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Druel J, Gelin N, Ollivier M, Roseren F, Chabrand P, Jacquet C, Argenson JNA. Outcomes of Short and Long Tibial Stems for Primary Total Knee Arthroplasty in a Population of Obese Patients at Two-Year Follow-Up: A Clinical and Biomechanical Study. J Arthroplasty 2024; 39:S174-S182. [PMID: 38401608 DOI: 10.1016/j.arth.2024.02.047] [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: 11/09/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Obesity can be a source of higher failure rates and inferior clinical outcomes after total knee arthroplasty (TKA). The aim of this study was to compare outcomes, failure rates, and stress distributions of TKA in obese patients using a short, long, or no tibial stem. METHODS A matching process based on the type of stem used and the age allowed included 180 patients who had a body mass index (BMI) > 30 and underwent a TKA between January 2010 and December 2019, with a minimum follow-up of 2 years. They were classified as moderately obese (MO: 30 < BMI < 35, N = 90) and severely obese (SO: BMI > 35, N = 90). For each, 3 subgroups were defined: thirty patients received a 30 mm short stem (SS), thirty received a 100 mm long stem (LS), and thirty received no stem (NS). Patients were assessed preoperatively and postoperatively using the Knee Society Score (KSS). A finite element model was developed to evaluate the biomechanical effects of the tibial stem on stress distribution in the subchondral bone based on BMI. RESULTS The SS patients had significantly higher postoperative KSS knee score [MO: 88.9 (SS) versus 79 (LS) versus 80.6 (NS); SO: 84.5 versus 72.4 versus 78.2] (P < .0001) and function score [MO: 90.4 (SS) versus 78.4 (LS) versus 68.5 (NS); SO: 85.5 versus 73 versus 61.8] (P < .0001) compared to LS and NS patients. The biomechanical study demonstrated a BMI-dependent increase in stress in the subchondral bone in contact with the tibial components. These stresses were mainly distributed at the tibial cut for NS and along the stem for SS and LS. CONCLUSIONS A short, cemented tibial stem offers better functional outcomes without increasing failure rates compared to a longer stem during primary TKA in a population of obese patients at two-year follow-up. A short tibial stem does not lead to increased stress compared to an LS, at least for certain BMI categories.
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Affiliation(s)
- Julien Druel
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Marseille, France; Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Nolwenn Gelin
- Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Matthieu Ollivier
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Marseille, France; Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Flavy Roseren
- Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Patrick Chabrand
- Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Christophe Jacquet
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Marseille, France; Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Jean-Noel A Argenson
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Marseille, France; Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
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Sanz-Ruiz P, Matas-Diez JA, Villanueva-Martínez M, Fernández-Fernández T, Prats-Peinado L, Vaquero J. How to remove a well-fixed metaphyseal sleeve in revision knee arthroplasty: A step-by-step surgical procedure. Knee 2024; 46:52-61. [PMID: 38061165 DOI: 10.1016/j.knee.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/17/2023] [Accepted: 11/15/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND The rising incidence and complexity of revision knee arthroplasty has led to an increase in the use of metaphyseal reconstruction systems. One of the most widely used systems are metaphyseal sleeves as they have demonstrated excellent long-term survival. However, there is concern about the possible difficulty of extracting a sleeve if it were necessary, as no known procedures have yet been validated. METHODS We examined the outcomes of removing 23 well-integrated metaphyseal sleeves using the same systematized technique. RESULTS All sleeves were extracted without any intraoperative complications. Four subjects required an osteotomy to complete the extraction, while 62% of the sample were found to have an AORI IIB defect. All cases were successfully reconstructed with a new metaphyseal fixation, implanting a new sleeve in 38% of subjects compared with cones in the remaining 62%. CONCLUSIONS The technique described here produced successful, reproducible outcomes for the removal of integrated metaphyseal sleeves with minimal bone loss and no intraoperative complications.
