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Kii S, Sonohata M, Nakashima T, Hashimoto A, Ueno M, Mawatari M. Comparison of the clinical outcomes following total knee arthroplasty in osseous ankylosed and non-ankylosed knees using propensity-score matching. Mod Rheumatol 2023; 34:226-237. [PMID: 36508296 DOI: 10.1093/mr/roac144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/10/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Few studies have compared the clinical outcomes and complications of total knee arthroplasty (TKA) in patients with and without osseous ankylosed knees. Thus, we investigated the clinical outcomes and complications of TKA in patients with osseous ankylosed knees using a propensity-score matching method. METHODS Thirteen knees in the osseous ankylosed-knees group and 13 knees in the non-ankylosed-knees group were included after excluding those with less than 2 years of follow-up or a lack of data and after propensity-score matching. The American Knee Society Score-knee (AKSS-knee), AKSS-function, knee-flexion angle, knee-extension angle, knee range of motion (ROM) before and after TKA, and the number of knees with postoperative complications were evaluated as primary outcomes. RESULTS The AKSS-knee, AKSS-function, knee-flexion angle, and knee ROM in the osseous ankylosed-knees group after TKA were significantly lower than those in the non-ankylosed-knees group. The knee-extension angle after TKA and number of knees with postoperative complications within 2 years were not significantly different between the two groups. CONCLUSIONS The clinical results of TKA in patients with osseous ankylosed knees were inferior to those in patients with non-ankylosed knees.
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Affiliation(s)
- Sakumo Kii
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takema Nakashima
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Akira Hashimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaya Ueno
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Rahmansyah N, Mulyadi D, Magetsari RMSN, Triangga AFR. Unconstrained one-stage total knee arthroplasty PS design in patient with secondary osteoarthritis due to granulomatous infection with medial femoral condyle defect: A case report. Int J Surg Case Rep 2022; 97:107469. [PMID: 35917602 PMCID: PMC9403358 DOI: 10.1016/j.ijscr.2022.107469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Granulomatous Mycobacterium Tuberculosis Infection Causes Secondary Knee Osteoarthritis is still a point of contention in terms of therapy, whether it is done early in the first stage or later in the second stage of knee surgery. Early Total Knee Arthroplasty as a therapy for secondary knee osteoarthritis induced by Granulomatous mycobacterium tuberculosis infection is still performed rarely. CASE PRESENTATION A case of left pain and swollen knee in males for 8 months. Because of pain and reduced knee range of motion, the patient now has an antalgic gait, which make him difficult to do daily activities. Treatment with medications and physiotherapy failed. Radiographs revealed juxta-articular osteoporosis, peripherally distributed osseous erosions, joint space narrowing, and a bony defect in the medial femoral condyle. This case was successfully treated using Unconstrained Knee Arthroplasty PS Design. CLINICAL DISCUSSION Case selection for granulomatous infection case is key element to determine whether a single TKA procedure can be used to treat knee pain problems as a result of secondary osteoarthritis. CONCLUSION This case shows secondary knee osteoarthritis caused by Granulomatous Mycobacterium Tuberculosis Infection without pyogenic pus production might allow for early one-stage total knee arthroplasty. Three months following surgery, the patient's knee was stable and painless, with good wound healing and no signs of infection.
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Affiliation(s)
- Nur Rahmansyah
- Lecturer of Medical Faculty of Bosowa University, Makassar, Indonesia,Department of Orthopedics and Traumatology, Dr. La Palaloi General Hospital, Maros, Indonesia
| | - Dicky Mulyadi
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Padjajaran University, Bandung, Indonesia,Division of Adult Reconstructive Surgery and Sports Injury, Dr.Hasan Sadikin General Hospital, Bandung, Indonesia,Corresponding author at: Department of Orthopaedic and Traumatology, Faculty of Medicine, Padjajaran University, Jl. Prof. Eyckman No.38, Pasteur, Kec. Sukajadi, Bandung, Jawa Barat 40161, Indonesia.
