scholarly journals The role of knee arthroscopy in managing common soft-tissue complications after total knee arthroplasty: a retrospective case series study

2020 ◽  
Author(s):  
Yunfei Hou ◽  
Jiaxiang Gao ◽  
Jian Chen ◽  
Jianhao Lin ◽  
Lei Ni ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Recurrence Rate ◽  
Knee Arthroplasty ◽  
Revision Rate ◽  
Function Score ◽  
Case Series Study ◽  
Prosthesis Revision ◽  
Total Knee

Abstract Background To investigate the therapeutic efficacy of arthroscopy in 3 common soft-tissue complications, peripatellar impingement, arthrofibrosis and generalized synovitis, after total knee arthroplasty (TKA). Methods A retrospective review of patients undertaking arthroscopy for peripatellar impingement(PI), arthrofibrosis(AF) and generalized synovitis(GS) was conducted. Outcome measures included range of motion (ROM), and Knee Society Score (KSS). Intraoperative findings, surgical procedures and the existence of recurrence, prosthesis revision and/or complications were recorded. Paired t test, Fisher exact test, Kruskal-Wallis test and post hoc analysis with Bonferroni correction were used to for statistical evaluation. Results 74 patients, including 35 patients peripatellar impingement, 25 with arthrofibrosis and 14 with generalized synovitis, with a mean age of 66.1 years were analyzed. The mean follow up(FU) duration was 81.3 months. Overall, patients acquired improvement on ROM from 81.7° to 96.8° (p < 0.05), on KSS knee score from 64.2 to 78.7 (p < 0.05), and on KSS function score from 61.1 to 77.3 (p < 0.05) postoperatively. Patients in all 3 groups had improvements on ROM (p < 0.05), KSS knee (p < 0.05) and KSS function score (p < 0.05). The overall recurrence rate was 22.9% (17/74) and revision rate was 14.9% (11/74). There were statistical differences on symptoms recurrence rate and the prosthesis revision rate among groups (p < 0.05). PI group had significant less symptom recurrence rate and revision rate of 11.4% and 8.6% respectively (p < 0.017), while GS group had the greatest recurrence rate (42.9%) and revision rate (35.7%) respectively (p < 0.017). There were 4 perioperative complications, including 1 acute myocardial infarction and 3 periprosthetic joint infections. Conclusions In the setting of symptomatic TKA, arthroscopic intervention could provide clinical improvement in most cases at an average 81.3 months follow-up. Patients with PI had the best outcome while patients with GS had the worst.

scholarly journals The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yunfei Hou ◽  
Jiaxiang Gao ◽  
Jian Chen ◽  
Jianhao Lin ◽  
Lei Ni ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Recurrence Rate ◽  
Revision Rate ◽  
Knee Score ◽  
Function Score ◽  
Prosthesis Revision ◽  
Total Knee ◽  
Symptom Recurrence

Abstract Background To investigate the feasibility, safety and therapeutic efficacy of arthroscopy in managing the 3 most common soft tissue complications, peripatellar impingement (PI), arthrofibrosis (AF) and generalized synovitis (GS), after total knee arthroplasty (TKA). Methods A retrospective review of patients undertaking arthroscopy for PI, AF and GS was conducted. Outcome measures included complications, postoperative range of motion (ROM), Knee Society Score (KSS) and rates of symptom recurrence, prosthesis revision. Intraoperative findings and surgical procedures were also recorded. Paired t test, Fisher’s exact test, Kruskal-Wallis test and post hoc analysis with Bonferroni correction were used for statistical evaluation. Results A total of 74 patients, including 35 patients with peripatellar impingement, 25 patients with arthrofibrosis and 14 patients with generalized synovitis, with a mean age of 66.1 ± 7.9 years, were analysed. The mean follow-up (FU) duration was 81.3 ± 40.6 months. All patients underwent arthroscopic surgery safely without intraoperative complications. However, there were 4 postoperative complications, including 1 acute myocardial infarction and 3 periprosthetic joint infections. Overall, patients acquired improvements in ROM from 81.7 ± 23.1° to 96.8 ± 20.5° (p < 0.05), in KSS knee score from 64.2 ± 9.6 to 78.7 ± 12.1 (p < 0.05) and in KSS function score from 61.1 ± 7.4 to 77.3 ± 12.2 (p < 0.05) postoperatively. Patients in all 3 groups had improvements in ROM (p < 0.05), KSS knee score (p < 0.05) and KSS function score (p < 0.05). The overall recurrence rate was 22.9% (95% confidence interval (CI) 15.1–34.9%), and the overall revision rate was 14.9% (95% CI 8.6–25.6%). There were significant differences in both the symptom recurrence and prosthesis revision rates among the groups (p < 0.05). The PI group had a significantly lower symptom recurrence rate (11.4%, 95% CI 4.5–28.7%) and revision rate (8.6%, 95% CI 2.9–25.3%) (p < 0.017), while the GS group had a significantly higher recurrence rate (42.9%, 95% CI 23.4–78.5%) and revision rate (35.7%, 95% CI 17.6–72.1%) (p < 0.017). Conclusions In the setting of symptomatic TKA, although carrying certain risks for PJI and other complications, arthroscopic intervention could be feasible and provide clinical improvement in most cases at an average of 81.3 months follow-up. Patients with PI had the best outcomes, while patients with GS had the worst outcomes. Level of evidence Level IV

