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Lee SA, Kang SB, Chang CB, Chang MJ, Kim YJ, Song MK, Jeong JH. Does the severity or cause of preoperative stiffness affect the clinical results and range of motion after total knee arthroplasty? PLoS One 2018; 13:e0205168. [PMID: 30308050 PMCID: PMC6181344 DOI: 10.1371/journal.pone.0205168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 09/20/2018] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to assess the overall clinical results and range of motion (ROM) after total knee arthroplasty (TKA) in patients with preoperative stiffness. We also aimed to determine whether the severity or cause of the stiffness can affect the clinical outcome after surgery. This retrospective study included 122 knees (117 patients) with follow-up of more than 2 years (mean age, 64.3 years). TKA was performed using posterior-stabilized, varus-valgus constrained (VVC), and hinged prostheses. To determine the effect of the severity of stiffness on the clinical outcome, the subjects were divided into two groups: the severe group (preoperative ROM ≤ 50°; 18 knees) and the moderate group (preoperative ROM, 50°–90°; 104 knees). Then, clinical results and ROM were compared according to the severity or cause of preoperative stiffness. After surgery, preoperative ROM (mean, 78°; range, 25°- 90°) was improved (mean, 107°; range, 70°- 130°). The severe group more frequently used the VVC or hinged prostheses (72% vs. 18%). Furthermore, the severe group had worse knee and function scores as well as more complications (33% vs. 13%), even though the severe group had a greater ROM increment (47° vs. 27°) after surgery. Patients with osteoarthritis and rheumatoid arthritis showed better ROM and clinical results compared to patients with infectious or traumatic arthritis. Although TKA in stiff knees can be successful, the results are inferior in knees with severe stiffness and knees with infectious or traumatic arthritis.
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Affiliation(s)
- Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
- * E-mail:
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Young Jun Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Min Kyu Song
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Jin Hwa Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
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Polascik BW, Bin Abd Razak HR, Chong HC, Lo NN, Yeo SJ. Acceptable Functional Outcomes and Patient Satisfaction Following Total Knee Arthroplasty in Asians with Severe Knee Stiffness: A Matched Analysis. Clin Orthop Surg 2018; 10:337-343. [PMID: 30174810 PMCID: PMC6107827 DOI: 10.4055/cios.2018.10.3.337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/05/2018] [Indexed: 11/17/2022] Open
Abstract
Background This study evaluated outcomes following total knee arthroplasty for severely stiff knees in Asians. Methods Registry data of patients undergoing primary total knee arthroplasty between 2004 and 2013 were collected and retrospectively reviewed. Sociodemographic and anthropometric data together with the Oxford Knee Score and the Knee Society Score (Knee Society Knee Score and the Knee Society Function Score) were collected both preoperatively and postoperatively for up to 2 years. Case subjects consisted of patients with a preoperative flexion range of ≤ 20°. Control subjects consisted of patients with a preoperative flexion range of > 90°. Patients were matched for age, sex, and all preoperative scores in a 2:1 fashion. Two-year outcomes and 5-year revision rates were then compared between cases and controls. Results There were 28 cases and 56 controls. Cases had a significantly lower body mass index than the controls (p = 0.003) and had a longer hospital stay (p < 0.0001). At 2 years, cases had a significantly lower flexion range (p < 0.001) and a lower Knee Society Function Score (p = 0.020) than the controls. Cases had a significantly greater improvement in the flexion range (p < 0.001) postoperatively than controls. The mean change in functional outcomes at 2 years was comparable between the two groups. Seventy-one percent of the cases and 88% of controls were satisfied. There was a significant difference in the 5-year revision rate (10% vs 0%, p = 0.013). More cases were discharged to a rehabilitation facility compared to controls (p = 0.011). There were no differences in inpatient complication rates. Conclusions Functional outcomes and patient satisfaction were acceptable following total knee arthroplasty in Asian patients with severe knee stiffness.
