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Singh J, Rassir R, Sierevelt IN, van Geene OFF, Rademakers MV, Spekenbrink-Spooren A, Nolte PA. Total Knee Arthroplasty in the Post-Traumatic Knee: Revision Risks and Functional Outcomes Compared to Osteoarthritic Knees. A Report of Primary Procedures From the Dutch Arthroplasty Register. J Arthroplasty 2024; 39:363-367. [PMID: 37598781 DOI: 10.1016/j.arth.2023.08.050] [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: 01/20/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) for post-traumatic arthritis (PTA) poses higher challenges and increased risks of complications compared to TKA for osteoarthritis (OA). This study aimed to compare implant survivorships, reasons for revision, and patient-reported outcome measures between OA and PTA as indications for TKA. METHODS We selected all primary TKAs for PTA or OA between 2007 and 2020 from the Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies). The study included 3,897 TKA procedures for PTA (median follow-up 4.6 years; interquartile range: 2.2, 7.3) and 255,259 procedures for OA (median follow-up 4.7 years; interquartile range 2.2, 7.6). A total of 10,480 revision procedures were performed across both groups (238 in PTA knees; 10,242 in OA knees). We analyzed the prevalence of preoperative comorbidities and postoperative complications, as well as the reasons for revision, and calculated the implant survival rates. RESULTS The survival revision rate in the OA group was significantly lower at both follow-up moments (5- and 10- years). The likelihood for revision was increased in TKA for PTA compared to TKA for OA (hazards ratio: 1.16 [95% confidence interval 1.02 to 1.33], P = .03). The most common reason for a revision was instability and arthrofibrosis in the PTA group compared to patellar pain for the OA group. CONCLUSION This study demonstrated an increased risk for revision for any reason in TKA for PTA compared to OA. Revision for instability and arthrofibrosis were more prevalent in the PTA group, while revision for patellar pain was less prevalent compared to TKA for OA.
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Affiliation(s)
- Jiwanjot Singh
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Rachid Rassir
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands; Orthopedic Department, Xpert Clinics, Amsterdam, The Netherlands
| | | | | | - Anneke Spekenbrink-Spooren
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), s-Hertogenbosch, The Netherlands
| | - Peter A Nolte
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
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Bormann M, Bitschi D, Neidlein C, Berthold DP, Jörgens M, Pätzold R, Watrinet J, Böcker W, Holzapfel BM, Fürmetz J. Mismatch between Clinical-Functional and Radiological Outcome in Tibial Plateau Fractures: A Retrospective Study. J Clin Med 2023; 12:5583. [PMID: 37685650 PMCID: PMC10488212 DOI: 10.3390/jcm12175583] [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: 06/14/2023] [Revised: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The evaluation of tibial plateau fractures (TPF) encompasses the assessment of clinical-functional and radiological parameters. In this study, the authors aimed to investigate the potential correlation between these parameters by utilizing both the clinical-functional and the modified radiological Rasmussen score. METHODS In this retrospective monocentric study conducted at a level-I trauma center, patients who underwent surgery between January 2014 and December 2019 due to a TPF were included. The clinical-functional Rasmussen score prior to the injury, at 1-year postoperatively, and during the last follow-up (minimum 18 months) was assessed using a standardized questionnaire. Additionally, the modified radiological Rasmussen score was determined at the 1-year postoperative mark using conventional radiographs in two planes. RESULTS A total of 50 patients were included in this study, comprising 40% (n = 20) men, and 60% (n = 30) women, with an average age of 47 ± 11.8 years (range 26-73 years old). Among them, 52% (n = 26) had simple fractures (classified according to Schatzker I-III), while 48% (n = 24; according to Schatzker IV-VI) had complex fractures. The mean follow-up was 3.9 ± 1.6 years (range 1.6-7.5 years). The functional Rasmussen score assessed before the injury and at follow-up showed an "excellent" average result. However, there was a significant difference in the values of complex fractures compared to before the injury. One year postoperatively, both the clinical-functional score and the modified radiological score demonstrated a "good" average result. The "excellent" category was more frequently observed in the functional score, while the "fair" category was more common in the radiological score. There was no agreement between the categories in both scores in 66% of the cases. CONCLUSIONS The data from this retrospective study demonstrated that patients with TPF are able to achieve a nearly equivalent functional level in the medium-term after a prolonged recovery period, comparable to their pre-injury state. However, it is important to note that the correlation between clinical-functional and radiological parameters is limited. Consequently, in order to create prospective outcome scores, it becomes crucial to objectively assess the multifaceted nature of TPF injuries in more detail, both clinically and radiologically.