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Affiliation(s)
- Pablo Sanz-Ruiz
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo no. 46, 28007 Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Madrid, Spain; Avanfi Institute, Madrid, Spain.
| | - José Antonio Matas-Diez
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo no. 46, 28007 Madrid, Spain
| | | | - Tanya Fernández-Fernández
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo no. 46, 28007 Madrid, Spain
| | - Lourdes Prats-Peinado
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo no. 46, 28007 Madrid, Spain
| | - Javier Vaquero
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo no. 46, 28007 Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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Laudren A, Delacroix R, Huten D. Is hybrid fixation in revision TKA using LCCK prostheses reliable? Orthop Traumatol Surg Res 2023; 109:103583. [PMID: 36878283 DOI: 10.1016/j.otsr.2023.103583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 03/07/2023]
Abstract
INTRODUCTION The optimal technique for component fixation in revision total knee arthroplasty (rTKA) remains controversial: full cementation (FC) versus hybrid fixation (HF), which involves press-fit stem with cement fixation in the metaphyseal and epiphyseal zones. Previous series have either demonstrated the superiority of one or the other of these techniques or their equivalence. However, few studies have compared these 2 methods for rTKA using the Legacy® Constrained Condylar Knee (LCCK) prosthesis (Zimmer, Warsaw, Indiana, USA). HYPOTHESIS Our hypothesis was that HF of LCCK components is associated with a higher rate of aseptic loosening (AL) than FC. MATERIALS AND METHODS This was a single-center, multi-surgeon, retrospective study. Primary revisions between January 2010 and December 2014 were included for all indications. The only exclusion criterion was death without revision before the 5-year follow-up. The primary objective of this study was to compare the survivorship of 2 groups of LCCK components (femoral or tibial), depending on whether their stems had been cemented (HF versus FC), taking AL, revised or not, as the endpoint. The secondary objective was to look for other predictive factors of AL. RESULTS A total of 75 rTKAs (150 components) were included. The FC group (51 components) had more Anderson Orthopedic Research Institute (AORI) type 2B and type 3 bone defects (BDs) (p<0.001), more reconstructions using trabecular metal (TM) cones (19 FCs and 5 HFs; p<0.001), and bone allografts (p<0.001). At more than 5 years, none of the FC components were loose compared to 10 HF components (9.4%), with 4 of these stems revised. The only significant difference was survivorship without radiographic AL at 9 years (FC=100%; HF=78.6%; p=0.04). The only predictive factor of AL in the HF group was the filling of the diaphyseal canal (p<0.01). The detrimental effect of BD severity (p=0.78) and the protective effect of TM cones were not demonstrated (p=0.21). DISCUSSION Other series studying revisions using the same type of prosthesis also concluded the superiority of FC, not found for other revision prostheses. Despite this study's limitations (retrospective, multi-surgeon, limited sample size, and limited follow-up), all patient outcomes were known, and the difference in survivorship between the groups was very significant. CONCLUSION HF has not been proven effective for the LCCK prosthesis. Better diaphyseal filling, wider metaphyseal bone tunnels enabling better cement injections, and stem designs more appropriate for press-fit fixation could improve these results. TM cones are an interesting avenue for further research. LEVEL OF EVIDENCE III; retrospective comparative study.
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Affiliation(s)
- Arthur Laudren
- Service d'orthopédie-traumatologie, CHU de Rennes, Rennes, France.
| | - Robin Delacroix
- Service d'orthopédie-traumatologie, CHU de Rennes, Rennes, France
| | - Denis Huten
- Service d'orthopédie-traumatologie, CHU de Rennes, Rennes, France
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Tovar-Bazaga M, Sáez-Martínez D, Auñón Á, López-Oliva F, Calvo E. Effectiveness and safety of a cement-on-cement removal system for hip and knee arthroplasty revision surgery. Acta Orthop Belg 2023; 89:348-354. [PMID: 37924553 DOI: 10.52628/89.2.11562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
Cement removal during hip or knee arthroplasty revision is challenging and not exempt of complications. Cement-on-cement procedure is among techniques developed to safe removal of cement from bone, and it could be a realistic solution. This cement-on-cement devices can provide advantages in removing bone cement during hip and knee arthroplasty septic and non-septic revision surgeries, and can be regarded as an effective and safe alternative. We present our experience using the cement-on-cement technique in 34 cases between 2010 and 2021, including revision surgeries for 20 knee and 14 hip arthroplasties. In 3 out of 34 cases the technique failed, with a success of 91%. Mean surgical time was 2.77 (SD 0.93) hours and blood transfusion was required in 23 cases. Success was achieved in every aseptic case. Of all patients, 60% were septic cases. Infection was considered to be eradicated in 70% (14/20) of patients with a septic revision. Cement-on-cement is a safe and effective alternative for cement removal during hip and knee arthroplasty revision. Level of evidence: III, retrospective case series.