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Affiliation(s)
| | | | - Hwei-Chi Chong
- SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Program, Singapore
| | - Ngai-Nung Lo
- SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Program, Singapore
| | - Seng-Jin Yeo
- SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Program, Singapore
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Kim HJ, Mun JU, Kim KH, Kyung HS. Total knee arthroplasty conversion for patients with ankylosed knees. J Orthop Surg (Hong Kong) 2017; 25:2309499016684095. [PMID: 28142345 DOI: 10.1177/2309499016684095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate the results of total knee arthroplasty for patients with ankylosed knees. METHODS We evaluated seven patients (10 knees) who underwent total knee arthroplasties for ankylosed knees from 1995 to 2008. There were two men and five women, with a mean age of 44.1 years (42-48 years). The mean follow-up period was 10.2 years (1-19.5 years). A rectus snip was performed in all cases, and V-Y quadricepsplasty was used in one case of severe quadriceps contracture. In all cases, we used the PFC Sigma PS fixed model (DePuy Orthopaedics Inc., Warsaw, Indiana, USA). The goal was more than 90° of flexion. Clinical evaluation was performed using range of motion (ROM), Knee Society (KS) Knee Score, KS Function Score, and complications. Radiographs were used to evaluate loosening or osteolysis. RESULTS The ROF was improved from 9.5° (0-30°) to 78.5° (15-115°), The Knee Score improved from 42.6 (25-70) to 68.6 (41-97), and the Function Score improved from 39 (0-60) to 66 (40-90). A radiolucent line was detected in two cases (one patient) around the tibial component, and one case had a necrosis of skin edge. Only one case had no improvement of motion. CONCLUSION Total knee arthroplasty conversion for patients with ankylosed knees can achieve good results for motion and function without osteotomy of the tibial tuberosity when there is good quality soft tissue of the thigh.
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Affiliation(s)
- Hee-June Kim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Jong-Uk Mun
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Kwang-Hwan Kim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hee-Soo Kyung
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
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Abstract
Wound healing complications associated with total knee arthroplasty present a considerable challenge to the orthopaedic surgeon. To ensure preservation of a functional joint, the management of periprosthetic soft-tissue defects around the knee requires rapid assessment, early and aggressive débridement, and durable, contoured coverage. Several reconstructive options are available to tailor soft-tissue coverage to the location, size, and depth of the wound. Special consideration should be given to the timing of the intervention, management of infection, and prosthesis salvage. The merits of each reconstructive option, including perforator, fasciocutaneous, muscular, and free microvascular flaps, should be weighed to select the most appropriate option. The proposed approach can guide surgeons in treating patients with these complex soft-tissue defects.
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Spontaneous Knee Ankylosis through Heterotopic Ossification after Total Knee Arthroplasty. Case Rep Orthop 2016; 2016:3548512. [PMID: 27119034 PMCID: PMC4828540 DOI: 10.1155/2016/3548512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/03/2016] [Accepted: 02/14/2016] [Indexed: 11/17/2022] Open
Abstract
This paper reports on a case of total ankylosis of the knee after a cruciate-sacrificing cemented total knee arthroplasty (TKA). An 82-year-old female patient previously underwent primary TKA for osteoarthritis twenty years ago in our institution. She had recovered uneventfully and returned to her regular activities. There was no history of postsurgical trauma; however, she progressively lost knee range of motion. Radiographs revealed severe bridging heterotopic ossification.