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Affiliation(s)
- Markus Bormann
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - David Bitschi
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Claas Neidlein
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Daniel P. Berthold
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Maximilian Jörgens
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Robert Pätzold
- Department of Trauma Surgery, Trauma Center Murnau, 82418 Murnau, Germany
| | - Julius Watrinet
- Department of Trauma Surgery, Trauma Center Murnau, 82418 Murnau, Germany
| | - Wolfgang Böcker
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Boris Michael Holzapfel
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Julian Fürmetz
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
- Department of Trauma Surgery, Trauma Center Murnau, 82418 Murnau, Germany
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Grammatico-Guillon L, Banaei-Bouchareb L, Solomiac A, Miliani K, Astagneau P, May-Michelangeli L. Validation of the first computerized indicator for orthopaedic surgical site infections in France: ISO-ORTHO. Antimicrob Resist Infect Control 2023; 12:44. [PMID: 37143157 PMCID: PMC10161661 DOI: 10.1186/s13756-023-01239-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The French national authority for health (HAS) develops in-hospital indicators for improving quality of care, safety and patient outcome. Since 2017, it has developed a measurement of surgical site infections (SSI) after total hip or knee arthroplasty (TH/KA) by using a computerized indicator, called ISO-ORTHO, based on a hospital discharge database (HDD) algorithm. The aim of the study was to assess the performance of this new indicator . METHODS The ISO-ORTHO performance was estimated via its positive predictive value (PPV) among adult patients having undergone a TH/KA between January 1st and September 30th 2018, based on the orthopaedic procedure codes. Patients at very high risk of SSI and/or with SSI not related to the in-hospital care were excluded. SSI were detected from the date of admission up to 90 days after the TH/KA using the ISO-ORTHO algorithm, based on 15 combinations of ICD-10 and procedure codes. Its PPV was estimated by a chart review in volunteer healthcare organisations (HCO). RESULTS Over the study period, 777 HCO including 143,227 TH/KA stays were selected, providing 1,279 SSI according to the ISO-ORTHO indicator. The 90-day SSI rate was 0.89 per 100 TH/KA stays (0.98% for THA and 0.80% for TKA). Among the 448 HCO with at least 1 SSI, 250 HCO participated in reviewing 725 SSI charts; 665 were confirmed, giving a PPV of 90.3% [88.2-92.5%], 89.9% [87.1-92.8%] in THA and 90.9% [87.7-94.2%] in TKA. CONCLUSIONS The PPV of ISO-ORTHO over 90% confirms its validity for any use according to the HAS method. ISO-ORTHO and detailed information were provided in 2020 to HCO and used for quality assessment and in-hospital risk management.
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Affiliation(s)
- Leslie Grammatico-Guillon
- Service of Public Health, Epidemiology and data center, Teaching hospital of Tours and Medical School of Tours, Tours, France.
- Medical School, University of tours, Tours, France.
- Center for Prevention of Healthcare Associated Infection, INSERM, Institute of Epidemiology and Public Health, Sorbonne University, Paris, F75013, France.
| | - Linda Banaei-Bouchareb
- French National Authority for Health ("Haute Autorité de Santé", HAS), Saint Denis, France
| | - Agnès Solomiac
- French National Authority for Health ("Haute Autorité de Santé", HAS), Saint Denis, France
| | - Katiuska Miliani
- Center for Prevention of Healthcare Associated Infection, INSERM, Institute of Epidemiology and Public Health, Sorbonne University, Paris, F75013, France
| | - Pascal Astagneau
- Center for Prevention of Healthcare Associated Infection, INSERM, Institute of Epidemiology and Public Health, Sorbonne University, Paris, F75013, France
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Prié H, Meyssonnier V, Kerroumi Y, Heym B, Lidove O, Marmor S, Zeller V. Pseudomonas aeruginosa prosthetic joint-infection outcomes: Prospective, observational study on 43 patients. Front Med (Lausanne) 2022; 9:1039596. [PMID: 36569155 PMCID: PMC9774483 DOI: 10.3389/fmed.2022.1039596] [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: 09/08/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives Analysis the outcomes of Pseudomonas aeruginosa prosthetic joint infection (PJI), and of their clinical and microbiological characteristics, surgical strategies and antibiotic treatments. Methods Monocenter cohort study in a Bone-and-Joint-Infection Referral Center (08/2004 to 10/2018) including all consecutive P. aeruginosa PJIs. Data were extracted from the prospective database, including the following events: relapses, new PJIs, related deaths. Results Median [IQR]: among the 43 patients included (28 females; 72 [63-80] years old; 27 hip, 15 knee, and 1 shoulder PJIs), 29 (67%) had underlying comorbidities, 12 (28%) had previously been treated for another PJI and 9 (21%) had undergone previous surgeries for their P. aeruginosa PJI. Eleven (26%) PJIs were polymicrobial, 16 (37%) strains were wild type, 8 (19%) ciprofloxacin-resistant. PJIs were classified as late chronic (n = 33), early postoperative (n = 9) or acute hematogenous infection (n = 1). Forty patients underwent surgery: 27 one-stage and 5 two-stage exchanges, 3 debridement and implant retention, and 5 other surgical strategies. Antibiotic treatments were: 29 received 41 [37-43] days of combination therapy (IV anti-pseudomonal β-lactam and 3-5 days of amikacin, then β-lactam and oral ciprofloxacin), followed by oral ciprofloxacin for a total of 12 weeks; 10 received only IV antibiotics for 83 [77-86] days, including 37 [32-46] days of combination therapy; 49 days of ceftazidime alone for 1. During follow-up lasting 33 [24-64.5] months, 2 relapses, 3 new PJIs, and 2 related deaths occurred. Thirty-three (82%) patients and 93% of those managed with one-stage exchange experienced no event. Conclusion Outcomes of our cohort's P. aeruginosa PJIs-predominantly monomicrobial, chronic, ciprofloxacin-susceptible, treated with one-stage exchange and prolonged IV antibiotics-were 82% favorable.
