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Lin J, Burge A, Li Q, Geannette C, Miller TT. Ultrasound assessment of synovitis in total knee replacements: concordance with MR imaging and joint aspiration. Skeletal Radiol 2024; 53:863-869. [PMID: 37930380 DOI: 10.1007/s00256-023-04485-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/14/2023] [Accepted: 10/15/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To determine if diagnostic ultrasound can reliably distinguish between synovial patterns of prosthetic joint infection and polymeric wear in total knee replacements. METHODS AND METHODS This retrospective study was approved by our hospital IRB. Using the radiology report database, MR examinations performed within a week of diagnostic ultrasound and/or ultrasound-guided aspiration were identified. This yielded (1) 24 cases with MR and ultrasound comparisons; (2) 44 cases with MR, ultrasound, and aspiration comparisons; and (3) 92 cases with ultrasound and aspiration comparisons. The MR studies were reviewed by a musculoskeletal radiologist. The ultrasound studies were each reviewed by 2 other musculoskeletal radiologists. Each study was graded for synovial pattern indicating infection, polymeric wear, or normal/nonspecific. Agreement between the MR grader and the ultrasound graders as well as ultrasound inter-rater agreement were assessed using k statistics. Sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound were calculated. RESULTS Agreement between ultrasound and MR imaging was fair to moderate: k of 0.27 (95% CI: 0.04, 0.50) and 0.44 (95% CI: 0.23, 0.65) for ultrasound raters 1 and 2, respectively. Inter-rater agreement between ultrasound graders 1 and 2 was moderate, with k of 0.56 (95% CI: 0.42, 0.70). Ultrasound sensitivities for infection were 0.13 and 0.09, while specificities were 0.94 and 0.98. Ultrasound sensitivities for polymeric wear were 0.38 and 0.62 with specificities of 0.90 and 0.76. CONCLUSION Ultrasound does not perform well in distinguishing patterns of synovitis either compared to MRI or a reference standard of aspiration/clinical follow-up.
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Affiliation(s)
- Ji Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Alissa Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Qian Li
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Christian Geannette
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Castille J, Remy S, Vermue H, Victor J. The use of virtual reality to assess the bony landmarks at the knee joint - The role of imaging modality and the assessor's experience. Knee 2024; 46:41-51. [PMID: 38061164 DOI: 10.1016/j.knee.2023.11.004] [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: 03/15/2023] [Revised: 08/22/2023] [Accepted: 11/13/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND At present, extended reality technologies such as virtual reality (VR) have gained popularity in orthopedic surgery. The first aim of this study was to assess the precision of VR and other imaging modalities - computed tomography (CT), magnetic resonance imaging (MRI) - to localize bony landmarks near the knee joint. Secondly, the impact of the educational level of the assessor - medical master students, orthopedic residents, and orthopedic surgeons - on the precision with which landmarks near the knee joint could be localized was analyzed. METHODS We included a total of 77 participants: 62 medical master students, 10 orthopedic residents, and 5 orthopedic surgeons to analyze three cadaver legs. Every participant localized a series of sixteen bony landmarks on six different imaging modalities (CT, MRI, 3D-CT, 3D-MRI, VR-CT, VR-MRI). RESULTS Concerning the imaging modality, the inter- and intra-observer variability were lowest for 3D and VR, higher for MRI (respectively 7.6 mm and 6.9 mm), and highest for CT (respectively 9 mm and 8.7 m).Concerning the educational level of the assessor, inter- and intra-observer variability in VR were lowest for surgeons, (respectively 3.2 mm and 3.6 mm), higher for residents (respectively 5.9 mm and 6.5 mm) and medical students (respectively 5.9 mm and 5.8 mm). CONCLUSIONS VR can be considered a reliable imaging technique. Localization of landmarks tends to be more precise in VR and on 3D than on conventional CT and MRI images. Furthermore, orthopedic surgeons localize landmarks more precisely than orthopedic residents and medical students in VR.
