1
|
Richardson MK, Ross RC, Kusnezov N, Vega AN, Ludington J, Longjohn DB, Oakes DA, Heckmann ND. Limited Durability of Extensor Mechanism Reconstruction Following Total Knee Arthroplasty: Mesh and Allograft Show Equivalent Outcomes at Five-Year Follow-Up. J Arthroplasty 2024; 39:772-777. [PMID: 37776982 DOI: 10.1016/j.arth.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Extensor mechanism disruption is a challenging complication following total knee arthroplasty. The purpose of this study was to compare outcomes between patients who received mesh versus allograft extensor mechanism reconstruction. METHODS All patients who underwent extensor mechanism reconstruction at a single institution were screened. Demographic and surgical variables were recorded, including technique (ie, synthetic mesh versus allograft reconstruction). Patients were assessed for preoperative and postoperative extensor lag, revision, and duration of follow-up. Analyses, including Kaplan-Meier survivorships, were performed to compare mesh to allograft reconstruction. In total, 50 extensor mechanism reconstructions (30 mesh and 20 allograft) were conducted between January 1st, 2001, and December 31st, 2022. RESULTS There were no differences between the cohorts with respect to revision (26.7 [8 of 30] versus 35.0% [7 of 20], P = .680) or failure defined as above knee amputation or fusion (6.7 [2 of 30] versus 5.0% [1 of 20], P = .808). There were also no differences in time to reoperation (average 27 months [range, 6.7 to 58.8] versus 29 months [range, 1.2 to 84.9], P = .910) or in postoperative extensor lag among patients who did not undergo a reoperation (13 [0 to 50] versus 11° [0 to 30], P = .921). The estimated 5-year Kaplan-Meier survival with extensor mechanism revision as the endpoint was similar between the 2 groups (52.1, 95% confidence interval [CI] = 25.4 to 73.3 versus 55.0%, 95% CI = 23.0 to 78.4%, P = .990). CONCLUSIONS The purpose of this study was to present the findings of a large cohort of patients who required extensor mechanism reconstruction. Regardless of the reconstruction type, the 5-year outcomes of patients requiring extensor mechanism reconstruction are suboptimal.
Collapse
Affiliation(s)
- Mary K Richardson
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Ryan C Ross
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Nicholas Kusnezov
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Andrew N Vega
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - John Ludington
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Donald B Longjohn
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Daniel A Oakes
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| |
Collapse
|
2
|
Coden G, Bartashevskyy M, Berliner Z, Niu R, Freccero D, Bono J, Abdeen A, Smith EL. Modular Knee Arthrodesis as Definitive Treatment for Periprosthetic Infection, Bone Loss, and Failure of the Extensor Mechanism After Total Knee Arthroplasty. Arthroplast Today 2024; 25:101261. [PMID: 38269067 PMCID: PMC10805633 DOI: 10.1016/j.artd.2023.101261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/18/2023] [Accepted: 09/24/2023] [Indexed: 01/26/2024] Open
Abstract
Background Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) can result in bone and soft-tissue loss, leg length discrepancies, and dysfunctional extensor mechanisms. While above-knee amputation (AKA) is an established salvage treatment, modular knee arthrodesis (MKA) is a viable option that provides rigid stability and maintains leg length even in patients with severe bone and soft-tissue loss. We sought to report the outcomes of patients with an MKA as the definitive treatment. Methods We retrospectively reviewed 8 patients implanted with an MKA at 2 institutions between 2016 and 2022. The mean age was 69.63 years, and 50.0% of patients were women. All patients were indicated for conversion to an MKA as the definitive treatment in the setting of treated chronic PJI after TKA, severe bone loss, and failure of the extensor mechanism not amenable to repair. Medical records and radiographs were reviewed. Results No patients required incision and drainage or exchange of their MKA for PJI at mean 2-year follow-up. One patient required 2 revisions for mechanical failure of his implant at 5.0 and 6.4 years postoperatively. Conclusions MKA is a viable permanent alternative to AKA for patients with treated chronic PJI and dysfunctional extensor mechanism after TKA. The procedure restores leg lengths in the setting of severe bone and soft-tissue loss, therefore allowing patients to ambulate independently. Still, surgeons should be aware of the potential for mechanical failure requiring revision.