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Affiliation(s)
- Héloïse Prié
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France,Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Vanina Meyssonnier
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France,Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Younes Kerroumi
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Beate Heym
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France,Laboratoire des Centres de Santé et Hôpitaux d’Île-de-France, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Olivier Lidove
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Simon Marmor
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France,Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France,Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France,*Correspondence: Valérie Zeller,
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Kazarian GS, Haddad FS, Donaldson MJ, Wignadasan W, Nunley RM, Barrack RL. Implant Malalignment may be a Risk Factor for Poor Patient-Reported Outcomes Measures (PROMs) Following Total Knee Arthroplasty (TKA). J Arthroplasty 2022; 37:S129-S133. [PMID: 35248754 DOI: 10.1016/j.arth.2022.02.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Implant malalignment may be a risk factor for poor patient-reported outcomes measures (PROMs) following total knee arthroplasty (TKA). METHODS Postoperative surveys were administered to assess PROMs regarding satisfaction, pain, and function in 262 patients who underwent surgery at 4 centers in the U.S. and U.K (average age, 67.2) at a mean 5.5 years after primary TKA. Postoperative distal femoral angle (DFA), proximal tibial angle (PTA), and posterior tibial slope angle (PSA) were radiographically measured, and outliers were recorded. PROMs were compared between patients with aligned versus malaligned knees using univariate analysis. RESULTS Patients with DFA, PTA, and PSA outliers were more likely to experience similar or decreased activity levels postoperatively than patients with no alignment outliers, as were patients with 1 or 2 outliers of any kind (P < .05). Patients with DFA, PTA, and PSA outliers were significantly more likely to be dissatisfied with their ability to perform activities of daily living (ADLs), as were patients with 1 or 2 outliers of any kind (P < .05). Patients with DFA and PSA outliers were more likely to be dissatisfied with their degree of pain relief, as were patients with 2 outliers of any kind (P < .05). Finally, patients with DFA and PSA outliers, as well as those with 1 outlier of any kind, were more likely to be dissatisfied with their overall knee function (P < .05). CONCLUSION DFA, PTA, and PSA outliers represent a significant risk factor for decreased satisfaction with activities of daily living(ADLs), pain relief, and knee function, as well as decreased activity levels. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Fares S Haddad
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Matthew J Donaldson
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Warran Wignadasan
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
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van Rensch PJH, Heesterbeek PJC, van Loon CJ. Tibial metaphyseal sleeves in primary total knee arthroplasty following high tibial osteotomy and tibial plateau fracture; preliminary mid-term survival and outcome. Knee 2022; 35:98-104. [PMID: 35276553 DOI: 10.1016/j.knee.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 01/02/2022] [Accepted: 02/25/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous high tibial osteotomy (HTO), and tibial plateau fractures (TPF) may cause problems in subsequent total knee arthroplasty (TKA) due to altered metaphyseal bone structure. Higher rates of loosening of the tibial component have been described. In post-HTO and TPF cases, a more durable fixation could be achieved by tibial sleeves. This study investigates the preliminary short-to-midterm clinical and radiographic results in a cohort of these cases. METHODS A cohort of 28 patients was selected, 11 following HTO, and 17 following TPF. Standard clinical and radiologic follow-up was performed at 6 weeks, and one and two years. Revision with removal of primary prosthesis for any reason was the primary outcome. Patient reported pre- and postoperative pain, satisfaction and general health scores were collected at one and two years. Postoperative radiographs were analyzed for radiolucent lines. RESULTS There were no cases of aseptic loosening. Survival for all reasons was 96.4% (CI 77.2%-99.5%). One progressive radiolucent line was seen. Numerical rating scale (NRS) for pain with and without weightbearing at 2-year follow-up improved from 8 to 3 and from 5 to 2 points respectively. Overall general health scores improved with a median of 70 at ≥ 2 years, compared to 63 pre-operatively. CONCLUSION With no revision for aseptic loosening the use of tibial sleeves in primary TKA seems a safe and reliable method for fixation of the tibial component in metaphyseal bone with altered bone structure at short and mid-term follow-up. LEVEL OF EVIDENCE Level IV, cohort study.
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Affiliation(s)
- P J H van Rensch
- Department of Orthopedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AG Arnhem, the Netherlands; Currently Employed at CortoClinics, Beatrixstraat 31, 6031 BB, Nederweert, the Netherlands.
| | - P J C Heesterbeek
- Department of Research, Sint Maartenskliniek, PO Box 9011, 6500 GM Nijmegen, the Netherlands.
| | - C J van Loon
- Department of Orthopedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AG Arnhem, the Netherlands.
