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Revision knee arthroplasty

Sapan H Shah, Brian E Schwartz, Aaron R Schwartz, Benjamin A Goldberg, Samuel J Chmell
The rate of total knee arthroplasty (TKA) utilization in younger patients (< 65 years old) is increasing. Little is known regarding demographics and in-hospital outcomes in this population. The National Hospital Discharge Survey (NHDS) database was searched using International Classification of Diseases, Ninth Revision (ICD-9) procedure codes for patients admitted to U.S. hospitals for unilateral primary TKA between 2001 and 2010. Patients were separated into young (< 65 years of age) and senior cohorts (≥ 65 years of age)...
October 24, 2016: Journal of Knee Surgery
Gro S Dyrhovden, Anne M Fenstad, Ove Furnes, Øystein Gøthesen
Background and purpose - The long-term effects of computer-assisted surgery in total knee replacement (CAS) compared to conventionally operated knee replacement (CON) are still not clear. We compared survivorship and relative risk of revision in CAS and CON based on data from the Norwegian Arthroplasty Register. Patients and methods - We assessed primary total knee replacements without patellar resurfacing reported to the Norwegian Arthroplasty Register from 2005 through 2014. The 5 most used implants and the 3 most common navigation systems were included...
October 24, 2016: Acta Orthopaedica
R Gaillard, S Lustig, A Peltier, V Villa, E Servien, P Neyret
BACKGROUND: Despite excellent long-term outcomes, posterior stabilisation by a third condyle continues to receive unwarranted criticism regarding patellar complications and instability. HYPOTHESIS: Complication rates with a tri-condylar posterior-stabilised implant are similar to those with other posterior-stabilised prostheses and have diminished over time due to improvements in prosthesis design. MATERIAL AND METHODS: Post-operative complications and revision rates were assessed retrospectively in a prospective cohort of 4189 consecutive patients who had primary total knee arthroplasty (TKA) using a tri-condylar posterior-stabilised implant (Wright-Tornier) and were then followed-up for at least 24 months...
October 19, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Joan Manuel Burdeus González-Solís, Iván Díez-Santacoloma, Albert Isidro Llorens
Anterior tibial tubercle (ATT) osteotomy facilitates exposure in knee arthroplasty. However, it is not without complications. We have introduced some technical modifications that reduce the surgical aggression by designing a short osteotomy that does not invade the intramedullary canal, and synthesizing it with three cerclage wires with a particular layout that increases the solidity of the system. A retrospective review was performed on the surgical revision of total knee replacement cases intervened in our center that required an ATT osteotomy from February 2014 to February 2015, and who had a minimum clinical follow-up of 12 months...
October 21, 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
A C Paulus, S Haßelt, V Jansson, A Giurea, H Neuhaus, T M Grupp, S Utzschneider
Introduction. Increasing interest developed in the use of carbon-fiber-reinforced-poly-ether-ether-ketones (CFR-PEEK) as an alternative bearing material in knee arthroplasty. The effects of CFR-PEEK wear in in vitro and animal studies are controversially discussed, as there are no data available concerning human tissue. The aim of this study was to analyze human tissue containing CFR-PEEK as well as UHMWPE wear debris. The authors hypothesized no difference between the used biomaterials. Methods and Materials...
2016: BioMed Research International
Sarav S Shah, Alexander M Satin, James R Mullen, Sara Merwin, Mark Goldin, Nicholas A Sgaglione
BACKGROUND: Prior to 2012, the American Academy of Orthopaedic Surgeons (AAOS) and American College of Chest Physicians (ACCP) differed in their recommendations for postoperative pharmacologic venous thromboembolism prophylaxis (VTEP) after total joint arthroplasty. More specifically, aspirin (ASA) monotherapy was not endorsed by the ACCP as an acceptable prophylaxis. In 2012, the ACCP supported ASA monotherapy compared with no prophylaxis. Our aim was to investigate the impact of the convergence of ACCP and AAOS recommendations on surgeon prescribing patterns after knee arthroplasty (KA)...
October 20, 2016: Journal of Orthopaedic Surgery and Research
Nicholas Arlas, Harry Jergesen
Factors endemic in safety-net hospitals may breed poor outcomes in hip and knee arthroplasty. This review highlights these challenges and discusses strategies to reduce operative risk and promote better surgical outcomes. Sub-optimally managed medical co-morbidities, poverty, and substance abuse are examples of challenges common in safety-net hospital populations and are associated with poor surgical outcomes. Patient management strategies that positively affect surgical outcomes may be nonexistent, underfunded, or underused...
