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Hajebian HH, Burko I, Puyana SI, Van Wert MK, Chaffin A, Jansen DA. Soft Tissue Expansion in Total Knee Arthroplasty Due to Extensive Scarring and Fibrosis in Multiple-Operated Knee. EPLASTY 2022; 22:e33. [PMID: 36000013 PMCID: PMC9361387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Inadequate wound closure is a feared complication following total knee arthroplasty (TKA). A knee with a multiple operative history, excessive scarring, and fibrosed surrounding soft tissue presents a significant challenge. In cases with preoperative uncertainty for sufficient soft tissue coverage because of ischemia and tension on closure, soft tissue expansion (STE) has been reported to be an effective tool for optimizing successful closure. CASE REPORT For the case in this report, STE was performed on a knee with multiple scars, potential ischemia, fibrosis, and soft tissue contractures prior to TKA. CONCLUSIONS In cases of uncertain soft tissue coverage in TKA, the use of STE can be a useful method in creating adequate wound closure.
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Affiliation(s)
| | - Igor Burko
- Division of Plastic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA
- Department of Plastic and Reconstructive Surgery, Ochsner Clinic Foundation, New Orleans, LA
| | | | - Mary K Van Wert
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA
| | - Abigail Chaffin
- Division of Plastic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - David A Jansen
- Division of Plastic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA
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Systematic Review of Tissue Expansion: Utilization in Non-breast Applications. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3378. [PMID: 33564595 PMCID: PMC7862073 DOI: 10.1097/gox.0000000000003378] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
Background Tissue expansion is a versatile reconstructive technique providing well-vascularized local tissue. The current literature focuses largely on tissue expansion for breast reconstruction and in the context of burn and pediatric skin/soft tissue replacement; however, less traditional applications are also prevalent. The aim of this study was to systematically review the utilization of tissue expansion in such less well-characterized circumstances. Methods The authors conducted a systematic review of all publications describing non-breast applications of tissue expansion. Variables regarding expander specifications, expansion process, and complications were collected and further analyzed. Results A total of 565 publications were identified. Of these, 166 publications described tissue expansion for "less traditional" indications, which fell into 5 categories: ear reconstruction, cranioplasty, abdominal wall reconstruction, orthopedic procedures, and genital (penile/scrotal and vaginal/vulva) reconstruction. While lower extremity expansion is known to have high complication rates, tissue expander failure, infection, and exposure rates were in fact highest for penile/scrotal (failure: 18.5%; infection: 15.5%; exposure: 12.5%) and vaginal/vulva (failure: 20.6%; infection: 10.3%; exposure: 6.9%) reconstruction. Conclusions Tissue expansion enables index operations by providing additional skin before definitive reconstruction. Tissue expanders are a valuable option along the reconstructive ladder because they obviate the need for free tissue transfer. Although tissue expansion comes with inherent risk, aggregate outcome failures of the final reconstruction are similar to published rates of complications without pre-expansion. Thus, although tissue expansion requires a staged approach, it remains a valuable option in facilitating a variety of reconstructive procedures.