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Nagira K, Hagino H, Enokida M, Enokida S, Ishida K, Hayashi I, Nagashima H. Total knee arthroplasty in the past three decades: Trends in patient characteristics and implant survivorship. Mod Rheumatol 2022; 32:432-437. [PMID: 33853475 DOI: 10.1080/14397595.2021.1913823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To explore the trends in patient characteristics and implant survivorship (IS) for primary total knee arthroplasty (TKA) over the past three decades. METHODS This retrospective study enrolled a total of 635 knees who underwent TKA from 1985 to 2014. They were divided into three groups: group A, 125 knees in 1985-1994; group B, 203 knees in 1995-2004; and group C, 307 knees A in 2005-2014. The patient characteristics and IS were compared. RESULTS The mean age of patients undergoing TKA was getting older: 65.3 ± 9.7, 69.1 ± 10.0, and 74.6 ± 8.4 years, in groups A, B, and C, respectively (p = .001). The proportion of patients <60 years old with RA decreased (p < .001), whereas that of patients ≥ 80 years old with OA increased dramatically, it was 7.0%, 14.5%, and 32.0% in groups A, B, and C, respectively (p < .001). The IS free from infection was over 98% in all groups. Alternatively, the IS free from aseptic loosening become better, it was 83.7%, 95.2%, and 98.2% in groups A, B, and C, respectively (p = .014). CONCLUSIONS From these trends, we can estimate that the number of patients undergoing TKA will further increase in the future in an aging society.
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Affiliation(s)
- Keita Nagira
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hiroshi Hagino
- School of Health Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Makoto Enokida
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Shinpei Enokida
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Koji Ishida
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Ikuta Hayashi
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hideki Nagashima
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
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Shapira J, Abu Elasal A, Ghrayeb N, Nierenberg G. Multiple trauma-induced, secondary osteoarthritis, knee Arthroplasty and technology: Conventional approach to an unconventional scenario. BMJ Case Rep 2022; 15:e245263. [PMID: 35131774 PMCID: PMC8823041 DOI: 10.1136/bcr-2021-245263] [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] [Accepted: 12/30/2021] [Indexed: 11/03/2022] Open
Abstract
A 49-year-old man was involved in a high-energy motor vehicle accident. Haemodynamic instability with multiple long bone fractures of lower limbs was the hallmarks of the injury. Closed fragmented fracture of left femur shaft and open displaced supracondylar fracture of the contralateral femur. Closed comminuted high-grade fracture of the Tibia plateau (Schatzker VI) was diagnosed bilaterally. 'Orthopaedic damage control' was initiated with bilateral 'cross knee' external fixation, followed by conversion to open reduction internal fixation of all fracture sits at 8 days later. The patient underwent nine subsequent hospitalisations, of which eight involved operative treatment. The interval from admission to last documented surgery was 7 years. The endpoint was total knee arthroplasty (TKA) with mega prosthesis of the left knee and a primary-type TKA in the right knee. Both arthroplasties were non-assisted, conventional procedures. Postoperative Western Onterio and McMaster Universities Arthritis Index (WOMAC) score was 85 at 9-year follow-up from the injury incurred.
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Affiliation(s)
- Jacob Shapira
- Orthpaedics, Rambam Health Care Campus, Haifa, Israel
| | | | - Nabil Ghrayeb
- Orthpaedics, Rambam Health Care Campus, Haifa, Israel
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Kazarian GS, Lieberman EG, Hansen EJ, Nunley RM, Barrack RL. Clinical impact of component placement in manually instrumented total knee arthroplasty : a systematic review. Bone Joint J 2021; 103-B:1449-1456. [PMID: 34465158 DOI: 10.1302/0301-620x.103b9.bjj-2020-1639.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The goal of the current systematic review was to assess the impact of implant placement accuracy on outcomes following total knee arthroplasty (TKA). METHODS A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Ovid Medline, Embase, Cochrane Central, and Web of Science databases in order to assess the impact of the patient-reported outcomes measures (PROMs) and implant placement accuracy on outcomes following TKA. Studies assessing the impact of implant alignment, rotation, size, overhang, or condylar offset were included. Study quality was assessed, evidence was graded (one-star: no evidence, two-star: limited evidence, three-star: moderate evidence, four-star: strong evidence), and recommendations were made based on the available evidence. RESULTS A total of 49 studies were identified for inclusion. With respect to PROMs, there was two-star evidence in support of mechanical axis alignment (MAA), femorotibial angle (FTA), femoral coronal angle (FCA), tibial coronal angle (TCA), femoral sagittal angle (FSA), femoral rotation, tibial and combined rotation/mismatch, and implant size/overhang or offset on PROMs, and one-star evidence in support of tibial sagittal angle (TSA), impacting PROMs. With respect to survival, there was three- to four-star evidence in support FTA, FCA, TCA, and TSA, moderate evidence in support of femoral rotation, tibial and combined rotation/mismatch, and limited evidence in support of MAA, FSA, and implant size/overhang or offset impacting survival. CONCLUSION Overall, there is limited evidence to suggest that PROMs are impacted by the accuracy of implant placement, and malalignment does not appear to be a significant driver of the observed high rates of patient dissatisfaction following TKA. However, FTA, FCA, TCA, TSA, and implant rotation demonstrate a moderate-strong relationship with implant survival. Efforts should be made to improve the accuracy of these parameters in order to improve TKA survival. Cite this article: Bone Joint J 2021;103-B(9):1449-1456.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Elizabeth G Lieberman
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Erik J Hansen
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