2016: Journal of Health Care for the Poor and Underserved
David Gøttsche, Thomas Lind, Thorbjørn Christiansen, Henrik M Schrøder
INTRODUCTION: Revision total knee arthroplasty with a cementless metaphyseal sleeve is suggested to be used without stem in revision total knee arthroplasty (rTKA). To the best of our knowledge, no papers investigating this have been published. The purpose of this study was to evaluate clinical outcome. METHOD: In this retrospective study, 71 patients operated with rTKA with sleeves without stem in the period 2009-2011 were identified; 63 were examined. All patients with the prosthesis still in place were invited to a medical examination including X-rays...
October 19, 2016: Archives of Orthopaedic and Trauma Surgery
Christian Scheele, Matthias F Pietschmann, Christian Schröder, Thomas Grupp, Melanie Holderied, Volmar Jansson, Peter E Müller
BACKGROUND: Unicompartmental total knee arthroplasty (UKA) is a well-established treatment option for unicondylar osteoarthritis, and generally leads to better functional results than tricompartimental total knee arthroplasty (TKA). However, revision rates of UKAs are reported as being higher; a major reason for this is aseptic loosening of the tibial component due to implant-cement-bone interface fatigue. The objective of this study was to determine the effects of trabecular bone preparation, prior to implantation of tibial UKAs, on morphological and biomechanical outcomes in a cadaver study...
October 16, 2016: Knee
Olivier Borens, Pablo S Corona, Lars Frommelt, Stergios Lazarinis, Michael Richard Reed, Carlo Luca Romano
Total Joint Arthroplasty (TJA) continues to gain acceptance as the standard of care for the treatment of severe degenerative joint disease, and is considered one of the most successful surgical interventions in the history of medicine. A devastating complication after TJA is infection. Periprosthetic joint infection (PJI), represents one of the major causes of failure and remains a significant challenge facing orthopaedics today. PJI usually requires additional surgery including revision of the implants, fusion or amputations causing tremendous patient suffering but also a heavy health economics burden...
October 19, 2016: Advances in Experimental Medicine and Biology
Anton Khlopas, Michael A Mont, Morad Chughtai, Robert Molloy, Prem N Ramkumar, Steven F Harwin
Revision total knee arthroplasty (TKA) can be challenging in the setting of bone loss. Previously, severe bone loss was managed with impaction grafting and structural allografts; however, these had limited success. Recently, metaphyseal cones have been developed as useful adjuncts with good early outcomes. Presently, there are no published guidelines on how to preoperatively predict the need for metaphyseal cone implantation radiographically. Therefore, the purpose of this study was to evaluate how well preoperative radiographs were able to predict the use of cones in a small series of patients undergoing revision TKA...
October 17, 2016: Journal of Knee Surgery
Leif Claassen, Sarah Ettinger, Marc-Frederic Pastor, Stefan Budde, Henning Windhagen, Thilo Floerkemeier
INTRODUCTION: The diagnostic algorithm in cases of assumed low-grade infection after total knee arthroplasty is discussed controversial. The aim of this study was to evaluate the reliability of neosynovium biopsies via knee arthroscopies in predicting a periprosthetic knee joint infection (PJI). METHODS: From 2010 to 2015, 56 consecutive patients received a diagnostic arthroscopy of the knee joint by reason of an assumed PJI. In 34 cases, a revision arthroplasty was performed after the diagnostic arthroscopy...
October 12, 2016: Archives of Orthopaedic and Trauma Surgery
Martin Roche, Tsun Yee Law, Morad Chughtai, Randa K Elmallah, Zachary Hubbard
INTRODUCTION: The purpose of this study was to: 1) determine the incidence of revision total knee arthroplasty (TKA); 2) correlate the percent of glycated hemoglobin with incidence of revision; and 3) determine the cause of revision in diabetic patients stratified by a glycated hemoglobin level. MATERIALS AND METHODS: We analyzed 424,107 patients from a national private payer database from 2007 to 2015 to determine who had diabetes and underwent TKA. We determined the incidence of revision TKA in the overall cohort and stratified it by glycated hemoglobin levels...
October 6, 2016: Surgical Technology International
B Fink, R Lass
Background: Total hip arthroplasty (THA) is one of the most common and successful surgical procedures in orthopedic surgery and clinical success can be characterized by the revision rate and improvement of function, as well as the patient's satisfaction and pain. Despite the clinical success of primary THA with 10-year survival rates as high as 96 % (Swedish Hip Arthroplasty Register, 2011), the prevalence of groin pain after conventional total hip replacement ranges from 0.4 to 18.3 % and activity-limiting thigh pain is still an existing problem linked to the femoral component of uncemented hip replacement in up to 1...
