1
|
Golrokh Moghadam SA, Tajerian A, Mahmoudieh B, Parsi Khamene M, Kamali A. Comparing Apotel and Remifentanil for Multimodal Patient-Controlled Analgesia in Postoperative Pain Management Following Total Knee Arthroplasty Surgery: A Randomized Controlled Trial. Anesth Pain Med 2024; 14:e141975. [PMID: 38741899 PMCID: PMC11088846 DOI: 10.5812/aapm-141975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 05/16/2024] Open
Abstract
Background Total knee arthroplasty (TKA) is a standard surgical procedure for individuals with debilitating knee arthritis. Effective postoperative pain management is essential for successful recovery, although traditional opioid-based methods have limitations. Objectives This study aimed to compare the efficacy of Apotel and remifentanil patient-controlled analgesia in managing postoperative pain after TKA. Methods This double-blind, randomized, controlled clinical trial took place at Amir-al-Momenin and Qods Hospitals in Arak, Iran, spanning from June 2022 to September 2023. Sixty-two eligible patients scheduled for knee joint replacement were randomly assigned to receive either Apotel (Group A) or remifentanil (Group R) as part of multimodal analgesia administered via a pain pump for postoperative pain relief in TKA. The study assessed hemodynamic parameters, pain levels (measured using the Visual Analog Scale), analgesic duration, and narcotic consumption. Statistical analyses were performed using SPSS v.27 and Plotly. Results Subjects exhibited no statistically significant differences in age, gender distribution, duration of surgery, or anesthesia. The hemodynamic status assessment in the recovery room showed no significant differences in SPO2, PR, or MAP between the groups. However, remifentanil demonstrated superior effectiveness in reducing pain over 24 hours post TKA surgery compared to Apotel, as evidenced by lower average Visual Analog Scale (VAS) scores (P < 0.001), longer duration without the need for narcotic painkillers (P < 0.001), and lower cumulative opioid analgesic consumption in Group R (P < 0.001). Conclusions Remifentanil demonstrates superior pain control in a multimodal pain management approach compared to Apotel, providing sustained pain reduction over 24 hours post-surgery. Moreover, remifentanil offers longer-lasting pain relief and results in lower cumulative narcotic painkiller consumption compared to Apotel.
Collapse
Affiliation(s)
| | - Amin Tajerian
- School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Behnam Mahmoudieh
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Mohsen Parsi Khamene
- Department of Orthopedic Surgery, Arak University of Medical Sciences, Arak, Iran
| | - Alireza Kamali
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| |
Collapse
|
2
|
Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation. J Clin Med 2021; 10:jcm10214926. [PMID: 34768444 PMCID: PMC8584452 DOI: 10.3390/jcm10214926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to evaluate the bone union, complication rate, clinical and functional outcomes of long-stemmed total knee arthroplasty (TKA) in patients with periprosthetic femoral or tibial shaft fractures and in patients with femoral or tibial shaft fractures with coexisting advanced knee osteoarthritis (OA). This retrospective study comprised 25 patients who underwent surgery due to tibial or femoral shaft fractures: (1) with coexisting severe knee OA or (2) with a periprosthetic fracture requiring implant exchange. In all cases, fracture stabilization was performed intramedullary with the use of long-stemmed implants without the use of additional fixation material (plates, screws, or cerclage). Bone union was achieved in 22/25 patients (88%). One patient required revision with additional plate stabilization due to non-union, and asymptomatic partial bone union was observed in two cases. The group with periprosthetic fractures demonstrated good clinical (mean 73.1 ± 13.3) and moderate functional (mean 59.2 ± 18.8) outcomes in the Knee Society Scoring system (KSS). In the group with shaft fracture and coexisting OA significantly higher clinical (excellent results, mean 84.1 ± 11; p = 0.03) and functional (good results, mean 76.2 ± 20.6; p = 0.04) results were noted. There were no statistically significant differences in terms of range of motion (ROM) or complication rate between these two groups. One-stage TKA with a long-stemmed implant without the use of additional fixation material is an effective method for the treatment of femoral or tibial shaft fractures in patients who require joint replacement. Despite being technically demanding, the approach yields bone union and moderate to excellent clinical and functional outcomes with a relatively low complication rate.