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Affiliation(s)
- Jocelyn Castille
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Stijn Remy
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Hannes Vermue
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Jan Victor
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Walker EA, Fox MG, Blankenbaker DG, French CN, Frick MA, Hanna TN, Jawetz ST, Onks C, Said N, Stensby JD, Beaman FD. ACR Appropriateness Criteria® Imaging After Total Knee Arthroplasty: 2023 Update. J Am Coll Radiol 2023; 20:S433-S454. [PMID: 38040463 DOI: 10.1016/j.jacr.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Total knee arthroplasty is the most commonly performed joint replacement procedure in the United States. This manuscript will discuss the recommended imaging modalities for six clinical variants; 1. follow-up of symptomatic or asymptomatic patients with a total knee arthroplasty. Initial imaging, 2. Suspected infection after total knee arthroplasty. Additional imaging following radiographs, 3. Pain after total knee arthroplasty. Infection excluded. Suspect aseptic loosening or osteolysis or instability. Additional imaging following radiographs, 4. Pain after total knee arthroplasty. Suspect periprosthetic or hardware fracture. Additional imaging following radiographs, 5. Pain after total knee arthroplasty. Measuring component rotation. Additional imaging following radiographs, and 6. Pain after total knee arthroplasty. Suspect periprosthetic soft-tissue abnormality unrelated to infection, including quadriceps or patellar tendinopathy. Additional imaging following radiographs. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | | | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cristy N French
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Tarek N Hanna
- Emory University, Atlanta, Georgia; Committee on Emergency Radiology-GSER
| | | | - Cayce Onks
- Penn State Health, Hershey, Pennsylvania, Primary care physician
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
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Aparisi Gómez MP, Marcheggiani Muccioli GM, Guglielmi G, Zaffagnini S, Bazzocchi A. Particularities on Anatomy and Normal Postsurgical Appearances of the Knee. Radiol Clin North Am 2023; 61:219-247. [PMID: 36739143 DOI: 10.1016/j.rcl.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Detailed knowledge of anatomy helps to understand pathologic processes. This article focuses on the anatomy and functionality of the knee, with emphasis on recently studied concepts and anatomic features that have an association with the development of pathology. The most common anatomic variants posing a challenge for diagnosis and other common findings in asymptomatic patients are reviewed. Good understanding of the different surgical procedures helps in providing as much information as possible to guarantee a positive outcome, improving prognosis. We review what are the commonly expected postsurgical appearances and the most common postsurgical complications.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand; Department of Radiology, IMSKE, Calle Suiza, 11, Valencia 46024, Spain
| | - Giulio Maria Marcheggiani Muccioli
- 2nd Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, Bologna 40125, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, Hospital San Giovanni Rotondo, Italy; Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, Bologna 40125, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy.
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Moretti L, Coviello M, Rosso F, Calafiore G, Monaco E, Berruto M, Solarino G. Current Trends in Knee Arthroplasty: Are Italian Surgeons Doing What Is Expected? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091164. [PMID: 36143840 PMCID: PMC9504315 DOI: 10.3390/medicina58091164] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 01/18/2023]
Abstract
Objectives: The purpose of this study is to evaluate Italian surgeons’ behavior during knee arthroplasty. Materials and Methods: All orthopedic surgeons who specialized in knee replacement surgeries and were members of the Italian Society of Knee, Arthroscopy, Sport, Cartilage and Orthopedic Technologies (SIGASCOT) between January 2019 and August 2019 were asked to complete a survey on the management of knee arthroplasty. Data were collected, analyzed, and presented as frequencies and percentages. Results: One-hundred and seventy-seven surgeons completed the survey and were included in the study. Ninety-five (53.7%) surgeons were under 40 years of age. Eighty-five surgeons (48%) worked in public hospitals and 112 (63.3%) were considered “high volume surgeons”, with more than 100 knee implants per year. Postero-stabilized total knee arthroplasty was the most commonly used, implanted with a fully cemented technique by 162 (91.5%) surgeons. Unicompartmental knee arthroplasty (UKA) was a rarer procedure compared to TKA, with 77% of surgeons performing less than 30% of UKAs. Most common TKA pre-operative radiological planning included complete antero-posterior (AP) weight-bearing lower limb radiographs, lateral view and patellofemoral view (used by 91%, 98.9% and 70.6% of surgeons, respectively). Pre-operative UKA radiological images included Rosenberg or Schuss views, patellofemoral view and magnetic resonance imaging (66.1%, 71.8% and 46.3% of surgeons, respectively). One hundred and thirty-two surgeons (74.6%) included an AP weight-bearing lower limb X-ray one year after surgery in the post-operative radiological follow-up. Furthermore, 119 surgeons (67.2%) did not perform a post-operative patellofemoral view because it was not considered useful for radiological follow-up. There was no uniformity in the timing and features of post-operative follow-up, with 13 different combinations. Conclusions: Italian surgeons perform TKA more commonly than UKA. Pre-operative TKA planning is quite uniform rather than UKA planning. Despite literature evidence, there is no agreement on follow-up. It may be useful to create a uniform checklist, including correct timing and exams needed. This analysis is also part of a society surgical educational project for training doctor.