scholarly journals The role of knee arthroscopy in managing common soft-tissue complications after total knee arthroplasty: a retrospective case series study.

2020 ◽  
Author(s):  
Yunfei Hou ◽  
Jiaxiang Gao ◽  
Jian Chen ◽  
Jianhao Lin ◽  
Lei Ni ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Recurrence Rate ◽  
Revision Rate ◽  
Knee Score ◽  
Function Score ◽  
Prosthesis Revision ◽  
Total Knee ◽  
Symptom Recurrence

Abstract Background: To investigate the feasibility, safety and therapeutic efficacy of arthroscopy in managing the 3 most common soft-tissue complications, peripatellar impingement (PI), arthrofibrosis (AF) and generalized synovitis (GS), after total knee arthroplasty (TKA). Methods: A retrospective review of patients undertaking arthroscopy for PI, AF and GS was conducted. Outcome measures included complications, postoperative range of motion (ROM), Knee Society Score (KSS), and rates of symptom recurrence, prosthesis revision. Intraoperative findings and surgical procedures were also recorded. Paired t test, Fisher’s exact test, Kruskal-Wallis test and post hoc analysis with Bonferroni correction were used for statistical evaluation.Results: A total of 74 patients, including 35 patients with peripatellar impingement, 25 patients with arthrofibrosis and 14 patients with generalized synovitis, with a mean age of 66.1±7.9 years, were analysed. The mean follow-up (FU) duration was 81.3±40.6 months. All patients underwent arthroscopic surgery safely without intraoperative complications. However, there were 4 postoperative complications, including 1 acute myocardial infarction and 3 periprosthetic joint infections. Overall, patients acquired improvements in ROM from 81.7±23.1° to 96.8±20.5° (p <0.05), in KSS knee score from 64.2±9.6 to 78.7±12.1 (p <0.05), and in KSS function score from 61.1±7.4 to 77.3±12.2 (p <0.05) postoperatively. Patients in all 3 groups had improvements in ROM (p <0.05), KSS knee score (p <0.05) and KSS function score (p <0.05). The overall recurrence rate was 22.9% (95% confidence interval (CI) 15.1%-34.9%), and the overall revision rate was 14.9% (95% CI 8.6%-25.6%). There were significant differences in both the symptom recurrence and prosthesis revision rates among the groups (p<0.05). The PI group had a significantly lower symptom recurrence rate (11.4%, 95% CI 4.5%-28.7%) and revision rate (8.6%, 95% CI 2.9%-25.3%) (p <0.017), while the GS group had a significantly higher recurrence rate (42.9%, 95% CI 23.4%-78.5%) and revision rate (35.7%, 95% CI 17.6%-72.1%) (p <0.017). Conclusions: In the setting of symptomatic TKA, although carrying certain risks for PJI and other complications, arthroscopic intervention could be feasible and provide clinical improvement in most cases at an average of 81.3 months follow-up. Patients with PI had the best outcomes, while patients with GS had the worst outcomes.Level of evidence: Level IV

