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Revision knee

Jesús Gómez-Vallejo, Jorge Albareda-Albareda, Belén Seral-García, Nieves Blanco-Rubio, Laura Ezquerra-Herrando
INTRODUCTION: Modular systems with stems are necessary for the stability of revision total knee arthroplasty (rTKA), but controversy remains as to the best fixation method: cemented or hybrid (noncemented stem). The aim of this study was to assess the clinical, X-ray, life-quality and survival results obtained with each fixation method. MATERIALS AND METHODS: During the period 2000-2013, rTKA was performed on 67 patients (29 cemented arthroplasty and 38 hybrid fixation)...
August 17, 2018: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
Claude Schwartz
BACKGROUND: Osteopenia of the front half of the distal femur is a well-known problem after total knee arthroplasty (TKA) with secondary issues after years, especially when must be addressed fractures or revisions for loosening. Stress shielding has been recognized as a cause in different biomechanical studies of the bone. QUESTION/PURPOSES: It was logical to look for a solution by changing the design to minimize stress shielding behind the femoral shield. PATIENTS AND METHODS: It was proved that radiological measure of bone density was reliable although not so early and accurate as densitometry...
August 16, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Colin K Cantrell, Harshadkumar A Patel, Wesley R Stroud, Nicholas Dahlgren, Eva Lehtonen, Morad Qarmali, Kelly C Stéfani, Ashish Shah, Sameer M Naranje
The number of total knee arthroplasties (TKAs) being performed annually is steadily rising. Recommendations for clinical follow-up guidelines following these arthroplasties is controversial, with no strict guidelines for long-term follow up. Although a few case series exist which identify a minority of patients who require revision TKA for aseptic loosening or pain more than 15 years after index surgery, no published studies have yet described these patients or the pathology present at the time of surgery in detail...
June 13, 2018: Curēus
David A Crawford, Keith R Berend, Adolph V Lombardi
With recent design modifications, proper patient selection, and sound surgical technique, medial unicompartmental knee arthroplasty has demonstrated long-term success in the management of degenerative joint disease. Nevertheless, complications do occur, most often aseptic loosening, tibial fracture, polyethylene wear, bearing dislocation, disease progression, infection, and unexplained pain. Some failures can be managed with retention of the implant, whereas others require revision to total knee arthroplasty (TKA), possibly including augments and stems...
August 14, 2018: Journal of the American Academy of Orthopaedic Surgeons
Marie Reisener, Carsten Perka
Background: Culture-negative periprosthetic joint infections (CN PJI) have not been well studied, and due to the lack of consensus on PJI, especially with culture-negative infections, there are considerable uncertainties. Due to the challenging clinical issue of CN PJI the aim of this systematic review is to describe incidence, diagnosis, and treatment outcomes based on the current literature on CN PJI. Hypothesis: The review is designed to assess the formal hypothesis that CN PJI of the hip and knee have a poorer outcome when compared with culture-positive ones...
2018: BioMed Research International
A Munjal
Dislocation of meniscal bearing insert is a rare but well-recognised complication in meniscal bearing unicompartmental knee arthroplasty (UKA). On the other hand, fracture of meniscal bearing insert of phase III Oxford UKA has only been reported once in the current literature. The authors report a case of fracture and posterior dislocation of one of the fragments of the meniscal bearing insert in a mobile bearing medial UKA. The fracture was only diagnosed during the revision surgery. The posteriorly dislodged fragment was subsequently retrieved through the same skin incision and a new polyethylene insert of the same size was implanted...
July 2018: Malaysian Orthopaedic Journal
Nicholas Bene, Xing Li, Sumon Nandi
BACKGROUND: We sought to determine if reoperation-free survival following irrigation and debridement with polyethylene liner exchange of acutely infected primary TKA is affected by: 1) postoperative antibiotic duration; 2) patient characteristics or surgical factors; 3) infecting organism; or 4) whether infection was acute postoperative versus hematogenous. METHODS: Of revision TKAs from 2004 to 2012 (n = 1735), 76 underwent irrigation and debridement (I&D) with liner exchange after primary TKA with mean 3...
