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Moore MF, Tobase P, Allen DD. Meta-analysis: outcomes of total knee arthroplasty in the haemophilia population. Haemophilia 2017; 22:e275-85. [PMID: 27444973 DOI: 10.1111/hae.12885] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION People with haemophilia (PWH) experience end stage joint disease as a result of repeated hemarthrosis, commonly leading to total knee arthroplasty (TKA). AIM The goal of this meta-analysis is to calculate expected outcomes for range of motion (ROM), functional mobility, and complication rates in PWH following TKA. METHODS Studies published between 1980 and 2015 were identified. INCLUSION CRITERIA PWH having TKA, reporting Hospital for Special Surgery Knee Score or Knee Society Score, knee ROM, and incidence of complications for more than 5 TKAs. Inhibitor status, haemophilia severity and HIV status were not criteria for inclusion or exclusion. Meta-analysis was performed using mean, standard deviation, or P-value data to create effect sizes (ES) and 95% confidence intervals for each variable. RESULTS Twenty studies met inclusion criteria; ten had sufficient data for meta-analyses. A total of 336 TKAs in 254 PWH were analysed with mean follow-up of 6.3 years. Statistically significant ROM improvements were found with 9.72° improvement of flexion contracture (-0.73 effect size (ES) (-0.91 to -0.56)), and 15.69°increase into flexion (0.63 ES (0.34-0.91)). Knee scores showed statistically significant improvements: clinically, 37.9 point increase (3.21 ES [1.79-4.63]) and functionally, 13.50 point increase (1.50 ES [0.80-2.21]). A 31.5% complication rate was calculated with 106 reported in 336 TKAs. CONCLUSIONS TKA is an effective procedure for improving ROM and decreasing functional deficits resulting from haemophilic arthropathy. Knee score data shows TKA improves overall function. This study guides clinicians regarding outcome expectations post-TKA in PWH.
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Affiliation(s)
- M F Moore
- Physical Medicine and Rehabilitation, The Johns Hopkins Hospital Baltimore, MD, USA.,Graduate Program in Physical Therapy, University of California San Francisco/ San Francisco State University, San Francisco, CA, USA
| | - P Tobase
- University of California, San Francisco Medical Center, San Francisco, CA, USA
| | - D D Allen
- Graduate Program in Physical Therapy, University of California San Francisco/ San Francisco State University, San Francisco, CA, USA
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Luttjeboer JS, Bénard MR, Defoort KC, van Hellemondt GG, Wymenga AB. Revision Total Knee Arthroplasty for Instability-Outcome for Different Types of Instability and Implants. J Arthroplasty 2016; 31:2672-2676. [PMID: 27546470 DOI: 10.1016/j.arth.2016.06.062] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/20/2016] [Accepted: 06/28/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Given the mixed outcome after revision total knee arthroplasty (TKA) for instability in the literature and the relative high recurrence of instability, we were interested in the outcome of a cohort of patients operated for various types of clinical instability and with different types of implants. METHODS A total of 77 patients with unstable TKA were completely revised (19 hinged and 58 condylar implants). We classified the patients in 3 instability groups based on the literature: (1) anterior-posterior flexion instability (N = 29); (2) medial-lateral flexion instability (N = 16); and (3) multiplane instability (N = 32). Patients were evaluated up to 24 months postoperatively, concerning Knee Society clinical rating system, range of motion, visual analog scale (VAS) pain, and VAS satisfaction. RESULTS For the total group, all outcome scores improved, but substantial residual pain (VAS = 41) was reported. For type of instability, the clinical outcome was similar for all the groups. For type of implant, the hinged group had lower postoperative outcome scores but similar satisfaction scores compared with those in the condylar group. There was a considerable number of insert changes and secondary patellar resurfacing in the condylar group compared with no reoperations in the hinged group. Recurrent instability was not seen in the anterior-posterior flexion instability group and in patients who received a condylar constraint-type implant. CONCLUSIONS We recommend 3 options in revision TKA for instability: (1) hinged implants in cases with severe ligament instability in multiple planes or bone loss, (2) condylar implants with a posterior-stabilized insert in cases with isolated posterior cruciate ligament insufficiency, and (3) condylar implants with condylar constraints in all other cases.
