scholarly journals Influence of extension stem length and diameter on clinical and radiographic outcomes of revision total knee arthroplasty

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Sheng-Hsun Lee ◽  
Hsin-Nung Shih ◽  
Chih-Hsiang Chang ◽  
Tung-Wu Lu ◽  
Yu-Han Chang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Logistic Regression ◽  
Bone Defect ◽  
Revision Total Knee Arthroplasty ◽  
Stem Length ◽  
Prosthesis Loosening ◽  
Total Knee ◽  
Male Sex ◽  
The Relationship ◽  
Femoral Side

Abstract Background Extension stems provide stability to revision total knee arthroplasty (RTKA). Little is known regarding the relationship between stem characteristics and RTKA stability. We aimed to identify the relationship between canal filling ratio (CFR) and aseptic loosening following RTKA. Methods We retrospectively reviewed demographics, radiographic parameters, and outcomes associated with RTKA performed between 2008 and 2013 in a tertiary hospital. The inclusion criteria were: revision for aseptic loosening, hybrid fixation, minor bone defect, Zimmer® LCCK prosthesis, and follow-up > 24 months. Using the modified Knee Society radiographic scoring system, radiographic prosthesis loosening was defined as a radiolucent line (RLL) score ≥ 9 on the femoral side or ≥ 10 on the tibial side. We utilized receiver operating characteristic (ROC) curve analysis to evaluate the cutoff value for stem length and diameter in terms of prosthesis loosening or not. Furthermore, CFR-related parameters were analyzed with logistic regression to clarify their relationships with prosthesis loosening. Results Prosthesis loosening was detected in 17 of 65 patients included. On logistic regression analysis, male sex and severity of the tibial bone defect were associated with loosening. On multivariate analysis, male sex and bone defect severity were associated with loosening on the femoral side, while malalignment was associated with loosening on the tibial side. Protective factors included femoral CFR > 0.85, CFR > 0.7 for > 2 cm, and CFR > 0.7 for > 4 cm, as well as tibial CFR > 0.85. Conclusions To minimize loosening post-RTKA, femoral CFR > 0.7 for > 2 cm and tibial CFR > 0.85 are recommended. Risk factors may include male sex, bone defect severity, and malalignment.

Pain associated with cemented and uncemented long-stemmed tibial components in revision total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 165-170
Author(s):  
Darin J. Larson ◽  
John H. Rosenberg ◽  
Maxwell A. Lawlor ◽  
Kevin L. Garvin ◽  
Curtis W. Hartman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Stem Length ◽  
Exact Test ◽  
Patient Dissatisfaction ◽  
Total Knee ◽  
Revision Tka

Aims Stemmed tibial components are frequently used in revision total knee arthroplasty (TKA). The purpose of this study was to evaluate patient satisfaction, overall pain, and diaphyseal tibial pain in patients who underwent revision TKA with cemented or uncemented stemmed tibial components. Methods This is a retrospective cohort study involving 110 patients with revision TKA with cemented versus uncemented stemmed tibial components. Patients who underwent revision TKA with stemmed tibial components over a 15-year period at a single institution with at least two-year follow-up were assessed. Pain was evaluated through postal surveys. There were 63 patients with cemented tibial stems and 47 with uncemented stems. Radiographs and Knee Society Scores were used to evaluate for objective findings associated with pain or patient dissatisfaction. Postal surveys were analyzed using Fisher’s exact test and the independent-samples t-test. Logistic regression was used to adjust for age, sex, and preoperative bone loss. Results No statistically significant differences in stem length, operative side, or indications for revision were found between the two cohorts. Tibial pain at the end of the stem was present in 25.3% (16/63) of cemented stems and 25.5% (12/47) of uncemented stems (p = 1.000); 74.6% (47/63) of cemented patients and 78.7% (37/47) of uncemented patients were satisfied following revision TKA (p = 0.657). Conclusion There were no differences in patient satisfaction, overall pain, and diaphyseal tibial pain in cemented and uncemented stemmed tibial components in revision TKA. Patient factors, rather than implant selection and surgical technique, likely play a large role in the presence of postoperative pain. Stemmed tibial components have been shown to be a possible source of pain in revision TKA. There is no difference in patient satisfaction or postoperative pain with cemented or uncemented stemmed tibial components in revision TKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):165–170.

