scholarly journals Rotating Hinge Knee Arthroplasty for Revision Prosthetic-Knee Infection: Good Functional Outcomes but a Crucial Need for Superinfection Prevention

2021 ◽  
Vol 8 ◽  
Author(s):  
Florian Bourbotte-Salmon ◽  
Tristan Ferry ◽  
Mickaël Cardinale ◽  
Elvire Servien ◽  
Frédéric Rongieras ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Knee Prosthesis ◽  
Implant Removal ◽  
Knee Infection ◽  
Prosthetic Knee ◽  
Rotating Hinge ◽  
Total Knee ◽  
Prosthetic Knee Infection

Introduction: Management of chronic infection following total knee arthroplasty (TKA) is challenging. Rotating hinged prostheses are often required in this setting due to severe bone loss, ligamentous insufficiency, or a combination of the two. The nature of the mechanical and septic complications occurring in this setting has not been well-described. The aim of this study was to evaluate patient outcomes using a hinge knee prosthesis for prosthetic knee infections and to investigate risk factors for implant removal.Methods: This was a retrospective cohort study that included all patients treated in our tertiary level referral center between January 2009 and December 2016 for prosthetic knee infection with a hinge knee prosthesis. Only patients with a minimum 2-year of follow-up were included. Functional evaluation was performed using international knee society (IKS) “Knee” and “Function” scores. Survival analysis comparing implant removal risks for mechanical and septic causes was performed using Cox univariate analysis and Kaplan-Meier curves. Risk factors for implant removal and septic failure were assessed.Results: Forty-six knees were eligible for inclusion. The majority of patients had satisfactory functional outcomes as determined by mean IKS scores (mean knee score: 70.53, mean function score: 46.53 points, and mean knee flexion: 88.75°). The 2-year implant survival rate was 89% but dropped to 65% at 7 years follow-up. The risk of failure (i.e., implant removal) was higher for septic etiology compared to mechanical causes. Patients with American society of anesthesiologists (ASA) score>1, immunosuppression, or with peripheral arterial diseases had a higher risk for septic failure. Patients with acute infection according to the Tsukayamaclassification had a higher risk of failure. Of the 46 patients included, 19 (41.3%) had atleast one infectious event on the surgical knee and most of these were superinfections (14/19) with new pathogens isolated. Among pathogens responsible for superinfections (i) cefazolin and gentamicin were both active in six of the cases but failed to prevent the superinfection; (ii) cefazolin and/or gentamicin were not active in eight patients, leading to alternative systemic and/or local antimicrobial prophylaxis consideration.Conclusions: Patients with chronic total knee arthroplasty (TKA) infection, requiring revision using rotating hinge implant, had good functional outcomes but experienced a high rate of septic failure, mostly due to bacterial superinfection. These patients may need optimal antimicrobial systemic prophylaxis and innovative approaches to reduce the rate of superinfection.

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 Acute Infection in Total Knee Arthroplasty: Diagnosis and Treatment

2013 ◽  
Vol 7 (1) ◽  
pp. 197-204 ◽  
Author(s):  
Juan Carlos Martínez-Pastor ◽  
Francisco Maculé-Beneyto ◽  
Santiago Suso-Vergara
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Acute Infection ◽  
Septic Complication ◽  
Two Stage ◽  
Revision Process ◽  
Knee Infection ◽  
Prosthetic Knee ◽  
Total Knee ◽  
Prosthetic Knee Infection

Infection is one of the most serious complications after total knee arthroplasty (TKA). The current incidence of prosthetic knee infection is 1-3%, depending on the series.For treatment and control to be more cost effective, multidisciplinary groups made up of professionals from different specialities who can work together to eradicate these kinds of infections need to be assembled. About the microbiology,Staphylococcus aureusand coagulase-negative staphylococcus were among the most frequent microorganisms involved (74%).Anamnesis and clinical examination are of primary importance in order to determine whether the problem may point to a possible acute septic complication. The first diagnosis may then be supported by increased CRP and ESR levels. The surgical treatment for a chronic prosthetic knee infection has been perfectly defined and standardized, and consists in a two-stage implant revision process. In contrast, the treatment for acute prosthetic knee infection is currently under debate. Considering the different surgical techniques that already exist, surgical debridement with conservation of the prosthesis and polythene revision appears to be an attractive option for both surgeon and patient, as it is less aggressive than the two-stage revision process and has lower initial costs.The different results obtained from this technique, along with prognosis factors and conclusions to keep in mind when it is indicated for an acute prosthetic infection, whether post-operative or haematogenous, will be analysed by the authors.