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Affiliation(s)
- Jaap S Luttjeboer
- Department of Orthopedics, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
| | - Menno R Bénard
- Sint Maartenskliniek Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Koen C Defoort
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Ate B Wymenga
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands
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Grayson CW, Warth LC, Ziemba-Davis MM, Michael Meneghini R. Functional Improvement and Expectations Are Diminished in Total Knee Arthroplasty Patients Revised for Flexion Instability Compared to Aseptic Loosening and Infection. J Arthroplasty 2016; 31:2241-6. [PMID: 27067166 DOI: 10.1016/j.arth.2016.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/02/2016] [Accepted: 03/01/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Instability has emerged as the most common noninfectious cause necessitating early revision after total knee arthroplasty (TKA). Although studies have documented improvement in outcomes with revision for flexion instability, it remains unknown how the outcomes compare to patients revised for other failure etiologies. The study purpose was to compare outcomes after revision TKA based on failure etiology. METHODS A retrospective review of our prospectively collected revision TKA database was performed on patients who underwent revision TKA from October 1, 2010 to November 19, 2014. Demographic data; minimum 1-year Knee Society Scores; and University of California, Los Angeles activity level scores were obtained. RESULTS One hundred seventy-seven consecutive revision TKAs were evaluated. After exclusion of revisions with confounding variables and diagnosis groups with small numbers, 92 patients with a revision diagnosis of flexion instability, infection, or loosening/osteolysis were compared. There were no group differences in Knee Society objective (P ≥ .460) and satisfaction (P ≥ .112) scores or UCLA activity level scores at final follow-up (P ≥ .118). Preoperative Knee Society function scores were significantly higher in patients with flexion instability (P = .019), but the amount of improvement in function relative to baseline was equivalent in the 3 groups (P = .170). Patients revised for flexion instability were significantly more likely than patients in the other 2 groups to report that their expectations were not met (P = .028). CONCLUSION Patients and surgeons can expect that revision for isolated flexion instability may only obtain modest improvement compared with other diagnoses, potentially in part due to a higher preoperative functional level in patients with instability.
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Affiliation(s)
| | - Lucian C Warth
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Health Physicians, Orthopedics and Sports Medicine, Fishers, Indiana
| | - Mary M Ziemba-Davis
- Indiana University Health Physicians, Orthopedics and Sports Medicine, Fishers, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Health Physicians, Orthopedics and Sports Medicine, Fishers, Indiana
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Heesterbeek PJC, Goosen JHM, Schimmel JJP, Defoort KC, van Hellemondt GG, Wymenga AB. Moderate clinical improvement after revision arthroplasty of the severely stiff knee. Knee Surg Sports Traumatol Arthrosc 2016. [PMID: 26215774 DOI: 10.1007/s00167-015-3712-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Revision of the severe stiff total knee arthroplasty (TKA) is challenging, and clinical outcome is inferior to other indications for revision. The purpose of the present study was to determine clinical outcome of TKA revision in patients with severe stiffness (range of motion (ROM) ≤ 70°) and evaluate a possible influence of accompanying findings, such as component malposition, aseptic loosening or instability. METHODS A prospective cohort of 40 patients with a preoperative ROM ≤ 70° and a minimum of 2-year follow-up after total system revision (Genesis or Legion stemmed condylar implant) was evaluated. ROM, Knee Society Scoring System (KSS) and visual analogue scale (VAS) pain scores were obtained preoperatively and at 2 years. Patient satisfaction and complication rate were assessed. Component malposition was most frequently reported as accompanying finding (n = 27). Comparisons between pre- and postoperative outcome (p < 0.05) and between different subgroups (component malposition, aseptic loosening, and instability) based on accompanying findings were made (no statistical comparison). RESULTS ROM, KSS and VAS pain scores improved significantly (p < 0.001): median ROM at two years 85° (range 10-125) and median gain 25° (range -10 to +85). Median VAS satisfaction was 53.5 points (range 15-98). Seventeen patients reported at least one complication, including one re-revision. Six patients underwent manipulation under anaesthesia, and five were referred to the pain clinic. No clear differences between subgroups were observed. CONCLUSIONS TKA revision in patients with severe stiffness resulted in a moderate but significant improved clinical outcome after 2 years. Accompanying abnormalities such as component malposition, aseptic loosening or instability did not influence clinical outcome. Realistic patient counselling on the moderate outcome and possible remaining limitations in daily life might help to improve patient satisfaction. LEVEL OF EVIDENCE Therapeutic studies-case series with no comparison group, Level IV.