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Zaffagnini S, Di Paolo S, Meena A, Alesi D, Zinno R, Barone G, Pizza N, Bragonzoni L. Causes of stiffness after total knee arthroplasty: a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:1983-1999. [PMID: 33821306 DOI: 10.1007/s00264-021-05023-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Knee stiffness after total knee arthroplasty (TKA) often leads to pain and discomfort, failing to meet patients' expectations on the surgical procedure. Despite the growing debate on the topic, a comprehensive literature analysis of stiffness causes has never been conducted. Thus, the purpose of the present study was to systematically review the literature regarding the main causes of stiffness after TKA. METHODS Pubmed Central, Scopus, and EMBASE databases were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for studies on stiffness and pain or discomfort after TKA through November 2020. Overall, 25 articles matched the selection criteria and were included in the study. Clinical relevance and strength of evidence of the included studies were graded using the risk of bias and the methodological index for non-randomized studies quality assessment tools. RESULTS The main causes of pain and discomfort due to stiffness were surgery-related issues, i.e., component malpositioning and over-voluming, implant loosening, psychological distress, and obesity, which could be considered "modifiable" factors, and expression of profibrotic markers, high material hypersensitivity-related cytokines level, male gender, previous contralateral TKA, and high pre-operative pain, which could be considered "non-modifiable" factors. CONCLUSION The use of alternative technologies such as surgical robots, anatomy-based devices, and more inert and less stiff component materials could help in reducing stiffness caused by both modifiable and even some non-modifiable factors. Furthermore, early diagnostic detection of stiffness onset could consistently support surgeons in patient-specific decision-making.
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Affiliation(s)
- Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.,University of Bologna, Via Zamboni, 33, 40126, Bologna, Italy
| | | | - Amit Meena
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
| | - Domenico Alesi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.
| | - Raffaele Zinno
- University of Bologna, Via Zamboni, 33, 40126, Bologna, Italy
| | - Giuseppe Barone
- University of Bologna, Via Zamboni, 33, 40126, Bologna, Italy
| | - Nicola Pizza
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
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Potential Instability and Malfunction of Knee Joints with Vastus Medialis Impairment after Total Knee Arthroplasty. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11062764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Four pairs of fresh-frozen cadaver knees (eight knees, four male knees) with a mean age of 72 ± 7 years were used for tests involving a customized simulator capable of controlling quadriceps loading conditions. The muscle force distribution of the quadriceps for the normal loading condition was applied on the basis of muscle cross-sectional area data, as previously reported (VM: 31 N; RF/VI: 49 N; VL: 45 N). To simulate vastus medialis (VM) impairment, we set the muscle force for VM in the muscle force distribution of the quadriceps at zero (VM: 0 N; RF/VI: 49 N; VL: 45 N). The joint reaction forces and moments on knee joints that underwent total knee arthroplasty (TKA) did not differ significantly according to VM impairment status for all flexion angles (p > 0.05). Nevertheless, the vectors of internal–external moments mostly showed a tendency for alteration from external to internal due to VM impairment. This tendency was evident in 9 cases in 12 total test pairs (with and without VM impairment). Furthermore, the vectors of the anterior–posterior reaction forces mostly showed a tendency to increase anteriorly due to VM impairment. This tendency was also evident in 9 cases in 12 total test pairs (with and without VM impairment). These results indicate that posterior dislocation of the tibia may be induced if VM impairment occurs after TKA. In conclusion, VM impairment in knee joints undergoing TKA may contribute to posterior dislocation of the tibia by a paradoxical roll-back with enhancements of the anterior joint reaction force and external moment during knee-joint flexion. Our findings may be valuable for understanding the mechanism of potential instability and malfunction due to VM impairment in knee joints after TKA, and may help to optimize clinical/rehabilitation training plans to improve the prognosis (stability and function) of knee joints undergoing TKA.
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Güzel İ, Gül D, Akpancar S, Lyftogt J. Effectiveness of Perineural Injections Combined with Standard Postoperative Total Knee Arthroplasty Protocols in the Management of Chronic Postsurgical Pain After Total Knee Arthroplasty. Med Sci Monit 2021; 27:e928759. [PMID: 33547269 PMCID: PMC7874529 DOI: 10.12659/msm.928759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Despite increased experience and technical developments in total knee arthroplasty (TKA), chronic postsurgical pain (CPSP) remains one of physicians’ biggest challenges. The aim of the present study was to evaluate the effectiveness of perineural injection therapy (PIT) in the management of CPSP after TKA. Material/Methods A total of 60 patients who had been surgically treated with TKA because of advanced knee osteoarthritis was included in the present study. The study included 2 groups. Group A consisted of patients who received 3 rounds of PIT combined with standard postoperative TKA protocol during the same period. Group B received standard postoperative TKA protocols (rehabilitation programs, oral and intravenous analgesics). Clinical effectiveness was evaluated via Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Visual Analog Scale (VAS) at baseline and 1-, 3-, and 6-month follow-ups. Results All repeated measures showed significant improvements (P<0.001) in both groups for VAS and WOMAC scores. These scores were significantly better in group A in all follow-up periods compared with group B (P<0.001). Twenty-nine patients (93.5%) in group A reported excellent or good outcomes compared with 26 patients (89.6%) in group B. Conclusions PIT is a promising approach in CPSP with minimal cost, simple and secure injection procedures, minimal side effects, and higher clinical efficacy.