Collapse
Affiliation(s)
- Gloria Coden
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | | | - Zachary Berliner
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA
| | - Ruijia Niu
- Department of Research, New England Baptist Hospital, Boston, MA, USA
| | - David Freccero
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA
| | - James Bono
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Ayesha Abdeen
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA
| | - Eric L. Smith
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| |
Collapse
|
3
|
Büyükdoğan K, Öztürkmen Y, Goker B, Oral M, Atay T, Özkan K, Çağlar Ö, Ayvaz M. Early results of a novel modular knee arthrodesis implant after uncontrolled periprosthetic knee joint infection. BMC Musculoskelet Disord 2023; 24:889. [PMID: 37968710 PMCID: PMC10648648 DOI: 10.1186/s12891-023-07016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Abstract
AIM The aim of this study is to evaluate the functional outcomes and complications after non-fusion knee arthrodesis with a modular segmental intramedullary implant used for infected total knee arthroplasty revisions. METHODS A retrospective review of the patients who had been surgically treated with a modular intramedullary arthrodesis implant for recurrent infection after revision TKA between January 2016 and February 2020 were included. The indications for arthrodesis were failed infected TKA with massive bone loss, deficient extensor mechanism and poor soft tissue coverage that precluded joint reconstruction with revision TKA implants. Clinical outcomes were assesed with visual analogue scale for pain (pVAS), Oxford knee score (OKS) and 12-item short form survey (SF-12). Full-length radiographs were used to verify limb length discrepancies (LLD). RESULTS Fourteen patients (4 male and 10 female) patients with a mean age of 69.3 (range, 59 to 81) years at time of surgery were available for final follow-up at a mean of 28.8 months (range, 24-35 months). All clinical outcome scores improved at the final follow-up (pVAS, 8.5 to 2.6, p = .01; OKS, 12.6 to 33.8, p = .02; SF-12 physical, 22.9 to 32.1, p = .01 and SF-12 mental, 27.7 to 40.2, p = .01). The mean LLD was 1.0 cm (range, + 15 - 2.3 cm). Re-infection was detected in three patients (21.4%). Two patients were managed with suppressive antibiotic treatment and a third patient required repeat 2-stage revision procedure. In one patient, a periprosthetic femur fracture was observed and treated with plate osteosynthesis. CONCLUSION Uncontrolled infection after total knee arthroplasty can be effectively treated with arthrodesis using a modular intramedullary nail and satisfactory functional results can be obtained. LEVEL OF EVIDENCE Level 4, Retrospective cohort study.
Collapse
Affiliation(s)
- Kadir Büyükdoğan
- Department of Orthopedic Surgery, Güven Hospital, Şimşek Sokak, No: 29, A.Ayrancı, Ankara, Turkey.
| | - Yusuf Öztürkmen
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Barlas Goker
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Melih Oral
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tolga Atay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Korhan Özkan
- Orthopedics and Traumatology Department, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Ömür Çağlar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Ayvaz
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
4
|
Savvidou OD, Kaspiris A, Goumenos S, Trikoupis I, Melissaridou D, Kalogeropoulos A, Serenidis D, Georgoulis JD, Lianou I, Koulouvaris P, Papagelopoulos PJ. Knee Arthrodesis with a Modular Silver-Coated Endoprosthesis for Infected Total Knee Arthroplasty with Extensive Bone Loss: A Retrospective Case-Series Study. J Clin Med 2023; 12:jcm12103600. [PMID: 37240706 DOI: 10.3390/jcm12103600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Knee arthrodesis is a limb salvage intervention for persistent periprosthetic joint infection (PJI) when revision total knee arthroplasty fails. Conventional arthrodesis techniques are associated with the increased rate of complications, especially in patients with extensive bone loss and extensor tendon deficiency. METHODS Eight patients with a modular silver-coated arthrodesis implant after failed exchange arthroplasty for infection, were retrospectively reviewed. All patients had significant bone loss, while 5 displayed extensor tendon deficiency. Survivorship, complications, leg length discrepancy, median Visual Analogue Scale (VAS) and Oxford Knee score (OKS) were evaluated. RESULTS The median follow up was 32 months (range 24-59 months). The survivorship rate of the prosthesis was 86% during the minimum time of follow up of 24 months. In one patient recurrence of the infection was observed and above-knee amputation was performed. The median postoperative leg length discrepancy was 2.07 ± 0.67 cm. Patients were able to ambulate with mild or no pain. The median VAS and OKS was 2.14 ± 0.9 and 34.7 ± 9.3, respectively. CONCLUSIONS The results of our study demonstrated that knee arthrodesis with a silver coated arthrodesis implant, performed for persistent PJI in patients with significant bone loss and extensor tendon deficit, provided a stable construct, allowed eradication of infection and was associated with good functional outcome.
