidity index, diagnosis, operated side, underlying diseases and history of steroid usage intraoperative outcomes), intraoperative outcomes (operative time, surgical approach, type and brand of the prosthesis), and radiographic outcomes (distal femoral width; DFW, prosthesis-distal femoral width ratio; PDFW ratio, anatomical lateral distal femoral angle; LDFA, femoral component flexion angle; FCFA and anterior femoral notching; AFN) were recorded and compared between groups. Details of PFF, including fracture pattern, preoperative deformity, and time to PFF were also documented.ResultsIn univariate analysis, the PFF group had significantly older, right side injury, rheumatoid, dyslipidemia, Parkinson patients than the control group (p < 0.05). No cruciate-retaining design was used in PFF group (p = 0.004). Differences between the prosthetic brand used were found in this study (p = 0.046). For radiographic outcomes, PFF group had significantly lower DFW but higher PDFW ratio and LDFA than the control group (p < 0.05). While FCFA and AFN were similar between groups. The fracture patterns were medial condylar (45.8%), lateral condylar (25.0%) and supracondylar fracture (29.2%). The mean overall time to PFF was 37.2 ± 20.6 days (range 8 – 87 days). Preoperative deformity was significantly different among the three patterns (p < 0.05). When analyzed using the logistic regression model, age and dyslipidemia were only two independent risk factors for early PFF. The cut-off point of age was > = 75 years, with a sensitivity of 75.0% and specificity of 78.1%. The odds ratio of dyslipidemia was 6.63 (95% confidence interval, 1.11 to 39.8).ConclusionThis study determined that age and dyslipidemia were the independent risk factors for early PFF. However, further well-controlled studies with a larger sample size were needed to address this issue.

scholarly journals New option of tibial plateau plasty in total knee arthroplasty

2021 ◽  
Vol 27 (5) ◽  
pp. 592-596
Author(s):  
I.F. Akhtyamov ◽  
◽  
I.Sh. Gilmutdinov ◽  
E.R. Khasanov ◽  
◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Tibial Plateau ◽  
Proximal Tibia ◽  
Weight Bearing ◽  
Cement Augmentation ◽  
Early Weight Bearing ◽  
Regular Triangle ◽  
Total Knee

Abstract. Introduction There are several options of fixation and plasty for tibial defects. Screw and cement augmentation of the tibia is an alternative to conventional bone autograft and allograft. Although use of metal and cement augments provides reliable support for the tibial plateau and facilitates early weight-bearing on the operated limb the technique fails to maintain enough bone stock for future revisions. The purpose was to present an option of cement and metal augmentation of the tibial component in total knee arthroplasty (TKA). Material and methods The technique consists of cement and screw augmentation using three screws placed vertically as a regular triangle and being perpendicular to the tibial plateau. We describe the technique and a clinical instance of type 2A defect of the proximal tibia using the author's method. Outcome measures were goniometry and radiography. Results Goniometry examination showed positive dynamics in the first week after surgery with flexion of 110.0 degrees, extension 175.0 degrees; at 12 months with flexion of 90.0 degrees and extension of 180.0 degrees. Radiographic examination demonstrated no instability and micromobility of the cement mantle. Discussion The author's technique of screw and cement augmentation of the tibial component was practical for type 2A defects of the proximal tibia with a shortage of materials of bone autografts. This is a pilot study that requires further investigations.

scholarly journals Dislocation after Posterior Stabilized Primary Total Knee Replacement: A Rare Complication in Four Cases

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
W. Spierenburg ◽  
E. L. A. R. Mutsaerts ◽  
J. J. A. M. van Raay
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Case Reports ◽  
Rare Complication ◽  
Varus Deformity ◽  
Related Factors ◽  
Total Knee