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Affiliation(s)
- Lorenzo Moretti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neurscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Michele Coviello
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neurscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-3938165088
| | - Federica Rosso
- Ordine Mauriziano, Orthopaedics and Traumatology Department, Largo Turati 62, 10128 Turin, Italy
| | - Giuseppe Calafiore
- Department of Orthopaedic and Trauma Surgery, Città di Parma Clinic, Piazzale Athos Maestri 5, 43123 Parma, Italy
| | - Edoardo Monaco
- Orthopedic Unit, Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome Sapienza, 00189 Rome, Italy
| | - Massimo Berruto
- Chirurgia Articolare del Ginocchio, ASST Ospedale Gaetano Pini CTO, 20122 Milano, Italy
| | - Giuseppe Solarino
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neurscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Khalifa AA, Mullaji AB, Mostafa AM, Farouk OA. A Protocol to Systematic Radiographic Assessment of Primary Total Knee Arthroplasty. Orthop Res Rev 2021; 13:95-106. [PMID: 34305412 PMCID: PMC8294812 DOI: 10.2147/orr.s320372] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/05/2021] [Indexed: 12/14/2022] Open
Abstract
Although total knee arthroplasty (TKA) is considered one of the most successful procedures, however, a subset of patients are unsatisfied with the results, even with the introduction of new technologies and implant designs. Radiological assessment of TKA is still considered the most prevalent imaging modality for evaluating the knee joint pre-and postoperatively. Assessment of various angles and indices which could be measured in different radiographic views of the knee provides valuable information about the alignment of the entire limb and the individual prosthetic components, more so in the light of recent nuanced concepts of technique, alignment, and balance. This review article aims to present a comprehensive yet systematic approach to the most useful radiographic parameters for assessing the knee preoperatively and post-TKA by explaining the tools and techniques used for measuring various angles, indices and ratios in the coronal, sagittal and axial planes for diagnosis, preoperative planning, postoperative assessment, and routine follow-up. The protocol we followed in this review entailed first reporting the possible applications and software which could help in measuring these variables, then we mentioned the required series of knee radiographs. For the desired variables, we divided the assessment according to each plane, and in each, we reported the optimum position of the desired radiographic view followed by determining the axis and lines which will later form the desired angles to be measured; finally, we collected all the measurements in a table with the native knee values and the most accepted values after TKA.
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Affiliation(s)
- Ahmed A Khalifa
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt
| | - Arun B Mullaji
- Orthopaedic Department, Breach Candy Hospital, Mumbai, India
| | - Alaa M Mostafa
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt
| | - Osama A Farouk
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
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Hochman MG, Melenevsky YV, Metter DF, Roberts CC, Bencardino JT, Cassidy RC, Fox MG, Kransdorf MJ, Mintz DN, Shah NA, Small KM, Smith SE, Tynus KM, Weissman BN. ACR Appropriateness Criteria ® Imaging After Total Knee Arthroplasty. J Am Coll Radiol 2018; 14:S421-S448. [PMID: 29101982 DOI: 10.1016/j.jacr.2017.08.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/29/2023]
Abstract
Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in the United States and annual demand for primary TKA is expected to grow by 673% by 2030. The first part provides an overview of imaging modalities (radiographs, CT, MRI, ultrasound, and various nuclear medicine studies) and discusses their usefulness in the imaging evaluation of TKA. The second part focuses on evidence-based imaging and imaging-guided intervention algorithms for the workup of TKA and its complications, including routine follow-up, component wear, periprosthetic infection, aseptic loosening, granulomas/osteolysis, conventional and rotational instability, periprosthetic fracture, patellar complications, and a variety of periprosthetic soft tissue abnormalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Mary G Hochman
- Principal Author, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Yulia V Melenevsky
- Research Author, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Darlene F Metter
- Co-author, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | | | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Kathy M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
