Revision Total Knee Arthroplasty Causes of failure, bone loss management and outcomes\

2018 ◽  
Vol 69 (8) ◽  
pp. 2222-2227
Author(s):  
George Viscopoleanu ◽  
Bogdan Sendrea ◽  
Emil Haritinian
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Loss ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Bone Defects ◽  
Knee Score ◽  
Cause Of Failure ◽  
Total Knee

The objectives of the current study were to identify the causes leading to revision knee arthroplasty, analyse implant choices and assess the short-term outcome. The current study is a retrospective on including a group of 33 patients operated between Jan 2013-Dec 2016 in a single institution. Data was collected from the Romanian National Arthroplasty Register. The cause for revision surgery was noted, as well as the type of implant used during the surgical procedure. The bony defect was classified according to the Anderson Orthopaedic Research Institute (AORI) Classification and the reconstruction method was analysed. Functional outcome was assessed using Oxford Knee Score preoperatively and at one year follow-up. Infection was the cause of failure in 18 cases, aseptic loosening in 11 cases, malposition of implants in 2 cases, instability in 1 case and periprosthetic fracture in 1 case. Revision implants were chosen based on joint stability and degree bone loss. The preferred implant was a condylar constrained knee type (20 cases), followed by a rotating hinge type (5 cases). An unconstrained implant was used in 2 cases. Six infected cases required an arthrodesis of the knee. Based on the AORI Classification, there were 10 type III defects, 14 type IIB, 8 type IIA and only one type I defect. Metal augments were preferred for reconstruction of bone defects. Bone graft was used in 8 cases. The mean Oxford Knee Score was 15 pre-op (12-20) and 38 post-op (32-45). Implant survival at final follow-up was 100%. The most common cause of failure of primary total knee arthroplasty is prosthetic joint infection. Bone defects can be addressed using metal augments or bone allograft. Postoperative functional outcome is improved irrespective of the type of implant used.

Routine Histopathological Analysis of the Synovium in Patients with Primary Total Knee Arthroplasty

2020 ◽  
Vol 34 (01) ◽  
pp. 115-120
Author(s):  
Ali Utkan ◽  
Emrah Caliskan ◽  
Batuhan Gencer ◽  
Bulent Ozkurt
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Primary Total Knee Arthroplasty ◽  
Histopathological Analysis ◽  
Knee Score ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

AbstractAlthough there are numerous studies about routine histopathological analysis during arthroplasty surgeries, most of them showed that new diagnoses have rarely been obtained as a result. The aim of this study was to evaluate the efficacy of routine pathological analyses of synovia resected during primary total knee arthroplasty in patients with osteoarthritis and its relevance in the treatment process. Of the 47 included patients who were followed up prospectively, 26 patients had clinical and histopathological concordant diagnoses and 21 patients had discrepant diagnoses. Oxford knee score and visual analogue score were performed for all the patients. Kallgren-Lawrence score was used for radiological analyses. The Mann-Whitney U test was used to examine the differences between the abnormally distributed variables. Mean age was 65.9 ± 4.3 years (range, 50–89 years) and mean follow-up time was 19 ± 7.8 months (range, 6–39 months). Grade IV gonarthrosis was found to be statistically lower in the discrepant group (p = 0.046). The mean preoperative Oxford knee score was 16.8 ± 2.3 (range, 2–23) and the mean postoperative Oxford knee score was 44.6 ± 1.8 (range, 27–48; p = 0.016). Postoperative Oxford knee scores and VAS were significantly increased in both the concordant and discrepant groups (p = 0.026 and p = 0.035, p = 0.019 and p = 0.039, respectively). Resection and histopathologic analyses of the hypertrophied and inflamed synovium encountered during primary arthroplasty procedure should be performed. This examination not only could provide crucial information that may influence the postoperative follow-up guidelines but also could help us to expand our knowledge and awareness of rare diseases that might yield osteoarthritis. The level of evidence for the study is level II.

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 Is obesity a contraindication for simultaneous bilateral total knee arthroplasty? A prospective case–control study

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 42
Author(s):  
Sanjay Agarwala ◽  
Yash Santosh Wagh ◽  
Mayank Vijayvargiya
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Oxford Knee Score ◽  
Obese Group ◽  
Obese Patients ◽  
Knee Score ◽  
Total Knee ◽  
Simultaneous Bilateral Tka