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Cale F, Genet F, Rougereau G. New Distal femoral osteotomy technique for adult patients with major epiphyseal valgus dysplasia. J Clin Orthop Trauma 2023; 40:102167. [PMID: 37273766 PMCID: PMC10238761 DOI: 10.1016/j.jcot.2023.102167] [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: 01/15/2023] [Revised: 03/27/2023] [Accepted: 05/11/2023] [Indexed: 06/06/2023] Open
Abstract
The management of constitutional knee deformities may be a challenge. In most cases, the deformities are limited and accessible to conventional osteotomy techniques. This case reports an adult with extreme epiphyseal dysplasia of both distal femurs, and its management by a new osteotomy technique. At the last follow-up, 2.8 years after the previous surgery, the patient was walking without limitation or pain, and all osteotomies were healed. He had a Knee Society Score (KSS) of 57 and a functional KSS score of 100.
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Affiliation(s)
- Fabien Cale
- Department of Orthopedic Surgery, Raymond Poincaré Hospital, 104 BD Raymond Poincaré, 92380, Garches, France
| | - François Genet
- Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, 104 BD Raymond Poincaré, 92380, Garches, France
| | - Grégoire Rougereau
- Department of Orthopedic Surgery, Raymond Poincaré Hospital, 104 BD Raymond Poincaré, 92380, Garches, France
- Department of Orthopedics and Traumatology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
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Lim JB, Somerville L, Vasarhelyi EM, Howard JL, Naudie D, McCalden RW. Minimum 5 Year Clinical Outcomes And Survivorship For A Single Revision Total Knee Arthroplasty System Using Hybrid Fixation and Press-Fit Stems. J Arthroplasty 2023; 38:S297-S301. [PMID: 37003457 DOI: 10.1016/j.arth.2023.03.083] [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: 11/13/2022] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Hybrid fixation, utilizing diaphyseal press-fit stems and cement fixation in the tibial and femoral metaphyseal areas, has long been a strategy for revision total knee arthroplasty (rTKA). The purpose of this study was to evaluate the clinical outcomes and survivorships of hybrid fixation using a single rTKA revision system with a minimum of 5 years follow-up. METHODS We reviewed our prospectively collected database to identify 281 patients who underwent rTKA using a single revision system with hybrid fixation and press-fit stems between July 2006 and August 2016. We reviewed the clinical outcome scores, including the Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and Veterans RAND 12 Item Health Survey (VR-12). We also evaluated the 5- and 10-year survivorships and the indications for re-operations. RESULTS The cohort had a mean age of 70 years (range, x to y) and a mean body mass index of 33.4 (range, x to y). The mean time from rTKA surgery was 11.1 years (range, x to y). Above in yellow goes into ethods section Paired t-test analyses showed significant improvements from pre-operative versus post-operative clinical outcome scores (P<0.001) for KSS, WOMAC and VR-12 Physical component. Prosthetic joint infections after index rTKA was the most common failure mode with 29 patients requiring re-operations. Re-revision due to aseptic loosening was uncommon (6 patients) with a cumulative survival rate of 95.2% at 5 years and 94.2% at 10 years. CONCLUSION The use of this single rTKA system utilizing press fit stems combined with hybrid fixation provided significant improvements in the clinical outcomes and excellent survivorships at 5 and 10 years.
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Affiliation(s)
- Jason Bt Lim
- Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, S169608, Republic of Singapore
| | - L Somerville
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - E M Vasarhelyi
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - J L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Ddr Naudie
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - R W McCalden
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada.