Introduction. Dislocation of a total knee arthroplasty is a rare complication that has rarely been described, while the total knee arthroplasty is frequently performed. From literature, we know patient-related factors, like obesity, neuropsychiatric disease, and severe valgus or varus deformity, are associated with higher risk of dislocation. We show our cases for awareness of the risk factors for surgeons. Case Presentations. We present four patients with a dislocation after a total knee arthroplasty. We compare these case reports with previous literature and show the most important risk factors for these dislocations. In our cases, three of them suffered from obesity, which possibly has contributed to the dislocation. Three patients did have instability which emphasizes the importance of ligament balancing while performing a total knee replacement. In all cases, an exchange of the polyethylene liner was performed. Conclusion. Implant-related factors and surgical technique as well as patient-related factors can contribute to this uncommon complication. Obesity, neuropsychiatric disorders, and a severe valgus or varus deformity are important patient-related risk factors. Our cases show these risk factors too. Some of these risk factors were encountered as well as other comorbidity factors. Such risk factors must be taken into consideration when deciding whether to perform a total knee arthroplasty. This stresses the importance of patient education and shared decision-making before performing a total knee replacement.

scholarly journals Dislocation of a polyethylene insert in an infected knee joint after a Triathlon total knee arthroplasty

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Idrees Ahmed ◽  
James Murray
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Male Patient ◽  
Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Rare Complication ◽  
Joint Infection ◽  
Polyethylene Insert ◽  
Prosthetic Joint ◽  
Total Knee

Abstract This report presents the case of a 57-year-old male patient who underwent a total knee arthroplasty (TKA) using an uncemented Triathlon system and subsequently went on to develop a prosthetic joint infection (PJI) with eventual polyethylene insert dislocation. This report presents the clinical, radiological and surgical findings of the insert dislocation on the background of PJI and explores this rare complication of TKA by providing a summary of the literature on this topic.

scholarly journals Risk factors of early periprosthetic femoral fracture after total knee arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chaturong Pornrattanamaneewong ◽  
Akraporn Sitthitheerarut ◽  
Pakpoom Ruangsomboon ◽  
Keerati Chareancholvanich ◽  
Rapeepat Narkbunnam
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femoral Fracture ◽  
Univariate Analysis ◽  
Control Group ◽  
Periprosthetic Femoral Fracture ◽  
Radiographic Outcomes ◽  
Total Knee ◽  
Preoperative Deformity

Abstract Background Periprosthetic femoral fracture (PFF) is a serious complication after total knee arthroplasty (TKA). However, the risk factors of PFF in the early postoperative setting are not well documented. This study determines the risk factors of early PFF after primary TKA. Methods This study recruited 24 patients who had early PFF within postoperative 3 months and 96 control patients. Demographic data (age, gender, weight, height, body mass index, Deyo-Charlson comorbidity index, diagnosis, operated side, underlying diseases and history of steroid usage intraoperative outcomes), intraoperative outcomes (operative time, surgical approach, type and brand of the prosthesis), and radiographic outcomes (distal femoral width; DFW, prosthesis-distal femoral width ratio; PDFW ratio, anatomical lateral distal femoral angle; LDFA, the change of LDFA, femoral component flexion angle; FCFA and anterior femoral notching; AFN) were recorded and compared between groups. Details of PFF, including fracture pattern, preoperative deformity, and time to PFF were also documented. Results In univariate analysis, the PFF group had significantly older, right side injury, rheumatoid, dyslipidemia, Parkinson patients than the control group (p < 0.05). No cruciate-retaining design was used in PFF group (p = 0.004). Differences between the prosthetic brand used were found in this study (p = 0.049). For radiographic outcomes, PFF group had significantly lower DFW but higher PDFW ratio and postoperative LDFA than the control group (p < 0.05). While the change of LDFA, FCFA and AFN were similar between groups. The fracture patterns were medial condylar (45.8%), lateral condylar (25.0%) and supracondylar fracture (29.2%). The mean overall time to PFF was 37.2 ± 20.6 days (range 8–87 days). Preoperative deformity was significantly different among the three patterns (p < 0.05). When performed multivariate analysis using the logistic regression model, age was only an independent risk factor for early PFF. The cut-off point of age was > = 75 years, with a sensitivity of 75.0% and specificity of 78.1%. Conclusion This study determined that age was the independent risk factors for early PFF. However, further well-controlled studies with a larger sample size were needed to address this issue.