Prospective randomized trial of standard versus highly crosslinked tibial polyethylene in primary posterior-stabilized total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 33-39 ◽  
Author(s):  
P. F. Lachiewicz ◽  
J. A. O’Dell
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Randomized Study ◽  
Posterior Stabilized ◽  
Function Score ◽  
Score Change ◽  
Osteolytic Lesions ◽  
Significant Difference ◽  
Total Knee

Aims There is insufficient evidence to recommend the use of alternative polyethylene bearings in modular, fixed-bearing total knee arthroplasty (TKA). The purpose of this study was to compare standard polyethylene (SP) and highly crosslinked polyethylene (XLP) tibial liners in posterior-stabilized TKA, with osteolysis as the primary outcome and clinical results and the rate of re-operation as the secondary outcomes. Patients and Methods This is a single-surgeon, prospective randomized study involving one design of modular posterior-stabilized TKA. An analysis of 122 TKAs with an SP compression moulded liner and 123 with an XLP liner was performed, with a mean follow-up of six years (2 to 11). Patients were evaluated clinically using the Knee Society score, Lower Extremity Activity Score (LEAS), and the presence of an effusion, and standard radiographs were assessed for radiolucent lines and osteolytic lesions. Results Osteolysis was present in four TKAs (3.3%) in the SP group, and no knees in the XLP group (p = 0.06). There were no significant differences between the Knee Society total score, change in total score, knee function score, change in function score, LEAS, and change in LEAS in the two groups. There was a significant difference in the presence of an effusion (10/122 with SP liners, 1/123 with XLP liners; p = 0.02). There was no significant difference in the rate of re-operation between the two groups (p = 0.36). There were no complications related to the XLP liner. Conclusion At this length of follow-up, there were no advantages and no complications related to the use of this XLP tibial liner. The presence of effusion and small osteolytic lesions was more frequent with SP than XLP liners, but of unknown clinical significance. Cite this article: Bone Joint J 2019;101-B(7 Supple C):33–39

scholarly journals Complications of Patella in Total Knee Arthroplasty (TKA)

2021 ◽  
Vol 6 (5) ◽  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patellar Instability ◽  
Revision Rate ◽  
Functional Limitation ◽  
Patellofemoral Instability ◽  
Mobile Bearing ◽  
Extensor Mechanism ◽  
Total Knee

Background and Methods: Postoperative complications may impair the outcome of total knee arthroplasty (TKA). Patellar instability is a major cause of postoperative pain and functional limitation for which revision surgery may be necessary [1]. It may occur after TKA with or without patellar resurfacing. RESULTS AND CONCLUSIONS: Subluxation is more common than dislocation; the incidence of symptomatic instability leading to revision is low (0.5 to 0.8%) [2, 3]. In a multicentre study of low contact stress mobile bearing TKAs, only 6 of 259 revisions were associated with patellar instability, which accounted for a revision rate of 0.1% after a mean follow-up duration of 5.7 years [4]. A revision rate of 12% was reported secondary to complications of the extensor mechanism [5]. The aetiology of patellofemoral instability can be related to (1) the surgical technique and component positioning, (2) extensor mechanism imbalance, and (3) other causes.

scholarly journals Significant differences in rates of aseptic loosening between two variations of a popular total knee arthroplasty design

2021 ◽  
Author(s):  
Michael Brown ◽  
Rohan Ramasubbu ◽  
Mark Jenkinson ◽  
James Doonan ◽  
Mark Blyth ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Revision Rate ◽  
Primary Total Knee Arthroplasty ◽  
Cement Mantle ◽  
Kaplan Meier ◽  
Early Revision ◽  
Total Knee