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Affiliation(s)
| | - J H M Goosen
- Sint Maartenskliniek, PO Box 9011, 6500 GM, Nijmegen, Netherlands
| | - J J P Schimmel
- Sint Maartenskliniek, PO Box 9011, 6500 GM, Nijmegen, Netherlands
| | - K C Defoort
- Sint Maartenskliniek, PO Box 9011, 6500 GM, Nijmegen, Netherlands
| | | | - A B Wymenga
- Sint Maartenskliniek, PO Box 9011, 6500 GM, Nijmegen, Netherlands
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Microorganisms responsible for periprosthetic knee infections in England and Wales. Knee Surg Sports Traumatol Arthrosc 2016; 24:3080-3087. [PMID: 25829328 DOI: 10.1007/s00167-015-3539-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to delineate epidemiology of infecting microorganism genus in first-time revision knee arthroplasty for indication of periprosthetic joint infection in England and Wales using linked registry data. METHODS From the National Joint Registry database for England and Wales, a consecutive series of primary knee arthroplasties performed between April 2003 and January 2014 that went on to have a revision for periprosthetic infection were identified (n = 2810). Each case was then linked to microbiology data held by Public Health England in order to identify infecting microorganism at time of revision surgery established from intra-operative cultures. Following data linkage, 403 culture results at time of revision surgery were identified in a group of 331 patients. The demographic characteristics of five microorganism groups were compared: pure staphylococcus (single genus), pure streptococcus (single genus), other gram-positive infections (single genus), gram-negative infections (single genus) and mixed genus infections. RESULTS Staphylococcus species was the most common organism genus isolated after revision of a primary implant for infection and present in 72 % of cases overall (71.3 % of patients with a single-genus infection and 76.8 % of patients with mixed genus infection). A pure staphylococcal infection was present in 59 % of all cases. A single-genus infection was responsible for infection in 83.1 % of cases, and mixed genera were responsible in 16.9 % of cases. A significant difference was observed for mean age at primary procedure in the cohort of patients where there was an isolated pure streptococcal infection (73.2 years) when compared to gram-negative infections (65.0 years). No other significant differences were observed between microorganism groups in terms of BMI, gender, ASA grade, indication for primary procedure and primary implant characteristics. CONCLUSION Staphylococci were the most commonly isolated organism species responsible for periprosthetic infection of primary arthroplasty in England and Wales. This information can be used by surgeons to benchmark and audit their own practice against national, publicly available data. Furthermore, this study has shown that even when using the largest national databases available, there is a substantial volume of missing data. Antimicrobial resistance represents a growing clinical problem with significant health and social costs. In order to counteract this threat, this study would advocate the consolidation of national microbial data in order to guide effective strategies towards targeting and combating the threat of antimicrobial resistance. LEVEL OF EVIDENCE IV.
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Heesterbeek PJC, Wymenga AB, van Hellemondt GG. No Difference in Implant Micromotion Between Hybrid Fixation and Fully Cemented Revision Total Knee Arthroplasty: A Randomized Controlled Trial with Radiostereometric Analysis of Patients with Mild-to-Moderate Bone Loss. J Bone Joint Surg Am 2016; 98:1359-69. [PMID: 27535438 DOI: 10.2106/jbjs.15.00909] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In revision total knee arthroplasty (TKA), the femoral component and tibial baseplate are usually cemented. However, stems can be fixed either with cement or with a press-fit technique, with the latter resulting in hybrid fixation. There is no consensus on the preferred stem fixation technique. Therefore, we compared the stability of cemented TKA implants with the stability of TKA implants fixed with the hybrid technique in a prospective randomized trial using radiostereometric analysis (RSA). METHODS Thirty-two patients with a Type-I or II bone defect who needed revision TKA and were randomly allocated at the time of surgery into either the cemented or hybrid-fixation group were included in the study. The radiographs for the RSA were obtained during hospitalization (baseline); at 6 weeks; and at 3, 6, 12, and 24 months. Migration of the femoral and tibial implants was measured using model-based RSA and expressed along or around the 3 orthogonal axes and as total translation (TT) and total rotation (TR). Clinical results were evaluated using the Knee Society Score (KSS), the Knee injury and Osteoarthritis Outcome Score (KOOS), active flexion, and visual analog scale (VAS) scores for pain and satisfaction. Mann-Whitney and chi-square tests were used to compare migration and clinical outcomes between the cement and hybrid techniques. RESULTS At 24 months, no difference in median migration or the number of migrating components was found between the cemented and hybrid-fixation groups. In each group, approximately one-third of the tibial components had total rotation of >1°. The clinical scores did not differ between the techniques. CONCLUSIONS At 24 months after revision TKAs, cemented and hybrid-fixation replacements were equally stable. Unexpectedly, both groups had implants with >1 mm or >1° of micromotion although there were no clinical or radiographic signs of loosening. Whether these findings indicate the possibility of loosening with longer follow-up remains to be investigated. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- P J C Heesterbeek
