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.

Evaluation of quality of life and walking ability among amputated patients and those who refused to undergo amputation following infection of total knee arthroplasty: Small case series

2014 ◽  
Vol 39 (6) ◽  
pp. 463-469 ◽  
Author(s):  
Camilo Partezani Helito ◽  
Andre Thiago Scandiuzzi de Brito ◽  
Riccardo Gomes Gobbi ◽  
Marco Kawamura Demange ◽  
Luis Eduardo P Tirico ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Short Form ◽  
Case Series ◽  
Medical Community ◽  
Walking Ability ◽  
Retrospective Case ◽  
Total Knee

Background:Patients who undergo transfemoral amputation after infection of a total knee arthroplasty do not have good functional outcomes and have major difficulty walking.Objectives:To evaluate the quality of life and walking ability among patients who underwent amputation and among those who refused to undergo amputation following infection of a total knee arthroplasty.Study design:Retrospective case series.Methods:Patients who received an indication for amputation following an infection of a total knee arthroplasty were evaluated retrospectively. The patients were divided between those who accepted the amputation procedure and those who refused amputation (four amputee vs four non-amputees). Walking ability and quality of life were evaluated using the Short Form–36 questionnaire.Results:The average physical health was 27.4 for the amputees and 31.3 for the non-amputees. The average mental health was 49.9 for the amputees and 47.1 for the non-amputees. In relation to walking ability, only one (25%) of the amputees was able to walk, as opposed to 100% in the non-amputee groups.Conclusion:Twenty-five percent of the amputee patients continued to be able to walk. The functional outcome of non-amputee patients was better, with 100% being able to walk, though with limitations.Clinical relevanceThis is the first study evaluating patients who refused the amputation procedure and remained with the spacer. Despite the fact that this option is not recommended by the medical community, we believe that these data are useful when discussing, with a patient, quality of life after amputation.

The results of knee arthrodesis with dedicated modular intramedullary nail as a limb salvage procedure in infection complications of knee arthroplasty

2020 ◽  
Vol 86 (2) ◽  
pp. 33-38
Author(s):  
Marcin Para ◽  
◽  
Paweł Bartosz ◽  
Maciej Kogut ◽  
Gracjan Suchodolski ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Intramedullary Nail ◽  
Oxford Knee Score ◽  
Knee Score ◽  
Knee Arthrodesis ◽  
Bone Contact ◽  
Total Knee ◽  
The Mean

Introduction. Complications after arthroplasty often result in irreversible disability. In some cases, for the extremity to be salvaged, permanent knee joint arthrodesis is a last-chance procedure. Modular implant design simplifies surgical technique and knee arthrodesis without bone-on-bone contact, immediately provides full weight bearing and restores limb length and alignment. Puropose. The aim of this article was to perform a clinical evaluation of patients after knee arthrodesis with a dedicated modular intramedullary nail without bone-on-bone contact after a failed infected total knee arthroplasty. Methods. Between 2017 and 2021, 17 patients were treated with knee arthrodesis with a modular nail after a septic complication of total knee arthroplasty. Clinical evaluation of 15 patients was obtained during a follow-up visit, including: the pain severity using the Visual Analog Scale (VAS), physical function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score, gait independence, and the shortening of the affected limb in relation to the other one. Results. The mean follow-up duration was 1.4 years. The group included 11 women and 4 men with an average of 69.3 (57–84) years. All nails were cemented. There was one recurrence of infection. The mean VAS pain score was 2.73, also 4 patients felt no pain at all. The average functional score on the WOMAC scale was 36.4 (14–60) and for the Oxford Knee Score was 26.5 (15–41). Each patient achieved an independent gait. All patients reported the necessity of use of crutches outside home. The average limb shortening was 2.05 cm (0.5–3.0). In addition, 14 of the 15 patients positively evaluated the procedure results and if they had to, they would again decide on this form of treatment. During follow-up, no complication or problems with implants used were observed. Conclusions. Knee arthrodesis with modular nail offers an acceptable functional result and gives a chance of salvaging a limb in complex septic complications of TKA.

scholarly journals Total Knee Arthroplasty in the 21st century: Why Do They Fail? A Fifteen-Year Analysis of 11, 135 Knees

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0020
Author(s):  
Simon W Young ◽  
Chuan Kong Koh ◽  
Saiprasad Ravi ◽  
Mark Zhu ◽  
Kelly G Vince
Keyword(s):  
Total Knee Arthroplasty ◽  
New Zealand ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Tertiary Referral ◽  
Long Term Follow Up ◽  
Total Knee