scholarly journals Stem length in revision total knee arthroplasty

2015 ◽  
Vol 8 (4) ◽  
pp. 407-412 ◽  
Author(s):  
Anay Rajendra Patel ◽  
Brian Barlow ◽  
Amar S. Ranawat
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Stem Length ◽  
Total Knee

Comparative Analysis between Cone and Sleeve in Managing Severe Bone Defect during Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 31 (07) ◽  
pp. 677-685 ◽  
Author(s):  
Hyun Jung Kim ◽  
O-Sung Lee ◽  
Seung Hoon Lee ◽  
Yong Seuk Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Defect ◽  
Knee Arthroplasty ◽  
Statistical Significance ◽  
Radiolucent Line ◽  
Clinical Score ◽  
Revision Total Knee Arthroplasty ◽  
Quality Data ◽  
Radiological Outcome ◽  
Total Knee

AbstractThis review aims to compare the outcomes of revision total knee arthroplasty (TKA) performed using a tantalum cone and a titanium sleeve. A rigorous and systematic search was performed. Each of the selected studies was evaluated for methodological quality. Data were extracted according to the following: study design, level of evidence, cases enrolled, age, sex ratio, follow-up, involved part, bone defect, degree of constraint, augments (cone and/or sleeve), pre-clinical score, post-clinical score, radiological results, major complications, and endpoint analysis. Nineteen articles were included in the final analysis. The knee scores of the cone and sleeve groups were increased in all studies with or without statistical significance. For the radiological outcome, radiolucent line was seen in six cases in the cone group and in 15 cases in the sleeve group. Only a few specific augment-related complications were noted. Our results support the use of the newly devised augments in bone defect during revision TKA in terms of clinical and radiological outcome.

Influence of stem length on component flexion and posterior condylar offset in revision total knee arthroplasty

The Knee ◽  
2018 ◽  
Vol 25 (3) ◽  
pp. 480-484 ◽  
Author(s):  
Max Ettinger ◽  
Peter Savov ◽  
Omar Balubaid ◽  
Henning Windhagen ◽  
Tilman Calliess
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Stem Length ◽  
Posterior Condylar Offset ◽  
Posterior Condylar ◽  
Total Knee

scholarly journals Are Metaphyseal Sleeves a Viable Option to Treat Bone Defect during Revision Total Knee Arthroplasty? A Systematic Review

Joints ◽  
2019 ◽  
Vol 07 (01) ◽  
pp. 019-024 ◽  
Author(s):  
Tommaso Bonanzinga ◽  
Ibrahim Akkawi ◽  
Akos Zahar ◽  
Thorsten Gehrke ◽  
Carl Haasper ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Bone Defect ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Septic Loosening ◽  
Total Knee ◽  
Revision Tka

Abstract Purpose Bone loss is a challenging problem during revision total knee arthroplasty (TKA). Several studies have been published on the use of metaphyseal sleeves during revision TKA. Therefore, the aim of this systematic review was to summarize the clinical and radiographic outcomes of the use of metaphyseal sleeves in the setting of revision TKA. Methods A comprehensive search of PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar was performed, covering the period between January 1, 2000, and August 12, 2017. Various combinations of the following key words were used: “metaphyseal,” “sleeves,” “knee,” and “revision.” A total of 10 studies were included in the present systematic review. Results A total of 904 patients with 928 implants were recorded with a mean age of 69 years. They were evaluated at a mean follow-up of 45 months. Overall 1,413 sleeves, 888 in the tibia and 525 in the femur, were implanted. There were 36 septic re-revisions of the prosthetic components (4%). Five sleeves were found loose during septic re-revision; therefore, the rate of septic loosening of the sleeves was 0.35%. An aseptic re-revision of the prosthetic components was performed 27 times (3%). Ten sleeves were found loose during aseptic re-revision; therefore, the rate of aseptic loosening of the sleeves was 0.7%. Intraoperative fractures occurred 44 times (3.1%). Finally, clinical outcome was improved at final follow-up. Conclusion Metaphyseal sleeves demonstrate high radiographic signs of osteointegration, low septic loosening rate, low intraoperative fractures rate, and a good-to-excellent clinical outcome. Hence, they are a valid option to treat large metaphyseal bone defect during revision TKA. Level of Evidence This is a systematic review of level IV studies.

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