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Soft Tissue Issues and Considerations in Total Knee Arthroplasty. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Houdek MT, Wagner ER, Wyles CC, Harmsen WS, Hanssen AD, Taunton MJ, Moran SL. Long-Term Outcomes of Pedicled Gastrocnemius Flaps in Total Knee Arthroplasty. J Bone Joint Surg Am 2018; 100:850-856. [PMID: 29762280 DOI: 10.2106/jbjs.17.00156] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Deficient soft tissue following total knee arthroplasty (TKA) can jeopardize outcome. The gastrocnemius flap is an important means of providing coverage of a knee with deficient soft tissue. There is a paucity of long-term studies on the use of the gastrocnemius flap in the setting of TKA. The purpose of this study was to review the outcomes after the use of pedicled gastrocnemius flaps for coverage of a soft-tissue defect at the time of TKA. METHODS Eighty-three patients in whom a gastrocnemius flap had been used to cover the site of a primary (n = 18) or revision (n = 65) TKA over a 25-year period were identified. There were 48 women (58%) and 35 men (42%) with a mean age and body mass index (BMI) of 65 years and 32.6 kg/m. The mean wound size was 49 cm, and the wound was most commonly located over the anterior aspect of the knee/patellar tendon (n = 33). Patients were followed to the time of implant or flap revision, amputation, or death or for a minimum of 2 years (mean, 8 years). Clinical outcomes were assessed using the Knee Society Score (KSS) for pain and the KSS for function. The Kaplan-Meier method was used to assess revision and amputation-free survival. Risk factors for amputation and revision were identified with Cox regression. RESULTS The 10-year revision and amputation-free survival rates following gastrocnemius flap coverage were 68% and 79%, respectively. The risk of implant failure was increased by morbid obesity (BMI of ≥40 kg/m) (hazard ratio [HR] = 2.82, 95% confidence interval [CI] = 1.09 to 7.32, p = 0.03) and ≥5 prior surgical procedures on the knee (HR = 2.68, 95% CI = 1.04 to 6.88, p = 0.04). The risk of amputation was increased in patients with ≥5 prior surgical procedures (HR = 10.76, 95% CI = 2.38 to 48.58, p = 0.002), an age of ≥65 years (HR = 4.94, 95% CI = 1.10 to 22.09, p = 0.03), and a wound size of ≥50 cm (HR = 3.29, 95% CI = 1.14 to 9.53, p = 0.02). Preoperatively the mean KSSs for pain and function were 46 and 28, and these scores significantly (p < 0.05) improved to 78 and 43, respectively, at the time of follow-up. CONCLUSIONS The gastrocnemius flap reliably provides coverage of components used in complex knee reconstruction. A history of multiple surgical procedures on the knee and larger soft-tissue defects increase the risk of revision TKA and of amputation. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Matthew T Houdek
- Departments of Orthopedic Surgery (M.T.H., E.R.W., C.C.W., A.D.H., M.J.T., and S.L.M.) and Biostatistics and Health Sciences Research (W.S.H.) and Division of Plastic and Reconstructive Surgery (S.L.M.), Mayo Clinic, Rochester, Minnesota
| | - Eric R Wagner
- Departments of Orthopedic Surgery (M.T.H., E.R.W., C.C.W., A.D.H., M.J.T., and S.L.M.) and Biostatistics and Health Sciences Research (W.S.H.) and Division of Plastic and Reconstructive Surgery (S.L.M.), Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Departments of Orthopedic Surgery (M.T.H., E.R.W., C.C.W., A.D.H., M.J.T., and S.L.M.) and Biostatistics and Health Sciences Research (W.S.H.) and Division of Plastic and Reconstructive Surgery (S.L.M.), Mayo Clinic, Rochester, Minnesota
| | - William S Harmsen
- Departments of Orthopedic Surgery (M.T.H., E.R.W., C.C.W., A.D.H., M.J.T., and S.L.M.) and Biostatistics and Health Sciences Research (W.S.H.) and Division of Plastic and Reconstructive Surgery (S.L.M.), Mayo Clinic, Rochester, Minnesota
| | - Arlen D Hanssen
- Departments of Orthopedic Surgery (M.T.H., E.R.W., C.C.W., A.D.H., M.J.T., and S.L.M.) and Biostatistics and Health Sciences Research (W.S.H.) and Division of Plastic and Reconstructive Surgery (S.L.M.), Mayo Clinic, Rochester, Minnesota
| | - Michael J Taunton
- Departments of Orthopedic Surgery (M.T.H., E.R.W., C.C.W., A.D.H., M.J.T., and S.L.M.) and Biostatistics and Health Sciences Research (W.S.H.) and Division of Plastic and Reconstructive Surgery (S.L.M.), Mayo Clinic, Rochester, Minnesota
| | - Steven L Moran
- Departments of Orthopedic Surgery (M.T.H., E.R.W., C.C.W., A.D.H., M.J.T., and S.L.M.) and Biostatistics and Health Sciences Research (W.S.H.) and Division of Plastic and Reconstructive Surgery (S.L.M.), Mayo Clinic, Rochester, Minnesota
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Save AV, Wiznia DH, Wang M, Kim CY, Reach JS. The Use of Soft Tissue Expanders Prior to Total Ankle Arthroplasty. Foot Ankle Spec 2017; 10:473-479. [PMID: 28920485 DOI: 10.1177/1938640017695865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Soft tissue coverage and tension-free closure can often be challenging in patients with ankle arthropathy being considered for total ankle arthroplasty. We present 2 patients with severe posttraumatic ankle arthropathy who underwent placement of a soft tissue expander to assist with soft tissue coverage prior to total ankle arthroplasty. LEVELS OF EVIDENCE Level IV.