Collapse
|
3
|
Abstract
BACKGROUND Knee fractures may lead to post-traumatic knee osteoarthritis and subsequent TKA in some patients. However, absolute risk estimates and risk factors for TKA in patients with knee fractures compared with those of the general population remain largely unknown. Such knowledge would help establish the treatment burden and direct patient counseling after a knee fracture is sustained. QUESTIONS/PURPOSES (1) What is the short-term risk of TKA after knee fracture? (2) What is the long-term risk of TKA after knee fracture? (3) What are the risk factors for TKA in patients with knee fractures? METHODS A nationwide 20-year, matched-case comparison cohort study of prospectively collected data from the Danish National Patient Registry included all patients at least 15 years old with International Classification of Diseases, 10th revision codes DS724, DS820, or DS821 (knee fractures) on the date their knee fracture was registered. Each patient with a knee fracture was matched (by sex and age) to five people without knee fractures from the general Danish population on the date the knee fracture patient's knee fracture was registered (population controls). Patients with knee fractures and people in the population control group were followed from the date the knee fracture patient's knee fracture was registered to the date of TKA, amputation, knee fusion, emigration, death, or end of follow-up in April 2018. TKA risks for patients with knee fractures versus those for population controls and TKA risk factors in patients with knee fractures were estimated using hazard ratios (HRs) with 95% CIs. A total of 48,791 patients with knee fractures (median age 58 years [interquartile range 41-73]; 58% were female) were matched to 263,593 people in the population control group. RESULTS The HR for TKA in patients with knee fractures compared with population controls was 3.74 (95% CI 3.44 to 4.07; p < 0.01) in the first 3 years after knee fracture. Among knee fracture patients, the risk of undergoing TKA was 2% (967 of 48,791) compared with 0.5% (1280 of 263,593) of people in the population control group. After the first 3 years, the HR was 1.59 (95% CI 1.46 to 1.71) and the number of patients with knee fractures with TKA events divided by the number at risk was 2% (849 of 36,272), compared with 1% (2395 of 180,418) of population controls. During the 20-year study period, 4% of patients with knee fractures underwent TKA compared with 1% of population controls. Risk factors for TKA in patients with knee fractures were: primary knee osteoarthritis (OA) versus no primary knee OA (HR 9.57 [95% CI 5.39 to 16.98]), surgical treatment with external fixation versus open reduction and internal fixation and reduction only (HR 1.92 [95 % CI 1.01 to 3.66]), proximal tibia fracture versus patellar fracture (HR 1.75 [95 % CI 1.30 to 2.36]), and distal femur fracture versus patellar fracture (HR 1.68 [95 % CI 1.08 to 2.64]). Surgical treatment of knee fractures was also a risk factor for TKA. The HRs for TKA in patients with knee fractures who were surgically treated versus those who were treated non-surgically were 2.05 (95% CI 1.83 to 2.30) in the first 5 years after knee fracture and 1.19 (95% CI 1.01 to 1.41) after 5 years. CONCLUSIONS Patients with knee fractures have a 3.7 times greater risk of TKA in the first 3 years after knee fracture, and the risk remains 1.6 times greater after 3 years and throughout their lifetimes. Primary knee OA, surgical treatment of knee fractures, external fixation, proximal tibia fractures, and distal femur fractures are TKA risk factors. These risk estimates and risk factors highlight the treatment burden of knee fractures, building a foundation for future studies to further counsel patients on their risk of undergoing TKA based on patient-, fracture-, and treatment-specific factors. LEVEL OF EVIDENCE Level III, prognostic study.