- Departments of Research (P.J.C.H.) and Orthopaedics (A.B.W. and G.G.v.H.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - A B Wymenga
- Departments of Research (P.J.C.H.) and Orthopaedics (A.B.W. and G.G.v.H.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - G G van Hellemondt
- Departments of Research (P.J.C.H.) and Orthopaedics (A.B.W. and G.G.v.H.), Sint Maartenskliniek, Nijmegen, the Netherlands
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Steinbrück A, Schröder C, Woiczinski M, Müller T, Müller PE, Jansson V, Fottner A. Influence of tibial rotation in total knee arthroplasty on knee kinematics and retropatellar pressure: an in vitro study. Knee Surg Sports Traumatol Arthrosc 2016; 24:2395-401. [PMID: 25577221 DOI: 10.1007/s00167-015-3503-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Although continuous improvements have been made, there is still a considerable amount of unsatisfied patients after total knee arthroplasty (TKA). A main reason for this high percentage is anterior knee pain, which is supposed to be provoked by post-operative increased retropatellar peak pressure. Since rotational malalignment of the implant is believed to contribute to post-operative pain, the aim of this study was to examine the influence of tibial component rotation on knee kinematics and retropatellar pressure. METHODS Eight fresh-frozen knee specimens were tested in a weight-bearing knee rig after fixed-bearing TKA under a loaded squat from 20° to 120° of flexion. To examine tibial components with different rotations, special inlays with 3° internal rotation and 3° external rotation were produced and retropatellar pressure distribution was measured with a pressure-sensitive film. The kinematics of the patella and the femorotibial joint were recorded with an ultrasonic-based motion analysis system. RESULTS Retropatellar peak pressure decreased significantly from 3° internal rotation to neutral position and 3° external rotation of the tibial component (8.5 ± 2.3 vs. 8.2 ± 2.4 vs. 7.8 ± 2.5 MPa). Regarding knee kinematics femorotibial rotation and anterior-posterior translation, patella rotation and tilt were altered significantly, but relative changes remained minimal. CONCLUSION Changing tibial rotation revealed a high in vitro influence on retropatellar peak pressure. We recommend the rotational alignment of the tibial component to the medial third of the tibial tuberosity or even more externally beyond that point to avoid anterior knee pain after TKA.
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Affiliation(s)
- Arnd Steinbrück
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Tatjana Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Andreas Fottner
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
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Girerd D, Parratte S, Lunebourg A, Boureau F, Ollivier M, Pasquier G, Putman S, Migaud H, Argenson JN. Total knee arthroplasty revision with trabecular tantalum cones: Preliminary retrospective study of 51 patients from two centres with a minimal 2-year follow-up. Orthop Traumatol Surg Res 2016; 102:429-33. [PMID: 27052939 DOI: 10.1016/j.otsr.2016.02.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 02/10/2016] [Accepted: 02/16/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Successful management of large bone defects is of crucial importance when performing revision total knee arthroplasty (TKA). Trabecular tantalum cones may improve prosthesis fixation via their potential for reconstructing a stable metaphyseal support. The objective of this study was to evaluate the clinical and radiological outcomes and the complications of tantalum cones in revision TKA. HYPOTHESIS Trabecular tantalum cones provide stable and durable metaphyseal reconstruction when used during revision TKA. MATERIAL AND METHODS Trabecular Metal™ cones (Zimmer, Warsaw, IN, USA) were used for 52 revision TKAs in 51 patients (mean age, 68±9 years) managed in two centres between 2008 and 2013. A rotating hinge prosthesis was chosen for 38 (73%) knees and a condylar constrained knee prosthesis for 14 (27%) knees, with 37 tibial and 34 femoral cones. The two most common reasons for revision surgery were aseptic loosening (n=22, 42%) and infection (n=19, 37%). The bone loss was severe in most cases. At each centre, after a mean follow-up of 34 months (range, 24-52 months), two independent observers assessed the Knee Society Score (KSS), range of motion, mechanical axis, and osteo-integration for each patient. RESULTS Mean KSS increased from 46 preoperatively to 77 (P=0.001) at last follow-up and the mean KSS function from 39 to 57 (P=0.007). Mean range of motion improved from 93° (45°-120°) to 110° (65°-130°) (P=0.001). Mean postoperative mechanical axis was 180° (172°-190°). Radiographic evaluation showed evidence of osteo-integration for all cones. Four revisions were performed for recurrence of infection but none for mechanical failure. DISCUSSION The findings of our study confirm the biomechanical and biological reliability of Trabecular Metal™ cones used to fill metaphyseal bone defects during revision TKA. LEVEL OF EVIDENCE IV, retrospective therapeutic study.