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Planckaert C, Larose G, Ranger P, Lacelle M, Fuentes A, Hagemeister N. Total knee arthroplasty with unexplained pain: new insights from kinematics. Arch Orthop Trauma Surg 2018; 138:553-561. [PMID: 29322318 DOI: 10.1007/s00402-018-2873-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Up to 20% of total knee arthroplasty patients remain unsatisfied post-surgery, and a large proportion of them report anterior knee pain. This study aims to verify whether patients who experience anterior knee pain after total knee arthroplasty (TKA) will exhibit kinematic characteristics similar to those associated with patellofemoral syndrome, including in the frontal and transverse planes. MATERIALS AND METHODS Using four different assessment methods [radiological, patient-reported outcome, musculoskeletal assessment with functional performance testing, and a 3D kinematic assessment during gait], the clinical and 3D knee kinematic profiles of three groups were compared: a painful and an asymptomatic TKA group and a healthy control group. All three groups underwent a three-dimensional kinematic knee assessment while walking on a treadmill. Prosthetic component rotation was assessed through a CT scan measurement performed by one experienced radiologist. Flexion/extension, ab/adduction, and tibial internal rotation curves were compared, and significant differences were highlighted through ANCOVA analysis performed on SPSS. RESULTS A total of 62 knees were evaluated, 24 asymptomatic, 21 painful, and 17 control. A dynamic flexion contracture during gait was observed in the painful group, which was associated with a lack of flexibility of the thigh muscles. Moreover, painful TKA cases exhibited a valgus alignment (- 1.5°) during stance, which increases the Q angle and lateralizes the patella. Finally, CT scan evaluation of painful total knee arthroplasty patients revealed that their combined components rotation was in slight internal rotation (- 1.4°, SD 7.0°). CONCLUSIONS Painful TKA patients presented three well-known characteristics that tend to increase patellofemoral forces and that could be the cause of the unexplained pain: a stiff knee gait, a valgus alignment when walking, and combined TKA components slightly internally rotated.
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Affiliation(s)
- Célia Planckaert
- École de technologie supérieure, 1100 Rue Notre-Dame Ouest, Montreal, QC, H3C 1K3, Canada.,Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada
| | - Gabriel Larose
- Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada.,Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Pierre Ranger
- Hôpital Jean-Talon, 1385 Rue Jean-Talon E, Montreal, QC, H2E 1S6, Canada.,Hôpital Sacré-Coeur, Canada, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Marc Lacelle
- Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada
| | - Alexandre Fuentes
- Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada
| | - Nicola Hagemeister
- École de technologie supérieure, 1100 Rue Notre-Dame Ouest, Montreal, QC, H3C 1K3, Canada. .,Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada.
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Atrey A, Hussain N, Gosling O, Giannoudis P, Shepherd A, Young S, Waite J. A 3 year minimum follow up of Endoprosthetic replacement for distal femoral fractures - An alternative treatment option. J Orthop 2017; 14:216-222. [PMID: 28115800 DOI: 10.1016/j.jor.2016.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/25/2016] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Although the use of an endoprosthesis for distal femoral fractures remains a valid treatment option the widespread use is in its infancy. METHODOLOGY In this retrospective case series, we review cases of distal femoral fracture treated with endoprosthetic replacement (EPR). The outcomes we assessed were the time to start mobilising, the time to discharge, morbidity and mortality as well as an Oxford knee score to assess pain and function and also the early survivorship. 6 of the 11 from the cohort had existing Total Knee Replacements (TKRs) in situ. RESULTS There were 11 knees in our cohort with a mean age of 81.5 years (range 52-102 years). The median time to follow up was 3.5 years (range 1.6 to 5.5 years). The median times to theatre was 3 days and to discharge was 16 days. Oxford functional and pain scores were 32/48. DISCUSSION In the appropriate patient and fracture pattern, Endoprosthetic knee replacement is an excellent option in the treatment of distal femoral fractures whether associated with an existing TKR or not. The implant is more costly than traditional open reduction and internal fixation, but the earlier return to full mobility post-operatively may save on hospital/care home stay and free up hospital space and minimise complications.
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Affiliation(s)
- A Atrey
- St Michael's Hospital, Toronto, Canada
| | | | | | | | - A Shepherd
- Warwick Hospital Orthopaedic Research Unit, UK
| | - S Young
- Warwick Hospital Orthopaedic Research Unit, UK
| | - J Waite
- Warwick Hospital Orthopaedic Research Unit, UK
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Radiographic assessment of the postoperative knee. Clin Imaging 2016; 42:68-82. [PMID: 27889679 DOI: 10.1016/j.clinimag.2016.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/04/2016] [Accepted: 11/16/2016] [Indexed: 11/21/2022]
Abstract
Radiologists often encounter postoperative knee radiographs lacking any adjunct clinical data which might hinder accurate image interpretation. Surgical techniques are constantly evolving with new devices being used which make it sometimes challenging for the radiologist to deduce the performed procedure and to look for associated complications. This article reviews commonly performed surgical procedures of the knee, highlights their expected postoperative radiographic appearance and describes the appearance of certain postoperative complications.