Collapse
|
4
|
Wang XF, Ma ZH, Teng XR. Isokinetic Strength Test of Muscle Strength and Motor Function in Total Knee Arthroplasty. Orthop Surg 2020; 12:878-889. [PMID: 32436619 PMCID: PMC7307260 DOI: 10.1111/os.12699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/20/2020] [Accepted: 04/20/2020] [Indexed: 01/17/2023] Open
Abstract
Objective To use isokinetic strength testing system to test and analyze the relationship between changes in muscle strength before and after knee replacement in patients undergoing total knee arthroplasty (TKA). Methods A total of 200 patients with advanced knee osteoarthritis treated from June 2018 to June 2019 were selected for TKA. The patient's isokinetic muscle strength test was performed in the first, third, and the sixth month before and after the operation. The knee hamstring peak torque (PT value), quadriceps peak torque (PT value), and total work were mainly measured. The knee joint was evaluated at the hospital for special surgery score, range of motion and other knee function standards, and then healthy limbs and normal people were tested with the same method. Statistical data was used to analyze and deal with the data, evaluate the muscle strength and motor function changes with time progressing, then compare the differences to the healthy limb. From P < 0.05, we can see that the differences have some statistical significance. The influences that TKA has on motor function changes of lower limbs were also observed. Results Among the 200 subjects, 162 completed all follow‐up tests, and the remaining 38 were lost to follow‐up for various reasons. The rate of loss of follow‐up was approximately 19%. The isokinetic muscle strength test system and the knee joint function scoring standard were used to record the knee joint muscle strength and function changes before and after knee joint replacement. Statistical analysis was performed to show the knee joint hamstring muscle force and quadriceps muscle strength and joint mobility in the first month after the surgery. The knee joint muscle strength and joint mobility were significantly improved after the third month after the surgery, but there were still some differences compared with normal people. The knee function index was significantly improved in the sixth month after operation (P < 0.05), and there were no significant differences compared with normal people. Conclusions Knee joint strength and knee function after TKA are significantly improved compared with preoperative function, which is of great significance for the treatment of knee osteoarthritis. The constant velocity muscle strength test system has the advantages of safety, accuracy, repeatability and easy operation. It is a good method to evaluate the knee joint's muscle strength and function after the knee joint replacement.
Collapse
Affiliation(s)
| | - Zhen-Hua Ma
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Xue-Ren Teng
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, China
| |
Collapse
|
5
|
Grzelecki D, Szneider J, Marczak D, Kowalczewski J. Total knee arthroplasty with simultaneous tibial shaft osteotomy in patient with multiple hereditary osteochondromas and multiaxial limb deformity - a case report. BMC Musculoskelet Disord 2020; 21:233. [PMID: 32284061 PMCID: PMC7155326 DOI: 10.1186/s12891-020-03245-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hereditary multiple osteochondromas (hereditary multiple exostoses, HME) is a rare genetic disease characterized by the development of benign osteocartilaginous tumors that may cause severe limb deformities and early onset osteoarthritis. Total knee arthroplasty (TKA) is the method of choice for the treatment of advanced gonarthrosis, however the surgical management with coexisting severe axial limb deformity remains unclear. CASE PRESENTATION 65-year-old man with HME and extra-articular multi-axial limb deformity was admitted to the orthopedic department due to chronic knee pain and limited range of motion caused by secondary osteoarthritis. Regarding to the clinical and radiological examinations, after preoperative planning he was qualified to a one-stage TKA combined with tibial shaft osteotomy (TSO). In a one year follow-up full bone union was confirmed with no signs of implant loosening or prosthesis displacement. Patient was very satisfied, did not report any joint pain and has sufficient range of motion without knee instability. CONCLUSION The improvement of mechanical axis during TKA is a crucial factor for achieve operative success and long implant survival. Despite the higher risk of complication rate in comparison to two-stage treatment, one-stage TKA with simultaneous TSO should be a considerable method for patients with osteoarthritis and multiaxial limb deformities. This method can give a good clinical and functional outcomes, however should be performed subsequently to careful preoperative planning and proper patient qualification.
