Impact of perivascular lymphocytic infiltration in aseptic total knee revision

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 145-149
Author(s):  
David A. Crawford ◽  
Braden J. Passias ◽  
Joanne B. Adams ◽  
Keith R. Berend ◽  
Adolph V. Lombardi
Keyword(s):  
Clinical Outcomes ◽  
Revision Surgery ◽  
Large Scale ◽  
Histological Analysis ◽  
Lymphocytic Infiltration ◽  
Radiological Data ◽  
Significant Difference ◽  
Outcome Scores ◽  
Aseptic Revision ◽  
Total Knee

Aims A limited number of investigations with conflicting results have described perivascular lymphocytic infiltration (PVLI) in the setting of total knee arthroplasty (TKA). The purpose of this study was to determine if PVLI found in TKAs at the time of aseptic revision surgery was associated with worse clinical outcomes and survivorship. Methods A retrospective review was conducted on 617 patients who underwent aseptic TKA revision who had histological analysis for PVLI at the time of surgery. Clinical and radiological data were obtained pre- and postoperatively, six weeks postoperatively, and then every year thereafter. Results Within this cohort, 118 patients (19.1%) were found to have PVLI on histological analysis. Re-revision was performed on 83 patients (13.4%) with no significant differences in all-cause or aseptic revisions between groups. A higher incidence of PVLI was noted in female patients (p = 0.037). There was no significant difference in improvement in the range of motion (p = 0.536), or improvement of KSC (p = 0.66), KSP (p = 0.61), or KSF (p = 0.3) clinical outcome scores between PVLI and no PVLI sub-groups. There was a higher incidence of a preoperative diagnosis of pain in the PVLI group compared with patients without PVLI (p = 0.002) present. Conclusion PVLI found on large-scale histological analysis in TKAs at aseptic revision surgery was not associated with worse clinical outcomes or rates of re-revision. Cite this article: Bone Joint J 2021;103-B(6 Supple A):145–149.

Accelerometer-Based Portable Navigation System Is Useful for Tibial Bone Cutting in Modified Kinematically Aligned Total Knee Arthroplasty

2019 ◽  
Author(s):  
Masanori Tsubosaka ◽  
Tomoyuki Kamenaga ◽  
Yuichi Kuroda ◽  
Koji Takayama ◽  
Shingo Hashimoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Navigation System ◽  
Slope Angle ◽  
Posterior Slope ◽  
Tibial Bone ◽  
Significant Difference ◽  
Portable Navigation ◽  
Total Knee

AbstractSeveral studies have reported better clinical outcomes following kinematically aligned total knee arthroplasty (KA-TKA) than mechanically aligned TKA. Consistent reproduction of a KA-TKA is aided by accurate tibial bone resections using computer navigation systems. This study compares an accelerometer-based portable navigation system with a conventional navigation system on tibial bone resection and clinical outcomes in KA-TKA. This study included 60 knees of patients who underwent primary KA-TKA between May 2015 and September 2017. They were randomly assigned to the OrthoPilot and iASSIST groups. A tibial bone cut was performed with 3 degree varus and 7 degree posterior slope in relation to the mechanical axis in all cases. The tibial component angle (TCA) and posterior slope angle (PSA) were evaluated by postoperative radiography, and those that deviated more than 2 degree were set as outliers. The clinical outcomes were the knee range of motion (ROM) and 2011 Knee Society Score (KSS) evaluated at 1 year postoperation. The groups were compared in terms of the TCA, PSA, number of outliers, ROM, and 2011 KSS (p < 0.05). No significant difference was observed between the groups in terms of the mean TCA, PSA, number of outliers, ROM, and categories of the 2011 KSS (objective knee indicators, symptoms, satisfaction, expectations, and functional activities). Although tibial bone cuts were performed with 3 degree varus and 7 degree posterior slope, no significant difference was observed between the OrthoPilot and iASSIST groups in terms of the accuracy of cuts or postoperative clinical result. The iASSIST was found to be a simple and useful navigation system for KA-TKA.

scholarly journals Gap difference in navigated TKA: a measure of the imbalanced flexion-extension gap