August 13, 2018: Knee
David R Lionberger, Justin Samorajski, Charlie D Wilson, Andreana Rivera
BACKGROUND: Clinicians are often faced with the decision whether to revise a painful total knee replacement in patients who have chronic vague pain with no apparent explanation. A sensitive metal testing assay called the lymphocyte stimulation test has been used to detect nickel sensitization in patients with orthopedic implants. We hypothesize that nickel sensitization plays a role in the pathology of failed joint arthroplasty in patients with unexplained dissatisfaction. METHODS: 32 patients with symptomatic total knee arthroplasty without obvious mechanical findings were tested prior to revision surgery...
August 14, 2018: Journal of Experimental Orthopaedics
Willem A M van Lieshout, Kars P Valkering, Koen L M Koenraadt, Faridi S van Etten-Jamaludin, Gino M M J Kerkhoffs, Rutger C I van Geenen
PURPOSE: Total knee arthroplasty (TKA) is widely used as a treatment for knee osteoarthritis. However, still up to 20% of the patients are dissatisfied. Joint line elevation after TKA might be a contributing factor as it alters knee kinematics. The aim of this study was to investigate the effect of joint line elevation on outcome. METHODS: A systematic review of the literature was performed to select studies that reported on joint line alterations after primary or revision TKA and outcome...
August 14, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Moon Jong Chang, Jin Hwa Jeong, Chong Bum Chang, Young Jun Kim, Bo-Kyung Seo, Min Kyu Song, Taehoon Kang, Seung-Baik Kang
BACKGROUND: Some patients with recurrent symptomatic instability after primary anterior cruciate ligament (ACL) reconstruction have an extension deficiency (ED). This study 1) compared preoperative clinical conditions between the ED and non-ED groups undergoing revision ACL reconstruction, 2) documented clinical and arthroscopic findings in ACL-reconstructed patients with re-instability and ED, and 3) determined whether the ED could be resolved and whether the clinical results of revision surgery differed between the ED and non-ED groups METHODS: This study included 58 patients who underwent revision ACL reconstruction...
August 13, 2018: Scandinavian Journal of Medicine & Science in Sports
Ernesto Muñoz-Mahamud, Ignacio Molinas, Luis Lozano, Jordi Bosch, Laura Morata, Andrés Combalia, Álex Soriano, Guillem Bori
INTRODUCTION: Identification of microorganisms is critical for correct management of an infected arthroplasty. Our hypothesis is that the culture yield depends on the location around the prosthesis from which samples are obtained. METHODS: This prospective study included 298 revisions of the hip (123) and knee (175). We compared the yield of the intraoperative samples obtained, which included synovial fluid (two), neosynovium (two), and periprosthetic membrane (two)...
August 10, 2018: Journal of the American Academy of Orthopaedic Surgeons
Bernardo Innocenti, Gusztáv Fekete, Silvia Pianigiani
Augments are a common solution for treating bone loss in revision total knee arthroplasty and industry is providing to surgeons several options, in terms of material, thickness and shapes. Actually, while the choice of the shape and the thickness is mainly dictated by the bone defect, no proper guidelines are currently available to select the optimal material for a specific clinical situation. Nevertheless, different materials could induce different bone responses and, later, potentially compromise implant stability and performances...
July 23, 2018: Journal of Biomechanical Engineering
Hong-Man Cho, Jae-Woong Seo, Hyun-Ju Lee, Kyu-Bok Kang, Jung-Ryul Kim, Ho-Wook Wee
OBJECTIVE: There is limited literature concerning the outcomes and role of THA as a surgical option for amputee patients. The aim of this study is to determine the mid-to long-term survival and complication rates of cementless total hip arthroplasty (THA) in patients with contralateral below knee amputations. METHODS: A retrospective review of 54 patients with below knee amputation were perfomed who underwent THA for osteoarthritis of the contralateral hip over a 5-year period between 1999 and 2014...
August 7, 2018: Acta Orthopaedica et Traumatologica Turcica
Zhisen Gao, Xiang Li, Yinqiao Du, Yawen Peng, Wenming Wu, Yonggang Zhou
BACKGROUND The aim of this study was to investigate the success rate of fungal peri-prosthetic joint infection treated by 2-stage revision and related factors of treatment failure to offer a better treatment protocol. MATERIAL AND METHODS We reviewed 18 joints (13 knees and 5 hips) of 17 patients (10 women and 7 men) diagnosed with fungal peri-prosthetic joint infection from January 2000 to June 2015 at our institute. The mean follow-up was 65.1 months (range, 25-129 months). All joints were treated with complete debridement, implantation of antifungal-loaded cement spacers, at least 6 weeks of parenteral antifungal agents, and delayed reimplantation...