Introduction and Aims: As national total knee arthroplasty (TKA) registries evolve, there is an increasing trend towards publication of hospital and surgeon-level outcome data, with the goal of stimulating efforts to optimise the results of TKA. Such efforts first require understanding of the current mechanisms of TKA failure. Previous reports on revision TKA from tertiary referral centres lack data on the overall denominator, thus the relative importance of each failure mechanism leading to TKA revision over long term follow up remains unclear. The aim of this study was to analyse reasons for revision following primary TKA, and assess their relative frequencies over long-term follow-up. Methodology: 11,134 primary TKA performed between 2000-2015 at one of three tertiary referral hospitals were identified. ‘Failure’ was defined as patients undergoing subsequent revision surgery involving change of of one or more components or reoperation for deep periprosthetic joint infection (PJI). Patients were identified from a combination of the New Zealand National Joint Registry and individual search of patient records and clinical coding (ICD-9 and ICD-10). All relevant clinical records, radiographs, and lab results were obtained from all New Zealand hospitals to identify the primary reason for revision according to a standardised protocol. Results: A total of 357 (3.2%) failures over the 15 year period were identified. Of these, 36% were revised within one year and 56% were revised within 2 years of primary TKA. Periprosthetic joint infection (PJI) encompassed 48% of all reasons for revision, followed by aseptic loosening (15%), secondary patella resurfacing (14%), tibio-femoral instability (9%), stiffness (5%), polyethylene wear (2.5%), periprosthetic fracture (2.3%), patella maltracking (1.9%) and extensor mechanism discontinuity (0.9%). In the first 5 years following primary TKA, the most common reason for revision was PJI (52%), from 5-10 years PJI and aseptic loosening (35% each), and from 10-15 years aseptic loosening (41%). Conclusion: In this large cohort of patients with comprehensive follow up, PJI was the dominant reason for failure particularly in the first 10 years. Aseptic loosening becomes more important after 10 years follow up. Efforts to improve outcomes following primary TKA should focus on these areas, particularly prevention of PJI.

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 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

scholarly journals Patellar reconstruction following previous patellectomy: a review of the literature and a case series using distal femoral autograft during total knee arthroplasty

2017 ◽  
Vol 99 (3) ◽  
pp. e97-e101
Author(s):  
DA George ◽  
A Dosani ◽  
R Morgan-Jones
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femoral Condyle ◽  
Case Series ◽  
Knee Kinematics ◽  
Alternative Methods ◽  
Small Series ◽  
Total Knee ◽  
Resected Femoral

During total knee arthroplasty, the reconstruction of the patella following a previous patellectomy is challenging, and is undertaken to improve functional outcomes and patient satisfaction. In this case series, we have reconstructed the patella using a femoral condyle resected during total knee arthroplasty. The resected femoral condyle with best available bone stock is selected and secured to the extensor mechanism. We reviewed the preoperative indications and postoperative outcomes of two patients who underwent the above procedure at our Institute, and compared this to the literature. The cases include a 68-year old male (6 months follow-up) who sustained a multi-fragmentary fracture of his right patella and underwent a patellectomy 30 years previously, and a 45-year old female (4 years follow-up) who underwent a left-sided patellectomy 15 years previously following polytrauma. As a result of progressive osteoarthritis they required total knee arthroplasty, and simultaneous patella reconstruction with a femoral condyle autograft. Compared to their preoperative range of motion, both patients demonstrated an improvement post-operatively with successful pain-free knee function, with no radiological signs of graft resorption. In this limited, small series we have reported two patients who are clinically and functionally satisfied by the outcome of surgery, with comparable outcomes to alternative methods. We believe the use of a femoral condyle autograft for patellar reconstruction is a safe and simple technique that optimises knee kinematics, without associated donor morbidity.

scholarly journals Peri-implant fracture after dual-plating knee arthrodesis for failed total knee arthroplasty: case series

2019 ◽  
Vol 5 (4) ◽  
pp. 453-464
Author(s):  
Michael Ransone ◽  
Keith Fehring ◽  
Brian Curtin ◽  
J. Bohannon Mason
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Knee Arthrodesis ◽  
Dual Plating ◽  
Total Knee

scholarly journals Results of total knee arthroplasty for painless, stiff knees

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Young-Joon Choi ◽  
Dong-Kyo Seo ◽  
Ki Won Lee ◽  
Ho Jong Ra ◽  
Hyun Wook Kang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Case Series ◽  
High Rate ◽  
Total Knee ◽  
The Mean

Abstract Background Stiff knees, like completely ankylosed or arthrodesed knees, can be painless. Total knee arthroplasty (TKA) for these painless, stiff knees is technically demanding. However, it can correct the alignment and advance the range of motion to improve quality of life. So, we reviewed the preoperative and postoperative results of functional and pain scores, range of motion (ROM) and complications in painless, stiff knees treated by TKA. Methods Fifteen painless, stiff knees underwent TKA from January 1998 to January 2017. The mean follow-up period was 15.4 (2.4–22.2) years. All the knees were completely ankylosed or arthrodesed. Clinical outcome and complications were evaluated using medical record review, serial plan radiography, ROM assessment, Knee Society score (KSS), Knee Society function score (FS), and a visual analog scale for pain (VAS). Results All patients were satisfied with their operated knees. Mean KSS and FS scores were improved from 36 and 50.9 to 76.9 and 67.2, respectively (P < 0.001 and P = 0.01). The mean ROM increased from 0º preoperatively to 77.6º (15–130) at the final follow-up (P < 0.001). The mean VAS had worsened from 0 preoperatively to 0.2 postoperatively, however it was not significant (P = 0.1). Major postoperative complications were reported in five of the knees (33.3%). Conclusions The results of TKA for painless, stiff knees were satisfactory with improved ROM and quality of life. Although some patients had mild pain and complications postoperatively, they were satisfied with the result. However, our study recommends that surgeons should consider the high rate of complications in the completely ankylosed or arthrodesed knees. Level of evidence A retrospective case series, Level IV.

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