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Affiliation(s)
- İsmail Güzel
- Department of Orthopedic Surgery, Malatya Training and Research Hospital, Malatya, Turkey
| | - Deniz Gül
- Department of Orthopedic Surgery, Bursa Kestel State Hospital, Bursa, Turkey
| | - Serkan Akpancar
- Department of Orthopedic Surgery, Malatya Training and Research Hospital, Malatya, Turkey
| | - John Lyftogt
- Private Practice (Retired), Christchurch, New Zealand
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Tampere T, Ollivier M, Jacquet C, Fabre-Aubrespy M, Parratte S. Knee arthroplasty for acute fractures around the knee. EFORT Open Rev 2020; 5:713-723. [PMID: 33204515 PMCID: PMC7608576 DOI: 10.1302/2058-5241.5.190059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Results of open reduction and internal fixation for complex articular fractures around the knee are poor, particularly in elderly osteoporotic patients. Open reduction and internal fixation may lead to an extended hospital stay and non-weight-bearing period. This may lead to occurrence of complications related to decubitus such as thrombo-embolic events, pneumonia and disorientation. Primary arthroplasty can be a valuable option in a case-based and patient-specific approach. It may reduce the number of procedures and allow early full weight-bearing, avoiding the above-mentioned complications. There are four main indications:
1) Elderly (osteoporotic) patients with pre-existing (symptomatic) end-stage osteoarthritis. 2) Elderly (osteoporotic) patients with severe articular and metaphyseal destruction. 3) Pathological fractures of the distal femur and/or tibia. 4) Young patients with complete destruction of the distal femur and/or tibia.
The principles of knee (revision) arthroplasty should be applied; choice of implant and level of constraint should be considered depending on the type of fracture and involvement of stabilizing ligaments. The aim of treatment is to obtain a stable and functional joint. Long-term data remain scarce in the literature due to limited indications.
Cite this article: EFORT Open Rev 2020;5:713-723. DOI: 10.1302/2058-5241.5.190059
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Affiliation(s)
- Thomas Tampere
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Matthieu Ollivier
- Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France
| | - Christophe Jacquet
- Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France
| | - Maxime Fabre-Aubrespy
- Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France
| | - Sébastien Parratte
- Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France.,Department of Orthopaedic Surgery, International Knee and Joint Centre, Abu Dhabi, UAE
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Xu X, Xie L, Liu H, Hu Y. Transdermal buprenorphine patch versus oral celecoxib for pain management after total knee arthroplasty: An open- label, randomized controlled trial. Orthop Traumatol Surg Res 2020; 106:915-919. [PMID: 32624377 DOI: 10.1016/j.otsr.2020.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study was performed to evaluate the analgesic efficacy and safety of transdermal buprenorphine (TDB) patched for post-operative pain control after total knee arthroplasty (TKA). The hypothesis was that patients receiving the TDB patch would have less pain in comparison to those treated with the oral COX-2 inhibitor celecoxib without increasing side effects. PATIENTS AND METHODS A total of 160 patients scheduled for primary TKA were randomly assigned to two groups: patients provided the TDB patch (10μg/h) (TDB group) and those provided oral celecoxib (CX group). The outcomes were pain scores measured using the visual analogue scale (VAS) during rest and activity, as well as morphine requirement, operated knee functional recovery and adverse events post-operatively. RESULTS The total morphine given during the first 72h post-operatively was significantly lower in the TDB group than CX group. The VAS scores were significantly lower in the TDB group than CX group during rest at 2, 4, 6, 12, 24 and 48h post-operatively, and during activity at 12, 24 and 48h and 3 days post-operatively. The mean range of motion on post-operative days (PD) 1, 2 and 3 were significantly greater in the TDB group. In addition, the Lysholm score was significantly higher in the TDB group on PD 3. There were no remarkable adverse events in either group. DISCUSSION Use of the TDB patch provides effective pain relief and reduces the requirement for rescue morphine without increasing side effects in comparison with oral celecoxib during the early post-operative stage following TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Xinxian Xu
- The Osteopathy Department, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Linghui Xie
- The Radiology Department of Wenzhou Seventh Hospital, Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haixiao Liu
- The Osteopathy Department, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yuezheng Hu
- The Osteopathy Department, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
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Erivan R, Tardieu A, Villatte G, Ollivier M, Jacquet C, Descamps S, Boisgard S. Knee surgery trends and projections in France from 2008 to 2070. Orthop Traumatol Surg Res 2020; 106:893-902. [PMID: 32507586 DOI: 10.1016/j.otsr.2020.02.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Knee surgery makes up a large share of the orthopedic surgery practice. Data on how this activity has changed over time is not available in France, thus we wanted to do a study to determine 1) how many knee surgeries were performed in France in 2018, 2) how this changed between 2012 and 2018, and 3) how it is projected to change by 2070. The hypothesis is that the number of knee surgeries will increase over the next 50 years. METHODS This was an epidemiology study analysing coding data for surgical procedures in France between 2012 and 2018. Two scenarios were defined to assess the change over time: the first only considered population growth and how the age distribution changes over time, and the second extrapolated the trends observed over the past few years. RESULTS In 2018, 321,179 procedures were coded as a main knee surgery procedure. The three most frequent were primary knee arthroplasty with 113,600 procedures (31.2% of procedures) then meniscus surgery (110,510 procedures or 30.3%) and then ligament surgery (57,053 procedures or 15.7%). The number of primary knee arthroplasty procedures increased by 32.2% between 2012 and 2018. Between 2018 and 2050, the different scenarios suggested an increase of 30.8% to 152.8%. The number of ligament surgery procedures increased by 17.3% between 2012 and 2018. Between 2018 and 2050, an increase of 1.2% to 49.2% is expected. The number of meniscus procedures decreased by 14.2% between 2012 and 2018. Between 2018 and 2050, scenario 1 projects a 5.6% increase and scenario 2 a 73.6% reduction. DISCUSSION The number of knee surgery procedures per year has increased over the past few years in France and should continue to increase. LEVEL OF EVIDENCE IV, descriptive epidemiology study.