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Affiliation(s)
- D Girerd
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - S Parratte
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France.
| | - A Lunebourg
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - F Boureau
- Centre Hospitalier Régional Universitaire, Service de chirurgie orthopédique et traumatologie, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille, rue Paul-Duez, 59000 Lille, France
| | - M Ollivier
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - G Pasquier
- Centre Hospitalier Régional Universitaire, Service de chirurgie orthopédique et traumatologie, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille, rue Paul-Duez, 59000 Lille, France
| | - S Putman
- Centre Hospitalier Régional Universitaire, Service de chirurgie orthopédique et traumatologie, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille, rue Paul-Duez, 59000 Lille, France
| | - H Migaud
- Centre Hospitalier Régional Universitaire, Service de chirurgie orthopédique et traumatologie, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille, rue Paul-Duez, 59000 Lille, France
| | - J N Argenson
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
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Gibon E, Farman T, Marmor S. Knee arthroplasty and lawsuits: the experience in France. Knee Surg Sports Traumatol Arthrosc 2015; 23:3723-8. [PMID: 25209208 DOI: 10.1007/s00167-014-3292-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 08/28/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Data regarding knee arthroplasty and lawsuit are scarce. With the expected increase in knee arthroplasty over the next 25 years, the number of claims might follow the same trend. Therefore, the most frequent causes of litigation after knee arthroplasty in France, and what is considered as malpractice by the expert, were determined. METHODS Over 8-year period, data gathered from a French private insurance company specializing in malpractice for private practitioners were analyzed. Demographics, type of knee arthroplasty, reason for claim, details of the legal procedure and the expert's decision were reviewed. RESULTS One hundred and five claims were processed by four jurisdictions. Most of the cases concerned primary total knee arthroplasty. Surgeons and anesthesiologists were charged in 84 and 16 % of claims, respectively. The most frequent causes of litigation were infection, neurological deficit and unsatisfactory result, whereas the most common reasons for the surgeon's liability, as stated by the expert, were delay in diagnosis or treatment of a complication, infection and technical error. CONCLUSION Our findings show that frequent complications are not those which raise most of the claims. Patients sue the surgeon when the outcome of the surgery is different from what they were expecting. An unsatisfactory result, according to the patient's point of view, is the second most frequent cause of claim. LEVEL OF EVIDENCE IV, Economic and Decision Analysis. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Emmanuel Gibon
- Department of Orthopaedic Surgery, Diaconesses Croix-Saint-Simon Teaching Hospital, 125 rue d'Avron, 75020, Paris, France.
| | - Thierry Farman
- Mutuelle d'assurance du corps de santé français (MACSF), 10 cours du Triangle-de-l'Arche, TSA 40100, 92919, La Défense Cedex, Paris, France.
| | - Simon Marmor
- Department of Orthopaedic Surgery, Diaconesses Croix-Saint-Simon Teaching Hospital, 125 rue d'Avron, 75020, Paris, France.
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Kim DK, Seo MC, Song SJ, Kim KI. Are Korean Patients Different from Other Ethnic Groups in Total Knee Arthroplasty? Knee Surg Relat Res 2015; 27:199-206. [PMID: 26675374 PMCID: PMC4678240 DOI: 10.5792/ksrr.2015.27.4.199] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 01/14/2023] Open
Abstract
Most of the implants used for total knee arthroplasty (TKA) in Asian patients have been produced based on anthropometry of Western people. Since anatomic features and life styles are different between Western and Eastern people, there would be ethnic differences in terms of conformity of implants to the patient's anatomy or clinical results after TKA. Therefore, surgeons in Asia are particularly interested in related surgical techniques and implant designs used in TKA for improved clinical results and patient satisfaction. In this review, we investigated the anthropometric differences of Koreans from Westerners. Koreans are of shorter stature, less weight, and smaller skeletal structure and have a higher incidence of constitutional varus alignment of the lower extremity. Moreover, compared to Westerner TKA populations, the proportion of female patients was large and primary osteoarthritis was prevalent in preoperative diagnosis in Korean TKA patients. Culturally, Koreans have life styles that demand high flexion positions of the knee such as squatting, kneeling, and cross-legged sitting. Although there were no notable differences in the complication and revision rates following TKA between Westerners and Koreans, the incidence of postoperative deep vein thrombosis and pulmonary thromboembolism was lower in Koreans than Westerners. We hope that further research on implant designs and more interest in TKA will improve outcomes in Korean patients.
