scholarly journals Single-stage total knee arthroplasty and femoral osteotomy for osteoarthritis with severe supracondylar deformity

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jing-yang Sun ◽  
Guo-qiang Zhang ◽  
Jun-min Shen ◽  
Yin-qiao Du ◽  
Tie-jian Li ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Perioperative Complications ◽  
Corrective Osteotomy ◽  
Femoral Osteotomy ◽  
Single Stage ◽  
Cemented Stem ◽  
Total Knee

Abstract Background Knee osteoarthritis associated with extra-articular deformity (EAD) can confront the arthroplasty surgeons with challenges of bone resection and soft tissue balancing. The aim of this study was to describe a single-stage procedure associating corrective osteotomy with total knee arthroplasty (TKA), and to determine the outcome at mid- to long-term follow-up. Methods A total of seven patients (seven knees) with knee osteoarthritis and supracondylar deformity were included in this study. Six patients were female, and one was male, with the median age of 62 years (range, 37-76 years). All patients were treated with single-stage TKA and femoral osteotomy. Osteotomy was fixed with long cemented stem. Hospital of Special Surgery (HSS) scores, collateral ligament laxity, and range of motion (ROM) were clinically evaluated preoperatively and at each follow-up. Radiographic parameters including the mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), mechanical proximal tibial angle (mMPTA), and joint line congruence angle (JLCA) were also measured. The occurrence of perioperative complications was recorded. Results The median follow-up time was 91 months (range, 38-104 months). At the last follow-up, all components were stable and no patients required revision. Nonunion of the osteotomy occurred in one patient. In all patients, the lower limb mechanical alignment improved greatly. The mean angle of MAD was restored from 10.49±6.05 cm preoperatively to 1.11±4.97 cm postoperatively. The 90° mLDFA was almost acquired in all cases, with the postoperative value of 90.79±2.40°. After operation, the mMPTA improved from 84.18±6.13° to 91.33±3.13°. The JLCA changed from 2.94±1.61° to −0.71±3.50°. The median HSS score improved from 45 (range, 34-56) preoperatively to 90 (range, 82-97) postoperatively, with the outcome of all patients rated good to excellent. The median ROM improved from 70° (range 0–110°) preoperatively to 105° (range 90–125°) postoperatively. No instability of knee joint was observed. Complications included an intraoperative split fracture of distal femur and one case of wound exudation resulting from fat liquefaction. Conclusions For knee osteoarthritis with femoral supracondylar deformity, single-stage TKA and corrective osteotomy was feasible but technically demanding. The use of long cemented stem for osteotomy fixation can provide reliable rotational control of the bone segments.

scholarly journals Treatment Strategies and Clinical Outcomes of Knee Osteoarthritis With Extra-Articular Deformity

2021 ◽  
Author(s):  
Mingzhen Tao ◽  
Yufan Bu ◽  
Jiabang Huo ◽  
Xinjie Wang ◽  
Guangxin Huang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Computer Navigation ◽  
Femoral Osteotomy ◽  
Lower Limbs ◽  
Average Deviation ◽  
Total Knee

Abstract ObjectiveTo evaluate the methods, indications, and efficacy of the treatment of knee osteoarthritis with extra-articular deformity. MethodsA retrospective study of eight patients (three males and five females) with knee osteoarthritis complicated with extra-articular femoral deformity from February 2011 to April 2019; with an average age of 62.9 years (range 57 to 70 years). There were eight cases of coronal malformation with a mean angle of 15.5° (range 5° to 24°), and three cases of sagittal deformity with a mean angle of 14.0° (range12–16°). All eight patients underwent total knee arthroplasty (TKA). Three patients underwent femoral osteotomy and one-stage total knee arthroplasty, and one underwent femoral osteotomy and second-stage total knee joint replacement. ResultsThe mean follow-up time was 45.6 months (range 2 to 96 months). The average HSS score improved from 41.1 points (range, 28–53) preoperatively to 88.5 points (range, 71–95) at the time of the last follow-up. The average VAS score improved from 6.6 points (range, 3–10) preoperatively to 0.3 points (range, 0–1) at the time of the last follow-up. The average arc of knee motion improved from 66.3° (range 50° to 85°), preoperatively to 104.4°(range 95° to 120°) postoperatively. The average deviation of the mechanical axis of the knee improved from 17.3° (range 13° to 20°) preoperatively to 2.6°(range -6° to 6°) postoperatively. The differences between the preoperative data and postoperative follow-up data were statistically significant (P < 0.05). At the last follow-up visit, none of the eight patients had postoperative complications such as prosthesis loosening, infection, or deep vein thrombosis of the lower limbs. No bone nonunion, delayed union, or other complications occurred in the four patients with osteotomy. ConclusionAlthough it is difficult and complex to perform TKA surgery in patients with extra-articular deformity, a preoperative surgical plan should be made individually according to the patient's condition, and if necessary, the mechanical axis of the lower limbs can be effectively restored with the help of computer navigation technology or 3D printing technology, to achieve satisfactory surgical results.

scholarly journals Single-stage revision for the infected total knee arthroplasty