scholarly journals Phage Therapy for Limb-threatening Prosthetic Knee Klebsiella pneumoniae Infection: Case Report and In Vitro Characterization of Anti-biofilm Activity

2020 ◽  
Author(s):  
Edison J Cano ◽  
Katherine M Caflisch ◽  
Paul L Bollyky ◽  
Jonas D Van Belleghem ◽  
Robin Patel ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Klebsiella Pneumoniae ◽  
Knee Arthroplasty ◽  
Phage Therapy ◽  
Knee Infection ◽  
Prosthetic Knee ◽  
Satisfactory Outcome ◽  
Total Knee ◽  
Prosthetic Knee Infection

Abstract Background Prosthetic joint infection (PJI) is a potentially limb-threatening complication of total knee arthroplasty. Phage therapy is a promising strategy to manage such infections including those involving antibiotic-resistant microbes, and to target microbial biofilms. Experience with phage therapy for infections associated with retained hardware is limited. A 62-year-old diabetic man with a history of right total knee arthroplasty 11 years prior who had suffered multiple episodes of prosthetic knee infection despite numerous surgeries and prolonged courses of antibiotics, with progressive clinical worsening and development of severe allergies to antibiotics, had been offered limb amputation for persistent right prosthetic knee infection due to Klebsiella pneumoniae complex. Intravenous phage therapy was initiated as a limb-salvaging intervention. Methods The patient received 40 intravenous doses of a single phage (KpJH46Φ2) targeting his bacterial isolate, alongside continued minocycline (which he had been receiving when he developed increasing pain, swelling, and erythema prior to initiation of phage therapy). Serial cytokine and biomarker measurements were performed before, during, and after treatment. The in vitro anti-biofilm activity of KpJH46Φ2, minocycline and the combination thereof was evaluated against a preformed biofilm of the patient’s isolate and determined by safranin staining. Results Phage therapy resulted in resolution of local symptoms and signs of infection and recovery of function. The patient did not experience treatment-related adverse effects and remained asymptomatic 34 weeks after completing treatment while still receiving minocycline. A trend in biofilm biomass reduction was noted 22 hours after exposure to KpJH46Φ2 (P = .063). The addition of phage was associated with a satisfactory outcome in this case of intractable biofilm-associated prosthetic knee infection. Pending further studies to assess its efficacy and safety, phage therapy holds promise for treatment of device-associated infections.

Outcomes of Rotating-hinge Total Knee Arthroplasty Following Complex Primary and Revision Total Knee Arthroplasty

2021 ◽  
Author(s):  
Daniel Pfeufer ◽  
Jeremy Gililland ◽  
Priscila Monteiro ◽  
Marissa Stagg ◽  
Mike Anderson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Revision Total Knee Arthroplasty ◽  
Salvage Procedure ◽  
Rotating Hinge ◽  
Total Knee ◽  
The Mean ◽  
Revision Tka

In complex primary and revision total knee arthroplasty (TKA), rotating-hinge TKA (RH-TKA) prostheses play an important role. Compared to early fixed-hinge knee designs, new implants that include rotating platforms and improved hinge constructs may offer improvements in both survival and clinical outcomes. We sought to evaluate early survival following complex primary and revision TKA with a rotating-hinge knee prosthesis. We retrospectively reviewed a consecutive series of patients (n=47, 48 knees) who underwent revision TKA using an RH-TKA system. The mean age was 73 years (range, 37 – 86). The mean body mass index was 29 (range, 16.3 – 45.9) and the median ASA score was 3 (IQR, 2 – 3). As mortality was high, we performed a Kaplan-Meier analysis to evaluate survival, with death as failure. The median follow-up was 2.5 years (range, 0.07 – 9.8). Revision-free survival was 97% at a median 2.5 years of follow-up. Overall mortality was 46% (17/37) and survival free from death was 69% (49% - 82%) at a median of 2.5 years. Most reoperations were due to infection (5/12), following by wound-related complications (2/12) and hematomas (2/12). A high postoperative complication rate and mortality are evident in TKA using a hinged knee prosthesis in complex revision TKA. If the indication and surgical technique are matched to the complexity of the case, this type of implant offers a feasible salvage procedure.