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Affiliation(s)
- Roger Erivan
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.
| | - Anna Tardieu
- Université Clermont-Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Guillaume Villatte
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Matthieu Ollivier
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France; Institute for Locomotion, Department of Orthopedics and Traumatology St. Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29 13274 Marseille, France
| | - Christophe Jacquet
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France; Institute for Locomotion, Department of Orthopedics and Traumatology St. Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29 13274 Marseille, France
| | - Stéphane Descamps
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
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Li JQ, Hao-Xu, Sun ZG, Huang QS, Yao XD. The outcomes of post-traumatic arthritis vs osteoarthritis following primary total knee arthroplasty: A protocol of matched cohort study. Medicine (Baltimore) 2020; 99:e20077. [PMID: 32384476 PMCID: PMC7220653 DOI: 10.1097/md.0000000000020077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) for treatment of end-stage post-traumatic arthritis (PTA) has specific technical difficulties and complications. The aim of this study was to examine the outcome of TKA after PTA and to compare it with a cohort osteoarthritis (OA). METHODS A retrospective review of patients undergoing primary TKA at a single university hospital from 2013 to 2016 was performed. A minimum follow-up of 4 years was required. Patients in the study group were matched 1:2 with patients in the cohort group based on the following criteria: age at time of TKA (±3 years), body mass index (±3 points), sex, and American Society of Anesthesiologists score (±1 point). Outcome measures included surgical time, intraoperative complications, Oxford Knee Score, range of motion, postoperative complications, and revision. RESULTS This clinical trial is expected to determine whether PTA is associated with increased risks of complications and revision or reduced functional outcomes following TKA. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5455).
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Liu Y, Zhao XD, Zou C. Lingering risk: A meta-analysis of outcomes following primary total knee arthroplasty for patients with post-traumatic arthritis. Int J Surg 2020; 77:163-172. [PMID: 32247846 DOI: 10.1016/j.ijsu.2020.03.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Currently, no meta-analysis exists to elucidate the outcomes of primary total knee arthroplasty (TKA) in patients with post-traumatic arthritis (PTA). The primary aim of this meta-analysis was to compare revision and complication rates for patients with PTA versus osteoarthritis (OA). METHODS The following databases were used for searching existing literature (from their inception to October 2019): PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science. The primary outcomes were the incidences of revision and complications, Secondary outcomes included operative time and patient-reported outcomes (PRO) scores. RESULTS Nine studies with a total of 6,783,990 patients were included. This study found that there was a statistically significant difference in the rates of superficial wound infection, periprosthetic infection, stiffness, wound complications, and revision, with these outcomes occurring more frequently in patients with PTA. However, PTA did not increase the risks for periprosthetic fracture, aseptic loosening or instability, and VTE. Moreover, PTA was associated with increased operative time, worse postoperative PRO scores, and similar changes in PRO scores. CONCLUSIONS This meta-analysis highlight the complexity of PTA and demonstrates increased risks of infection, wound complications, stiffness, and revision. Surgeons can use this information to help aid in counseling patients preoperatively.
