scholarly journals Direct Repair of Extensor Mechanism Disruption After Total Knee Arthroplasty “A Case Series of 31 Patients”

2021 ◽  
Author(s):  
Tie-jian Li ◽  
Jing-yang Sun ◽  
Yin-qiao Du ◽  
Jun-min Shen ◽  
Bo-han Zhang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Quadriceps Tendon ◽  
Clinical Results ◽  
Extensor Mechanism ◽  
Direct Repair ◽  
Kaplan Meier ◽  
Total Knee

Abstract Background Extensor mechanism disruption following total knee arthroplasty is a destructive complication with poor outcomes. Presently, limited data exists regarding the direct repair therapy and long-term outcomes. This study was to evaluate the clinical results and complications of direct repair therapy, and compare it with similar studies to determine whether there is a better treatment. Methods During the period of 2008 to 2020, 31 patients underwent direct repair for an extensor mechanism disruption after total knee arthroplasty (15 patellar fractures, 9 patellar tendon disruptions, and 7 quadriceps tendon disruptions). Mean follow-up was 4.9 years. Demographic, operative, and clinical data were collected. The following statistical methods will be employed to analyze the data: descriptive statistics, paired t test, and the Kaplan-Meier method. Results For all 31 patients underwent direct repair for extensor mechanism disruption, 6 patients failed : 2 knees (6%) of infections and 4 knees (13%) of re-rupture. ROM was 94.1° ± 15.7° preoperatively to 73° ±52° postoperatively, average extensor lag reduced from 45° to 20.2° at follow-up, and the WOMAC and HSS averaged 65 and 72 points. The Kaplan-Meier estimated survivorship with failure for complications as the end point was 81% (95% confidence interval [95% CI], 42.7% to73.3%) at 12 years. Conclusion Direct repair of the extensor mechanism disruption is not an ideal therapy, it’s actually ineffective for the recovery of knee joint function in patients, and will remain severe knee extension lag. No matter which part of the extensor mechanism disruption, direct repair should not be the preferred treatment

Is There Any Role for Direct Repair of Extensor Mechanism Disruption Following Total Knee Arthroplasty?

2018 ◽  
Vol 33 (7) ◽  
pp. S244-S248 ◽  
Author(s):  
P. Maxwell Courtney ◽  
Tori A. Edmiston ◽  
Caleb T. Pflederer ◽  
Brett R. Levine ◽  
Tad L. Gerlinger
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Extensor Mechanism ◽  
Direct Repair ◽  
Total Knee

scholarly journals Quadriceps Tendon Rupture Following Total Knee Arthroplasty

2019 ◽  
Vol 13 (1) ◽  
pp. 250-254
Author(s):  
Steven T. Heer ◽  
James O'Dowd ◽  
Rebecca R. Butler ◽  
David O. Dewitt ◽  
Gaurav Khanna ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Rare Complication ◽  
Quadriceps Tendon ◽  
Quadriceps Tendon Rupture ◽  
Significant Difference ◽  
Total Knee ◽  
Suture Anchor Repair ◽  
Extensor Lag

Introduction: Rupture of a Quadriceps Tendon (QT) following a Total Knee Arthroplasty (TKA) is a rare complication. The purpose of this study was to report outcomes and complications of QT repair following TKA. Methods: From a cohort of 437 QT repairs, 19 individuals were identified who had previously undergone a TKA on the ipsilateral leg. Data was collected on individuals with a minimum follow up of 3 months post QT repair (n=16), including Knee Society Scores, pre and post-operative lag, and pre and post-operative range of motion. Results: 13 patients were treated with End-to-End (EE) repairs and 6 were treated with transosseous or suture anchor repair (ATO). In the ATO group, there was no difference in pre (68.0 ± 22.5) and post KSS (82 ± 9.16) (p=0.231), but in the EE group, there was a significant improvement in KSS (pre=67.8 ± 13.1, post=86 ± 16.75, p=0.0027). There was significant difference in post-operative extension lag between ATO (26.0 ± 12.6) vs. EE (4.0 ± 2.74) (p=0.0083). Four out of six ATO patients had extension lag ≥10 degree extensor lag (66.7%) compared to 2 out of 13 (15.4%) patients in the EE group. Compared to EE, ATO repair had an 8.00 times odds of re-tear (95% CI: 0.53,120.6; p=0.133) and 2.75 times greater risk of infection (95% CI: 0.284, 26.61; p=0.382). Conclusion: Patients who underwent EE repair had better functional improvements compared to the ATO group and smaller extension lag.

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 Cement Arthrodesis of the Knee with a Custom Long Recon Nail After Failed Total Knee Arthroplasty: Surgical Technique and Results

2018 ◽  
Vol 12 (1) ◽  
pp. 554-566
Author(s):  
Malcolm R. DeBaun ◽  
Stuart B. Goodman ◽  
David W. Lowenberg
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Treatment Algorithm ◽  
Case Series ◽  
Cement Spacer ◽  
Knee Arthrodesis ◽  
Retrospective Case ◽  
Total Knee

Background and Objective: Persistent periprosthetic joint infection (PJI) is a devastating complication after Total Knee Arthroplasty (TKA). We hypothesize that our novel treatment algorithm utilizing a customized knee spanning recon nail combined with an antibiotic eluting cement spacer improves ambulation status and prevents recurrent PJI in patients with failed TKA and severe bone loss. Methods: In a retrospective case series, 15 consecutive patients who underwent knee arthrodesis after failed ipsilateral TKA secondary to infection from 2004-2017 with at least 1 year of follow-up were enrolled. The average age of patients at the time surgery was 68 (range 50-81) years with an average follow-up of 3.2 (range 1-6) years. Post-surgical ambulation status and eradication of index infection were analyzed as primary outcomes using McNemar’s test for before-and-after study design with p<0.05 for significance. Results: Cement arthrodesis significantly improved ambulation with 67% (10/15) of patients unable to ambulate before arthrodesis and 93% (14/15) of patients able to ambulate at final follow-up (p=0.004). The complication rate was 20% (3/15). There were no periprosthetic fractures. Amongst patients who presented with active PJI, 91% (10/11) had eradication of their index infection final follow-up (p=0.002). Overall prevention of recurrent index infection was 93% (14/15) (p=0.0001). Conclusion: Cement arthrodesis utilizing a custom knee spanning recon nail combined with an antibiotic eluting spacer improves ambulation status and prevents or treats recurrent infection in the majority of patients who have failed total knee arthroplasty.