2021 ◽  
Vol 2 (5) ◽  
pp. 305-313
Author(s):  
Nima Razii ◽  
Juliet M. Clutton ◽  
Rahul Kakar ◽  
Rhidian Morgan-Jones
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Single Stage ◽  
Tissue Loss ◽  
One Stage ◽  
Total Knee ◽  
Revision Tka ◽  
Culture Negative

Aims Periprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). Two-stage revision has traditionally been considered the gold standard of treatment for established infection, but increasing evidence is emerging in support of one-stage exchange for selected patients. The objective of this study was to determine the outcomes of single-stage revision TKA for PJI, with mid-term follow-up. Methods A total of 84 patients, with a mean age of 68 years (36 to 92), underwent single-stage revision TKA for confirmed PJI at a single institution between 2006 and 2016. In all, 37 patients (44%) were treated for an infected primary TKA, while the majority presented with infected revisions: 31 had undergone one previous revision (36.9%) and 16 had multiple prior revisions (19.1%). Contraindications to single-stage exchange included systemic sepsis, extensive bone or soft-tissue loss, extensor mechanism failure, or if primary wound closure was unlikely to be achievable. Patients were not excluded for culture-negative PJI or the presence of a sinus. Results Overall, 76 patients (90.5%) were infection-free at a mean follow-up of seven years, with eight reinfections (9.5%). Culture-negative PJI was not associated with a higher reinfection rate (p = 0.343). However, there was a significantly higher rate of recurrence in patients with polymicrobial infections (p = 0.003). The mean Oxford Knee Score (OKS) improved from 18.7 (SD 8.7) preoperatively to 33.8 (SD 9.7) at six months postoperatively (p < 0.001). The Kaplan-Meier implant survival rate for all causes of reoperation, including reinfection and aseptic failure, was 95.2% at one year (95% confidence interval (CI) 87.7 to 98.2), 83.5% at five years (95% CI 73.2 to 90.3), and 78.9% at 12 years (95% CI 66.8 to 87.2). Conclusion One-stage exchange, using a strict debridement protocol and multidisciplinary input, is an effective treatment option for the infected TKA. This is the largest single-surgeon series of consecutive cases reported to date, with broad inclusion criteria. Cite this article: Bone Jt Open 2021;2(5):305–313.

Patellar Resurfacing Does Not Improve Clinical Outcome in Patients with Symptomatic Tricompartmental Knee Osteoarthritis. An RCT Study of 40 Patients Receiving Primary Cruciate Retaining Total Knee Arthroplasty

2020 ◽  
Author(s):  
Tom M. van Raaij ◽  
Evelien van der Meij ◽  
Astrid J. de Vries ◽  
Jos J.A.M. van Raay
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Outcome Measurement ◽  
Measurement Tool ◽  
Patellar Resurfacing ◽  
Cruciate Retaining ◽  
Alignment Procedure ◽  
Total Knee

AbstractThere is some evidence that patellofemoral (PF) joint osteoarthritis (OA) causes anterior knee pain (AKP) after total knee arthroplasty (TKA). We hypothesized that patellar resurfacing in primary TKA for patients with symptomatic tricompartmental knee OA yields better clinical results after 2 years than non-resurfacing. A single center randomized controlled clinical trial comparing 40 patients receiving 42 cruciate retaining TKAs with (n = 21) or without patellar resurfacing (n = 21) was conducted. Primary outcome was the specific PF joint score HSS Baldini and secondary outcomes were the Knee Society Score (KSS) and the Knee Osteoarthritis Outcome Scale (KOOS). After 2 years no significant differences between both groups and between the groups in time for HSS Baldini, KSS, and KOOS were found. HSS Baldini score improved significantly after 6 weeks in both groups (p < 0.001) and did not improve in time afterward. At final follow-up the HSS Baldini mean score improved from a preoperative mean of 39 to 88 (difference of 49 points; p < 0.001)) for without patellar resurfacing group, and from a preoperative mean of 37 to 81 for patellar resurfacing group (difference of 47 points; p < 0.001). One patient in the patellar resurfacing group underwent a soft tissue re-alignment procedure because of patellar subluxation. Two patients in without patellar resurfacing group received secondary patellar button placement. Patellar resurfacing in primary TKA for patients with symptomatic tricompartmental OA has no beneficial effect over non-resurfacing and seems unnecessary. A special PF joint outcome measurement tool (HSS Baldini) and common knee scores showed no better knee function or AKP outcomes for with patellar resurfacing over without patellar resurfacing group in time and after 2 years of follow-up.

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

scholarly journals Management and results in periprosthetic tibial fracture after total knee arthroplasty: Two-center 15-case retrospective series at 2 years’ follow-up

2020 ◽  
Vol 106 (3) ◽  
pp. 449-458
Author(s):  
Camille Bauer ◽  
Bogdan Zaharia ◽  
Florent Galliot ◽  
Jauffrey Parot ◽  
Fayçal Houfani ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Fracture ◽  
Total Knee
Sign in / Sign up

Export Citation Format

Share Document