Abstract Purpose The NexGen Legacy Posterior Stabilised (LPS) prosthesis (Zimmer Biomet, Warsaw, IN, USA) has augmentable and non-augmentable tibial baseplate options. We have noted an anecdotal increase in the number of cases requiring early revision for aseptic loosening since adopting the non-augmentable option. The purpose of this study was to ascertain our rates of aseptic tibial loosening for the two implant types within five years of implantation and to investigate the causes for any difference observed. Methods A database search was performed for all patients who underwent primary total knee arthroplasty (TKA) using the NexGen LPS between 2009 and 2015. Kaplan–Meier curves were plotted to assess for differences in revision rates between cohorts. We collected and compared data on gender, age, body mass index, component alignment and cement mantle quality as these were factors thought to affect the likelihood of aseptic loosening. Results Two thousand one hundred seventy-two TKAs were included with five year follow-up. There were 759 augmentable knees of which 14 were revised and 1413 non-augmentable knees of which 48 were revised. The overall revision rate at five years was 1.84% in the augmentable cohort and 3.4% in the non-augmentable cohort. The revision rate for aseptic loosening was 0.26% in the augmentable group and 1.42% in the non-augmentable group (p = 0.0241). Conclusions We have identified increased rates of aseptic loosening in non-augmentable components. This highlights the effect that minor implant changes can have on outcomes. We recommend that clinicians remain alert to implant changes and publish their own results when important trends are observed.

scholarly journals Condylar constrained knee prosthesis and rotating hinge prosthesis for revision total knee arthroplasty for mechanical failure have not the same indications and same results

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 45
Author(s):  
William Barnoud ◽  
Axel Schmidt ◽  
John Swan ◽  
Elliot Sappey-Marinier ◽  
Cécile Batailler ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Rate ◽  
Knee Prosthesis ◽  
Revision Total Knee Arthroplasty ◽  
Mechanical Failure ◽  
Complication Rates ◽  
Rotating Hinge ◽  
Total Knee

Purpose: This study aimed to evaluate whether there are any differences in outcomes and complication rates between condylar constrained knee (CCK) and rotating hinge knee (RHK) prostheses used for the first revision of total knee arthroplasty (rTKA) after mechanical failure. Methods: Sixty-three consecutive non-septic revisions of posterior stabilized implants using 33 CCK and 30 RHK prostheses were included. Clinical evaluation and revision rate were compared between the two groups at two years minimum follow-up. Results: The CCK group had significantly better clinical outcomes and satisfaction rates compared to patients with RHK (KSS-knee 70.5 versus 60.7 (p < 0.003) and KSS-function 74.9 versus 47.7 (p < 0.004) at 3.7 (2.0–9.4) years mean follow-up. Moreover, the clinical improvement was significantly higher for the CCK group concerning the KSS-Knee (+23.9 vs. +15.2 points, p = 0.03). The postoperative flexion was significantly better in the CCK group compared to the RHK group (115° vs. 103°, p = 0.01). The prosthesis-related complications and the re-revision rate were higher in the RHK group, especially due to patellofemoral complications and mechanical failures. Conclusions: CCK prostheses provided better clinical and functional outcomes and fewer complications than RHK prostheses when used for the first non-septic rTKA. CCK is a safe and effective implant for selected patients, while RHK should be used with caution as a salvage device for complex knee conditions, with particular attention to the balance of the extensor mechanism.

scholarly journals Clinical outcomes and patient satisfaction after total knee arthroplasty: a follow-up of the first 50 cases by a single surgeon

2019 ◽  
Vol 47 (4) ◽  
pp. 1667-1676 ◽  
Author(s):  
Jacob A. West ◽  
Travis Scudday ◽  
Scott Anderson ◽  
Nirav H. Amin
Keyword(s):  
Total Knee Arthroplasty ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Function Score ◽  
Total Knee ◽  
One Year ◽  
Postoperative Knee

Objective To examine the association between single-surgeon learning curve and clinical outcomes following total knee arthroplasty (TKA). Methods This prospective study included the first consecutive patients undergoing TKA conducted by the same surgeon using the JOURNEY II Bi-Cruciate Stabilized Knee System (Smith & Nephew, Andover, MA, USA). Patients were assessed preoperatively, and at three months and one year postoperatively using Oxford Knee Score (OKS), Knee Society Score (KSS) and Knee Function Score (KFS). Outcomes were statistically analysed using sequential patient cohorts. Results Fifty patients were grouped into five sequential cohorts of 10 patients each. All patients showed significant improvement in postoperative knee scores following TKA. There was a trend toward increased improvement in knee scores in the later patient cohorts, at the three-month and 1-year follow-up. Conclusions The single-surgeon learning curve for minimally invasive TKA had a small effect on knee satisfaction scores at 3 months and 1 year following surgery in the first 50 consecutive cases, and only minor complications were encountered. A larger trial is necessary to draw generalizable conclusions regarding patient outcomes during surgeon learning.