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Ryu JJ, Kim YH, Choi CH. The additional tibial stem extension is not mandatory for the stability of 5 mm metal block augmented tibial prosthesis construct in primary total knee arthroplasty: 5-year minimum follow-up results. Knee Surg Relat Res 2023; 35:5. [PMID: 36726180 PMCID: PMC9890779 DOI: 10.1186/s43019-023-00174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/31/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine whether additional stem extension for stability is necessary, we performed mid-term follow-up of patients who had been managed with 5-mm metal block augmentation for a tibial defect, where tibial prosthesis was fixed using bone cement without stem extension. Also, we evaluated clinical and radiologic results including survival rate of patients without stem extension. METHODS We retrospectively analyzed patients with tibial bone defect, had undergone primary total knee arthroplasty, and had been treated with 5-mm metal block augmentation without stem extension between March 2003 and September 2013. Among 74 patients (80 cases), 47 patients (52 cases) were followed up for at least 5 years. RESULTS Mean flexion contracture improved from 8.8° (0-40°) preoperatively to 0.4° (-5° to 15°) at final follow-up (P < 0.01), but there was no significant change in the mean angle of great flexion: 124.6° (75-150°) preoperatively and 126.2° (90-145°) at final follow-up (P = 0.488). Mean range of motion improved from 115.8° (35-150°) preoperatively to 125.5° (90-145°) at final follow-up (P < 0.01). Mean knee score improved from 38.7 points (0-66 points) preoperatively to 93.2 points (79-100 points) at final follow-up (P < 0.01), and mean functional score also improved from 50.4 points (10-70 points) preoperatively to 81.8 points (15-100 points) at final follow-up (P < 0.01). The mean postoperative Western Ontario and McMaster University osteoarthritis score was 19.5 points (0-66.0 points). The mean femorotibial angle was corrected from 9.0° varus (23.0° varus-6.3° valgus) preoperatively to 5.5° valgus (2.2° varus-11.1° valgus) at final follow-up (P < 0.01). There was no change in the mean β-angle, which was 90.7° (87.2-94.9°) immediately postoperative and 90.8° (87.2-94.9°) at final follow-up (P = 0.748) and in the mean δ-angle, which was 86.2° (81.3-90.0°) immediately postoperative and 87.2° (83.1-96.5°) at final follow-up (P = 0.272). Radiolucent lines (RLL) were observed in ten cases (26.3%), and the mean RLL scores at final follow-up were 0.34 points (0-3 points) in the anteroposterior view and 0.42 points (0-6 points) in the lateral view. Scores for the RLL were ≤ 4 points in 36 cases, 5-9 points in two cases. Revision surgery due to aseptic loosening (three cases) is rarely required, and the Kaplan-Meier survival rate at 10 postoperative years was 96.4% CONCLUSION: When performing 5-mm metal block augmentation for a proximal tibial defect, no additional tibial stem extension can be a good surgical option for the stability of tibial prosthetic construct and mid-term clinical and radiologic results. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jae Joon Ryu
- grid.49606.3d0000 0001 1364 9317Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yeong Hwan Kim
- grid.49606.3d0000 0001 1364 9317Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Choong Hyeok Choi
