Isolated Liner Revision for Total Knee Arthroplasty Instability: A Road That Should Remain Less Taken

2020 ◽  
Author(s):  
Jason D. Tegethoff ◽  
Rafael Walker-Santiago ◽  
William M. Ralston ◽  
James A. Keeney
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
P Value ◽  
Surgical Morbidity ◽  
Exact Test ◽  
Total Knee ◽  
Component Revision

AbstractIsolated polyethylene liner exchange (IPLE) is infrequently selected as a treatment approach for patients with primary total knee arthroplasty (TKA) prosthetic joint instability. Potential advantages of less immediate surgical morbidity, faster recovery, and lower procedural cost need to be measured against reoperation and re-revision risk. Few published studies have directly compared IPLE with combined tibial and femoral component revision to treat patients with primary TKA instability. After obtaining institutional review board (IRB) approval, we performed a retrospective comparison of 20 patients treated with IPLE and 126 patients treated with tibial and femoral component revisions at a single institution between 2011 and 2018. Patient demographic characteristics, medical comorbidities, time to initial revision TKA, and reoperation (90 days, <2 years, and >2 years) were assessed using paired Student's t-test or Fisher's exact test with a p-value <0.01 used to determine significance. Patients undergoing IPLE were more likely to undergo reoperation (60.0 vs. 17.5%, p = 0.001), component revision surgery (45.0 vs. 8.7%, p = 0.002), and component revision within 2 years (30.0 vs. 1.6%, p < 0.0001). Differences in 90-day reoperation (p = 0.14) and revision >2 years (p = 0.19) were not significant. Reoperation for instability (30.0 vs. 4.0%, p < 0.001) and infection (20.0 vs. 1.6%, p < 0.01) were both higher in the IPLE group. IPLE does not provide consistent benefits for patients undergoing TKA revision for instability. Considerations for lower immediate postoperative morbidity and cost need to be carefully measured against long-term consequences of reoperation, delayed component revision, and increased long-term costs of multiple surgical procedures. This is a level III, case–control study.

scholarly journals Long-Term Postoperative Total Knee Arthroplasty Flexion Scores in Relation to Body Mass Index

2020 ◽  
Author(s):  
Matthew A. Siegel ◽  
Michael J. Patetta ◽  
Angie M. Fuentes ◽  
Armaan S. Haleem ◽  
Craig W. Forsthoefel ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Statistical Significance ◽  
P Value ◽  
Preoperative Body Mass Index ◽  
Total Knee

AbstractKnee range of motion (ROM) is an important postoperative measure of total knee arthroplasty (TKA). There is conflicting literature whether patients who are obese have worse absolute ROM outcomes than patients who are not obese. This study analyzed whether preoperative body mass index (BMI) influences knee ROM after patients' primary TKA. A retrospective investigation was performed on patients, who underwent primary TKA at an academic institution, by one of three fellowship-trained adult reconstruction surgeons. Patients were stratified according to their preoperative BMI into nonobese (BMI < 30.0 kg/m2) and obese (BMI ≥ 30.0 kg/m2) classifications. Passive ROM was assessed preoperatively as well as postoperatively at patients' most recent follow-up visit that was greater than 2 years. Mann–Whitney U tests were performed to determine statistical significance at p-value <0.05 for ROM outcomes. No statistically significant differences were observed when ROM in the nonobese group was compared with ROM in the obese group both preoperatively (105.73 ± 11.58 vs. 104.14 ± 13.58 degrees, p-value = 0.417) and postoperatively (105.83 ± 14.19 vs. 104.49 ± 13.52 degrees, p-value = 0.777). Mean follow-up time for all patients was 4.49 ± 1.92 years. In conclusion, long-term postoperative ROM outcomes were similar between patients who were nonobese and patients who were obese.