Collapse
Affiliation(s)
- Olga D Savvidou
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Angelos Kaspiris
- Laboratory of Molecular Pharmacology, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Stavros Goumenos
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Ioannis Trikoupis
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Dimitra Melissaridou
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | | | - Dimitris Serenidis
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Jim-Dimitris Georgoulis
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Ioanna Lianou
- Department of Orthopaedics, Rion University Hospital University of Patras, 26504 Patras, Greece
| | - Panagiotis Koulouvaris
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Panayiotis J Papagelopoulos
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| |
Collapse
|
5
|
Kyriakidis T, Pitsilos C, Hernigou J, Verdonk R, Hantes M. Satisfactory outcomes of patellar tendon reconstruction using achilles' tendon allograft with bone block after infected total knee arthroplasty. J Exp Orthop 2023; 10:12. [PMID: 36752929 PMCID: PMC9908794 DOI: 10.1186/s40634-022-00565-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/16/2022] [Indexed: 02/09/2023] Open
Abstract
PURPOSE Extensor mechanism disruption is an uncommon and devastating complication after total knee arthroplasty. It negatively affects patients' quality of life and leads to significant functional limitations and the inability to stand and walk. The purpose of the present study was to evaluate the outcomes of the extensor mechanism reconstruction using Achilles' tendon allograft after infected total knee arthroplasty. It was hypothesized that it is a safe procedure and that patients will present good clinical and functional results. METHODS Ten patients treated for infra-patellar extensor mechanism disruption after infected total knee arthroplasty were prospectively followed for two years. The mean age of patients was 70.8 (range 55-85), with a median BMI of 28.72 ± 2.2 kg/m2. All patients underwent reconstruction using a fresh frozen Achilles tendon allograft. Preoperative and postoperative evaluation included knee-related clinical and functional assessment based on objective and subjective scores, including the knee flexion, the extension lag, the Knee Society Score (KSS) clinical and functional, and the visual analog scale (VAS) for pain at 12 and 24 months. Radiological evaluation was also performed using the Caton-Deschamps index. Reported complications were also recorded. RESULTS Clinical and functional outcomes recorded significant improvements (p < 0.05) at the final follow-up compared with baseline as follows: Knee flexion was improved from 66° ± 4.8 to 99.7° ± 3.9, and the extension lag was decreased from 28.3° ± 4.4 to 9° ± 2.7. The mean KSS clinical and functional were also improved from 22.6 ± 7.9 to 73.4 ± 3.9 and from 10 ± 13.8 to 55 ± 13.8, respectively. The VAS for pain was decreased from 8.1 ± 1.2 to 1.9 ± 1.2. The Caton-Deschamps index demonstrated a tendency to patella Alta. Two treatment failures were recorded, one patellar dislocation and one re-rupture revised to arthrodesis. CONCLUSIONS Extensor mechanism reconstruction using Achilles' tendon allograft after infected total knee arthroplasty is an efficient and safe procedure for infra-patellar disruption. The present study's findings demonstrate that most of the patients (80%) presented significant clinical and functional improvement at two-year follow-up.
Collapse
Affiliation(s)
- Theofylaktos Kyriakidis
- Department of Orthopaedic Surgery and Traumatology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. .,2nd Department of Orthopaedic Surgery and Traumatology, Aristotle University of Thessaloniki, "G. Gennimatas" General Hospital, Ethnikis Aminis 41, 54635, Thessaloniki, Hellas.
| | - Charalampos Pitsilos
- grid.4793.900000001094570052nd Department of Orthopaedic Surgery and Traumatology, Aristotle University of Thessaloniki, “G. Gennimatas” General Hospital, Ethnikis Aminis 41, 54635 Thessaloniki, Hellas
| | - Jacques Hernigou
- grid.490660.dDepartment of Orthopaedics and Traumatology, Centre Hospitalier EpiCURA, Sites Hornu/Baudour, Hainaut, Belgium
| | - René Verdonk
- grid.4989.c0000 0001 2348 0746Department of Orthopaedic Surgery and Traumatology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - Michael Hantes
- grid.410558.d0000 0001 0035 6670Department of Orthopedic Surgery, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| |
Collapse
|
6
|
Mohler SA, Stambough JB, Mears SC, Barnes CL, Stronach BM. A Review of Periprosthetic Tibial Fractures: Diagnosis and Treatment. Orthop Clin North Am 2021; 52:357-368. [PMID: 34538348 DOI: 10.1016/j.ocl.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Periprosthetic fracture occurring during or after total knee arthroplasty is a rare injury. Literature concerning periprosthetic tibial factures is sparse, and there is limited guidance for evidence-based management. This review aims to provide readers with an overview of the epidemiology, risk factors, and classification of these fractures. Management includes nonoperative treatment of nondisplaced fractures, fixation for those with stable implants, and revision for those with loose implants.