- grid.49606.3d0000 0001 1364 9317Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Impact of stem profile on the revisability and the need for osteotomy in well-fixed cemented revision total knee arthroplasty implants. Arch Orthop Trauma Surg 2023; 143:469-479. [PMID: 35930052 PMCID: PMC9886614 DOI: 10.1007/s00402-022-04559-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/18/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION While re-revision total knee arthroplasty (ReRTKA) steadily increases, the ease and bone-sparing removal of RTKA implants is gaining more and more in importance. Biomechanical data suggest that cemented conical stems can be removed significantly easier than cylindrical stems. However, no clinical evidence exists supporting this observation. Aim of this study was to compare the revisability and need for osteotomy (OT) between removals of well-fixed cemented conical vs. cylindrical RTKA stems. MATERIALS AND METHODS 55 removals of well-fixed full-cemented RTKA stems (29 knees) performed between 2016 and 2018 were retrospectively analyzed. Main outcome variables were: bone loss, fractures, osteotomy incidence, surgery duration, early postoperative complications (EPC), hemoglobin drop and blood transfusion. SPSS was used for the statistical analysis. RESULTS 44.8% were conical, 48.3% cylindrical, and 6.9% combined stem designs. Causes for re-revision were PJI (75.9%), malposition (17.2%) and persistent pain (6.9%). 10 stem removals (18.2%) required an OT (four femoral, six tibial): eight stems (14.5%) had cylindrical and two (3.6%) conical designs (P = 0.041). Fractures were noted solely in removals without OT (11.1% vs. 0%,). There was a tendency to more bone loss in cylindrical stem revisions (53.8% vs. 32%, P = 0.24). A longer overall surgery time was observed in revisions of cylindrical stems (+ 37 min, P = 0.05). There was higher hemoglobin drop and need for blood transfusion in revisions of cylindrical stems or after OT but without reaching statistical significance. The EPC rates were slightly higher in ReRTKA on cylindrical stems (P = 0.28). CONCLUSION Well-fixed cemented conical stems may be revision friendlier with less demands on OT and shorter overall surgery time than cemented cylindrical stems.
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Filip AC, Cuculici SA, Cristea S, Filip V, Negrea AD, Mihai S, Pantu CM. Tibial Stem Extension versus Standard Configuration in Total Knee Arthroplasty: A Biomechanical Assessment According to Bone Properties. Medicina (B Aires) 2022; 58:medicina58050634. [PMID: 35630051 PMCID: PMC9146833 DOI: 10.3390/medicina58050634] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives: This study’s purpose was to examine the benefit of using a tibial extension in the primary operation of total knee arthroplasty (TKA). This is important because it is not a common practice to use the extension in a primary TKA, a standard configuration offering sufficient stability and good long-term survivorship. The following question arises: which situation requires the use of a standard configuration implant (without a stem) and which situation requires using the extension? Materials and Methods: The opportunity to use the tibial extension in the primary TKA was analyzed in correlation to the tibial bone structural properties. Using finite elements (FEs), the virtual model of the tibial bone was connected to that of the prosthetic implant, with and without a stem, and its behavior was analyzed during static and dynamic stresses, both in the situation in which the bone had normal physical properties, as well as in the case in which the bone had diminished physical properties. Results: The maximum stress and displacement values in the static compression regime show that adding a stem is only beneficial to structurally altered bone. Compression fatigue was reduced to almost half in the case of altered bone when adding a stem. Dynamic compression showed slightly better results with the tibial stem in both healthy and degraded bone. Conclusions: It was concluded that, if the bone is healthy and has good structural properties, it is not necessary to use the tibial extension in the primary operation; and if the bone has diminished physical properties, it is necessary to use the tibial extension at the primary operation, enhancing the stability, fixation, and implant lifespan.