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11
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Imaging of knee implants and related complications. Diagn Interv Imaging 2016; 97:809-21. [DOI: 10.1016/j.diii.2016.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/25/2016] [Indexed: 11/23/2022]
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12
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MRI of Polyethylene Tibial Inserts in Total Knee Arthroplasty: Normal and Abnormal Appearances. AJR Am J Roentgenol 2016; 206:1264-71. [PMID: 26999729 DOI: 10.2214/ajr.15.15107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the normal and abnormal MRI appearances of polyethylene tibial inserts. Subjects who underwent MRI before revision total knee arthroplasty were identified. The polyethylene tibial insert's shape was categorized on MRI, and the presence of abnormalities was noted. CONCLUSION The shape of the polyethylene tibial insert varied with the design. Polyethylene tibial insert abnormalities seen on MRI included displacement and fracture. MRI distinguishes various designs of polyethylene tibial inserts and can show associated abnormalities.
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TIBIAL COMPONENT IN REVISION OF TOTAL KNEE ARTHROPLASTY: COMPARISON BETWEEN CEMENTED AND HYBRID FIXATION. Rev Bras Ortop 2015; 46:585-90. [PMID: 27027058 PMCID: PMC4799319 DOI: 10.1016/s2255-4971(15)30416-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 03/21/2011] [Indexed: 01/22/2023] Open
Abstract
Objective: To compare the clinical, radiographic and medium-term follow-up results from two fixation methods for the tibial component in revision procedures on total knee prostheses: cemented (tray and stem) and hybrid (cemented tray and uncemented, nonporous canal-filling stem). Methods: Between August 1999 and November 2005, 30 revision procedures on total knee arthroplasties were performed on 26 patients, who were divided between group I (cemented fixation; 21 knees) and group II (hybrid fixation; nine knees). The mean follow-up was 52 months and no patients were lost from the follow up. Results: No differences in the scores from the WOMAC and Knee Society questionnaires were observed between the two groups. One patient in group I presented radiographic signs of loosening. Two patients (one in each group) complained of pain in the diaphyseal region, compatible with the location of the stem tip. The pedestal radiographic sign was observed in 89% of the knees with uncemented stems and in none of the cemented group. Conclusion: The comparative analysis between the two methods did not show any differences regarding clinical and radiographic parameters, or arthroplasty survival.
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Kumar N, Yadav C, Raj R, Anand S. How to interpret postoperative X-rays after total knee arthroplasty. Orthop Surg 2015; 6:179-86. [PMID: 25179351 DOI: 10.1111/os.12123] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 03/17/2014] [Indexed: 11/30/2022] Open
Abstract
Today, total knee arthroplasty (TKA) is one the most commonly performed surgeries worldwide. The purpose of this article is to review the appearance of normal post-TKA roentgenographs and describe the correct sequence for their interpretation. It is unwise to depend solely on patients' symptoms when diagnosing TKA complications because serial radiographs can foresee failures well before they manifest clinically. Ideal post-TKA radiographs comprise whole lower extremity anteroposterior and lateral views taken under weight bearing conditions along with a skyline view of the patellofemoral joint. Among other things, weight bearing exposes the true alignment, ligamentous laxity and polyethylene wear. On the basis of follow-up of our TKA cases, we have drawn up a protocol for assessing postoperative X-ray films after TKAs. Following the proposed sequence, surgeon can easily decide how to proceed with follow-up and foresee complications. Careful interpretation of postoperative radiographs after TKA is essential to careful monitoring of patients and implant survival.