October 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
Jens Ole Laursen
PURPOSE: The HemiCAP-Wave® implant for the patellofemoral resurfacing treatment of large cartilage lesions and osteoarthritis (OA) was introduced in 2009. The outcome of a prospective cohort study of 18 patients with large trochlea lesions or isolated OA treated with the HemiCAP-Wave® implant is presented with up to a 6-year survival rate, and hypothesised short-to mid-term reduced pain and improved function. METHODS: Indication for treatment with the HemiCAP-Wave® implant was a symptomatic, large cartilage lesion in trochlea demonstrated by MRI or arthroscopy, which was ICRS grades 3-4 and larger than 4 cm(2)...
October 6, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Nirav K Patel, Eric G Kim, Morad Chughtai, Anton Khlopas, Randa D K Elmallah, Steven F Harwin, Ronald E Delanois, Michael A Mont
Highly porous metaphyseal cones are used for the management of large bone defects in revision total knee arthroplasty. These cones fill defects and allow bony ongrowth while providing several sizing and offset options. In this case series, we evaluated three patients who received these latest generation metaphyseal cones. Specifically, these cases will be explored in detail with respect to history, indications, operative technique, and short-term outcomes. Overall, these newer generation porous coated cones are excellent options for large contained bone loss in the absence of infection, and they have demonstrated good clinical and radiological outcomes at short-term follow-up...
October 6, 2016: Journal of Knee Surgery
Friedrich Boettner, Gabriele Koehler, Alexander Wegner, Tom Schmidt-Braekling, Georg Gosheger, Christian Goetze
OBJECTIVE: The current study investigates the diagnostic accuracy of the criteria described for frozen sections and whether modern leukocyte specific staining techniques including leukocyte peroxidase and Naphtol-AS-D-chloroacetate-esterase will improve the accuracy of the intra-operative histology. METHOD: 77 patients undergoing revision total hip and knee arthroplasty were included in this retrospective study. Patients were grouped into septic and aseptic based on intraoperative cultures...
2016: Open Orthopaedics Journal
Miguel Ortega-Andreu, Gloria Talavera, Norma G Padilla-Eguiluz, Hanna Perez-Chrzanowska, Reyes Figueredo-Galve, Carlos E Rodriguez-Merchán, Enrique Gómez-Barrena
PURPOSE: To clarify if blood loss and transfusion requirements can be decreased in revision knee surgery through a multimodal blood loss approach with tranexamic acid (TXA). PATIENTS AND METHODS: A retrospective study was designed in 87 knees (79 patients) that received a knee revision between 2007 and 2013. To avoid heterogeneity in the surgical technique, only revisions with one single implant system were included. A treatment series of 44 knees that received TXA and other techniques in a multimodal blood loss protocol was compared to a control series of 43 knees that received neither TXA nor the rest of the multimodal blood loss protocol...
2016: Open Orthopaedics Journal
Bilal Farouk El-Zayat, Thomas J Heyse, Nelson Fanciullacci, Luc Labey, Susanne Fuchs-Winkelmann, Bernardo Innocenti
INTRODUCTION: No evidence-based guidelines are available to determine the appropriate stem length, and whether or not to cement stems in revision total knee arthroplasty (TKA). Therefore, the objective of this study was to compare stresses and relative movement of cemented and uncemented stems of different lengths using a finite element analysis. MATERIALS AND METHODS: A finite element model was created for a synthetic tibia. Two stem lengths (95 and 160 mm) and two types of fixation (cemented or press fit) of a hinged TKA were examined...
October 4, 2016: Archives of Orthopaedic and Trauma Surgery
Michael E Steinhaus, Alexander S McLawhorn, Shawn S Richardson, Patrick Maher, David J Mayman
BACKGROUND: Proper alignment of total knee arthroplasty (TKA) is essential for TKA function and may reduce the risk of aseptic failure. Technologies that prevent malalignment may reduce the risk of revision surgery. QUESTIONS/PURPOSES: The purpose of this study was to compare two competing TKA systems that purport improved alignment: patient-specific instrumentation (PSI), and a handheld portable navigation device (NAV). METHODS: After IRB approval, 49 consecutive PSI TKAs (40 patients) were matched based on preoperative characteristics to 49 NAV TKAs (40 patients) performed by a single surgeon...
October 2016: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
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