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Affiliation(s)
- Alexandru Cristian Filip
- Radiology and Medical Imaging Department, ‘Dr. Carol Davila’ Central University Emergency Military Hospital, 010825 Bucharest, Romania;
- Department 8—Radiology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Stefan Alexandru Cuculici
- Department of Orthopedic Surgery, Ilfov County Emergency Clinical Hospital, 022104 Bucharest, Romania
- Department of Orthopedic Surgery and Trauma, ‘Sf. Pantelimon’ Emergency Clinical Hospital, 021659 Bucharest, Romania;
- Department 14—Orthopedics, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence: ; Tel.: +40-734309777
| | - Stefan Cristea
- Department of Orthopedic Surgery and Trauma, ‘Sf. Pantelimon’ Emergency Clinical Hospital, 021659 Bucharest, Romania;
- Department 14—Orthopedics, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Viviana Filip
- Mechanical Department, Doctoral School, ‘Valahia’ University, 130004 Targoviste, Romania;
| | - Alexis Daniel Negrea
- Mechanical Department, Materials and Mechanical Faculty, ‘Valahia’ University, 130004 Targoviste, Romania;
| | - Simona Mihai
- Mechanical Department, Institute of Multidisciplinary Research for Science and Technology, ‘Valahia’ University, 130004 Targoviste, Romania;
| | - Cosmin Marian Pantu
- Department 2—Morphological Sciences—Anatomy, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania;
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Song SJ, Le HW, Bae DK, Park CH. Long-term survival of fully cemented stem in re-revision total knee arthroplasty performed on femur with diaphyseal deformation due to implant loosening. INTERNATIONAL ORTHOPAEDICS 2022; 46:1521-1527. [PMID: 35471610 DOI: 10.1007/s00264-022-05412-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The study aims to analyze long-term clinical and radiographic results, and survival of re-revision total knee arthroplasty (TKA) using fully cemented stems performed on femurs with diaphyseal deformation. METHODS Thirty-seven re-revision TKAs using fully cemented stems performed in femoral diaphyseal deformations, characterized as diaphyseal canal enlargement and cortex deformation due to aseptic loosening of previously implanted stems, between 2003 and 2015 were retrospectively reviewed. The mean follow-up period was 10.0 years. Clinically, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were evaluated. Radiographically, mechanical axis (MA) and component positions were measured. Complications and survival rates were also analyzed. RESULTS Clinically, the WOMAC significantly improved at final follow-up (61.2 vs 47.2, p < 0.001), but not the ROM (95.5 vs 102.5, p = 0.206). Radiographically, the MA and component positions were appropriate, with no changes in component positions from immediately post-operative to final follow-up, but with MA change from varus 2.9° to 3.7° (p = 0.020). Two cases (5.4%) with history of previous infections developed periprosthetic joint infection (PJI). Debridement with polyethylene insert exchange following antibiotic suppression were performed in those cases because of concern for difficult implant-cement removal. The five and ten year survival rates were 100% and 93.2%, respectively. CONCLUSION Fully cemented stems are viable in providing long-term satisfactory survival after re-revision TKA in patients with femoral diaphyseal deformation. However, it should be used carefully for those with previous infections.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, Korea
| | - Hyun Woo Le
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, Korea.
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Akkaya M, Vles G, Bakhtiari IG, Sandiford A, Salber J, Gehrke T, Citak M. What is the rate of reinfection with different and difficult-to-treat bacteria after failed one-stage septic knee exchange? INTERNATIONAL ORTHOPAEDICS 2022; 46:687-695. [PMID: 34984498 DOI: 10.1007/s00264-021-05291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Re-operation after septic failure of a one-stage exchange for prosthetic joint infection (PJI) of the knee is a highly challenging procedure with concerns over residual bone stock, soft tissues, and stability. The associated changes in microbiology in cases of reinfection are still largely unknown. METHODS A comprehensive analysis was performed of all patients treated at our tertiary institution between 2001 and 2017 who developed reinfection after a one-stage exchange for PJI of the knee. Prerequisites for inclusion were a certain diagnosis of PJI according to the ICM criteria and a minimum follow-up of three years. Data on comorbidities, previous surgical interventions, microbiological findings at the time of the initial one-stage exchange and at the time of reinfection, detection methods, and antibiotic resistance patterns were retrospectively studied. RESULTS Sixty-six patients were identified that met the inclusion criteria. Reinfection occurred after a mean time interval of 27.7 months (SD ± 33.9, range 1-165). Ten types of bacteria were found that were not present before the one-stage exchange. The causative pathogen remained identical in 22 patients (33%) and additional microorganisms were detected in ten patients (15%). Half of the reinfections were however due to (a) completely different microorganism(s). A significant increase in the number of PJIs on the basis of high-virulent (23 vs 30, p = 0.017) and difficult-to-treat bacteria (13 vs 24, p = 0.035) was found. CONCLUSION The present study provides a novel insight into the microbiological changes following septic failure after one-stage exchange for PJI of the knee. A higher prevalence of more difficult-to-treat bacteria might increase the complexity of subsequent procedures. Also, a longer follow-up of these patients than previously suggested seems in order.