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Affiliation(s)
- Dong-Kyoon Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Min-Chul Seo
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang-Joon Song
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea. ; Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
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Abstract
Revision knee arthroplasty presents a number of challenges, not least of which is obtaining solid primary fixation of implants into host bone. Three anatomical zones exist within both femur and tibia which can be used to support revision implants. These consist of the joint surface or epiphysis, the metaphysis and the diaphysis. The methods by which fixation in each zone can be obtained are discussed. The authors suggest that solid fixation should be obtained in at least two of the three zones and emphasise the importance of pre-operative planning and implant selection.
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Affiliation(s)
- R Morgan-Jones
- Cardiff & Vale NHS Trust, University Hospital Llandough, Penlan Road, Llandough, Penarth, Vale of Glamorgan, CF64 2XX, UK
| | - S I S Oussedik
- University College London Hospitals, London, 235 Euston Road, London NW1 2BU, UK
| | - H Graichen
- Hospital for Orthopaedic Surgery Lindenlohe, Lindenlohe 18, 92421 Schwandorf, Germany
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
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Lindberg-Larsen M, Jørgensen CC, Bæk Hansen T, Solgaard S, Odgaard A, Kehlet H. Re-admissions, re-operations and length of stay in hospital after aseptic revision knee replacement in Denmark: a two-year nationwide study. Bone Joint J 2015; 96-B:1649-56. [PMID: 25452368 DOI: 10.1302/0301-620x.96b12.33621] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present detailed information about early morbidity after aseptic revision knee replacement from a nationwide study. All aseptic revision knee replacements undertaken between 1st October 2009 and 30th September 2011 were analysed using the Danish National Patient Registry with additional information from the Danish Knee Arthroplasty Registry. The 1218 revisions involving 1165 patients were subdivided into total revisions, large partial revisions, partial revisions and revisions of unicondylar replacements (UKR revisions). The mean age was 65.0 years (27 to 94) and the median length of hospital stay was four days (interquartile range: 3 to 5), with a 90 days re-admission rate of 9.9%, re-operation rate of 3.5% and mortality rate of 0.2%. The age ranges of 51 to 55 years (p = 0.018), 76 to 80 years (p < 0.001) and ≥ 81 years (p < 0.001) were related to an increased risk of re-admission. The age ranges of 76 to 80 years (p = 0.018) and the large partial revision subgroup (p = 0.073) were related to an increased risk of re-operation. The ages from 76 to 80 years (p < 0.001), age ≥ 81 years (p < 0.001) and surgical time > 120 min (p < 0.001) were related to increased length of hospital stay, whereas the use of a tourniquet (p = 0.008) and surgery in a low volume centre (p = 0.013) were related to shorter length of stay. In conclusion, we found a similar incidence of early post-operative morbidity after aseptic knee revisions as has been reported after primary procedures. This suggests that a length of hospital stay ≤ four days and discharge home at that time is safe following aseptic knee revision surgery in Denmark.