The Adjustment of the Rotational Alignment of the Distal End of the Extramedullary Guide to the Anteroposterior Axis of the Proximal Tibia in Total Knee Arthroplasty

2021 ◽  
Author(s):  
Hideki Mizu-uchi ◽  
Hidehiko Kido ◽  
Tomonao Chikama ◽  
Kenta Kamo ◽  
Satoshi Kido ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Navigation System ◽  
Proximal Tibia ◽  
Rotational Alignment ◽  
Coronal Alignment ◽  
Ideal Position ◽  
Total Knee ◽  
Alignment Guide ◽  
The Ideal

AbstractThe optimal placement within 3 degrees in coronal alignment was reportedly achieved in only 60 to 80% of patients when using an extramedullary alignment guide for the tibial side in total knee arthroplasty (TKA). This probably occurs because the extramedullary alignment guide is easily affected by the position of the ankle joint which is difficult to define by tibial torsion. Rotational direction of distal end of the extramedullary guide should be aligned to the anteroposterior (AP) axis of the proximal tibia to acquire optimal coronal alignment in the computer simulation studies; however, its efficacy has not been proven in a clinical setting. The distal end of the guide can be overly displaced from the ideal position when using a conventional guide system despite the alignment of the AP axis to the proximal tibia. This study investigated the effect of displacement of the distal end of extramedullary guide relative to the tibial coronal alignment while adjusting the rotational alignment of the distal end to the AP axis of the proximal tibia in TKA. A total of 50 TKAs performed in 50 varus osteoarthritic knees using an image-free navigation system were included in this study. The rotational alignment of the proximal side of the guide was adjusted to the AP axis of the proximal tibia. The position of the distal end of the guide was aligned to the center of the ankle joint as viewed from the proximal AP axis (ideal position) and as determined by the navigation system. The tibial intraoperative coronal alignments were recorded as the distal end was moved from the ideal position at 3-mm intervals. The intraoperative alignments were 0.5, 0.9, and 1.4 degrees in valgus alignment with 3-, 6-, and 9-mm medial displacements, respectively. The intraoperative alignments were 0.7, 1.2, and 1.7 degrees in varus alignment with 3-, 6-, and 9-mm lateral displacements, respectively. In conclusion, the acceptable tibial coronal alignment (within 2 degrees from the optimal alignment) can be achieved, although some displacement of the distal end from the ideal position can occur after the rotational alignment of the distal end of the guide is adjusted to the AP axis of the proximal tibia.

Providing Inpatient Mobilization with a Mobility Technician Constrains Cost in Primary Total Knee Arthroplasty

2020 ◽  
Author(s):  
Thomas A. Novack ◽  
Christopher J. Mazzei ◽  
Jay N. Patel ◽  
Eileen B. Poletick ◽  
Roberta D'Achille ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Care Pathway ◽  
Primary Total Knee Arthroplasty ◽  
Cost Savings ◽  
Patient Discharge ◽  
Control Group ◽  
Study Group ◽  
Bundled Payment ◽  
Total Knee

AbstractSince the 2016 implementation of the comprehensive care for joint replacement (CJR) bundled payment model, our institutions have sought to decrease inpatient physical therapy (PT) costs by piloting a mobility technician program (MTP), where mobility technicians (MTs) ambulate postoperative total knee arthroplasty (TKA) patients under the supervision of nursing staff members. MTs are certified medical assistants given specialized gate and ambulation training by the PT department. The aim of this study was to examine the economic and clinical impact of MTs on the primary TKA postoperative pathway. We performed a retrospective review of TKA patients who underwent surgery at our institution between April 2018 and March 2019 and who were postoperatively ambulated by MTs. The control group included patients who had surgery during the same months of the prior year, preceding introduction of MTs to the floor. Inclusion criteria included: unilateral primary TKA for arthritic conditions and conversion to unilateral primary TKA from a previous knee surgery. Minitab Software (State College, PA) was used to perform the statistical analysis. There were 658 patients enrolled in the study group and 1,400 in the control group. The two groups shared similar demographics and an average age of 68 (p = 0.177). The median length of stay (LOS) was 2 days in both groups (p = 0.133) with 90.5% of patients in the study group discharged to home versus 81.5% of patients in the control group (p < 0.001). The ability of MTs to increase patient discharge to home without negatively impacting LOS suggest MTs are valuable both clinically to patients, and economically to the institution. Cost analysis highlighted the substantial cost savings that MTs may create in a bundled payment system. With the well-documented benefits of early ambulation following TKA, we demonstrate how MTs can be an asset to optimizing the care pathway of TKA patients.