Acupuncture needle-associated prosthetic knee infection after total knee arthroplasty

2010 ◽  
Vol 20 (6) ◽  
pp. 627-631 ◽  
Author(s):  
Arata Nakajima ◽  
Ryutaku Kaneyama ◽  
Hitoshi Watanabe ◽  
Masazumi Murakami ◽  
Koichi Nakagawa ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Infection ◽  
Acupuncture Needle ◽  
Prosthetic Knee ◽  
Total Knee ◽  
Prosthetic Knee Infection

Early Clinical and Radiological Outcomes of the Metaphyseally Fixed Totally Stabilized Knee Prosthesis in Primary Total Knee Arthroplasty

2019 ◽  
Vol 33 (07) ◽  
pp. 678-684 ◽  
Author(s):  
Fahad Hossain ◽  
Sujith Konan ◽  
Babar Kayani ◽  
Christina Kontoghiorghe ◽  
Toby Barrack ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Oxford Knee Score ◽  
Primary Total Knee Arthroplasty ◽  
Primary Tkas ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

AbstractThe use of valgus–varus constrained (VVC) implant designs in primary total knee arthroplasty (TKA) is considered in situations of severe deformities, bone loss, and inadequate soft tissue balance. It is not known whether the use of such prosthesis designs may predispose to reduced function owing to its constraining design. The components are usually implanted with diaphyseal stem extensions to dissipate the increased forces. The totally stabilized (TS) implant is a contemporary VVC design with metaphyseal fixation only. It has a conforming articulation with increased rotational freedom compared with conventional VVC designs. The aim of this study was to assess whether the use of the contemporary TS implant with its metaphyseally fixed components would be associated with inferior outcomes compared with conventional standard primary posterior stabilized (PS) implants. We reviewed 38 consecutive complex primary TKAs performed using the metaphyseally fixed TS implant and 76 matched patients receiving primary PS TKA, at a minimum follow-up of 24 months. The mean follow-up was 61.1 months (24–102). Only patients with osteoarthritis were included. Clinical outcome was assessed using range of motion (ROM) and Oxford knee score (OKS). Radiographic assessment was performed using the femorotibial angle (FTA) at 6 weeks followed by assessment of bone–implant interface lucencies at final follow-up. There were no major early postoperative complications. The mean postoperative ROM in the TS and PS groups were 114.1 and 112.0, respectively. There was no difference in the mean ROM and OKS between the two groups. The mean FTA for patients in both groups was within 3° of the expected. There was no evidence of progressive lucencies or implant migration at final follow-up. The metaphyseally fixed TS knee design achieves comparable short-term functional outcomes when compared with conventional PS designs in primary knee arthroplasty. Long-term follow-up studies are required to assess survivorship.

scholarly journals Posterior Dislocation of the Hinge-Post Extension in a Rotating Hinge Total Knee Prosthesis

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Givenchy Manzano ◽  
Ran Schwarzkopf
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Knee Dislocation ◽  
Posterior Dislocation ◽  
Rotating Hinge ◽  
History Of ◽  
Total Knee ◽  
Rotating Hinge Knee ◽  
Anterior Knee

The rotating hinge knee prosthesis is a popular intervention in patients lacking stability with highly constrained total knee arthroplasty. Despite improvements in design, nonmechanical and mechanical complications continue to be a problem. Dislocation of the hinge has been widely described, mainly due to the component fracture. Few reports describe isolated dislocation of the rotating stem. We report a case of isolated disengagement of the rotating hinge mechanism, due to severe flexion gap imbalance, leading to subsequent posterior dislocation of the hinge and anterior knee dislocation, in a patient with a history of multiple total knee arthroplasty revisions. This case suggests the importance of the soft tissue balancing, the adequate patellar tracking, and use of a long cylindrical, minimally tapered rotating stem in hinge arthroplasty to minimize hinge dislocation.

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