Allograft Reconstruction for Extensor Mechanism Rupture After Total Knee Arthroplasty: 4.8-Year Follow-Up

Orthopedics ◽  
2003 ◽  
Vol 26 (12) ◽  
pp. 1205-1208
Author(s):  
Stefan A Prada ◽  
Frankie M Griffin ◽  
Carl L Nelson ◽  
Kevin L Garvin
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Extensor Mechanism ◽  
Allograft Reconstruction ◽  
Total Knee

The fate of Baker’s cysts at mid-term follow-up after total knee arthroplasty

2020 ◽  
Vol 102-B (1) ◽  
pp. 132-136
Author(s):  
Hagen Hommel ◽  
Roland Becker ◽  
Peter Fennema ◽  
Sebastian Kopf
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Short Term ◽  
Cyst Size ◽  
Baker’S Cyst ◽  
Baker's Cyst ◽  
Total Knee ◽  
The Mean

Aims We report the natural course of Baker’s cysts following total knee arthroplasty (TKA) at short- and mid-term follow-up. Methods In this prospective case series, 105 TKA patients were included. All patients who received surgery had a diagnosis of primary osteoarthritis and had preoperatively presented with a Baker’s cyst. Sonography and MRI were performed to evaluate the existence and the gross size of the cyst before TKA, and sonography was repeated at a mean follow-up time of 1.0 years (0.8 to 1.3; short-term) and 4.9 years (4.0 to 5.6; mid-term) after TKA. Symptoms potentially attributable to the Baker’s cyst were recorded at each assessment. Results At the one-year follow-up analysis, 102 patients were available. Of those, 91 patients were available for the 4.9-year assessment (with an 86.7% follow-up rate (91/105)). At the short- and mid-term follow-up, a Baker’s cyst was still present in 87 (85.3%) and 30 (33.0%) patients, respectively. Of those patients who retained a Baker’s cyst at the short-term follow-up, 31 patients (35.6%) had popliteal symptoms. Of those patients who continued to have a Baker’s cyst at the mid-term follow-up, 17 patients (56.7%) were still symptomatic. The mean preoperative cyst size was 14.5 cm2 (13.1 to 15.8). At the short- and mid-term follow-up, the mean cyst size was 9.7 cm2 (8.3 to 11.0) and 10.4 cm2 (9.8 to 11.4), respectively. A significant association was found between the size of the cyst at peroperatively and the probability of resolution, with lesions smaller than the median having an 83.7% (36/43) probability of resolution, and larger lesions having a 52.1% (25/48) probability of resolution (p < 0.001). At the mid-term follow-up, no association between cyst size and popliteal symptoms was found. Conclusion At a mean follow-up of 4.9 years (4.0 to 5.6) after TKA, the majority (67.0%, 61/91) of the Baker’s cysts that were present preoperatively had disappeared. The probability of cyst resolution was dependent on the size of the Baker’s cyst at baseline, with an 83.7% (36/43) probability of resolution for smaller cysts and 52.1% (25/48) probability for larger cysts. Cite this article: Bone Joint J. 2020;102-B(1):132–136

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 Bicruciate retaining total knee arthroplasty : results throughout history

2021 ◽  
Vol 87 (1) ◽  
pp. 73-83
Author(s):  
Jef De Mulder ◽  
Pieter Berger ◽  
Hilde Vandenneucker
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Kinematics ◽  
Functional Results ◽  
Clinical Results ◽  
High Rate ◽  
Total Knee ◽  
High Level ◽  
Bcr Tka

Approximately 20% amongst patients are dissatisfied after total knee arthroplasty (TKA). Bicruciate retaining (BCR) TKA offers superior knee kinematics and proprioception, but many surgeons abandoned its use because of complications and technical difficulties. Recently, two new BCR implant designs were introduced : Vanguard XP (Zimmer Biomet) and Journey XR (Smith&Nephew). We searched Pubmed, Limo, Embase and Cochrane, screened reference lists of eligible studies and included studies that met the inclusion criteria. We included 35 articles reporting on ten different BCR implants, including three articles presenting results of the Vanguard XP prosthesis. Unfortunately, no articles reporting on the results of the Journey XR prosthesis had been published. The BCR implants of the early 1970s showed good functional results, but a high rate of complications, mainly loosening and infections. The Townley Anatomic TKA was the first BCR implant with good clinical results, a low incidence of loosening and a high survivorship. One article of the three reporting on the Vanguard XP yielded high patient satisfaction (94%) with two revisions (1.4%). The two other articles reported three revisions (5%) after one year of follow-up and 19 revisions (13.4%) after three years of follow-up. Throughout history, the functional results of BCR TKA improved, with lessening of the complications. The short-term results of the Vanguard XP implant showed good functional results, but two out of three articles reported a high rate of loosening. Based on the results reported in this review, the use of BCR TKA is still debatable. Further high-level evidence research is necessary to assess the clinical benefit of BCR TKA.

Sign in / Sign up

Export Citation Format

Share Document