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Affiliation(s)
- M Lindberg-Larsen
- Copenhagen University Hospital Rigshospitalet, Section of Surgical Pathophysiology and The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - C C Jørgensen
- Copenhagen University Hospital Rigshospitalet, Section of Surgical Pathophysiology and The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - T Bæk Hansen
- Holstebro Regional Hospital, Department of Orthopaedic Surgery, Lægårdvej 12, 7500 Holstebro, Denmark
| | - S Solgaard
- Copenhagen University Hospital Gentofte, Department of Orthopaedic Surgery, Niels Andersens Vej 65, 2900 Hellerup, Denmark
| | - A Odgaard
- Copenhagen University Hospital Gentofte, Department of Orthopaedic Surgery, Niels Andersens Vej 65, 2900 Hellerup, Denmark
| | - H Kehlet
- Copenhagen University Hospital Rigshospitalet, Section of Surgical Pathophysiology and The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
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Naranje S, Lendway L, Mehle S, Gioe TJ. Does operative time affect infection rate in primary total knee arthroplasty? Clin Orthop Relat Res 2015; 473:64-9. [PMID: 24740318 PMCID: PMC4390911 DOI: 10.1007/s11999-014-3628-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Prolonged operative time may increase the risk of infection after total knee arthroplasty (TKA). Both surgeon-related and patient-related factors can contribute to increased operative times. QUESTIONS/PURPOSES The purpose of this study was to determine (1) whether increased operative time is an independent risk factor for revision resulting from infection after TKA; (2) whether increasing body mass index (BMI) increased operative time; and (3) whether increasing experience substantially decreased operative time. METHODS We retrospectively evaluated primary TKAs from our joint registry between March 2000 and August 2012. Cox proportional hazard models were used to assess the relationship between operative time and revision resulting from infection after accounting for age, sex, BMI, and Agency for Healthcare Research and Quality comorbidity score. Of 9973 instances of primary TKA, 73 underwent revision surgery for infection (0.73%). RESULTS After accounting for the confounders of age and sex, operative time was not found to have a significant effect; a 15-minute increase in operative time increased the hazard of revision resulting from infection by only 15.6% (p=0.053; 95% confidence interval, 0.0%-34.0%). In addition, a five-unit increase in BMI was found to increase mean operative time by 1.9 minutes, on average, regardless of sex (p<0.0001). Operative time decreases with increasing experience but appears to plateau at approximately 300 surgeries. CONCLUSIONS Operative time is only one of many factors that may increase infection risk and may be influenced by numerous confounders. Increasing BMI increased operative time but the effect was modest. The effect of increasing experience on operative duration of this common procedure was surprisingly limited among our surgeons. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sameer Naranje
- />Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN USA
| | - Lisa Lendway
- />HealthEast Department of Research, St Paul, MN USA
| | - Susan Mehle
- />HealthEast Department of Research, St Paul, MN USA
| | - Terence J. Gioe
- />Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN USA
- />Minneapolis Veterans Administration Health Care System, Section 112E, 1 Veterans Drive, Minneapolis, MN 55417 USA
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Jæger P, Koscielniak-Nielsen ZJ, Schrøder HM, Mathiesen O, Henningsen MH, Lund J, Jenstrup MT, Dahl JB. Adductor canal block for postoperative pain treatment after revision knee arthroplasty: a blinded, randomized, placebo-controlled study. PLoS One 2014; 9:e111951. [PMID: 25386752 PMCID: PMC4227669 DOI: 10.1371/journal.pone.0111951] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/29/2014] [Indexed: 11/28/2022] Open
Abstract
Background Revision knee arthroplasty is assumed to be even more painful than primary knee arthroplasty and predominantly performed in chronic pain patients, which challenges postoperative pain treatment. We hypothesized that the adductor canal block, effective for pain relief after primary total knee arthroplasty, may reduce pain during knee flexion (primary endpoint: at 4 h) compared with placebo after revision total knee arthroplasty. Secondary endpoints were pain at rest, morphine consumption and morphine-related side effects. Methods We included patients scheduled for revision knee arthroplasty in general anesthesia into this blinded, placebo-controlled, randomized trial. Patients were allocated to an adductor canal block via a catheter with either ropivacaine or placebo; bolus of 0.75% ropivacaine/saline, followed by infusion of 0.2% ropivacaine/saline. Clinicaltrials.gov ID: NCT01191593. Results We enrolled 36 patients, of which 30 were analyzed. Mean pain scores during knee flexion at 4 h (primary endpoint) were: 52±22 versus 71±25 mm (mean difference 19, 95% CI: 1 to 37, P = 0.04), ropivacaine and placebo group respectively. When calculated as area under the curve (1–8 h/7 h) pain scores were 55±21 versus 69±21 mm during knee flexion (P = 0.11) and 39±18 versus 45±23 mm at rest (P = 0.43), ropivacaine and placebo group respectively. Groups were similar regarding morphine consumption and morphine-related side effects (P>0.05). Conclusions The only statistically significant difference found between groups was in the primary endpoint: pain during knee flexion at 4 h. However, due to a larger than anticipated dropout rate and heterogeneous study population, the study was underpowered. Trial Registration Clinicaltrials.gov NCT01191593