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Affiliation(s)
- Nishikant Kumar
- All India Institute of Medical Sciences, Orthopaedics, Ansari Nagar Aiims, New Delhi, India
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15
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van IJsseldijk EA, Harman MK, Luetzner J, Valstar ER, Stoel BC, Nelissen RGHH, Kaptein BL. Validation of a model-based measurement of the minimum insert thickness of knee prostheses: a retrieval study. Bone Joint Res 2014; 3:289-96. [PMID: 25278502 PMCID: PMC4220171 DOI: 10.1302/2046-3758.310.2000304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Wear of polyethylene inserts plays an important role in failure of total knee replacement and can be monitored in vivo by measuring the minimum joint space width in anteroposterior radiographs. The objective of this retrospective cross-sectional study was to compare the accuracy and precision of a new model-based method with the conventional method by analysing the difference between the minimum joint space width measurements and the actual thickness of retrieved polyethylene tibial inserts. METHOD Before revision, the minimum joint space width values and their locations on the insert were measured in 15 fully weight-bearing radiographs. These measurements were compared with the actual minimum thickness values and locations of the retrieved tibial inserts after revision. RESULTS The mean error in the model-based minimum joint space width measurement was significantly smaller than the conventional method for medial condyles (0.50 vs 0.94 mm, p < 0.01) and for lateral condyles (0.06 vs 0.34 mm, p = 0.02). The precision (standard deviation of the error) of the methods was similar (0.84 vs 0.79 mm medially and both 0.46 mm laterally). The distance between the true minimum joint space width locations and the locations from the model-based measurements was less than 10 mm in the medial direction in 12 cases and less in the lateral direction in 13 cases. CONCLUSION The model-based minimum joint space width measurement method is more accurate than the conventional measurement with the same precision. Cite this article: Bone Joint Res 2014;3:289-96.
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Affiliation(s)
- E A van IJsseldijk
- Leiden University Medical Center, Department of Orthopaedics, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - M K Harman
- Clemson University, Department of Bioengineering, 301 Rhodes Engineering Research Center, Clemson, 29634, USA
| | - J Luetzner
- University Hospital Carl Gustav Carus, Department of Orthopaedic and Trauma Surgery, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - E R Valstar
- Leiden University Medical Center, Department of Orthopaedics, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - B C Stoel
- Leiden University Medical Center, Department of Radiology, Div. of Image Processing, PO 9600, 2300 RC, Leiden, The Netherlands
| | - R G H H Nelissen
- Leiden University Medical Center, Department of Orthopaedics, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - B L Kaptein
- Leiden University Medical Center, Department of Orthopaedics, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
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16
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van Ijsseldijk EA, Valstar ER, Stoel BC, de Ridder R, Nelissen RGHH, Kaptein BL. Measuring polyethylene wear in total knee arthroplasty by RSA: differences between weight-bearing and non-weight-bearing positioning. J Orthop Res 2014; 32:613-7. [PMID: 24395396 DOI: 10.1002/jor.22579] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 12/06/2013] [Indexed: 02/04/2023]
Abstract
Measuring the minimum-joint-space-width (mJSW) in total knee arthroplasty (TKA) in Roentgen stereophotogrammetric analysis (RSA) provides valuable information on polyethylene wear, a leading cause for TKA failure. Most existing studies use non-weight-bearing (NWB) patient positioning. The latter may compromise mJSW measurements due to knee laxity with subsequent non-contact between the TKA components. We investigated the difference in mJSW between weight-bearing (WB) and NWB images and the association with mediolateral (ML) knee stability. At one-year follow-up, 23 TKAs were included from an ongoing RSA study, and ML stability was evaluated. For each examination, the mJSW and femoral-tibial contact locations were measured. A linear regression model was used to analyze the association between the mJSW difference (NWB-WB) with the ML stability and contact locations. The mean mJSW difference was 0.28 mm medially and 0.20 mm laterally. Four TKAs had medium (5-9°) and 19 TKAs had high (<5°) ML stability. A higher mJSW difference was found for TKAs with medium stability (0.36 mm, P = 0.01). In conclusion, mJSW measurements in existing (NWB) RSA studies are influenced by knee laxity, but may still provide information on wear progression based on TKA with high ML stability. A direct comparison of mJSW measurements from WB and NWB data is not possible.
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Affiliation(s)
- Emiel A van Ijsseldijk
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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17
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Abstract
OBJECTIVE The purposes of this article are to review current concepts of knee replacement, including features of traditional and newer prosthetic designs, materials, and surgical techniques; illustrate normal and abnormal postoperative imaging findings; and to relate the complications to current understanding of how and why these failures occur. CONCLUSION Complications after knee replacement may be asymptomatic. For this reason, assessment with postoperative imaging is important. The foundation of radiologic interpretation of knee replacement is knowledge of the physiologic purpose, orthopedic trends, imaging findings, and complications.
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Abstract
OBJECTIVE This article reviews current concepts of knee replacement. Features of traditional and new prosthetic designs, materials, and surgical techniques are discussed. Normal and abnormal postoperative imaging findings are illustrated. Complications are reviewed and related to the current understanding about how and why these failures occur. CONCLUSION It is well known that after knee replacement, patients with complications may be asymptomatic, and, for this reason, assessment of postoperative imaging is important. The foundation of radiologic interpretation of knee replacement is knowledge of the physiologic purpose, orthopedic trends, imaging findings, and complications.