Aim: Total Knee Arthroplasty (TKA) for decades has been an effective treatment modality for chronic arthritis of the knee. However, there is scarcity of literature comparing the functional outcomes of simultaneous bilateral TKA in obese patients with non-obese Indian population. We conducted this study to evaluate the functional outcomes and complication rates of simultaneous bilateral TKA in obese patients matched control with non-obese patients. Materials and methods: We divided the patients into two study groups based on their body mass index (BMI). Patients with a BMI of less than 30 were classified as non-obese and those with a BMI of more than 30 were classified as obese. All the patients underwent simultaneous bilateral TKA by a single surgeon using the same implant and technique. Patients were followed up regularly and functional outcomes in terms of Oxford knee score were noted at 6 weeks, 3 months, and 1 year. Post-operative complications and time to recovery was also compared. Results: Mean follow-up in obese group was 18 months (12–25 months) and in non-obese group was 17 months (12–24 months). Both the groups were matched with control in terms of pre-operative parameters. Post-operative hemoglobin drop, ICU requirement, length of hospital stay, mean walking time, and mean time to climbing stairs were similar in both the groups. Oxford knee score was significantly better in non-obese group at 6 weeks, but was similar in both the groups at 3 months, 6 months, 1 year, and last follow-up. There was no statistically significant difference seen in the complication rate in both the groups. There was no implant loosening or radiolucency seen. Conclusion: We conclude in our study that simultaneous bilateral TKA gives comparable mid-term results in obese patients in comparison to the non-obese patients.

scholarly journals The influence of joint line position on functional outcome in primary total knee arthroplasty

2021 ◽  
Vol 7 (3) ◽  
pp. 526
Author(s):  
Nikhil Gupta ◽  
Rajesh Singh ◽  
Akash Saxena
Keyword(s):  
Total Knee Arthroplasty ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Joint Line ◽  
Knee Score ◽  
Good Functional Outcome ◽  
Total Knee ◽  
Primary Total Knee

<p><strong>Background:</strong> To find out the cut off for position of joint line which will provide a good functional outcome.</p><p><strong>Methods:</strong> 58 patients underwent total knee arthroplasty using standard medial parapatellar approach were included in this study. Pre-operative and post-operative radiological joint line were assessed. Pre-operative and post-operative functional assessment were done using oxford knee score and International knee society score. functional outcome was assessed at 1, 3 and 6 months. Influence of post-operative joint line change on functional outcome was assessed on follow up visit in 6<sup>th </sup>month.</p><p><strong>Results:</strong> Of 58 patients studied, mean age ± SD was 69.0±7.5 years. Joint line elevation of 36, 16, 8 and 2 patients were between 0-2, 2-4 4-8 and&gt;8 mm respectively with mean ± SD of joint line elevation of 2.24±2.07 mm in the group. Mean OKS-knee score at 6 months follow-up of study group was 36.60 with mean IKSS-knee score of 38.17 at 6 months follow up of group&lt;4 mm which was significant (p&lt;0.05) when compared to mean IKSS-knee score at 6 months follow up of group&gt;4 mm (28.40).</p><p><strong>Conclusions:</strong> It was concluded that joint line restoration is necessary for getting a good functional outcome after primary total knee arthroplasty. The functional outcome of patients with joint line elevation between 4-8mm showed inferior outcomes in comparison to the patients with joint line elevation within 4 mm.</p>

Venous thromboembolism after total knee arthroplasty is associated with a worse functional outcome at one year

2021 ◽  
Vol 103-B (7) ◽  
pp. 1254-1260
Author(s):  
Lorenzo Calabro ◽  
Nick D. Clement ◽  
Deborah MacDonald ◽  
James T. Patton ◽  
Colin R. Howie ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Venous Thromboembolism ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Significant Independent Predictor ◽  
Total Knee ◽  
Five Dimension ◽  
One Year

Aims The primary aim of this study was to assess whether non-fatal postoperative venous thromboembolism (VTE) within six months of surgery influences the knee-specific functional outcome (Oxford Knee Score (OKS)) one year after total knee arthroplasty (TKA). Secondary aims were to assess whether non-fatal postoperative VTE influences generic health and patient satisfaction at this time. Methods A study of 2,393 TKAs was performed in 2,393 patients. Patient demographics, comorbidities, OKS, EuroQol five-dimension score (EQ-5D), and Forgotten Joint Score (FJS) were collected preoperatively and one year postoperatively. Overall patient satisfaction with their TKA was assessed at one year. Patients with VTE within six months of surgery were identified retrospectively and compared with those without. Results A total of 37 patients (1.5%) suffered a VTE and were significantly more likely to have associated comorbidities of stroke (p = 0.026), vascular disease (p = 0.026), and kidney disease (p = 0.026), but less likely to have diabetes (p = 0.046). In an unadjusted analysis, patients suffering a VTE had a significantly worse postoperative OKS (difference in mean (DIM) 4.8 (95% confidence interval (CI) 1.6 to 8.0); p = 0.004) and EQ-5D (DIM 0.146 (95% CI 0.059 to 0.233); p = 0.001) compared with patients without a VTE. After adjusting for confounding variables VTE remained a significant independent predictor associated with a worse postoperative OKS (DIM -5.4 (95% CI -8.4 to -2.4); p < 0.001), and EQ-5D score (DIM-0.169 (95% CI -0.251 to -0.087); p < 0.001). VTE was not independently associated with overall satisfaction after TKA (odds ratio 0.89 (95% CI 0.35 to 2.07); p = 0.717). Conclusion Patients who had a VTE within six months of their TKA had clinically significantly worse knee-specific outcome (OKS) and general health (EQ-5D) scores one year postoperatively, but the overall satisfaction with their TKA was similar to those patients who did not have a VTE. Cite this article: Bone Joint J 2021;103-B(7):1254–1260.