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Strauss AC, Schmolders J, Friedrich MJ, Pflugmacher R, Müller MC, Goldmann G, Oldenburg J, Pennekamp PH. Outcome after total knee arthroplasty in haemophilic patients with stiff knees. Haemophilia 2015; 21:e300-5. [PMID: 25931189 DOI: 10.1111/hae.12698] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Advanced haemophilic arthropathy of the knee is associated with progressive joint stiffness. Results after total knee arthroplasty (TKA) in stiff knees are considered to be inferior compared to those with less restricted preoperative range of motion (ROM). There is only very limited data on the results of primary TKA in haemophilic patients with stiff knees. AIM The purpose of this retrospective study was to evaluate the clinical outcome after TKA performed in haemophilic patients with preoperative ROM of 50° or less. METHODS Twenty one patients (23 knees) undergoing TKA with stiff knees were retrospectively evaluated. Mean follow-up was 8.3 years (range, 2-25). Clinical assessment included ROM, degree of flexion contracture and complication rate. Functional evaluation and pain status were assessed using the Knee Society's Scoring System (KSS). RESULTS Range of motion improved from 26.7° preoperatively to 73.0° postoperatively. Flexion contracture decreased from 21.7° to 8.3°. KSS increased from 22.9 to 72.9 points. Evaluation of pain revealed a decrease from 8.4 points preoperatively to 2.1 points postoperatively. All these differences were statistically significant (P < 0.005). The complication rate was 8.7% including one late periprosthetic infection, and one aseptic implant loosening. Nine patients who required VY-quadricepsplasty for knee exposure developed a mean postoperative extensor lag of 7°. CONCLUSION Total knee arthroplasty in haemophilic patients presenting with stiff knees results in significant improvement of function and reduction in pain. Although the clinical outcome is inferior compared to nonstiff knees reported in the literature, joint replacement surgery can be successfully performed in this particular group of patients.
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Affiliation(s)
- A C Strauss
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - J Schmolders
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - M J Friedrich
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - R Pflugmacher
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - M C Müller
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - G Goldmann
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - J Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - P H Pennekamp
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
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Jamshidi K, Hadi H, Ramezan Shirazi M, Moslem A. Conversion of fused knee following distal femur tumor surgery to total knee arthroplasty. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:870-2. [PMID: 24616802 PMCID: PMC3929827 DOI: 10.5812/ircmj.7693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/04/2013] [Accepted: 07/15/2013] [Indexed: 11/23/2022]
Abstract
Conversion of knee arthrodesis to total knee arthroplasty is a difficult procedure accompanied by many complications due to soft tissue and extensor mechanism contracture and bone defects. We report two cases of distal femur osteosarcoma that had been undergone wide resection arthrodesis initially. Arthrodesis was converted to total knee arthroplasty with hinged prosthesis after many years. We describe patients' history and outline their surgical therapy and prognosis. To the best of the authors' knowledge, few cases have been previously reported in the literature.
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Affiliation(s)
- Khodamorad Jamshidi
- Department of Orthopedic Surgery, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hoseinali Hadi
- Department of Orthopedic Surgery, Arak University of Medical Science, Arak, IR Iran
| | - Mehdi Ramezan Shirazi
- Department of Anesthesiology, Gonabad University of Medical Sciences, Gonabad, IR Iran
| | - Alireza Moslem
- Department of Orthopedic Surgeon, Gonabad University of Medical Sciences, Gonabad, IR Iran
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Hsu CH, Lin PC, Chen WS, Wang JW. Total knee arthroplasty in patients with stiff knees. J Arthroplasty 2012; 27:286-92. [PMID: 21723089 DOI: 10.1016/j.arth.2011.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 05/03/2011] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to evaluate the clinical outcome of total knee arthroplasty and analyze the prognostic factors in patients with stiff knees. Thirty-two patients (39 knees) with severe knee arthritis and an arc of motion of 50° or less were treated by total knee arthroplasty. The mean follow-up period was 58 months (range, 24-123 months). The mean arc of motion improved from 35° before the operation to 94° at the time of the latest follow-up (P<.05). Improvement in knee motion after postoperative 3 months was insignificant. The most important factor related to the final arc of knee motion was preoperative arc of knee motion. The V-Y quadricepsplasty was associated with an inferior clinical outcome. Total knee arthroplasty in patients with stiff knees has substantially improved in the clinical outcome and the arc of motion.