Collapse
Affiliation(s)
- Samantha A Mohler
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W Markham St, Mail Slot # 531, Little Rock, AR 72205, USA
| | - Jeffery B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W Markham St, Mail Slot # 531, Little Rock, AR 72205, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W Markham St, Mail Slot # 531, Little Rock, AR 72205, USA
| | - Charles Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W Markham St, Mail Slot # 531, Little Rock, AR 72205, USA
| | - Benjamin M Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W Markham St, Mail Slot # 531, Little Rock, AR 72205, USA.
| |
Collapse
|
7
|
Suda AJ, Brachtendorf X, Tinelli M, Wagokh R, Abou-Nouar G, Bischel OE. Low complication rate and better results for intramedullary nail - arthrodesis for infected knee joints compared to external fixator-a series of one hundred fifty two patients. INTERNATIONAL ORTHOPAEDICS 2021; 45:1735-1744. [PMID: 33893523 DOI: 10.1007/s00264-021-05054-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/19/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE Arthrodesis of the knee joint is still a salvage procedure after recurrent prosthetic joint infections (PJI) of total knee arthroplasties (TKA) with substantial bone loss and seems to be a good solution to avoid amputation. Until now, intramedullary arthrodesis has increasingly been performed; no study has yet been published to compare these techniques after septic removal of TKA in terms of functional assessment and quality of daily life. METHODS In a single-centre retrospective setting, clinical and radiographic evaluation of consecutive patients after knee arthrodesis using intramedullary and external fixation for infected knee joints was performed. All patients were evaluated clinically, with x-ray and questionnaire including analysis regarding any complications at latest follow-up of a minimum 12 months postoperatively. RESULTS We included 152 patients (75 females, 77 males) in this study. The mean age of the patients at surgery was 63.6 years (range 12 to 90 years). The minimum follow-up was 12 months (mean 3.1 years, range 12 to 49 months). Arthrodesis with external fixator (83 patients, 52.2%) showed less blood loss and less peri-operative complications (1.6%) but a high rate of post-operative, pin-track infections (35.5%); loose pins (12.7%); and pin fractures (4.8%), and therefore risk factors for instability and nonunion (30.9%). Revision rate was 22.6% for arthrodesis with external fixator, and the primary union rate was 65.6%. Intramedullary arthrodesis (69 patients, 43.4%) showed a similar re-infection rate to external fixation (16.1% and 15.9%, respectively) but a significantly lower revision rate (5.4%, p < 0.001). Eighty percent of patients with intramedullary arthrodesis showed very good patient-related outcomes regarding pain, function and daily life activities in the questionnaire. CONCLUSION Despite similar results regarding patient satisfaction and everyday competences in questionnaires, intramedullary arthrodesis of the knee is superior to the external fixator, as it results in fewer complications, lower revision rate, and union rates/loosening.
Collapse
Affiliation(s)
- Arnold J Suda
- AUVA Trauma Center Salzburg, Department of Orthopaedics and Trauma Surgery, Academic Teaching Hospital of Paracelsus Medical University, Dr. Franz-Rehrl-Platz 5, 5010, Salzburg, Austria.
| | - Xaver Brachtendorf
- BG Trauma Center Ludwigshafen, Department of Trauma and Orthopaedics, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Marco Tinelli
- Sinsheim Hospital, Department of Orthopaedics and Trauma Surgery, Sinsheim, Germany
| | - Raed Wagokh
- Jordanian Royal Medical Services, Department of Orthopaedics, Amman, Jordan
| | - Ghaith Abou-Nouar
- Jordanian Royal Medical Services, Department of Orthopaedics, Amman, Jordan
| | - Oliver E Bischel
- BG Trauma Center Ludwigshafen, Department of Trauma and Orthopaedics, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| |
Collapse
|