Manipulation under Anesthesia after Knee Arthroplasty Is Associated with Worse Long-Term Clinical Outcomes and Survivorship

2019 ◽  
Author(s):  
David A. Crawford ◽  
Joanne B. Adams ◽  
Michael J. Morris ◽  
Keith R. Berend ◽  
Adolph V. Lombardi
Keyword(s):  
Total Knee Arthroplasty ◽  
Relative Risk ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Long Term Outcomes ◽  
Manipulation Under Anesthesia ◽  
Total Knee ◽  
Primary Total Knee

AbstractThe literature is mixed on the long-term fate of knees that undergo manipulation under anesthesia (MUA). The purpose of this study is to evaluate the long-term outcomes and survivorship of patients who required a MUA after primary total knee arthroplasty (TKA) compared with a cohort of patients who did not undergo a MUA. Between 2003 and 2007, 2,193 patients (2,783 knees) underwent primary TKA with 2-year minimum follow-up; 182 knees (6.5%) had a MUA. Patients who had a manipulation were younger (p < 0.001) and had worse preoperative range of motion (ROM) (p < 0.001). Postoperative ROM, Knee Society clinical (KSC), functional, and pain (KSP) scores, revisions, and survivorship were compared between MUA and no MUA. Mean follow-up was 9.7 years. MUA patients had lower postoperative ROM (p < 0.001), change in ROM (p < 0.001), KSC (p < 0.001), KSP (p < 0.001), and change in KSP scores (0.013). Revisions occurred in 18 knees (9.9%) in the MUA group compared with 77 knees (3%) without a MUA (p < 0.001). Most common reason for revision after MUA was continued stiffness (50%). Relative risk for revision after one MUA was 2.01 (95% confidence interval [CI], 1.1–3.8, p < 0.001) and after three or more MUAs were 27.02 (95% CI, 16.5–44.1, p < 0.001). Ten-year survival after MUA was 89.4% (95% CI, 87.1–91.7%) compared with 97.2% (95% CI, 96.9–97.5%) without a MUA (p < 0.001). Patients who undergo a MUA after primary TKA may have a knee at risk with higher revision rates, worse long-term clinical scores, ROM and survivorship.

scholarly journals Ceramic Femoral Components in Total Knee Arthroplasty - Two Year Follow-Up Results of an International Prospective Multi-Centre Study

2012 ◽  
Vol 6 (1) ◽  
pp. 172-178 ◽  
Author(s):  
Philipp Bergschmidt ◽  
Rainer Bader ◽  
Dirk Ganzer ◽  
Christian Hauzeur ◽  
Christoph Lohmann ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Multi Centre Study ◽  
Centre Study ◽  
Radiolucent Lines ◽  
Sf 36 ◽  
Total Knee

Background:Total knee arthroplasty can be considered as a reliable surgical procedure with a good long-term clinical result. However, implant failure due to particle induced aseptic loosening as well as the aspect of hypersensitivity to metal ions still remains an emerging issue.Methods:The purpose of this prospective international multi-centre study was to evaluate the clinical and radiological outcomes and the reliability of the unconstrained Multigen Plus Total Knee System with a new BIOLOX® delta ceramic femoral component. Cemented total knee arthroplasty was performed on 108 patients (110 knees) at seven hospitals in three countries. Clinical and radiological evaluations were performed preoperatively, and after 3, 12 and 24 months postoperatively using the HSS-, WOMAC-, SF-36-score and standardised X-rays.Results:The mean preoperative HSS-Score amounted to 55.5 ± 11.5 points and improved significantly in all postoperative evaluations (85.7 ± 11.7 points at 24 months). Furthermore, improvements in WOMAC- and SF-36-score were evaluated as significant at all points of evaluation. Radiolucent lines around the femoral ceramic component at 24 months were found in four cases. Progression of radiolucent lines was not seen and no implant loosening was observed. During the 24 month follow-up eight patients underwent subsequent surgery due to reasons unrelated to the implant material.Conclusions:The observed clinical and radiological results are encouraging for a long-term survival of the ceramic femoral component. Therefore, ceramic implants could be a promising solution not only for patients with allergies against metallic implant materials, but also for the osteoarthritic knee joint. Long-term follow-up is necessary to draw conclusions regarding the superiority of the ceramic knee implants concerningin vivowear and long-term survivorship.