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Affiliation(s)
- Chi-Hsiang Hsu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Panni AS, Vasso M, Cerciello S, Salgarello M. Wound complications in total knee arthroplasty. Which flap is to be used? With or without retention of prosthesis? Knee Surg Sports Traumatol Arthrosc 2011; 19:1060-8. [PMID: 21161178 DOI: 10.1007/s00167-010-1328-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 11/08/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of our review paper is to present a possible algorithm of treatment of knee periprosthetic soft tissue defects, relative to their extent and depth. Different management of exposed total joints is also proposed, depending on the presence or loss of deep infection and on the timing of infection itself. METHODS In accordance with literature and the experience of senior knee surgeon, the incidence and risk factors, and possible treatment options of wound complications following total knee arthroplasty have been throughly analyzed. RESULTS There is much controversy regarding the optimal management of wound necrosis around a total knee. Local wound care, debridement, and fasciocutaneous, muscle and perforator flaps have been differently used. Muscle coverage remains the standard to which all other flaps should be compared, especially in infected wounds. Perforator flaps have recently represented a true revolution in the soft tissue reconstruction around the knee, with peculiar advantages due to their low donor morbidity and long pedicles. CONCLUSION When wound complications occur, prompt management is mandatory. An algorithm for treatment of wound defects is presented, available for both primary and revision knee replacement.
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Affiliation(s)
- Alfredo Schiavone Panni
- Department of Science for Health, University of Molise, Via Francesco De Sanctis, Campobasso, Italy
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Fosco M, Filanti M, Amendola L, Savarino LM, Tigani D. Total knee arthroplasty in stiff knee compared with flexible knees. Musculoskelet Surg 2011; 95:7-12. [PMID: 21472529 DOI: 10.1007/s12306-011-0099-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 02/14/2011] [Indexed: 11/26/2022]
Abstract
This retrospective study was done to evaluate the results of total knee arthroplasty performed on 32 patients with stiff knee, having a preoperative arc of movement between 0° and 50° (average 30°). This group of patients were matched with a group of 32 flexible knees, randomly selected from the same cohort of patients who underwent knee arthroplasty in our ward. At a mean follow-up of 4.5 years (min 2, max 11 years), seven patients of the stiff group reported complications (21.8% overall): four prosthetic infection that successively underwent removal of the implant, one skin necrosis 4 months after the intervention, one early contracture and one late stiffness of the knee. In the control group, in two cases, there was substitution of the implant due to periprosthetic infection. At the end of the study period, the clinical evaluation was not possible in four patients of the stiff and in two patients of the control group who underwent revision of the prosthetic components. An excellent or good clinical result was obtained in 92% of stiff group and in 96% of the control group patients. Although the final results achieved in these patients are worse than those of patients with flexible knee due to disadvantageous preoperative conditions and high complication rate, our results demonstrate the efficacy of the arthroplasty procedure as treatment of stiff knee.
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Affiliation(s)
- M Fosco
- Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, University of Bologna, Via Pupilli 1, 40136 Bologna, Italy.
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Kim YH, Kim JS. Does TKA improve functional outcome and range of motion in patients with stiff knees? Clin Orthop Relat Res 2009; 467:1348-54. [PMID: 18712582 PMCID: PMC2664409 DOI: 10.1007/s11999-008-0445-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 07/25/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED The main goals of TKA are pain relief and improvement of function and range of motion (ROM). To ascertain whether TKA in patients with stiff knees would relieve pain and improve functional outcome and ROM, we asked four questions: whether (1) Knee Society and WOMAC scores would improve after TKA; (2) poor preoperative ROM would improve after TKA; (3) the revision rate of TKA in stiff knees would be high; and (4) complication rates would be high in these patients after TKA. We retrospectively reviewed 74 patients (86 knees) with stiff knees (mean age, 56.8 years) who underwent TKAs with a condylar constrained or a posterior stabilized prosthesis. The minimum followup was 5 years (mean, 9.1 years; range, 5-12 years). The mean preoperative Hospital for Special Surgery knee score and Knee Society knee and functional scores were 42, 11, and 42 points, respectively, and postoperatively they were 84, 90, and 84 points, respectively. Preoperative and postoperative total WOMAC scores were 73 and 34 points, respectively. One knee (1.2%) had aseptic loosening of the tibial component and 12 knees (14%) had complications. Despite a relatively high rate of complications, most patients had substantial improvement in function. LEVELS OF EVIDENCE Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center of Korea, Ewha Womans University School of Medicine, MokDong Hospital, 911-1, MokDong, YangCheon-Gu, Seoul, 158-710, South Korea.