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Affiliation(s)
- Ameya V Save
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | - Daniel H Wiznia
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | - Mike Wang
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | - Chang-Yeon Kim
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | - John S Reach
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
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Does a thrombin-based topical haemostatic agent reduce blood loss and transfusion requirements after total knee revision surgery? A randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc 2015; 23:3337-42. [PMID: 25011643 DOI: 10.1007/s00167-014-3153-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 06/19/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of the present study was to assess the efficacy of a thrombin-based topical haemostatic in reducing blood requirements after total knee replacement (TKR) revision surgery. METHODS This prospective, randomized, controlled study was designed to evaluate the haemostatic efficacy and safety of a thrombin-based topical haemostatic (Floseal) versus standard treatment in patients receiving total knee revision arthroplasty. The decrease in haemoglobin values postsurgery and the blood units transfused were recorded. The decision to transfuse was made by a surgeon blinded to the patient's group allocation. RESULTS Forty-eight patients were enroled in the study; twenty-four patients each were randomized to the treatment and control groups, respectively. The median decrease in haemoglobin concentration on the first postoperative day was 2.2 g/dL in the treatment group and 2.7 g/dL in the control group. A significant reduction in units of blood transfused was also observed in the treatment group compared with the control group [1.1 ± 1.13 (range 0-4) vs. 1.9 ± 1.41 (range 0-5) blood units; P = 0.04]. No major treatment-related adverse events were recorded in the study. CONCLUSIONS This study shows that a thrombin-based topical haemostatic reduces the need for blood transfusion in TKR revision surgery. CLINICAL RELEVANCE A thrombin-based topical haemostatic agent can be an appropriate solution to enhance haemostasis and vessel sealing at the operative site in TKR revision surgery, in order to reduce the need for blood transfusion after surgery. LEVEL OF EVIDENCE II.
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Abstract
Satisfactory primary wound healing following total joint replacement is essential. Wound healing problems can have devastating consequences for patients. Assessment of their healing capacity is useful in predicting complications. Local factors that influence wound healing include multiple previous incisions, extensive scarring, lymphoedema, and poor vascular perfusion. Systemic factors include diabetes mellitus, inflammatory arthropathy, renal or liver disease, immune compromise, corticosteroid therapy, smoking, and poor nutrition. Modifications in the surgical technique are necessary in selected cases to minimise potential wound complications. Prompt and systematic intervention is necessary to address any wound healing problems to reduce the risks of infection and other potential complications.
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Affiliation(s)
- R E Jones
- University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, Texas, 75390, USA
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Long WJ, Wilson CH, Scott SMC, Cushner FD, Scott WN. 15-year experience with soft tissue expansion in total knee arthroplasty. J Arthroplasty 2012; 27:362-7. [PMID: 21855275 DOI: 10.1016/j.arth.2011.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 06/14/2011] [Indexed: 02/01/2023] Open
Abstract
Preoperative identification of a knee at risk for wound healing after total knee arthroplasty (TKA) allows the surgeon to apply a soft tissue expansion technique to expand the available tissue for closure and healing after TKA. A consecutive series of 64 soft tissue expansions were performed for 59 cases of conflicting incisions and 5 cases of severe angular deformity, with a mean of 3.5 previous surgeries. An average 2.1 expanders were used for a total volume of 359 mL. Expansion took a mean of 70 days during which 14 minor and 7 major complications occurred. There were 8 post-TKA complications, 5 of which required a return to the operating room. Soft tissue expansion is a safe, prophylactic technique that provides adequate coverage in this complex subset of patients.
