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Revision knee

Tomas A Correa, Bidyut Pal, Richard J van Arkel, Felice Vanacore, Andrew A Amis
BACKGROUND: Revision total knee arthroplasty (RTKA) has poorer results than primary total knee arthroplasty (TKA), and the prostheses are invasive and cause strain-shielding of the bones near the knee. This paper describes an RTKA system with extracortical fixation. It was hypothesised that this would reduce strain-shielding compared with intramedullary fixation. METHODS: Twelve replica tibiae were prepared for full-field optical surface strain analysis. They were either left intact, implanted with RTKA components with cemented intramedullary fixation stems, or implanted with a novel design with a tibial tray subframe supported by two extracortical fixation plates and screw fixation...
October 10, 2018: Medical Engineering & Physics
Annett Klinder, Sarah Zaatreh, Martin Ellenrieder, Sylvio Redanz, Andreas Podbielski, Tobias Reichel, Hans Bösebeck, Wolfram Mittelmeier, Rainer Bader
Two-stage revision arthroplasty is the treatment of choice for periprosthetic infection, a serious complication after knee or hip arthroplasty. Our prospective clinical trial aimed to investigate the concentrations of gentamicin and vancomycin in wound exudate and tissue in two-stage revision arthroplasty. Wound exudate and periprosthetic membrane samples were collected from 18 patients (10 hip and eight knee patients), who were due for two-stage treatment after a periprosthetic joint infection. Samples were taken during insertion of antibiotic-impregnated spacers and after their removal...
October 12, 2018: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
Nicholas J Zarkadis, Philip J Belmont, Michael A Zachilli, Courtney A Holland, Allison R Kinsler, Michael S Todd, Mark P Pallis, Brian R Waterman
BACKGROUND: The occupational and functional results of patellofemoral autologous chondrocyte implantation (ACI) are underreported. This investigation sought to establish clinical outcomes and rates for return to work in a predominantly high-demand military cohort undergoing this procedure. PURPOSE: To determine the return-to-work, pain relief, and perioperative complication rates in a high-demand athletic cohort undergoing patellofemoral ACI. STUDY DESIGN: Case series; Level of evidence, 4...
October 11, 2018: American Journal of Sports Medicine
Bertrand Sonnery-Cottet, Cesar Praz, Nikolaus Rosenstiel, William G Blakeney, Herve Ouanezar, Vikram Kandhari, Thais Dutra Vieira, Adnan Saithna
BACKGROUND: Ramp lesions are characterized by disruption of the peripheral meniscocapsular attachments of the posterior horn of the medial meniscus. Ramp repair performed at the time of anterior cruciate ligament reconstruction (ACLR) has been shown to improve knee biomechanics. PURPOSE: The primary objectives of this study were to evaluate the incidence of and risk factors for ramp lesions among a large series of patients undergoing ACLR. Secondary objectives were to determine the reoperation rate for failure of ramp repair, defined by subsequent reoperations for partial medial meniscectomy...
October 11, 2018: American Journal of Sports Medicine
Jimmy Chow, Tsun Yee Law, Martin Roche
Total knee arthroplasty (TKA) is a highly successful procedure with utilization expected to grow substantially over the coming decades. However, the revision burden has not concurrently improved, with over 30% of revisions related to technical imperfections (Mulhall KJ, Ghomrawi HM, Scully S, Callaghan JJ, Saleh KJ, Clin Orthop Relat Res 446:45, 2006; Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM, Clin Orthop Relat Res 404:7, 2002; Wylde V, Hewlett S, Learmonth ID, Dieppe P, Pain 152(3):566, 2011)...
2018: Advances in Experimental Medicine and Biology
Robert C Spang, Frances A Tepolt, Nikolaos K Paschos, Lauren H Redler, Eric A Davis, Mininder S Kocher
OBJECTIVES: A variety of surgical options exist to treat the challenging problem of recurrent patellar instability in children and adolescents. The goal of the current study is to describe a novel combined reconstruction technique of both the medial patellofemoral ligament (MPFL) and the medial quadriceps tendon-femoral ligament (MQTFL) and report patient outcomes of a single-surgeon series. METHODS: All patients studied underwent simultaneous MPFL and MQTFL reconstruction for patellar instability using gracilis allograft...