Dual Antibiotic Prophylaxis in Primary Total Knee Arthroplasty—No Benefit for Extremely Obese Patients

2021 ◽  
Author(s):  
Mark K. Lane ◽  
James A. Keeney
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Prophylaxis ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Primary Total Knee Arthroplasty ◽  
Obese Patients ◽  
Exact Test ◽  
Primary Tkas ◽  
Risk Patients ◽  
Total Knee

AbstractWe performed this study to assess the effectiveness of multimodal total knee arthroplasty prosthetic joint infection (TKA-PJI) prophylaxis including “on-time” dual-antibiotic prophylaxis, and the influence of body mass index (BMI) on prophylaxis effectiveness. After obtaining Institutional Review Board approval, we assessed 1,802 primary TKAs (1,496 patients) who received cefazolin alone or cefazolin combined with vancomycin for TKA-PJI prophylaxis. A detailed chart review was performed to determine patient demographic features (age, gender, BMI, American Society of Anesthesiologists Score), antibiotic selection, vancomycin administration timing, and 1-year PJI rates. Statistical assessment was accomplished using a two-sided Student's t-test or Fisher's exact test. Patients who received dual-antibiotic prophylaxis with “on time” vancomycin infusion (Group CVt) had significantly lower infection rates than other TKA patients (0.8 vs. 2.7%, p < 0.01). “On Time” vancomycin administration was associated with a lower TKA-PJI rate for patients with a BMI < 45 kg/m2 (0.5 vs. 2.6%, p < 0.01) with no infections in 120 TKA patients with a BMI between 40 and 44.9 kg/m2 (p < 0.01). No difference was noted for patients with a BMI ≥ 45 kg/m2 (3.3 vs. 2.6%, p = 0.71). There were no infections in 150 TKA patients with a normal BMI (18–25 kg/m2) in any PJI-prophylaxis treatment group. Adoption of a dual-antibiotic prophylaxis approach can successfully reduce TKA-PJI rates among overweight and moderately obese patients. The approach does not appear to influence outcomes for low risk patients with a normal BMI (18–25 kg/m2) or for higher risk patients with a BMI > 45 kg/m2.

ROTATIONAL ALIGNMENT OF THE FEMORAL COMPONENT IN TOTAL KNEE ARTHROPLASTY FOR VARUS OSTEOARTHRITIS OF THE KNEE; A RETROSPECTIVE STUDY

2021 ◽  
pp. 46-48
Author(s):  
Pooyan Jalalpour ◽  
Mohammadreza Minator Sajadi ◽  
Seyed Amirali Matini ◽  
Kamyar Makvandi
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Study ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
External Rotation ◽  
Rotational Alignment ◽  
P Value ◽  
Osteoarthritis Of The Knee ◽  
Posterior Condylar ◽  
Total Knee

Background and Aims: Achieving proper axial rotational alignment of the femoral component for varus knees is a critical step in total knee arthroplasty (TKA). Trans epicondylar axis (TEA) is the most reliable reference for alignment of femoral component. Yet, nding the exact location is sometimes difcult and time consuming. The aim of this study was to determine the correlation between the TEA and posterior condylar line reference (PCL) in varus knees. Besides, the other aim of this study was to nd the relationship between lateral distal femoral angle (LDFA) and femoral component external rotation (ER) measured intraoperatively. Material and Methods: This retrospective study was conducted on patients who were candidates for total knee arthroplasty from May 2016 to December 2019. LDFA, VA were calculated based on hip-to-ankle (HTA) radiographs before the surgery. All patients underwent TKA through an anterior midline incision. ER was calculated by determining TEA intraoperatively. All data were entered into SPSS software for data analysis. Results: One hundred and four patients were included in the nal analysis. Nineteen patients (18.3%) were male and 85 out of 104 (81.7%) were female. (P value = 0.001). No signicant relationship between the amount of ER measured during surgery and the amount of varus angle in varus knees was observed. Furthermore, there were no correlations between ER and LDFA in varus knees. Conclusion: Adjusting femoral component in 3 degrees external rotation relative to posterior condylar line reference achieves proper rotational alignment of the femoral component in the axial plane in varus knees. Also, the lateral distal femoral angle measured preoperatively from knee radiographs is not a predictor of ER in varus knees

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