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Affiliation(s)
- Pia Jæger
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - Zbigniew J. Koscielniak-Nielsen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik M. Schrøder
- Department of Orthopaedic Surgery, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ole Mathiesen
- Section of Acute Pain Management, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria H. Henningsen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jørgen Lund
- Department of Anaesthesia, Aleris-Hamlet Hospitals, Copenhagen, Denmark
| | | | - Jørgen B. Dahl
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Early results of a new rotating hinge knee implant. BIOMED RESEARCH INTERNATIONAL 2014; 2014:948520. [PMID: 25089279 PMCID: PMC4095738 DOI: 10.1155/2014/948520] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/07/2014] [Accepted: 06/10/2014] [Indexed: 12/03/2022]
Abstract
Background. Indication for rotating hinge (RH) total knee arthroplasty (TKA) includes primary and revision cases, with contradictory results. The aim of this study was to report prospective early results of a new modular rotating hinge TKA (EnduRo). For this implant several new design features and a new bearing material (carbon-fiber reinforced poly-ether-ether-ketone) have been developed. Furthermore, we tried to establish a new classification of failure modes for revision TKA. Methods. 152 EnduRo rotating-hinge prostheses were implanted in two centers. In 90 patients a primary implantation has been performed and 62 patients were revision cases. Knee Society Score (KSS), Western Ontario and McMaster Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), and Range of motion (ROM) were assessed before surgery, 3 months postoperatively, 12 months postoperatively, and annually thereafter. We defined 3 types of complications: Type 1, infection; type 2, periprosthetic complications; type 3, implant failures. Results. KSS, WOMAC, OKS, and ROM revealed significant improvements between the preoperative and the follow-up investigations. There were 14 complications (9.2%) leading to revision surgery, predominantly type 2. Conclusion. Our study shows excellent clinical results of the EnduRo TKA. Furthermore, no premature material failure or unusual biological response to the new bearing material could be detected.
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Ali A, Sundberg M, Robertsson O, Dahlberg LE, Thorstensson CA, Redlund-Johnell I, Kristiansson I, Lindstrand A. Dissatisfied patients after total knee arthroplasty: a registry study involving 114 patients with 8-13 years of followup. Acta Orthop 2014; 85:229-33. [PMID: 24786904 PMCID: PMC4062787 DOI: 10.3109/17453674.2014.916487] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE In 2003, an enquiry by the Swedish Knee Arthroplasty Register (SKAR) 2-7 years after total knee arthroplasty (TKA) revealed patients who were dissatisfied with the outcome of their surgery but who had not been revised. 6 years later, we examined the dissatisfied patients in one Swedish county and a matched group of very satisfied patients. PATIENTS AND METHODS 118 TKAs in 114 patients, all of whom had had their surgery between 1996 and 2001, were examined in 2009-2010. 55 patients (with 58 TKAs) had stated in 2003 that they were dissatisfied with their knees and 59 (with 60 TKAs) had stated that they were very satisfied with their knees. The patients were examined clinically and radiographically, and performed functional tests consisting of the 6-minute walk and chair-stand test. All the patients filled out a visual analog scale (VAS, 0-100 mm) regarding knee pain and also the Hospital and Anxiety and Depression scale (HAD). RESULTS Mean VAS score for knee pain differed by 30 mm in favor of the very satisfied group (p < 0.001). 23 of the 55 patients in the dissatisfied group and 6 of 59 patients in the very satisfied group suffered from anxiety and/or depression (p = 0.001). Mean range of motion was 11 degrees better in the very satisfied group (p < 0.001). The groups were similar with regard to clinical examination, physical performance testing, and radiography. INTERPRETATION The patients who reported poor response after TKA continued to be unhappy after 8-13 years, as demonstrated by VAS pain and HAD, despite the absence of a discernible objective reason for revision.
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Affiliation(s)
- Abdulemir Ali
- Department of Orthopedics, Clinical Sciences, and the Swedish Knee Arthroplasty Register, Lund University and Skåne University Hospital
| | - Martin Sundberg
- Department of Orthopedics, Clinical Sciences, and the Swedish Knee Arthroplasty Register, Lund University and Skåne University Hospital
| | - Otto Robertsson
- Department of Orthopedics, Clinical Sciences, and the Swedish Knee Arthroplasty Register, Lund University and Skåne University Hospital
| | - Leif E Dahlberg
- Department of Orthopedics, Clinical Sciences, and the Swedish Knee Arthroplasty Register, Lund University and Skåne University Hospital
| | - Carina A Thorstensson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg,Register Centre Västra Götaland, Gothenburg, Sweden
| | | | | | - Anders Lindstrand
- Department of Orthopedics, Clinical Sciences, and the Swedish Knee Arthroplasty Register, Lund University and Skåne University Hospital
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