scholarly journals Clinical radiographic outcomes and survivorship of medial pivot design total knee arthroplasty: a systematic review of the literature

2021 ◽  
Author(s):  
Mattia Alessio-Mazzola ◽  
Antonio Clemente ◽  
Antonio Russo ◽  
Peter Mertens ◽  
Giorgio Burastero ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Rate ◽  
Analysis Data ◽  
Systematic Research ◽  
Radiographic Outcomes ◽  
Patient Reported ◽  
Medial Pivot ◽  
Total Knee

Abstract Background Total knee arthroplasty is a reliable procedure able to reduce pain and disability in patients suffering from osteoarthritis. However, a considerable percentage of patients still experiences unsatisfactory results. Medial pivot total knee arthroplasty has been introduced in the clinical practice to overcome problems related with classic design implants and better mimic native knee kinematics. The aim of this study was to analyze survivorship and clinical and radiographic outcomes of medial pivot implants. Methods A systematic research was conducted in eight different databases. Thirty-four studies met the inclusion criteria and were included in the analysis. Data on objective and patients-reported outcomes, radiographic alignment, and survivorship were collected and analyzed. Revision rate was expressed as revision per 100 components years. Result A total of 3377 procedures were included. Mean follow-up was 85.7 months (range, 12–182). The revision per 100 components years was 0.19, which corresponds to a revision rate of 1.9% after 10 years. Mean post-operative range of motion was 117.3 ± 0.4°. Mean clinical and functional Knee Society Score were, respectively, 85.9 ± 1.1 and 84.7 ± 3.5 at final follow-up. Post-operative femorotibial alignment was 177.1 ± 0.5°. Alfa and beta angles were 95.7 ± 0.1° and 89.2 ± 0.1°, respectively. Gamma and delta angles were 2.3 ± 0.6° and 86.7 ± 0.4°. Conclusion Medial pivoting implants provided excellent survivorship and low revision rate, as well as good-to-excellent results in term of objective and patient-reported clinical outcomes, and reliable correction of radiographic parameters. More high-quality studies with long-term follow-up are needed to clarify the role of medial pivoting implants.

scholarly journals Total knee arthroplasty: A single centre review at 10 years of follow-up

2020 ◽  
Vol 27 (2) ◽  
pp. 142-147
Author(s):  
Tao Sun Tycus Tse ◽  
Yik-Cheung Samuel Wan ◽  
Kin-Ho Leo Leung ◽  
Man-Kwan Wong
Keyword(s):  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Knee Arthroplasty ◽  
Revision Rate ◽  
Revision Arthroplasty ◽  
Infection Rates ◽  
Single Centre ◽  
Common Procedure ◽  
Total Knee

Background: Total knee arthroplasty is a common procedure for treatment of various non-infective arthritis. This study reviewed total knee arthroplasty cases up to 10 years of follow-up for the survival rate, reasons of revision and associated perioperative risk factors for revision. Methods: All cases to total knee arthroplasty performed in a single centre in the years 2007 and 2008 were reviewed. A total of 227 cases of total knee arthroplasty were performed during the 2-year period, with 156 cases followed up to 10 years. Perioperative information, follow-up information and information of possible complications were obtained. Results: The survival rate of total knee arthroplasty in this study is 98.2% at 5 years and 94.2% at 10 years of follow-up. The early post-operative complication rate was low, and majority of cases had improvement of function at 1 year after the operation. Early post-operative infection rate was low at 0.4%, and overall infection up to 10 years of follow-up was also low at 4.4%. Ten cases had undergone revision of arthroplasty by 10 years after operation. Conclusion: The survival rate of total knee replacement was high. The revision rate and infection rates were low up to 10 years of follow-up. The most common reasons of revision arthroplasty were infection and aseptic loosening. Cases which required revision arthroplasty had significantly longer operative duration compared with cases without revision at 10 years of follow-up ( p = 0.01).

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