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Boopalan PRJVC, Daniel AJ, Chittaranjan SB. Managing skin necrosis and prosthesis subluxation after total knee arthroplasty. J Arthroplasty 2009; 24:322.e23-7. [PMID: 18555649 DOI: 10.1016/j.arth.2008.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 03/02/2008] [Indexed: 02/01/2023] Open
Abstract
Skin necrosis and prosthetic subluxation are dreaded complications after total knee arthroplasty. It can result in deep infection with subsequent failure of prosthesis. The incidence of infection in patients with rheumatoid arthritis who undergo knee arthroplasty is high when compared to patients with primary osteoarthritis. The gastrocnemius muscle flap has been described for cover of proximal tibia and tendon loss because of malignancy and has been used as a bridge graft in trauma patients with patellar tendon loss. We describe a patient with total knee arthroplasty with anterior knee skin necrosis and prosthesis subluxation because of attenuation and loss of continuity of patellar tendon. This was managed by using gastrocnemius bridge grafting. Here, the gastrocnemius bridge graft was used as a soft tissue cover as well as a dynamic anterior stabilizer for the prosthesis.
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Affiliation(s)
- P R J V C Boopalan
- Department of Orthopedics Unit III, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract
OBJECTIVE To present nine patients with ankylosis in their knees that were submitted to a total arthroplasty to lessen their pain and improve their functional limitation. For these patients, arthrodesis remained a possibility in the event of arthroplasty failure. INTRODUCTION Ankylosis of the knee is a severe functional limitation that becomes worse when pain is present. Arthrodesis of the knee is a classical indication for such patients, since it resolves the pain; however, the severe functional limitation remains. METHODS In the present study, we evaluated the clinical course of nine patients who underwent total arthroplasty of the knee, and were followed up for at least five years. RESULTS The results demonstrate that all of the patients experienced a significant reduction in pain and some improvement in the degree of knee flexion and extension. CONCLUSION Based on the latest follow-up, there has been no need to perform arthrodesis for any of our patients, showing that a total arthroplasty could be a option for treatment in knee ankylosis.
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Affiliation(s)
- Gilberto Luiz Camanho
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil.
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Abstract
We compared the results of total knee arthroplasties in patients with stiff or ankylosed knees. We retrospectively reviewed 90 total knee arthroplasties in 52 patients with minimum 2 years followup who had less than a 50 degrees arc of flexion preoperatively. Preoperative and intraoperative data were retrieved from a computerized database. Patients were followed for an average of 6.5 years at an outpatient department. Knee Society knee scores improved from 34.6 points preoperatively to 89.5 points postoperatively in the stiff knees and from 47 points preoperatively to 75 points postoperatively in the ankylosed knees. The arc of flexion improved from 35 degrees -69 degrees preoperatively to 1 degrees -94 degrees postoperatively in the stiff knees and from 0 degrees to 3 degrees -77 degrees in the ankylosed knees. There were major complications in four of the 26 ankylosed knees and in two of the 64 stiff knees. The data suggest results of total knee arthroplasty are better in patients with stiff knees than in patients with ankylosed knees.
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Affiliation(s)
- S Bhan
- Department of Orthopedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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Abstract
Nine patients were treated for skin necrosis after total knee arthroplasty. Eight patients had predisposing factors, which may have increased their risk of developing wound complications. Seven patients developed necrosis over the patellar tendon or tibial tubercle, of whom 6 were treated with muscle flap coverage. Two patients developed necrosis over the patella, both of whom were treated with local wound care and skin grafting. Successful wound healing and salvage of the total knee arthroplasty was achieved in all cases. Treatment of necrosis over the patellar tendon or tibial tubercle usually requires muscle flap coverage, whereas necrosis over the patella may be treated with local wound care and skin grafting.
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Affiliation(s)
- Michael D Ries
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California 94143-0728, USA.
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