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 30 ◽  
Author(s):  
Zi-Yang Chia ◽  
Hee-Nee Pang ◽  
Mann-Hong Tan ◽  
Seng-Jin Yeo
Keyword(s):  
Total Knee Arthroplasty ◽  
Social Functioning ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Computer Calculation ◽  
Bodily Pain ◽  
Significant Difference ◽  
Flexion Extension ◽  
Total Knee ◽  
The Mean

Introduction: The success of Total Knee Arthroplasty (TKA) hinges on balanced flexion-extension gaps. This paper aims to evaluate the correlation between imbalanced gaps and clinical outcomes, and hence help quantify the imbalanced gap in navigation-assisted total knee arthroplasty. Methods: We studied 195 knees with an average follow-up of two years. Flexion-extension gaps were obtained from computer calculation upon cementation of implants in both flexion (90°) and extension. The gap difference (GD) was defined as the measured difference between the gaps in flexion and extension. Results: At 2 years after surgery, the mean ROM in the balanced group, with GD less than or equal to 2 mm, was 115.1° ± 16.6° and the mean ROM in the imbalanced group was 116.7° ± 12.1°. This was not statistically significant with p-value 0.589. Balanced flexion-extension gaps also did not show significant difference in terms of mechanical alignment, with 0.29 ± 0.89 in the balanced group at 2 years, and 0.65 ± 1.51 in the imbalanced group with p-value 0.123. Balanced gaps however, were associated with improved outcomes in terms of physical functioning, bodily pain, social functioning, Oxford and Knee scores at 6 months and improved social functioning scores at 2 years. Conclusions: Computer navigation is a useful tool for assessing the gap balance in TKA. Balanced flexion-extension gaps, with gap differences of less than or equal to 2 mm, is associated with improved clinical outcomes at 6 months.

Clinical Outcomes and Complications Following Limited Open Achilles Repair Without an Instrumented Guide

2020 ◽  
pp. 107110072096249
Author(s):  
Craig C. Akoh ◽  
Amanda Fletcher ◽  
Akhil Sharma ◽  
Selene G. Parekh
Keyword(s):  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Tendon Repair ◽  
Case Series ◽  
Postoperative Outcome ◽  
Foot And Ankle ◽  
Achilles Tendon Repair ◽  
Significant Difference ◽  
Patient Reported ◽  
Outcome Scores

Background: We report the clinical outcomes and complications following our limited open incision Achilles tendon repair technique without instrument guides. Methods: A total of 33 patients were included in this study. We recorded pre- and postoperative scores on the Foot and Ankle Disability Index (FADI), visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS). Subgroup analyses were performed for acute (<2 weeks) and subacute (2-6 weeks) Achilles tendon repairs. A P value <.05 was considered significant for all statistical analyses. Results: The median time from injury to surgery was 10.0 days (range, 1-45 days). At a median follow-up of 3.7 years (range, 1.0-9.8 years), the average pre- and postoperative outcome scores improved significantly for the following: FADI index (49.1-98.4, P < .001), VAS (4.8-0.2, P < .001), FAOS Pain (54.8-99.2, P < .001), FAOS Symptoms (84.6-97.0, P < .001), FAOS activities of daily living (61.4-97.2, P < .001), FAOS Sports and Recreational Activity (39.5-98.5, P < .001), and FAOS quality of life (39.7-88.7, P < .001). There were no significant differences between pre- and postoperative outcome scores between the acute and subacute Achilles repair groups. There were no wound complication, reruptures, or reoperations in the entire cohort. Conclusion: Patients showed improvements in postoperative patient-reported outcome scores with minimal complications. There was no significant difference in outcomes for acute vs subacute repairs. Our limited open incision Achilles tendon repair, which required no additional targeting instrumentation, had favorable midterm results. Level of Evidence: Level IV, retrospective case series.

scholarly journals Variation of synovial fluid leucocyte cell count and polymorphonuclear percentage in patients with aseptic revision total knee arthroplasty

2021 ◽  
Vol 2 (8) ◽  
pp. 566-572
Author(s):  
Michael Fuchs ◽  
Felix Kirchhoff ◽  
Heiko Reichel ◽  
Carsten Perka ◽  
Martin Faschingbauer ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Synovial Fluid ◽  
Cell Count ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Joint Infection ◽  
Revision Total Knee Arthroplasty ◽  
Time Points ◽  
Aseptic Revision ◽  
Total Knee