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19
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Validation of the in vivo volumetric wear measurement for total knee prostheses in model-based RSA. J Biomech 2013; 46:1387-91. [PMID: 23540721 DOI: 10.1016/j.jbiomech.2013.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 02/02/2013] [Accepted: 02/26/2013] [Indexed: 11/20/2022]
Abstract
Implant failure related to polyethylene wear remains an important issue in total knee arthroplasty. Polyethylene wear is usually assessed in vivo by measuring the remaining insert thickness on X-ray images of the knee. To reflect the amount of wear debris more accurately, a 3-dimensional overlap measurement has been suggested, which is based on implant component models which are matched on calibrated stereo X-ray images using model-based roentgen stereophotogrammatic analysis. The goal of this study was to determine the influence of pose estimation, insert thickness deviation and variation in the femoral-tibial contact location on the accuracy and precision of the measurement using simulations and a phantom experiment. We found that the pose estimation was the largest source of variation. The 95% prediction interval varied between 111 and 283 mm(3), which is approximately 100-200% of the detected volumetric wear. Insert thickness variation resulted in prediction intervals of 74-174 mm(3). Variation of the femoral-tibial contact location in the phantom experiment gave a prediction interval of 40 mm(3). Large differences in the detected wear volume were found for different flexion angles. At most 56% of the true wear volume was detected (129 of 230 mm(3), 30° of flexion). In summary, both the accuracy and precision of the volumetric wear measurement were low. The prediction interval of the volumetric wear measurement is at least as large as the measurement outcome itself. This is an important limitation to the applicability of the volumetric wear measurement in clinical practice and further clinical validation is required.
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van IJsseldijk E, Valstar E, Stoel B, Nelissen R, Kaptein B. A model-based approach to measure the minimum joint space width of total knee replacements in standard radiographs. J Biomech 2012; 45:2171-5. [DOI: 10.1016/j.jbiomech.2012.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 04/12/2012] [Accepted: 05/08/2012] [Indexed: 10/28/2022]
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21
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Gnannt R, Chhabra A, Theodoropoulos JS, Hodler J, Andreisek G. MR imaging of the postoperative knee. J Magn Reson Imaging 2012; 34:1007-21. [PMID: 22002752 DOI: 10.1002/jmri.22672] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Advances in orthopedic and arthroscopic surgical procedures of the knee such as, knee replacement, ligamentous reconstruction as well as articular cartilage and meniscus repair techniques have resulted in a significant increase in the number of patients undergoing knee arthroscopy or open surgery. As a consequence postoperative MR imaging examinations increase. Comprehensive knowledge of the normal postoperative MR imaging appearances and abnormal findings in the knee associated with failure or complications of common orthopedic and arthroscopic surgical procedures currently undertaken is crucial. This article reviews the various normal and pathological postoperative MR imaging findings following anterior and posterior cruciate ligament, medial collateral ligament and posterolateral corner reconstruction, meniscus and articular cartilage surgery as well as total knee arthroplasty with emphasis on those surgical procedures which general radiologists will likely be faced in their daily clinical routine.
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Affiliation(s)
- Ralph Gnannt
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
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22
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Peel TN, Buising KL, Choong PFM. Prosthetic joint infection: challenges of diagnosis and treatment. ANZ J Surg 2010; 81:32-9. [DOI: 10.1111/j.1445-2197.2010.05541.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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23
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Ahmed TAE, Hincke MT. Strategies for articular cartilage lesion repair and functional restoration. TISSUE ENGINEERING PART B-REVIEWS 2010; 16:305-29. [PMID: 20025455 DOI: 10.1089/ten.teb.2009.0590] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Injury of articular cartilage due to trauma or pathological conditions is the major cause of disability worldwide, especially in North America. The increasing number of patients suffering from joint-related conditions leads to a concomitant increase in the economic burden. In this review article, we focus on strategies to repair and replace knee joint cartilage, since knee-associated disabilities are more prevalent than any other joint. Because of inadequacies associated with widely used approaches, the orthopedic community has an increasing tendency to develop biological strategies, which include transplantation of autologous (i.e., mosaicplasty) or allogeneic osteochondral grafts, autologous chondrocytes (autologous chondrocyte transplantation), or tissue-engineered cartilage substitutes. Tissue-engineered cartilage constructs represent a highly promising treatment option for knee injury as they mimic the biomechanical environment of the native cartilage and have superior integration capabilities. Currently, a wide range of tissue-engineering-based strategies are established and investigated clinically as an alternative to the routinely used techniques (i.e., knee replacement and autologous chondrocyte transplantation). Tissue-engineering-based strategies include implantation of autologous chondrocytes in combination with collagen I, collagen I/III (matrix-induced autologous chondrocyte implantation), HYAFF 11 (Hyalograft C), and fibrin glue (Tissucol) or implantation of minced cartilage in combination with copolymers of polyglycolic acid along with polycaprolactone (cartilage autograft implantation system), and fibrin glue (DeNovo NT graft). Tissue-engineered cartilage replacements show better clinical outcomes in the short term, and with advances that have been made in orthopedics they can be introduced arthroscopically in a minimally invasive fashion. Thus, the future is bright for this innovative approach to restore function.