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Affiliation(s)
- William J Long
- Insall Scott Kelly Institute, New York, New York 10065, USA
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Casey WJ, Rebecca AM, Krochmal DJ, Kim HY, Hemminger BJ, Clarke HD, Spangehl MJ, Smith AA. Prophylactic Flap Reconstruction of the Knee Prior to Total Knee Arthroplasty in High-Risk Patients. Ann Plast Surg 2011; 66:381-7. [PMID: 21301314 DOI: 10.1097/sap.0b013e3181e37c04] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
BACKGROUND Total knee arthroplasty (TKA) in patients with skeletal dysplasias is particularly challenging as a result of the anatomic variances and substantial bony deformities. Little has been written regarding technical considerations that should be made when performing TKA in skeletal dysplasia. QUESTIONS/PURPOSES We describe special operative considerations that must be made when performing TKA on patients with skeletal dysplasia, including implant selection and ligamentous balancing. PATIENTS AND METHODS We retrospectively reviewed 12 TKAs in eight patients with varying degrees of deformity (ranging from 30° of varus to 45° of valgus) secondary to three types of skeletal dysplasias: multiple hereditary exostosis, achondroplasia, and osteogenesis imperfecta. Clinical notes, operative records, and radiographic data were reviewed. Minimum followup was 1 year (average, 4 years; range, 1-10 years). RESULTS We used customized implants in three of the 12 knees. Constrained tibial inserts were used in five knees. All 12 knees underwent releases (soft tissue or epicondylar osteotomy) to address gap balancing or patellar tracking. Average Knee Society scores improved from 35.9 preoperatively to 82.9 postoperatively and average function scores improved from 47.9 preoperatively to 96.7 postoperatively. Complications included two transient peroneal nerve palsies. CONCLUSIONS Special considerations must be made with regard to implant selection and ligamentous balancing as a result of the unusual anatomy and deformities that accompany skeletal dysplasia, but the short-term clinical results reveal consistent improvements in pain and function. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Abstract
Obtaining primary wound healing in total joint arthroplasty is essential to a good result. Wound healing problems can occur and the consequences can be devastating. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as type A, no healing compromises; and type B, systemic or local healing compromising factors present. Local factors include traumatic arthritis, multiple previous incisions, extensive scarring, lymphedema, poor vascular perfusion. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immunocompromise, steroids, smoking, and poor nutrition. In high-risk patients, the surgeon should encourage positive choices such as smoking cessation and nutritional supplementation to elevate the total lymphocyte count and total albumin. Careful planning of incisions, particularly in patients with scarring or multiple previous operations, is productive. Around the knee the vascular viability is better in the medial flap. Thus, use the most lateral previous incision, do minimal undermining, and handle tissue meticulously. We perform all potentially complicated total knee arthroplasties without tourniquet to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound problems. If wound drainage or healing problems occur, immediate action is required. Deep sepsis can be ruled out with a joint aspiration and cell count (>2000), differential (>50% polys), and negative culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be managed by debridement to obtain a live wound.
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Affiliation(s)
- Richard E Jones
- Department Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA.
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12
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Tiengo C, Macchi V, Vigato E, Porzionato A, Stecco C, Azzena B, Morra A, De Caro R. Reversed gracilis pedicle flap for coverage of a total knee prosthesis. J Bone Joint Surg Am 2010; 92:1640-6. [PMID: 20595571 DOI: 10.2106/jbjs.i.00195] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Poor wound-healing and skin necrosis are potentially devastating complications after total knee arthroplasty. Primary soft-tissue coverage with a medial or lateral gastrocnemius transposition flap is typically the first choice for reconstruction. The aim of this study was to evaluate the use of a distally based secondary-pedicle flap of the gracilis muscle for reconstruction of a soft-tissue defect. METHODS The characteristics of the distally based (secondary) pedicles of the gracilis muscle were studied with use of dissection (ten cadavers) and computed tomographic angiograms (fifty patients). On the basis of the anatomical features, an extended reversed gracilis flap based on the secondary pedicles was used in three patients with severe soft-tissue complications of total knee arthroplasty. RESULTS The mean number of secondary pedicles was 1.8 (range, one to four). The pedicles originated from the superficial femoral or popliteal artery. The most proximal pedicle was often the largest (mean caliber, 2.0 mm), and its point of entry into the gracilis muscle was an average (and standard deviation) of 21 +/- 3.6 cm (range, 16 to 28 cm) from the ischiopubic branch. A significant positive association (p = 0.001; r(2) = 0.49) was found between the caliber of the proximal secondary pedicle and the number of other secondary pedicles. In all three patients, the adequate caliber of the secondary pedicles (as shown on preoperative computed tomographic angiograms) and good muscle vascularization confirmed the utility of the gracilis as a distally based pedicle flap. CONCLUSIONS For the treatment of large soft-tissue defects of the patella or the proximal part of the knee, or for soft-tissue reconstruction over an exposed total knee prosthesis, the reversed gracilis pedicle flap may be an alternative to, or may be integrated with, a lateral or medial gastrocnemius flap.