Aims Current guidelines consider analyses of joint aspirates, including leucocyte cell count (LC) and polymorphonuclear percentage (PMN%) as a diagnostic mainstay of periprosthetic joint infection (PJI). It is unclear if these parameters are subject to a certain degree of variability over time. Therefore, the aim of this study was to evaluate the variation of LC and PMN% in patients with aseptic revision total knee arthroplasty (TKA). Methods We conducted a prospective, double-centre study of 40 patients with 40 knee joints. Patients underwent joint aspiration at two different time points with a maximum period of 120 days in between these interventions and without any events such as other joint aspirations or surgeries. The main indications for TKA revision surgery were aseptic implant loosening (n = 24) and joint instability (n = 11). Results Overall, 80 synovial fluid samples of 40 patients were analyzed. The average time period between the joint aspirations was 50 days (SD 32). There was a significantly higher percentage change in LC when compared to PMN% (44.1% (SD 28.6%) vs 27.3% (SD 23.7%); p = 0.003). When applying standard definition criteria, LC counts were found to skip back and forth between the two time points with exceeding the thresholds in up to 20% of cases, which was significantly more compared to PMN% for the European Bone and Joint Infection Society (EBJIS) criteria (p = 0.001), as well as for Musculoskeletal Infection Society (MSIS) (p = 0.029). Conclusion LC and PMN% are subject to considerable variation. According to its higher interindividual variance, LC evaluation might contribute to false-positive or false-negative results in PJI assessment. Single LC testing prior to TKA revision surgery seems to be insufficient to exclude PJI. On the basis of the obtained results, PMN% analyses overrule LC measurements with regard to a conclusive diagnostic algorithm. Cite this article: Bone Jt Open 2021;2(8):566–572.

scholarly journals Observational Study of Total Knee Arthroplasty in Aseptic Revision Surgery: Clinical Results

2020 ◽  
Vol 12 (1) ◽  
pp. 177-183 ◽  
Author(s):  
Gabriel Oliver ◽  
Luis Jaldin ◽  
Eric Camprubí ◽  
Guillermo Cortés
Keyword(s):  
Total Knee Arthroplasty ◽  
Observational Study ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Clinical Results ◽  
Aseptic Revision ◽  
Total Knee

scholarly journals Periprosthetic Joint Infection Does Not Preclude Good Outcomes after a Revision Total Knee Arthroplasty: A 7-Year Follow-Up Study of 144 Retrospective Cases

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Du Hyun Ro ◽  
Jong-Keun Kim ◽  
Sunghwan Kim ◽  
Hyuk-Soo Han ◽  
Myung Chul Lee
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Bone Defects ◽  
Revision Total Knee Arthroplasty ◽  
Factors Associated ◽  
Aseptic Revision ◽  
Total Knee ◽  
Grade 3 ◽  
Septic Revision

Background and Purpose. Debate exists on whether septic revision total knee arthroplasty (TKA) results in inferior clinical outcomes, and limited information is available regarding the factors associated with such outcomes. This study aimed to (1) compare clinical outcomes and characteristics of aseptic versus septic revision TKA and (2) identify the risk factors associated with inferior clinical outcomes. Methods. We retrospectively reviewed 144 revision TKAs (90 aseptic and 54 septic revisions) that were followed for a minimum of 3 years (mean = 7 years). Clinical outcome data, namely, Knee Society knee and function scores and the Hospital for Special Surgery knee score, were collected. We reviewed 13 pre- and intraoperative variables. Results. Postoperative clinical outcomes were inferior in septic revision surgeries (p<0.05). In regression analyses, however, septic revision was not an independent risk factor for poor clinical outcomes. The independent risk factors for poor outcome were identified where Anderson Orthopedic Research Institute grade 3 femoral and tibial bone defects, more than three surgeries, and treatment for persistent infection were associated with inferior clinical outcomes (all p<0.05). Standard two-stage septic revision without grade 3 bone defects or additional surgeries showed comparable outcomes to aseptic revision. Interpretation. Clinical outcomes of septic revision were inferior to those of aseptic revision. However, poor outcomes were mainly associated with large bone defects and an increased number of surgeries. The outcomes of aseptic and septic revision surgery were similar when patients with larger bone defects and more than three surgeries were excluded.

