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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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Abstract
BACKGROUND Free flap coverage in the setting of a total knee arthroplasty is rare. The purpose of the current study was to evaluate the outcome of patients who underwent a free flap to assist with soft-tissue coverage following a complex total knee arthroplasty. METHODS The authors used their institutional total joint registry to retrospectively review patients undergoing a free soft-tissue flap in the setting of complex primary and revision total knee arthroplasty. Among 29,069 primary and 6433 revision total knee arthroplasties from 1994 to 2017, eight (0.02 percent) required a free flap for wound coverage. This included three primary total knee arthroplasties (0.01 percent) for posttraumatic arthritis and five revision total knee arthroplasties (0.07 percent) in the setting of infection. Median follow-up was 4 years. RESULTS Free flaps included vertical rectus abdominis (n = 3), anterior lateral thigh (n = 2), latissimus (n = 2), and transverse rectus abdominis (n = 1). There were no total flap losses; however, one patient required additional skin grafting. Reoperation occurred in six patients, of which four were revisions of the total knee arthroplasty for infection (n = 2) and tibial component loosening (n = 2). One patient ultimately underwent transfemoral amputation for persistent infection. Following reconstruction, there was improvement in the median Knee Society Score (49 versus 82; p = 0.03) and total range of motion between preoperative and postoperative assessments (70 degrees versus 85 degrees; p = 0.14). CONCLUSION Free flap coverage in the setting of total knee arthroplasty was associated with a high rate of reoperation; however, the limb was able to be preserved in the majority of patients, with a reasonable functional outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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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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Electricwala AJ, Amanatullah DF, Narkbunnam RI, Huddleston JI, Maloney WJ, Goodman SB. Comprehensive Operative Note Templates for Primary and Revision Total Hip and Knee Arthroplasty. Open Orthop J 2016; 10:725-731. [PMID: 28144382 PMCID: PMC5220177 DOI: 10.2174/1874325001610010725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adequate preoperative planning is the first and most crucial step in the successful completion of a revision total joint arthroplasty. The purpose of this study was to evaluate the availability, adequacy and accuracy of operative notes of primary surgeries in patients requiring subsequent revision and to construct comprehensive templates of minimum necessary information required in the operative notes to further simplify re-operations, if they should become necessary. METHODS The operative notes of 144 patients (80 revision THA's and 64 revision TKA's) who underwent revision total joint arthroplasty at Stanford Hospital and Clinics in the year 2013 were reviewed. We assessed the availability of operative notes and implant stickers prior to revision total joint arthroplasty. The availability of implant details within the operative notes was assessed against the available surgical stickers for adequacy and accuracy. Statistical comparisons were made using the Fischer-exact test and a P-value of less than 0.05 was considered statistically significant. RESULTS The primary operative note was available in 68 of 144 revisions (47%), 39 of 80 revision THAs (49%) and 29 of 66 revision TKAs (44%, p = 0.619). Primary implant stickers were available in 46 of 144 revisions (32%), 26 of 80 revision THAs (32%) and 20 of 66 revision TKAs (30%, p = 0.859). Utilizing the operative notes and implant stickers combined identified accurate primary implant details in only 40 of the 80 revision THAs (50%) and 34 of all 66 revision TKAs (52%, p = 0.870). CONCLUSION Operative notes are often unavailable or fail to provide the necessary information required which makes planning and execution of revision hip and knee athroplasty difficult. This emphasizes the need for enhancing the quality of operative notes and records of patient information. Based on this information, we provide comprehensive operative note templates for primary and revision total hip and knee arthroplasty.
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Affiliation(s)
- Ali J. Electricwala
- Stanford University Department of Orthopaedic Surgery, 450 Broadway Street, Redwood City, CA 94063-6342, USA
- Electricwala Hospital and Clinics, Pune, Maharashtra, India
| | - Derek F. Amanatullah
- Stanford University Department of Orthopaedic Surgery, 450 Broadway Street, Redwood City, CA 94063-6342, USA
| | - Rapeepat I. Narkbunnam
- Siriraj Hospital, Department of Orthopaedic Surgery, Mahidol University, Bankok, Thailand
| | - James I. Huddleston
- Stanford University Department of Orthopaedic Surgery, 450 Broadway Street, Redwood City, CA 94063-6342, USA
| | - William J. Maloney
- Stanford University Department of Orthopaedic Surgery, 450 Broadway Street, Redwood City, CA 94063-6342, USA
| | - Stuart B. Goodman
- Stanford University Department of Orthopaedic Surgery, 450 Broadway Street, Redwood City, CA 94063-6342, USA
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Hansen DC, Moon WK, Kusuma SK. Prophylactic Free Flap for Chronic Lower-Extremity Soft-Tissue Defect Prior to Total Knee Arthroplasty: A Case Report. JBJS Case Connect 2013; 3:e75. [PMID: 29252614 DOI: 10.2106/jbjs.cc.m.00005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Dane C Hansen
- Department of Orthopaedic Surgery, Doctors Hospital Medical Education, 5100 West Broad Street, Columbus, OH 43228.
| | - Wong K Moon
- Department of Plastic Surgery (W.K.M.), Department of Orthopaedic Surgery (S.K.K.), Grant Medical Center, 393 East Town Street, Columbus, OH 43215
| | - Sharat K Kusuma
- Department of Plastic Surgery (W.K.M.), Department of Orthopaedic Surgery (S.K.K.), Grant Medical Center, 393 East Town Street, Columbus, OH 43215
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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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Dennis DA. A stepwise approach to revision total knee arthroplasty. J Arthroplasty 2007; 22:32-8. [PMID: 17570275 DOI: 10.1016/j.arth.2007.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Accepted: 01/03/2007] [Indexed: 02/01/2023] Open
Abstract
Successful revision total knee arthroplasty requires detailed preoperative planning and then a meticulous, stepwise execution of the predetermined plan. Critical factors in revision total knee arthroplasty include the choice of skin incision, type of surgical approach, and component removal without removal of substantial additional bone. The surgeon must then assess the degree of bone loss and ligamentous stability and the position of the current joint line, and then determine the type of bone graft, prosthetic components, and fixation methods required to correct the intraoperative deficiencies. Accurate restoration of flexion-extension gap balance is imperative to ensure long-term successful results.