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Affiliation(s)
- C Tiengo
- Section of Anatomy, Department of Human Anatomy and Physiology, School of Medicine, University of Padova, Via A Gabelli 65, 35127 Padova, Italy.
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Abstract
Wound problems can often be prevented with careful planning. When transverse incisions are used for knee surgery many years prior to any anticipated knee arthroplasty, no major problems are typically encountered with a conventional, anterior longitudinal incision. We recommend lateral incisions (eg, after a previous lateral tibial plateau fracture) be reused for TKA. When confronted with multiple previous incisions, surgeons would best use the most recently healed or the most lateral. We prefer soft tissue reconstruction with expanders or a gastrocnemius flap if there are multiple incisions, if the skin and scar tissue are adherent to underlying tissue, or if wound healing seems questionable. Deep infection must be determined by aspiration. When present, we believe treatment must include irrigation, débridement, polyethylene exchange if acute, and resection arthroplasty if chronic. Poor wound healing is a potentially devastating complication that may result in multiple reconstructive procedures and even amputation. Early recognition followed by expeditious débridement and soft tissue reconstruction should be used for managing wound complications after TKA.
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Affiliation(s)
- Kelly G Vince
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Abstract
A retrospective study was done to evaluate the results of total knee arthroplasty performed on 84 knees in 53 patients with spontaneously ankylosed knees, having a preoperative arc of movement between 0 degrees and 20 degrees (average, 14 degrees). The difficulties encountered in surgical exposure were managed by using various extensile exposure techniques. Follow-up ranged from 4 to 15 years (average, 9 years). The average postoperative arc of movement at final follow-up was 75 degrees, with a significant average gain of 61 degrees (P < .01). The average extensor lag was 6 degrees. Four knees had a residual flexion contractures of 5 degrees or less. Total knee arthroplasty in ankylosed knees can achieve correction of deformity with a significant gain in range of motion and marked improvement in quality of life.
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Affiliation(s)
- Ashok Rajgopal
- Department of Orthopedic Surgery, Fortis Hospital, Noida, Uttar Pradesh, India
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Abstract
Wound healing problems after TKA can be minimized by identifying at-risk patients, using postoperative oxygen liberally, careful surgical technique, and allowing wound healing to take priority over early motion. If a wound problem develops, prompt treatment will decrease the risk of catastrophic deep infection.
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Affiliation(s)
- Mary I O'Connor
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
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Abstract
The most common indication for arthrodesis of the knee is an infection at the site of a total knee arthroplasty. Deficiencies in bone stock and poor bone apposition adversely affect the success of a knee arthrodesis. Arthrodesis of the knee can provide a stable, painless extremity for high-functioning patients who are able to walk. Patient function after arthrodesis of the knee is superior to that after above-the-knee amputation. Conversion of a solid knee fusion to a total knee arthroplasty has a substantial complication rate.
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Affiliation(s)
- Janet D Conway
- Rubin Institute for Advanced Orthopaedics, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
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Abstract
To do a successful total knee arthroplasty (TKA), adequate exposure of the tibial plateau and distal femur is required. Difficulty with exposure often is encountered in the patient with a stiff or ankylosed knee. This can lead to complications including component malpositioning and extensor mechanism problems, such as patellar tendon rupture. In these cases where the knee has limited motion preoperatively, knowledge of advanced techniques for soft tissue treatment, and for optimizing exposure are required. Numerous such techniques have been described, including the quadriceps snip, V-Y quadriceps turndown, tibial tubercle osteotomy, and femoral peel. A systematic review of these techniques, including indications and results, based published reports and our experiences, is presented.
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Affiliation(s)
- Michael A Kelly
- Insall Scott Key Institute for Orthopaedics & Sports Medicine, Beth Israel Medical Center-Singer Division, New York, NY 10128, USA
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Rand JA, Ries MD, Landis GH, Rosenberg AG, Haas S. Intraoperative assessment in revision total knee arthroplasty. J Bone Joint Surg Am 2003; 85-A Suppl 1:S26-37. [PMID: 12540667 DOI: 10.2106/00004623-200300001-00007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- James A Rand
- Department of Orthopaedics, Mayo Clinic Scottsdale, AZ 85259, USA
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Affiliation(s)
- F D Cushner
- Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, Beth Israel Medical Center, New York, NY 10128, USA
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