The Effect of Preoperative Video Based Pain Training on Postoperative Pain and Analgesic Use in Patients Undergoing Total Knee Arthroplasty: A Non-randomized Control Group Intervention Study

2020 ◽  
pp. 105477382098336
Author(s):  
Ceyda Su Gündüz ◽  
Nurcan Çalişkan
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Group Intervention ◽  
Intervention Study ◽  
Intervention Group ◽  
Control Group ◽  
Total Knee ◽  
Randomized Control ◽  
Analgesic Use

This non-randomized control group intervention study was conducted to determine the effect of preoperative video based pain training on postoperative pain and analgesic use in patients undergoing total knee arthroplasty. During the study, the patients in the control ( n = 40) received routine care and the patients in the intervention group ( n = 40) received video based pain training. İt was determined that the mean postoperative pain scores of the intervention group were significantly lower and their pain management was better compared to the control group ( p < .05). The intervention group was found to use significantly less paracetamol on operation day compared to the control group ( p < .05). The intervention group was determined to benefit from non-pharmacological methods more than the control group did ( p < .05). Providing video based pain training to patients undergoing total knee arthroplasty is recommended since it reduces postoperative pain levels and increases the use of non-pharmacological pain control methods.

scholarly journals Intravenous patient-controlled analgesia vs nurse administered oral oxycodone after total knee arthroplasty: a retrospective cohort study

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Katarina Lahtinen ◽  
Elina Reponen ◽  
Anne Vakkuri ◽  
Riku Palanne ◽  
Mikko Rantasalo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Pain Medication ◽  
Secondary Outcome ◽  
Control Group ◽  
Patient Controlled Analgesia ◽  
Total Knee Arthroplasty Patient ◽  
Opioid Dose ◽  
Total Knee

AbstractShort CommunicationsSevere post-operative pain is common after total knee arthroplasty. Patient-controlled analgesia is an alternative method of pain management, whereby a patient administers his or her own pain medication. Patients seem to prefer this method over nurse-administered analgesia. However, it remains unclear whether patients using patient-controlled analgesia devices use higher or lower doses of opioids compared to patients treated with oral opioids.Objectives and MethodsThis retrospective study examined 164 patients undergoing total knee arthroplasty. Post-operatively, 82 patients received oxycodone via intravenous patient-controlled analgesia devices, while the pain medication for 82 patients in the control group was administered by nurses. The main outcome measure was the consumption of intravenous opioid equivalents within 24 h after surgery. Secondary outcome measures were the use of anti-emetic drugs and the length of stay. Furthermore, we evaluated opioid-related adverse event reports.ResultsThe consumption of opioids during the first 24 h after surgery and the use of anti-emetic drugs were similar in both groups. The median opioid dose of intravenous morphine equivalents was 41.1 mg (interquartile range (IQR): 29.5–69.1 mg) in the patient-controlled analgesia group and 40.5 mg (IQR: 32.4–48.6 mg) in the control group, respectively. The median length of stay was 2 days (IQR: 2–3 days) in the patient-controlled analgesia group and 3 days (IQR: 2–3 days) in the control group (p=0.02). The use of anti-emetic drugs was similar in both groups.ConclusionsThe administration of oxycodone via intravenous patient-controlled analgesia devices does not lead to increased opioid or anti-emetic consumptions compared to nurse-administered pain medication after total knee arthroplasty. Patient-controlled analgesia might lead to shortened length of stay.

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