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Affiliation(s)
- Mustafa Akkaya
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Georges Vles
- Division of Orthopaedic Surgery, Hip Unit, Gasthuisberg, University Hospitals Leuven, Leuven, Belgium.,Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals, Leuven, Belgium
| | - Iman Godarzi Bakhtiari
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Amir Sandiford
- Department of Orthopaedic Surgery, Southland Teaching Hospital, Invercargill, New Zealand
| | - Jochen Salber
- Department of Surgery, Ruhr-University Hospital, Bochum, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
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Abstract
Revision total knee arthroplasty (rTKA) is a challenging procedure with often unreproducible results. A step-by-step approach is fundamental to achieving good outcomes. Successful surgery requires a correct diagnosis of the original cause of failure. Only with an accurate and detailed plan can surgeons overcome difficulties presented in this scenario. Any bone loss should be prevented during prosthetic component removal. Efficient tools must be chosen to avoid time-consuming manoeuvres. Joint reconstruction based on a ‘dual-zone’ fixation is essential to provide a long-term survivorship of the implant. The use of relatively short fully cemented stems combined with a biological metaphyseal fixation is highly recommended by authors. Flexion and extension gaps are accurately balanced after the establishment of the tibial platform. Varus-valgus laxity is commonly managed with a condylar constrained prosthesis. If hinged implants are required, a stronger implant fixation is needed to counteract constraints forces.
Cite this article: EFORT Open Rev 2021;6:495-500. DOI: 10.1302/2058-5241.6.210018
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Affiliation(s)
- Paolo Salari
- Institute for Complex Arthroplasty and Revisions (ICAR), Villa Ulivella Clinic, Florence, Italy
| | - Andrea Baldini
- Institute for Complex Arthroplasty and Revisions (ICAR), Villa Ulivella Clinic, Florence, Italy
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Tovar-Bazaga M, Sáez-Martínez D, Auñón Á, López-Oliva F, Pardos-Mayo B, Calvo E. Surgical Technique of a Cement-On-Cement Removal System for Hip and Knee Arthroplasty Revision Surgery. Arthroplast Today 2021; 9:112-117. [PMID: 34189215 DOI: 10.1016/j.artd.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/01/2021] [Accepted: 05/08/2021] [Indexed: 11/26/2022] Open
Abstract
Cement removal during hip or knee arthroplasty revision surgery is technically demanding and prone to severe complications such as periprosthetic fractures, incomplete cement removal, or perforations. Several alternative techniques have been developed to enable complete, accurate, and safe removal of cement from bone, including osteotomies and cortical windows, endoscopic instruments, ultrasound devices, lithotripsy, and laser-assisted removal. We describe a cement-on-cement technique with a sterile, single-use tool for cement removal. The cement is removed piece by piece using a specifically designed device, without osteotomies or cortical windows.
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Affiliation(s)
- Miguel Tovar-Bazaga
- Departments of Orthopedic and Traumatology Surgery. IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - David Sáez-Martínez
- Departments of Orthopedic and Traumatology Surgery. IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Auñón
- Departments of Orthopedic and Traumatology Surgery. IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Felipe López-Oliva
- Departments of Orthopedic and Traumatology Surgery. IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Belén Pardos-Mayo
- Departments of Orthopedic and Traumatology Surgery. IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Departments of Orthopedic and Traumatology Surgery. IIS-Fundación Jiménez Díaz, Madrid, Spain
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Liu J, Xu L, Zhou A. The effect of continuous proximal adductor block combined with IPACK block on ERAS in total knee arthroplasty. Minerva Med 2021; 112:822-823. [PMID: 33464235 DOI: 10.23736/s0026-4806.20.07247-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Junfeng Liu
- Department of Anesthesiology, Dongying Second People's Hospital, Dongying, Shandong, China
| | - Li Xu
- Department of Anesthesiology, Dongying Second People's Hospital, Dongying, Shandong, China
| | - Aichun Zhou
- Department of Anesthesiology, Dongying Second People's Hospital, Dongying, Shandong, China -
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