The influence of obesity on functional outcome and quality of life after total knee arthroplasty

2018 ◽  
Vol 100-B (5) ◽  
pp. 579-583 ◽  
Author(s):  
S. Xu ◽  
J. Y. Chen ◽  
N. N. Lo ◽  
S. L. Chia ◽  
D. K. J. Tay ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Obese Group ◽  
Control Group ◽  
Obese Patients ◽  
Knee Score ◽  
Total Knee

AimsThis study investigated the influence of body mass index (BMI) on patients’ function and quality of life ten years after total knee arthroplasty (TKA).Patients and MethodsA total of 126 patients who underwent unilateral TKA in 2006 were prospectively included in this retrospective study. They were categorized into two groups based on BMI: < 30 kg/m2(control) and ≥ 30 kg/m2(obese). Functional outcome was assessed using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), and Oxford Knee Score (OKS). Quality of life was assessed using the Physical (PCS) and Mental Component Scores (MCS) of the 36-Item Short-Form Health Survey.ResultsPatients in the obese group underwent TKA at a younger age (mean, 63.0 years, sd 8.0) compared with the control group (mean, 65.6 years, sd 7.6; p = 0.03). Preoperatively, both groups had comparable functional and quality-of-life scores. Ten years postoperatively, the control group had significantly higher OKS and MCS compared with the obese group (OKS, mean 18 (sd 5) vs mean 22 (sd 10), p = 0.03; MCS, mean 56 (sd 10) vs mean 50 (sd 11), p = 0.01). After applying multiple linear regression with the various outcomes scores as dependent variables and age, gender, and Charlson Comorbidity Index as independent variables, there was a clear association between obesity and poorer outcome in KSFS, OKS, and MCS at ten years postoperatively (p < 0.01 in both KSFS and OKS, and p = 0.03 in MCS). Both groups had a high satisfaction rate (97.8% in the control group vs 87.9% in the obese group, p = 0.11) and fulfillment of expectations at ten years (98.9% in the control group vs 100% in the obese group, p = 0.32).ConclusionAlthough both obese and non-obese patients have significant improvements in function and quality of life postoperatively, obese patients tend to have smaller improvements in the OKS and MCS ten years postoperatively. It is important to counsel patients on the importance of weight management to achieve a more sustained outcome after TKA. Cite this article: Bone Joint J 2018;100-B:579–83.

CLINICAL AND RADIOLOGICAL RESULTS OF TOTAL KNEE REPLACEMENT USING PATIENT-SPECIFIC POSITIONING GUIDES WITH AT LEAST 5 YEARS OF FOLLOW-UP

2020 ◽  
pp. 2050020
Author(s):  
Xabier Foruria ◽  
Jesús Moreta ◽  
Carlos Jaramillo ◽  
Ane Anton ◽  
Isidoro Calvo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Knee Score ◽  
Conventional Instrumentation ◽  
Total Knee ◽  
The Mean ◽  
Clinical And Radiological Results ◽  
Coronal Malalignment

Objective: Patient-specific positioning guides have been designed to improve precision in total knee arthroplasty. The aim of this study is to evaluate the medium-term clinical and radiological outcomes with magnetic resonance imaging-based patient-specific positioning guides. Material and methods: We retrospectively reviewed patients from two centers treated with total knee arthroplasty performed with patient-specific positioning guides. We enrolled patients operated on between January 2011 and December 2013, with a minimum follow-up of 5 years. Preoperative and postoperative hip knee angle (HKA) and position of each component in the coronal plane were assessed. Overall malalignment was defined as an outlier of more than [Formula: see text] from the neutral mechanical axis and specific malalignment as when any component showed more than [Formula: see text] of deviation. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) knee Score. Results: This study included 68 patients with a mean age of 72 years. The mean postoperative alignment (HKA) was [Formula: see text] and 26.5% of patients showed coronal malalignment [Formula: see text]. Regarding femoral components, 19.1% showed specific malalignment [Formula: see text], while 11.7% of tibial components were classified as outliers. The mean HSS Knee Score at final follow up was 89.2. Patients whose implants were mechanically aligned did not obtain better functional outcomes ([Formula: see text]). Conclusion: In our series, the use of patient-specific positioning guides resulted in a range of mechanical malalignment, similar to conventional instrumentation results reported in the literature.

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