Total knee arthroplasty in stiff knees after previous infection

Between July 1986 and August 1996, we performed 32 total knee arthroplasties (TKA) on 32 patients with partially or completely ankylosed knees secondary to infection. Their mean age at surgery was 40 years (20 to 63) and the mean follow-up was ten years (5 to 13). The mean post-operative range of movement was 75.3° (30 to 115) in those with complete and 98.7° (60 to 130) in those with partial ankylosis. The mean Hospital for Special Surgery knee score increased from 57 to 86 points post-operatively. There were complications in four knees (12.5%), which included superficial infection (one), deep infection (one), supracondylar femoral fracture (one) and transient palsy of the common peroneal nerve (one). Although TKA in the ankylosed knee is technically demanding and has a considerable rate of complications, reasonable restoration of function can be obtained by careful selection of patients, meticulous surgical technique, and aggressive rehabilitation.

[Late results of the surgical treatment of temporomandibular joint ankylosis in children]

Long-term outcome after surgical treatment of temporomandibular joint ankylosis is not always satisfactory in children. Interposition of a temporalis muscle flap is insufficient to ensure good functional results if the surgical procedure is not followed by careful active and passive physiotherapy. The results can be evaluated only after the child has grown.

Microbiology of ligature-induced marginal inflammation around osseointegrated implants and ankylosed teeth in cynomolgus monkeys (Macaca fascicularis)

The microbiota associated with ligature-induced marginal inflammation around osseointegrated dental implants, ankylosed teeth, and normal control teeth was investigated in 8 cynomolgus monkeys (Macaca fascicularis). Submucosal/subgingival plaque was sampled with paper points on the day of literature placement and after 7 weeks. The samples were evaluated by phase-contrast microscopy and by cultivation on enriched non-selective and various solid media. The submucosal/subgingival flora was changed 7 weeks after ligation. The total number of cultivable bacteria and the proportions of motile rods, anaerobic Gram-negative rods, black-pigmented rods, Porphyromonas gingivalis, and Prevotella intermedia increased significantly around implants, ankylosed teeth, and normal control teeth. Except for a significantly higher proportion of anaerobic Gram-positive cocci around implants compared to ankylosed teeth and normal control teeth at the end of the study, no significant microbiological differences were observed between implants, ankylosed teeth, and normal control teeth neither at baseline nor at the end of the study. Consequently, the microbiota associated with marginal inflammation around implants, ankylosed teeth, and normal control teeth appears to be rather similar in cynomolgus monkeys.

Experimentally induced ankylosis and facial asymmetry in the macaque monkey

Six Macaca nemestrina were used for induction of ankylosis by different methods. One TMJ capsule was either (a) mechanically damaged, (b) injected with sodium morrhuate, or (c) injected with a strain of Staphylococcus aureus. The other capsule served as a control. Facial asymmetry of varying degrees was evident from dry-skull preparations and histologically. Sodium morrhuate caused the least degree of alteration; mechanical damage, the most. The effects of Staph. aureus injection into the TMJ seemed to depend upon the length of time elapsed since injection. In one animal there was no change at autopsy after two injections several weeks apart, once on each side; in the other, the capsule injected initially showed no change at autopsy, whereas that injected several weeks prior to autopsy was considerably altered. Induction of ankylosis was achieved with varying degrees of success, causing differing degrees of facial asymmetry.