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Affiliation(s)
- Tamer A E Ahmed
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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24
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Molina E, Defasque A, Barron MP, Cyteval C. [Imaging of knee prostheses]. JOURNAL DE RADIOLOGIE 2009; 90:561-575. [PMID: 19503044 DOI: 10.1016/s0221-0363(09)74022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The authors present a pictorial essay illustrating the different types of knee prostheses, their normal appearances, as well as the imaging features (radiographs, CT, US) of the main complications that may occur.
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Affiliation(s)
- E Molina
- Service de Radiologie, Hôpital Lapeyronie, CHRU Montpellier, 371, avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5.
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Ohashi K, El-Khoury GY. Musculoskeletal CT: Recent Advances and Current Clinical Applications. Radiol Clin North Am 2009; 47:387-409. [DOI: 10.1016/j.rcl.2008.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Soininvaara T, Nikola T, Vanninen E, Miettinen H, Kröger H. Bone mineral density and single photon emission computed tomography changes after total knee arthroplasty: a 2-year follow-up study. Clin Physiol Funct Imaging 2008; 28:101-6. [DOI: 10.1111/j.1475-097x.2007.00782.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Ghanem E, Parvizi J, Clohisy J, Burnett S, Sharkey PF, Barrack R. Perioperative antibiotics should not be withheld in proven cases of periprosthetic infection. Clin Orthop Relat Res 2007; 461:44-7. [PMID: 17452914 DOI: 10.1097/blo.0b013e318065b780] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Intraoperative tissue or fluid culture remains the gold standard in diagnosing periprosthetic infection. However, an organism is not always isolated from intraoperative cultures. We asked whether preoperative antibiotics interfered with the isolation of organisms from intraoperative tissue samples. We hypothesized organisms isolated from preoperative joint aspirate correspond to those cultures from intraoperative specimens. We retrospectively reviewed 171 patients undergoing TKA, diagnosed with periprosthetic infections from 2000 to 2005, who had a positive preoperative aspiration culture. The details of any antibiotics given to the patients preoperatively were documented. Seventy-two of 171 patients received preoperative antibiotics before surgery. Intraoperative culture was negative in nine of the 72 patients who received antibiotics: a false-negative rate of 12.5%. An organism could not be isolated from intraoperative samples in eight of the 99 patients who did not receive preoperative antibiotics: a false-negative rate of 8%. We observed no difference in the incidence of false-negative cultures between the two groups. The organisms isolated from the aspirate culture were identical to their intraoperative counterparts in 97% of the cases. Administration of preoperative antibiotics to patients with a positive preoperative joint aspirate did not interfere with the isolation of the infecting organism from intraoperative culture samples more than when antibiotics were withheld.
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Affiliation(s)
- Elie Ghanem
- Rothman Institute of Orthopedics, Philadelphia, PA 19107, USA
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28
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Abstract
The knee is a frequently injured joint and, thus, a common focus of operative intervention. As operative techniques and imaging modalities evolve, radiologists must be aware of the expected postoperative appearance after knee surgeries that are performed commonly and also must be comfortable recognizing complications encountered commonly in the immediate and delayed postoperative period. Drawing on the large amount of attention this subject has received of late in the radiologic and orthopedic literature, this article reviews the knee surgeries performed most commonly and the expected normal and most frequently encountered abnormal postoperative imaging findings with an emphasis on MR imaging.
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Affiliation(s)
- Matthew A Frick
- Department of Radiology, Division of Musculoskeletal Radiology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
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