Collapse
Affiliation(s)
- Dariusz Grzelecki
- Department of Orthopaedics and Rheumoortopaedics, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400 Otwock, Poland
| | - Jan Szneider
- Department of Traumatology and Orthopaedic Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400 Otwock, Poland
| | - Dariusz Marczak
- Department of Orthopaedics and Rheumoortopaedics, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400 Otwock, Poland
| | - Jacek Kowalczewski
- Department of Orthopaedics and Rheumoortopaedics, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400 Otwock, Poland
| |
Collapse
|
6
|
Patel KH, Reddy AVG, Eachempati K, Muralidhar S, Jungele A. A Patient with Osteoarthritis Knee and Prior Patella Fracture: Single Stage Fixation and Total Knee Arthroplasty: A Case Report. J Orthop Case Rep 2018; 8:67-70. [PMID: 29854698 PMCID: PMC5974682 DOI: 10.13107/jocr.2250-0685.1004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Osteoarthritis knee associated with periarticular fractures (femur, tibia, or patella) in geriatric patients is a treatment challenge for orthopedic surgeon. In geriatric patient, early mobilization is key for a better outcome and to prevent immobilization related complications. Hence, this case report is important for all orthopedic surgeons. Case Report: We had a 65-year-old male patient who came for the treatment ofhis patella fracture and deformity ofboth knees. Conclusion: Elderly patients who sustained a patella fracture can be treated with single stage primary total knee replacement and fixation of patella fracture. There is no need for two stage surgery. Rehabilitation and pain relief along with mobilization is better with single stage surgery.
Collapse
Affiliation(s)
- Krunal H Patel
- Department of Orthopedics, Sunshine Hospitals Sunshine Hospitals, Secunderabad, Telangana, India
| | - A V Guarava Reddy
- Department of Orthopedics, Sunshine Hospitals Sunshine Hospitals, Secunderabad, Telangana, India
| | | | - S Muralidhar
- Department of Orthopedics, Sunshine Hospitals Sunshine Hospitals, Secunderabad, Telangana, India
| | - Ajit Jungele
- Department of Orthopedics, Sunshine Hospitals Sunshine Hospitals, Secunderabad, Telangana, India
| |
Collapse
|
7
|
Abstract
The surgical management of tibial plateau fractures can be technically demanding. In younger patients, the mainstay is fixation with cartilage preservation. In older patients with osteoporotic bone, this method has higher rates of fixation failure; in addition, it requires prolonged bed rest or protected weight bearing, which are major challenges in this group. In contrast, total knee arthroplasty performed acutely for primary treatment of tibial plateau fractures has potential advantages for elderly patients, such as immediate stability, early mobilization, and positive functional outcomes with decreased rates of reoperation. Additionally, arthroplasty can be technically challenging in younger patients with previous tibial plateau fractures in whom debilitating posttraumatic arthritis develops. In these patients, old wounds, retained metalwork, bony deficiency, and instability can lead to poorer outcomes and higher complication rates than in routine knee arthroplasty. In both cases, we recommend surgery be performed by experienced arthroplasty surgeons with ample access to a range of implants with varying constraints and the option of stems and augments.
Collapse
|
8
|
Aurich M, Koenig V, Hofmann G. Comminuted intraarticular fractures of the tibial plateau lead to posttraumatic osteoarthritis of the knee: Current treatment review. Asian J Surg 2018; 41:99-105. [DOI: 10.1016/j.asjsur.2016.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/18/2016] [Accepted: 11/24/2016] [Indexed: 11/30/2022] Open
|
9
|
Khanna V, Sambandam SN, Ashraf M, Mounasamy V. Extra-articular deformities in arthritic knees-a grueling challenge for arthroplasty surgeons: An evidence-based update. Orthop Rev (Pavia) 2018; 9:7374. [PMID: 29564077 PMCID: PMC5850062 DOI: 10.4081/or.2017.7374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/09/2017] [Accepted: 12/10/2017] [Indexed: 12/21/2022] Open
Abstract
Critical to the success of a total knee arthroplasty (TKA) is the anatomical alignment. This may appear as a challenge in an extra-articular deformity (EAD) that may be inherent in certain people or result from fracture malunion, congenital disorders, nutritional, metabolic and infective causes. This appraisal aimed at providing the reader with an up-todate overview of the research carried out on, and existent evidence of EAD correction while planning a TKA. We reviewed the current English literature on TKA in extra-articular knee deformities. Among the published data, a common initial approach of mandatory clinical and radiological assessment emerges as an obligatory step while handling cases with EAD. While several methods of managing the deformity and arthritis have been described, a broad division into intra-articular and extra-articular means can be deciphered. The relatively old-school, yet reliable thought process of extra-articular correction allows an all-inclusive restoration of alignment with the inherent complications related to the necessary osteotomy. A cohort of younger and more venturesome surgeons seem inclined towards performing navigated, intra-articular correction for mild to moderate and sometimes, severe deformities. The crux of the matter lies is obtaining a well-balanced knee without violating the all-important cruciates. Restoring the patient’s ambulatory status seems sooner with the intra-articular methods which are also more precise in determining the axes and while removing minimum bone. Greatest satisfaction is accomplished in those with less grotesque, rotationallyaligned knees while meticulously balancing soft-tissues and encouraging earlier weightbearing.
