Zonal Fixation in Revision TKA: The Key Is Metaphyseal Fixation

2021 ◽  
Author(s):  
Jason H. Oh ◽  
Giles R. Scuderi
Keyword(s):  
Bone Loss ◽  
Revision Surgery ◽  
Total Knee Arthroplasties ◽  
Metaphyseal Fixation ◽  
Revision Arthroplasties ◽  
Total Knee ◽  
Revision Tka ◽  
Primary Total Knee

AbstractAs the volume of primary total knee arthroplasties continues to rise, so will the volume of revision arthroplasties. Bone loss is commonly encountered in revision surgery and must be managed appropriately to optimize outcomes. The concept of zonal fixation highlights the importance of attaining secure fixation within each of the three major osseous zones: the epiphysis, the metaphysis, and the diaphysis. While each zone is important, the metaphysis carries particular significance. The development of new implants such as metaphyseal cones and sleeves has greatly expanded the orthopedic surgeon's armamentarium to allow for solid metaphyseal fixation in virtually every case.

scholarly journals Bone loss management in total knee revision surgery

2014 ◽  
Vol 38 (2) ◽  
pp. 419-427 ◽  
Author(s):  
Gabriele Panegrossi ◽  
Marco Ceretti ◽  
Matteo Papalia ◽  
Filippo Casella ◽  
Fabio Favetti ◽  
...  
Keyword(s):  
Bone Loss ◽  
Revision Surgery ◽  
Knee Revision Surgery ◽  
Total Knee ◽  
Knee Revision

scholarly journals Unicompartmental knee arthroplasty and revision total knee arthroplasty have a lower risk of venous thromboembolism disease at 30 days than primary total knee arthroplasty

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Andrew M. Schneider ◽  
Daniel R. Schmitt ◽  
Nicholas M. Brown
Keyword(s):  
Total Knee Arthroplasty ◽  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Lower Risk ◽  
Primary Total Knee Arthroplasty ◽  
Unicompartmental Knee ◽  
Total Knee ◽  
Revision Tka ◽  
Primary Total Knee

Abstract Background While multiple studies have demonstrated a lower venous thromboembolism disease (VTED) risk for unicompartmental knee arthroplasty (UKA) compared to primary total knee arthroplasty (TKA), recent reports have shown that revision TKA also had a lower VTED risk compared to primary TKA, an unexpected finding because of its theoretical increased risk. Given the paucity of up-to-date comparative studies, our goal was to perform a high-powered VTED risk comparison study of UKA and revision TKA to primary TKA using recent data. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried between 2011 and 2018, and we identified 213,234 patients for inclusion: 191,810 primary TKA, 9294 UKA, and 12,130 revision TKA. Demographics, medical comorbidities, and possible VTE risk factors were collected. Thirty-day outcomes, including deep vein thrombosis (DVT), pulmonary embolism (PE), and all-cause VTED were compared between knee arthroplasty types. Results On multivariate analysis, UKA was significantly associated with lower rates of DVT [OR 0.44 (0.31–0.61); P < 0.001], PE [OR 0.42 (0.28–0.65); P < 0.001], and all-cause VTED [OR 0.42 (0.32–0.55); P < 0.001] when compared to primary TKA. Revision TKA was significantly associated with lower rates of PE [OR 0.62 (0.47–0.83); P = 0.002], and all-cause VTED [OR 0.82 (0.70–0.98); P = 0.029] when compared to primary TKA. Conclusions Utilizing recent data from a nationwide patient cohort and controlling for confounding variables, our results showed that both revision TKA and UKA had a lower risk of VTED compared to primary TKA, corroborating the results of recent investigations. Additional prospective investigations are needed to explain this unexpected result.

Comparing Steri-Strip and surgical staple wound closures after primary total knee arthroplasties

2016 ◽  
Vol 27 (1) ◽  
pp. 113-118 ◽  
Author(s):  
Satoshi Takayama ◽  
Takeshi Yamamoto ◽  
Chiduru Tsuchiya ◽  
Hideo Noguchi ◽  
Junko Sato ◽  
...  
Keyword(s):  
Total Knee Arthroplasties ◽  
Total Knee ◽  
Primary Total Knee

Removal and successful re-implantation of a customized interpositional knee device following an early postoperative infection: A case report

Open Medicine ◽  
2010 ◽  
Vol 5 (4) ◽  
pp. 442-446 ◽  
Author(s):  
Franz Koeck ◽  
Bjoern Rath ◽  
Hans-Robert Springorum ◽  
Markus Tingart ◽  
Joachim Grifka ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Revision Surgery ◽  
Rare Case ◽  
Postoperative Infection ◽  
Clinical Results ◽  
Total Knee Arthroplasties ◽  
First Case ◽  
Alternative Treatment Option ◽  
Total Knee

AbstractWe report the first case of early postoperative infection after a medial hemiarthroplasty of the knee with a customized ConforMIS iForma™ interpositional device. The infection was treated successfully by revision surgery with implant removal and antibiotic therapy. Despite the additional diagnosis of rheumatoid arthritis that did not affect the treated knee, the preservation of bony and ligamentous structures enabled a successful re-implantation of another iForma™ implant 9 months later with good clinical results at follow-up examination 1 year postoperatively. This is very much in contrast to the extensive and complex revision surgery, with significant bone loss, in patients with infected unicompartmental or total knee arthroplasties. The iForma™ device may be an alternative treatment option in early and moderate unicompartmental arthritis of the knee, with easy revision with the same type of implant in the rare case of infection.

scholarly journals Is Utilizing a Modular Stemmed Tibial Component in Obese Patients Undergoing Primary Total Knee Replacement Cost-Effective?