October 8, 2018: Journal of Pediatric Orthopedics
Sanjeev Agarwal, Devdatta Suhas Neogi, Rhidian Morgan-Jones
BACKGROUND: Metal metaphyseal sleeves are an option for reconstruction as well as enhancing fixation in managing challenging bone defects in revision knee replacement. We report our results of revision knee replacement using metaphyseal sleeves with a minimum of seven years of follow-up. METHODS: The records of 103 patients (104 knees) who underwent revision knee replacement using metaphyseal sleeves in our centre were evaluated. The follow-up included clinical assessment, functional scores and radiologic assessment...
October 5, 2018: Knee
Barbara H Currier, Paul J Hecht, James A Nunley, Michael B Mayor, John H Currier, Douglas W Van Citters
BACKGROUND: Although advances in joint-replacement technology have made total ankle arthroplasty a viable treatment for end-stage arthritis, revision rates for ankle replacements are higher than in hip or knee replacements. The questions asked in this study were what can retrieved ankle devices demonstrate about ankle arthroplasty failures and how can understanding the causes of these failures inform clinical decisions for current and future ankle arthroplasty patients? METHODS: An IRB-approved retrieval laboratory received retrieved components and surgeon-supplied reason for revision from 70 total-ankles (7 designs, including 5 currently marketed designs) from 2002 to 2018...
October 8, 2018: Foot & Ankle International
M Křivohlávek, J Šrám, J Pazour, M Kloub
PURPOSE OF THE STUDY The locked nailing of diaphyseal fractures of the tibia currently represents a method of choice for treating the closed diaphyseal fractures, some of the tibial metaphyseal fractures and open tibial diaphyseal fractures classified as grade I and II according to Gustilo-Anderson (GA) classification. The suprapatellar (SP) approach is an alternative technique of insertion of the nail in semi-extension of the lower extremity with easier reduction, namely of multiple fractures and proximal diaphyseal fractures of the tibia in particular...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
D Y Ponzio, L Weitzler, A deMeireles, C I Esposito, T M Wright, D E Padgett
AIMS: The aim of this study was to evaluate the surface damage, the density of crosslinking, and oxidation in retrieved antioxidant-stabilized highly crosslinked polyethylene (A-XLPE) tibial inserts from total knee arthroplasty (TKA), and to compare the results with a matched cohort of standard remelted highly crosslinked polyethylene (XLPE) inserts. MATERIALS AND METHODS: A total of 19 A-XLPE tibial inserts were retrieved during revision TKA and matched to 18 retrieved XLPE inserts according to the demographics of the patients, with a mean length of implantation of 15 months (1 to 42)...
October 2018: Bone & Joint Journal
Jess H Lonner, Mitchell R Klement
Medial unicompartmental knee arthroplasty (UKA) has several benefits over total knee arthroplasty for the surgical treatment of isolated medial compartmental arthritis in the knee, including reduced surgical risk and postoperative morbidity, rapid recovery, more normal kinematics, greater patient satisfaction, and shorter hospitalization. Nonetheless, there is substantial concern about the higher revision rates and lower survivorship in UKA compared to those in total knee arthroplasty. Robotic assistance has been advanced to improve the precision of bone preparation, component alignment, and quantified ligament balance in UKA, with the ultimate goal of improving kinematics and implant survivorship...
October 4, 2018: Journal of the American Academy of Orthopaedic Surgeons
Joel Wei-An Lim, Jerry Yongqiang Chen, Hwei Chi Chong, Hee Nee Pang, Darren Keng Jin Tay, Shi-Lu Chia, Ngai Nung Lo, Seng Jin Yeo
PURPOSE: The purpose of this study was to assess 10-year functional outcome and survivorship analysis of patients with significant radiographic evidence of patellofemoral joint arthritis treated with fixed bearing unicompartmental knee arthroplasty. METHODS: Two hundred and sixteen patients (263 knees) that underwent UKA from 2003 to 2005 for a mean of 10.5 ± 2.1 years were prospectively followed up. Preoperative radiological assessment of the patellofemoral joint state was assessed according to the Ahlback classification by an independent assessor and radiographically significant patellofemoral disease was defined as grade 2 or more...
October 4, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Feng-Chih Kuo, Pao-Yen Lin, Jun-Wen Wang, Po-Chun Lin, Mel S Lee, Antonia F Chen
Purpose: Massive perioperative blood loss in complex revision total joint arthroplasty (TJA) often requires blood transfusions. Tranexamic acid (TXA) has been used in elective primary TJA to minimize blood loss and transfusions. The purpose of this meta-analysis was to evaluate the safety and efficacy of intravenous TXA in revision TJA. Methods: A literature search of PubMed, Scopus, and the Cochrane Controlled Trials Register was performed to identify studies published between January 2000 and May 2017...