Collapse
Affiliation(s)
| | | | - Munis Ashraf
- K.G. Hospital and Post Graduate Medical Institute, Arts College Road, Coimbatore, Tamil Nadu, India
| | | |
Collapse
|
10
|
Erdogan F, Sarikaya IA, Can A, Gorgun B. Management of knee rheumatoid arthritis and tibia nonunion with one-stage total knee arthroplasty and intramedullary nailing: A report of two cases. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:65-69. [PMID: 28583752 PMCID: PMC6136314 DOI: 10.1016/j.aott.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 06/09/2016] [Accepted: 06/28/2016] [Indexed: 11/24/2022]
Abstract
Total knee arthroplasty (TKA) is a surgical procedure which is widely used in the treatment of gonarthrosis secondary to rheumatoid arthritis (RA). The incidence of stress fractures in tibia in the patients with RA is higher compared to normal patients. In this study, we report two cases of TKA and intramedullary nailing in RA patients with severe knee arthritis and tibial nonunion. Both patients had a satisfactory clinical outcome with radiological healing of the tibial fracture.
Collapse
|
11
|
Xu Z, Wang W, Zhuang Z, Zhang Y. [Effectiveness of total knee arthroplasty using three-dimensional printing technology for knee osteoarthritis accompanied with extra-articular deformity]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:913-917. [PMID: 29806424 PMCID: PMC8458590 DOI: 10.7507/1002-1892.201701075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 07/03/2017] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness of total knee arthroplasty (TKA) using three-dimensional (3D) printing technology for knee osteoarthritis (KOA) accompanied with extra-articular deformity. Methods Between March 2013 and December 2015, 15 patients (18 knees) with extra-articular deformity and KOA underwent TKA. There were 6 males (6 knees) and 9 females (12 knees), aged 55-70 years (mean, 60.2 years). The mean disease duration was 10.8 years (range, 7-15 years). The unilateral knee was involved in 12 cases and bilateral knees in 3 cases. The clinical score was 57.44±1.06 and the functional score was 60.88±1.26 of Knee Society Score (KSS). The range of motion of the knee joint was (72.22±0.18)°. The deviation of mechanical axis of lower limb was (18.89±0.92)° preoperatively. There were 8 cases (10 knees) with extra-articular femoral deformity, 5 cases (5 knees) with extra-articular tibial deformity, and 2 cases (3 knees) with extra-articular femoral and tibial deformities. Bone models and the navigation templates were printed and the operation plans were designed using 3D printing technology. The right knee joint prostheses were chosen. Results The operation time was 65-100 minutes (mean, 75.6 minutes). The bleeding volume was 50-150 mL (mean, 90.2 mL). There was no poor incision healing, infection, or deep venous thrombosis after operation. All patients were followed up 12- 30 months (mean, 22 months). Prostheses were located in the right place, and no sign of loosening or subsidence was observed by X-ray examination. At last follow-up, the deviation of mechanical axis of lower limb was (2.00±0.29)°, showing significant difference when compared with preoperative one ( t=13.120, P=0.007). The KSS clinical score was 87.50±0.88 and function score was 81.94±1.41, showing significant differences when compared with preoperative ones ( t=27.553, P=0.000; t=35.551, P=0.000). The range of motion of knee was (101.94±1.42)°, showing significant difference when compared with preoperative one ( t=31.633, P=0.000). Conclusion For KOA accompanied with extra-articular deformity, TKA using 3D printing technology has advantages such as individualized treatment, reducing the difficulty of operation, and achieving the satisfactory function.