August 10, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Seung Min Ryu, Chang Hyun Choi, Han Seok Yang, Wook Tae Park, Oog Jin Shon, Sam-Guk Park
PURPOSE: Treatment of a tibial plateau fracture (TPF) remains controversial and is generally challenging. Many authors report good results after conventional open reduction and internal fixation in TPF, but complications still occur. This study analyzed causes and outcomes of revision surgery for TPF. The usefulness of a flow chart for revision surgery in TPF was also evaluated. METHODS: We reviewed all patients who underwent more than two operations for a TPF between 2008 and 2015...
August 8, 2018: International Orthopaedics
Sandro Giannini, Antonio Mazzotti, Deianira Luciani, Giada Lullini, Giuseppe Tedesco, Isabella Andreoli, Matteo Cadossi, Cesare Faldini
OBJECTIVE: To compare the effectiveness in wound healing of negative pressure wound therapy (NPWT) versus a standard dressing in patients who underwent hip or knee revision surgery. METHOD: Participating patients scheduled for hip and knee prosthetic revision were randomised into two groups: one receiving standard povidone-iodine gauze and patch wound dressing (control group) and the other NPWT over the sutured wound area (NPWT group). Patients were evaluated by means of ASEPSIS score, occurrence of blisters, visual analogue scale (VAS) and dressing changes seven days after surgery...
August 2, 2018: Journal of Wound Care
Peter Kloen, Olivier D R van Wulfften Palthe, Jorn Nützinger, Johanna C E Donders
OBJECTIVE: To describe patients' outcomes after revision of tibial plateau fracture fixation within 12 months of the initial surgical procedure. To assess differences in objective outcome scores (IKDC, SF-36, arthrosis score, physical examination) depending on whether patients were treated for mal-reduction, mal-union, or non-union. DESIGN: Retrospective case series. PATIENTS: Twenty-seven patients who underwent revision within 1 year of primary surgery and with a minimum follow up of 1 year...
July 30, 2018: Journal of Orthopaedic Trauma
Jeff Gonzales, Scott T Lovald, Edmund C Lau, Kevin L Ong
Postoperative analgesia after primary total knee arthroplasty (TKA) and revision knee arthroplasty (RKA) can be reliant on the use of opioids and may lead to opioid-related adverse events (ORAEs). This study evaluated the risk of ORAEs following TKA and RKA using the 5% Medicare claims (2010-2013) database. There were 41,702 TKA and 3817 RKA patients who met the inclusion criteria. At 90 days, respiratory complications were the most common complication (TKA: 6.12%; RKA: 8.01%), followed by postoperative nausea and vomiting (TKA: 2...
December 0: Journal of Surgical Orthopaedic Advances
Stefano Zaffagnini, Alberto Grassi, Iacopo Romandini, Maurilio Marcacci, Giuseppe Filardo
PURPOSE: Aim of this study is to document if combined meniscal allograft transplantation (MAT) and ACL reconstruction can improve knee function, reduce pain and allow patients with meniscal defect and ACL lesion to resume sport activities. METHODS: Fifty MAT, arthroscopically performed without bone plugs and combined with one-stage primary or revision ACL reconstruction, with or without high tibial osteotomy (HTO), were included. Patients (aged 38.2 ± 10.6 years, 87% males) were evaluated at a mean follow-up of 5 years with Lysholm, Tegner and VAS scores...
August 6, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Yong Seuk Lee, Hyun Jung Kim, Su Jung Mok, O-Sung Lee
The present systematic review and meta-analysis were conducted to find out how effective any subsequent conversion total knee arthroplasty (TKA) would be after unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) and which is better in outcomes. A rigorous and systematic approach was used. Each of the selected studies was evaluated for methodological quality. Data were extracted by the following standardized protocol: study design, level of evidence, cases enrolled, age, sex ratio, follow-up, kind of index surgery, type of index surgery, average time to failure, mode of failure, surgical data, preclinical score, post-clinical score, and major related complications...
August 6, 2018: Journal of Knee Surgery
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