2018: Drug Design, Development and Therapy
Charlotte M Mallon, Rachael Gooberman-Hill, Andrew J Moore
BACKGROUND: Approximately 340,000 knee replacements are performed each year in the USA and UK. Around 1% of patients who have had knee replacement develop deep infection around the prosthesis: periprosthetic knee infection. Treatment often requires a combination of one or more major operations and antibiotic therapy. This study aimed to understand and characterise patients' experiences of periprosthetic knee infection. METHODS: Qualitative semi-structured interviews were conducted with 16 patients (9 men, 7 women; 59-80 years, mean age 72) who experienced periprosthetic knee infection and subsequent revision treatment in six National Health Service orthopaedic departments...
October 2, 2018: BMC Musculoskeletal Disorders
Jean-Louis Prudhon, Régis Verdier, Jacques H Caton
INTRODUCTION: Using a cementless fixation for total knee arthroplasty (TKA) is controversial. We hypothesized that cementless tibial base plate with a monoblock long stem (MLS) would provide secure tibial alignment and stable fixation when bone conditions were considered as poor for a cementless fixation. The purpose of this study was to compare the mean eight year survivorship of cementless standard keels (SK) vs cementless MLS. MATERIAL METHODS: We report a matched series of 98 cases of SK and 98 cases of MLS in patients with poor bone conditions...
October 3, 2018: International Orthopaedics
Martin Roche, Tsun Yee Law, Jennifer Kurowicki, Nipun Sodhi, Samuel Rosas, Leah Elson, Spencer Summers, Karim Sabeh, Michael A Mont
Nutritional status has become increasingly important in optimizing surgical outcomes and preventing postoperative infection and wound complications. However, currently, there is a paucity in the orthopaedics literature investigating the relationship between nutritional status and wound complications following total knee arthroplasty (TKA). Therefore, the purpose of this study was to determine the prevalence of (1) postoperative infections, (2) wound complications, (3) concomitant infection with wound (CoIW) complication, and (4) infection followed by wound complication by using (1) albumin, (2) prealbumin, and (3) transferrin levels as indicators of nutritional status...
October 3, 2018: Journal of Knee Surgery
Zaki Suliman Alhifzi, Yousef Tawfik Khoja, Gavin C Wood
In total primary knee replacement surgery, the use of all-polyethylene tibial (APT) components has many advantages, including no backside wear and no linear dissociation. In addition, the greater polyethylene thickness permits more conservative bone resection compared with that for metal-backed components, with a lower unit cost and similar functional results. Thus, the use of an APT in primary total knee arthroplasty remains an attractive option. This is a review of 158 patients who underwent primary knee replacement using APT components from a single manufacturer...
October 3, 2018: Journal of Knee Surgery
Chloe E H Scott, Katrina R Bell, Richard T Ng, Deborah J MacDonald, James T Patton, Richard Burnett
PURPOSE: Over 2 million Triathlon single-radius total knee arthroplasties (TKAs) have been implanted worldwide. This study reports the 10-year survival and patient-reported outcome of the Triathlon TKA in a single independent centre. METHODS: From 2006 to 2007, 462 consecutive cruciate-retaining Triathlon TKAs were implanted in 426 patients (median age 69 (21-89), 289 (62.5%) female). Patellae were not routinely resurfaced. Patient-reported outcome measures (SF-12, Oxford Knee Scores (OKS), satisfaction) were assessed preoperatively and at 1, 5 and 10 years when radiographs were reviewed...
October 1, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Kinh Luan Thanh Dang, Helen Badge, Ian A Harris
BACKGROUND: Evaluating the effectiveness of total hip arthroplasty (THA) and total knee arthroplasty (TKA) often relies on accurate patient reporting of postoperative complications. Despite this, there is little research regarding the accuracy of patient reports. We aimed to determine the accuracy of patient-reported significant complications after THA and TKA. METHODS: Patients were recruited prior to undergoing primary hip or knee arthroplasty at 19 high-volume hospitals...
May 2018: Journal of Orthopaedic Surgery
David Dejour, Marco Pungitore, Jeremy Valluy, Luca Nover, Mo Saffarini, Guillaume Demey
PURPOSE: The aim of this study was to determine patient and anatomic factors that influence anteroposterior and rotational laxity in knees with ACL tears. Based on the findings of biomechanical studies, we hypothesized that static and dynamic anterior tibial translation (ATT) as well as positive pivot shift would increase with female gender, tibial slope, and meniscal tears. METHODS: The authors prospectively collected preoperative data and intraoperative findings of 417 patients that underwent ACL reconstruction...
September 29, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
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