Collapse
Affiliation(s)
- Zhiqing Xu
- Department of Joint Surgery, Quanzhou Orthopedic-Traumatological Hospital of Fujian Traditional Chinese Medicine University, Quanzhou Fujian, 362000, P.R.China
| | - Wulian Wang
- Department of Joint Surgery, the Second Hospital of Fuzhou, Teaching Hospital of Xiamen University, Fuzhou Fujian, 350001, P.R.China
| | - Zhikun Zhuang
- Department of Joint Surgery, Quanzhou Orthopedic-Traumatological Hospital of Fujian Traditional Chinese Medicine University, Quanzhou Fujian, 362000, P.R.China
| | - Yiyuan Zhang
- Department of Joint Surgery, the Second Hospital of Fuzhou, Teaching Hospital of Xiamen University, Fuzhou Fujian, 350001,
| |
Collapse
|
12
|
Marczak D, Kowalczewski J, Czubak J, Okoń T, Synder M, Sibiński M. Short and mid term results of revision total knee arthroplasty with Global Modular Replacement System. Indian J Orthop 2017; 51:324-329. [PMID: 28566786 PMCID: PMC5439320 DOI: 10.4103/0019-5413.205684] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The original knee megaprostheses with fixed or rotating hinge articulation were custom made and only used for reconstruction of the knee following distal femoral or proximal tibial tumor resections. The aim of the study was to analyze the short- and mid-term results of revision total knee arthroplasty with Global Modular Replacement System (GMRS) used in difficult situations not amenable to reconstruction with standard total knee replacement implants. MATERIALS AND METHODS Nine patients (9 knees) were treated with this comprehensive modular implant system, with a mean age of 73.7 years (range 56-83 years) and a mean followup of 5 years (range 3-8 years). Two patients were treated for distal femoral nonunion, five for distal femur periprosthetic fracture and two for periprosthetic joint infection. RESULTS The mean Knee Society Score: Knee and functional scores were 77.9 and 40 points, respectively. All demonstrated full extension and flexion was at least 90°. Recurrence of infection was present in one patient. No signs of loosening, dislocation, or implant failure were observed. CONCLUSIONS Based on our small series of patients that represent severe cases, GMRS provides relatively good mid-term functional results, pain relief, and good implant survivorship with a low complication rate. This salvage procedure allows elderly, infirm patients to regain early ambulatory ability.
Collapse
Affiliation(s)
- Dariusz Marczak
- Department of Orthopaedics, Postgraduate Medical Education Center, Otwock, Poland
| | - Jacek Kowalczewski
- Department of Orthopaedics, Postgraduate Medical Education Center, Otwock, Poland
| | - Jarosław Czubak
- Department of Orthopaedics, Postgraduate Medical Education Center, Otwock, Poland
| | - Tomasz Okoń
- Department of Orthopaedics, Postgraduate Medical Education Center, Otwock, Poland
| | - Marek Synder
- Department of Orthopaedics, Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland
| | - Marcin Sibiński
- Department of Orthopaedics, Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland,Address for correspondence: Dr. Marcin Sibiński, Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland. E-mail:
| |
Collapse
|
13
|
Hazratwala K, Matthews B, Wilkinson M, Barroso-Rosa S. Total knee arthroplasty in patients with extra-articular deformity. Arthroplast Today 2016; 2:26-36. [PMID: 28326394 PMCID: PMC4957157 DOI: 10.1016/j.artd.2015.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 12/03/2022] Open
Abstract
Multiple acceptable options are available for the correction of distal femoral deformity associated with knee arthritis. The treatment modality should be chosen based on the extent of deformity and attention to preservation of the collateral ligaments. Surgical options range from osteotomy alone, arthroplasty with intra-articular correction, or arthroplasty with extra-articular correction. Different implant choices and fixation methods for the osteotomy possess advantages and disadvantages which need to be considered carefully. In addition to discussing principles of management based on current literature, this article includes a case report using a previously undescribed technique using corrective osteotomy, intramedullary nail fixation, and total knee arthroplasty with computer navigation.
Collapse
Affiliation(s)
| | - Brent Matthews
- Corresponding author. 7 Turner Street, Townsville, Queensland 4812, Australia. Tel.: +61747550564.7 Turner StreetTownsvilleQueensland4812Australia
| | | | | |
Collapse
|