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Affiliation(s)
- Yang Liu
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, 610041, PR China.
| | - Xiao-Dan Zhao
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, 610041, PR China.
| | - Chang Zou
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, 610041, PR China
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Wojtowicz R, Henricson A, Nilsson KG, Crnalic S. Uncemented monoblock trabecular metal posterior stabilized high-flex total knee arthroplasty: similar pattern of migration to the cruciate-retaining design - a prospective radiostereometric analysis (RSA) and clinical evaluation of 40 patients (49 knees) 60 years or younger with 9 years' follow-up. Acta Orthop 2019; 90:460-466. [PMID: 31210081 PMCID: PMC6746276 DOI: 10.1080/17453674.2019.1626097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Uncemented monoblock cruciate retaining (CR) trabecular metal (TM) tibial components in total knee arthroplasty (TKA) work well in the long-term perspective in patients ≤ 60 years. Younger persons expect nearly normal knee flexion after TKA, but CR implants generally achieve less knee flexion compared with posterior stabilized (PS) implants. Cemented PS implants have higher revision rate than CR implants. Can an uncemented monoblock PS TM implant be used safely in younger patients? Patients and methods - 40 patients (49 knees) age ≤ 60 years with primary (20 knees) or posttraumatic osteoarthritis (OA) were operated with a high-flex TKA using an uncemented monoblock PS TM tibial component. Knees were evaluated with radiostereometric analysis (RSA) a mean 3 days (1-5) postoperatively, and thereafter at 6 weeks, 3 months, 1, 2, 5, and 9 years. Clinical outcome was measured with patient-related outcome measures (PROMs). Results - The implants showed a pattern of migration with initial large migration followed by early stabilization lasting up to 9 years, a pattern known to be compatible with good long-term results. Clinical and radiological outcome was excellent with 38 of the 40 patients being satisfied or very satisfied with the procedure and bone apposition to the entire implant surface in 46 of 49 knees. Mean knee flexion was 130°. 1 knee was revised at 3 months due to medial tibial condyle collapse. Interpretation - The uncemented monoblock PS TM implant works well in younger persons operated with TKA due to primary or secondary OA.
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Affiliation(s)
- Radoslaw Wojtowicz
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden;
| | | | - Kjell G Nilsson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden; ,Correspondence:
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden;
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Pietrzak J, Common H, Migaud H, Pasquier G, Girard J, Putman S. Have the frequency of and reasons for revision total knee arthroplasty changed since 2000? Comparison of two cohorts from the same hospital: 255 cases (2013-2016) and 68 cases (1991-1998). Orthop Traumatol Surg Res 2019; 105:639-645. [PMID: 31088772 DOI: 10.1016/j.otsr.2019.01.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/13/2019] [Accepted: 01/31/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The number of total knee arthroplasty (TKA) revisions is expected to increase 601% in the United States between 2005 and 2030. This type of information is not available in France, and the last national study on this topic was done in 2000. This led us to perform a comparative study to determine if 1) the frequency of TKA revisions has increased and 2) the reasons for reoperation have changed relative to data gathered in 2000 at a single hospital in France. HYPOTHESIS The frequency of TKA revision has increased between the two studies, performed 15 years apart. MATERIAL AND METHODS In this retrospective observational single-center study (January 2013 to December 2016), all patients with a TKA who were reoperated with or without any component change were included. This cohort was compared to our historical cohort defined in 2000 of 68 TKA reoperations between January 1991 and January 1998. The reasons for revision were determined by consulting computerized patient records to find the disease history, clinical examinations, imaging findings, laboratory tests and the surgery report. Cases due to periprosthetic fractures, infection and skin-related complications were excluded in order to be consistent with the indications of the historical cohort. RESULTS Between 2013 and 2016, 349 TKA revisions were performed, and 255 met the inclusion criteria. Note that the historical cohort had 68 cases. The mean time elapsed between the primary TKA and revision procedure was 5.3 years [34 days to 31 years]. Eight reasons for reoperation were identified. Aseptic loosening (85 cases (33.3%)), stiffness (70 cases (27.5%)), tibiofemoral laxity (39 cases (15.3%)) and patellar complications (34 cases (13.3%)) were the four most common reasons for reoperation. The frequency has changed over time: relative to 2000, the annual frequency increased by a factor of 6.5. The reasons have also changed over time: there was an increase in revisions for aseptic loosening (33.3% vs. 23.5%), stiffness (27.5% vs. 20.6%) and knee joint laxity (15.3% vs. 10.3%). Conversely, there was a reduction in revisions for patellar complications (13.3% vs. 26.5%), unexplained pain (0.4% vs. 8.8%) and patellar clunk syndrome (1.2% vs. 4.4%). DISCUSSION The number of TKA revisions has increased by a factor of 6.5, with aseptic loosening still being the most common reason. The number of revisions performed for stiffness and knee joint laxity have increased. Fewer revisions are being done for unexplained pain because surgeons are now better able to determine the cause of TKA-related pain. There were fewer patella-related complications because of technical progress. The data generated from our single-center study are consistent with current published data. LEVEL OF EVIDENCE II, comparative study.
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Affiliation(s)
- Julien Pietrzak
- Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie, Hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France.
| | - Harold Common
- Service d'orthopédie, CHU Ponchaillou, Université de Rennes 1, 2, rue Henri-Guilloux, 35000 Rennes, France
| | - Henri Migaud
- Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie, Hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - Gilles Pasquier
- Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie, Hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - Julien Girard
- Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie, Hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - Sophie Putman
- Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie, Hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
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Cizmic Z, Feng JE, Huang R, Iorio R, Komnos G, Kunutsor SK, Metwaly RG, Saleh UH, Sheth N, Sloan M. Hip and Knee Section, Prevention, Host Related: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S255-S270. [PMID: 30348549 DOI: 10.1016/j.arth.2018.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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