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Affiliation(s)
- Douglas A Dennis
- Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee, USA
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Abstract
UNLABELLED Safely obtaining adequate exposure at the time of revision total knee arthroplasty is an integral step in successfully performing the procedure. A medial capsular approach combined with an extensive intraarticular synovectomy provides adequate exposure for most patients. If further exposure is required, a quadriceps snip can be used to free the proximal extensor mechanism. The benefits of this approach include its technically simple nature and an unaltered postoperative rehabilitation regimen. We report a series of 126 consecutive revision knee procedures in which a medial capsular approach was adequate in 111 cases, representing 92% of the patients with an intact extensor mechanism. A quadriceps snip was required in nine cases. If more extensive exposure is required for an excessively stiff or difficult to expose knee, a tibial tubercle osteotomy or V-Y quadricepsplasty provides wider exposure. LEVEL OF EVIDENCE Therapeutic study, level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, 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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Affiliation(s)
- Douglas A Dennis
- Rocky Mountain Musculoskeletal Research Laboratory, Denver, Col 80222, USA
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Manifold SG, Cushner FD, Craig-Scott S, Scott WN. Long-term results of total knee arthroplasty after the use of soft tissue expanders. Clin Orthop Relat Res 2000:133-9. [PMID: 11064982 DOI: 10.1097/00003086-200011000-00017] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The success of total knee arthroplasty can be jeopardized by poor wound healing. In the current study, the results of knee arthroplasty after soft tissue expansion were reviewed retrospectively in 27 patients (29 knees) at risk for problematic healing. The incidence of wound complications was recorded for all patients after the expansion procedure and the arthroplasty. A Knee Society score also was calculated at the latest evaluation. Minor wound complications occurred after 21% (six of 29) of the tissue expansion procedures and after 18% (five of 28) of the subsequent arthroplasties. One major wound complication occurred during tissue expansion necessitating abandonment of the planned arthroplasty. No major wound complications occurred in those patients who underwent knee arthroplasty. At an average followup of 34.4 months, the average Knee Society score was 83.7 points. The results of the current study show that the technique of soft tissue expansion before total knee arthroplasty in patients at high risk for wound healing problems can successfully prevent catastrophic wound complications after the arthroplasty procedure and can avoid the need for disfiguring soft tissue reconstructions.
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Affiliation(s)
- S G Manifold
- Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, Beth Israel Medical Center-Singer Division, New York, NY, USA
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Abstract
The outcomes of total knee arthroplasty for post-traumatic arthrosis were studied in 31 knees. The average age at arthroplasty was 60 years old (range, 36-78 years). The interval from fracture to total knee arthroplasty averaged 13 years. Simultaneous corrective osteotomy was necessary in 4 patients to correct axial alignment and preserve ligamentous integrity. Follow-up averaged 46 months. Mean arc of motion increased significantly, from 94 degrees to 100 degrees (P = .027). Average function score improved from 44 to 72 points. This change was statistically significant (P<.0001). Knee Society knee scores also improved significantly, from 36 to 78 points (P<.0001). At most recent follow-up, the functional scores were considered excellent or good in 58%; knee scores were considered excellent or good in 71% of cases. All periarticular osteotomies and tibial tubercle osteotomies healed uneventfully within 16 weeks. Complications occurred in 57% of cases, including aseptic failure (26%), septic failure (10%), patellar tendon rupture (3%), patellar subluxation (6%), thromboembolism (6%), and wound breakdown requiring debridement and muscle flap coverage (6%). Despite significant improvements in motion and function, patients with post-traumatic arthrosis are susceptible to high rates of complications. Adverse outcomes can be minimized by restoring limb alignment, soft tissue balance, and component alignment and by preserving vascularity of the skin and subcutaneous tissues.
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Affiliation(s)
- J H Lonner
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, USA
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Masri BA, Campbell DG, Garbuz DS, Duncan CP. Seven specialized exposures for revision hip and knee replacement. Orthop Clin North Am 1998; 29:229-40. [PMID: 9553568 DOI: 10.1016/s0030-5898(05)70321-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With the increasing rates and complexity of revision hip and knee arthroplasty, it has become more important than ever to approach the joint in a safe and rational manner. The development of extensile approaches have significantly simplified the removal of solidly fixed components without compromising bone stock. The extended trochanteric osteotomy enables controlled access to the femoral component and is a useful technique for revision of solidly-fixed femoral components. The trochanteric slide allows comprehensive exposure of the acetabulum and femur comparable to trochanteric osteotomy with a diminished risk of trochanteric escape. The vastus slide allows wide exposure of the femoral shaft when using an anterolateral approach. In revision total knee arthroplasty, the extensor mechanism is often at risk of disruption or avulsion, and in most cases, maneuvers that allow wide exposure of the femur and tibia while preserving the extensor mechanism are essential. Such exposures include one of the extensor mechanism reflecting techniques either proximally by rectus snip or patellar turndown, or distally by tibial tubercle osteotomy. Occasionally a femoral peel or epicondylar osteotomy is required. There should be a low threshold to consider one of these specialized approaches during revision hip and knee arthroplasty.
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Affiliation(s)
- B A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
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