scholarly journals Functional Outcomes of Revision Total Knee Arthroplasty Following Failed Unicompartmental Knee Arthroplasty

2015 ◽  
Vol 4 (4) ◽  
pp. 22-26
Author(s):  
Christopher Ironside ◽  
Simon Coffey ◽  
Guy Eslick ◽  
Rami Sorial
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Unicompartmental Knee Arthroplasty ◽  
Functional Outcomes ◽  
Oxford Knee Score ◽  
Unicompartmental Knee ◽  
Significant Difference ◽  
Subsequent Revision ◽  
Total Knee

Introduction: Unicompartmental knee arthroplasty (UKA) can be used to treat medial compartment osteoarthritis of the knee. Some of these knees will eventually fail, and need to be revised. There is controversy about using UKA in younger patients as a definitive procedure or as a means to delay total knee arthroplasty (TKA) because the outcomes of subsequent revision surgery may be inferior to a primary TKA. Methods: We retrospectively reviewed a series of 46 revision TKA patients following failed UKA (UKA revisions) using functional outcomes questionnaires and compared the results with a cohort of age and gender matched primary TKA patients. Our hypothesis was that UKA revision surgery would be inferior to primary TKA surgery. Results: Data was collected on 33 knees after a mean follow-up period of five years. There was no significant difference in the Oxford Knee Score (33.7 vs 37.1, p = 0.09) or the Western Ontario and MacMasters Universities Arthritis Index (WOMAC) (24.8 vs. 19.1, p = 0.22). A subgroup analysis demonstrated that UKAs, which fail early, are more likely to produce an inferior outcome following revision surgery than those that survive more than five years. Discussion: We conclude that UKA can be used effectively in appropriately selected patients, as the functional outcome of their subsequent revision to TKA is not significantly inferior to a primary TKA.Keywords: unicompartmental knee arthroplasty, revision knee arthroplasty

scholarly journals Bilateral single-staged arthroscopic rotator cuff repair is comparable to staged procedures: a retrospective follow up study of 2 years

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chen Wang ◽  
Pu Yang ◽  
Dongfang Zhang ◽  
In-Ho Jeon ◽  
Tengbo Yu ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Single Stage ◽  
Arthroscopic Rotator Cuff Repair ◽  
Significant Difference ◽  
Outcome Scores ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Abstract Background Bilateral rotator cuff tears are not uncommon and the timing of the surgical treatment of both shoulders is debated. In the present study, we aimed to compare the clinical outcomes of patients who underwent single-stage or staged bilateral arthroscopic rotator cuff repair. Methods From March 2013 to May 2018, a retrospective review on all patients who underwent bilateral arthroscopic rotator cuff repair at our department was performed. Patients were separated into 2 groups: single-stage and staged. The minimum follow-up period was 2 years. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, Constant-Murley (Constant) score, the range of motion (ROM) of the shoulder and the hospitalization costs were evaluated for comparison between the two groups before and after the operation. Differences between groups were assessed using t-tests and ANOVA. Results All 51 patients completed follow-up of 2 years, single stage (n = 24) and staged group (n = 27). There was no significant difference in the VAS, ASES, UCLA and Constant scores between the single-stage group and the staged group before the operation. Postoperative clinical scores were significantly improved in both groups (P < 0.05). All outcome scores were significantly different between the two groups at 6 months postoperatively, and the staged scored better than the single-stage (P < 0.05). At 12, 18, and 24 months after the operation, the outcome scores were not significantly different between the two groups. At follow-up, the ROM of the shoulder was not significantly different between the two groups. In the single-stage group, the outcome scores and ROM were similar for both shoulders and comparable to the staged group. We also found significant cost savings in the single-stage group (4440.89 ± 130.55 USD) compared to the staged group (5065.73 ± 254.76 USD) (p < 0.05). Conclusions Patients receiving single-stage or staged bilateral arthroscopic rotator cuff repair showed similarly good clinical outcomes at follow-ups longer than 6 months. Moreover, good outcomes were observed on both sides of the single-stage group.

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