2018 ◽  
Vol 8 (2) ◽  
Author(s):  
J. Ryan Martin ◽  
Jesse Otero ◽  
Walter Beaver ◽  
Bryan Springer ◽  
William Griffin
Keyword(s):  
Cost Effectiveness ◽  
Revision Surgery ◽  
Patient Population ◽  
Tibial Component ◽  
Cost Effective ◽  
Obese Patients ◽  
Price Point ◽  
Total Knee ◽  
The Cost ◽  
Primary Total Knee

Introduction: There has been recent enthusiasm for the use of modular stemmed tibial components in obese (BMI ≥35kg/m2) patients undergoing primary total knee arthroplasty (TKA). This has been mainly driven by studies demonstrating statistically significant increases in the rates of aseptic tibial loosening (ATL) in this patient population. However, to our knowledge, no study has specifically evaluated the cost effectiveness of this current recommendation.Methods: The following study was performed utilizing previously obtained data on the incidence of ATL in obese patients undergoing primary TKA. This data was then utilized to create a cost calculator that can evaluate the price point at which the use of a stemmed tibial component in all obese patients would be less than or equal to the costs of revision surgery if a stemmed implant was not utilized.Results: Utilizing historical data with a revision rate of 4% for aseptic loosening of the tibia on obese patients, a cost calculator was developed. The cost calculator requires the input of expected or known incidence of ATL utilizing a stem extension and the expected or known costs of revision for ATL.Conclusion: The following cost calculator quickly determines a price point at which the use of a tibial stem offsets the costs of revision surgery. While this study may not provide an exact cost-effectiveness of modular stem fixation due to model limitations, it will hopefully initiate the discussion for providing more cost-effective individualized care for this patient population.

Clinical Outcomes and Survivorship of Contemporary Cementless Primary Total Knee Arthroplasties

JBJS Reviews ◽  
2020 ◽  
Vol 8 (8) ◽  
pp. e20.00026-e20.00026
Author(s):  
Joshua S. Bingham ◽  
Christopher G. Salib ◽  
Arlen D. Hanssen ◽  
Michael J. Taunton ◽  
Mark W. Pagnano ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Total Knee Arthroplasties ◽  
Total Knee ◽  
Primary Total Knee

scholarly journals Influence of the Maryland All-Payer Model on Primary Total Knee Arthroplasties

2019 ◽  
Vol 4 (4) ◽  
pp. e0041
Author(s):  
Ronald E. Delanois ◽  
Jennifer I. Etcheson ◽  
Iciar M. Dávila Castrodad ◽  
Nequesha S. Mohamed ◽  
Andrew N. Pollak ◽  
...  
Keyword(s):  
Total Knee Arthroplasties ◽  
Total Knee ◽  
Primary Total Knee

Knee Arthroscopy Prior to Revision TKA Is Associated with Increased Re-Revision for Stiffness

2021 ◽  
Author(s):  
Ruben Oganesyan ◽  
Christian Klemt ◽  
John Esposito ◽  
Venkatsaiakhil Tirumala ◽  
Liang Xiong ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Odds Ratio ◽  
Knee Arthroscopy ◽  
Revision Total Knee Arthroplasty ◽  
Adverse Outcomes ◽  
Control Group ◽  
Total Knee ◽  
Matched Study ◽  
The Impact ◽  
Revision Tka

AbstractThis is an experimental study. As knee arthroscopy may be used as a suitable temporizing alternative prior to revision surgery, knee arthroscopy potentially may be a risk factor for subsequent adverse outcomes after revision total knee arthroplasty (TKA). This study aimed to evaluate the impact of prior knee arthroscopy on outcomes of subsequent TKA revision surgery. We identified 1,689 consecutive patients who underwent revision TKA: (1) patients with no prior knee arthroscopy (n = 1,549) and (2) patients with knee arthroscopy prior to revision TKA (n = 140). A control group of matched revision TKA patients who did not undergo prior knee arthroscopy was identified (700 patients), using one-to-five matching. Matched patients with prior knee arthroscopy demonstrated an increased likelihood of requiring re-revision (odds ratio [OR], 2.06, p < 0.001), particularly for stiffness (OR, 2.72, p < 0.02) compared with patients who underwent revision TKA without prior knee arthroscopy. Knee arthroscopy demonstrated a time-dependent impact on revision TKA outcomes, with an increased likelihood of requiring re-revision for patients who underwent knee arthroscopy within 6 months prior to revision TKA compared with patients who underwent knee arthroscopy within 6 to 12 months prior to revision TKA (OR, 3.16, p < 0.04). This cohort matched study shows that patients who had prior knee arthroscopy demonstrated a significantly higher likelihood of requiring re-revision compared with patients who underwent revision TKA without prior knee arthroscopy. Additionally, there was a significant increased likelihood in requiring re-revision for patients who had prior knee arthroscopy within 6 months. This provides clinically useful information for counseling of patients who are considering temporizing their symptoms with knee arthroscopy prior to revision TKA.

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