| | - Raden Moechammad Satrio Nugroho Magetsari
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Padjajaran University, Bandung, Indonesia,Division of Adult Reconstructive Surgery and Sports Injury, Dr.Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Aditya Fuad Robby Triangga
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia,Division of Adult Reconstructive Surgery and Sports Injury, Dr. Sardjito Hospital General Hospital, Yogyakarta, Indonesia
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Hip and Knee Replacement. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1007/978-3-030-78529-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pietsch M, Hochegger M, Djahani O, Hofmann S, Mlaker G, Eder-Halbedl M, Hofstätter T. A two-stage approach to primary TKA using articulating antibiotic-loaded spacers improve function and eradicate infection in septic arthritic knees. Knee Surg Sports Traumatol Arthrosc 2021; 29:3186-3194. [PMID: 32556435 DOI: 10.1007/s00167-020-06106-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/11/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The treatment of an infected arthritic knee might be challenging. The failure rate has been reported to be high for open or arthroscopic debridement. A subsequently high rate of infection has been noted in these patients undergoing primary total knee arthroplasty (TKA). In the present study, a two-stage approach using an articulating spacer was used. The hypothesis was that the procedure would eradicate the infection and improve pain and function in these patients. METHODS A total of 16 consecutive patients were enrolled in this retrospective study. The mean follow-up time was 6.1 years (range 2.0-9.9 years). Patients with advanced osteoarthritis and infection of the knee were included. All patients had previously undergone one or more failed arthroscopic or open procedures for the eradication of infection. All patients received the same homemade metal-on-plastic articulating antibiotic spacer. Double antibiotic therapy was given for 2 weeks intravenously and orally for 4 weeks. TKA implantation was performed 6 weeks after the first stage. RESULTS The infection was eradicated without recurrence in all patients. The functional results were significantly improved, and pain was significantly reduced after spacer and TKA implantation. The mean amount of knee flexion was 95 ± 30° preoperatively, and it increased to 109 ± 14° (p = 0.012) after spacer implantation and to 119 ± 10° (p = 0.002) after TKA implantation. The mean KSS objective was 58 ± 12 preoperatively, and it increased to 75 ± 14 (p < 0.0001) after spacer implantation and to 96 ± 3 (p < 0.0001) after TKA implantation. The mean KSS function was 17 ± 11 preoperatively, and it increased to 46 ± 10 (p < 0.0001) after spacer implantation and to 86 ± 6 (p < 0.0001) after TKA implantation. The mean VAS score was 65 ± 11 preoperatively, and it decreased to 2 ± 4 (p < 0.0001) after spacer implantation and to 1 ± 2 (p < 0.0001) after TKA implantation. CONCLUSION The two-stage procedure for the treatment of infected arthritic knees after failed eradication surgery was effective in all patients. Using an antibiotic articulating metal-on-plastic cement spacer showed improved functional results between the stages and at the final follow-up. No intra- or postoperative complications occurred.
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Affiliation(s)
- M Pietsch
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria.
| | - M Hochegger
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - O Djahani
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - S Hofmann
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - G Mlaker
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - M Eder-Halbedl
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - Th Hofstätter
- Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Sharma M, Sharma S, Upadhyaya AR. Classification-Based Management of Stiff/Ankylosed Knees. Indian J Orthop 2021; 55:1158-1174. [PMID: 34824716 PMCID: PMC8586129 DOI: 10.1007/s43465-021-00457-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/08/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Stiff knees are defined as those with an arc of motion < 50°. They pose a considerable surgical challenge to the operating surgeon. Based on our experience to deal with these complex cases, we have developed a working classification that outlines a flowchart to manage the stiff/ankylosed knees. MATERIALS AND METHODS It was a retrospective study conducted in our department. Out of 570 TKA performed in last 5 years, 57 had stiffness and four had bony ankyloses (total 61 knees). Patients were classified based on the fibrous or bony ankylosis and preoperative ROM. RESULTS Patients were followed for an average 2.4 years (1.8-5.5 years). KSS pain scores improved from an av. 32 preop (18-64) to av. 76 postoperatively (61-90). The KSS function scores improved from a preoperative value of 36 (16-56) to an av. 78 (52-90) postoperatively. ROM improved from an average of 35.6° (0°-44°) preoperatively to an average of 95.6° (ROM 73°-118°) postoperatively. Extension lag was an av. 8° (3°-12°) and was seen in 13 patients postoperatively. Residual fixed flexion deformity was an av. 7° (3°-14°) and seen in 17 patients. The stiff knees (type 1 and type 2) fared better than ankylosed knees (type 3) in all aspects. Complication rate was high (24%) in our series. CONCLUSION Our classification of stiff/ankylosed knees guides the surgeon to decide upon which approach to take, which implants to keep handy and has a predictive and prognostic value.
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Affiliation(s)
- Mrinal Sharma
- Asian Institute of Medical Sciences, Badkal Flyover Road, Sec 21A, Faridabad, Delhi NCR India
| | - Saurabh Sharma
- Asian Institute of Medical Sciences, Badkal Flyover Road, Sec 21A, Faridabad, Delhi NCR India
| | - Akshay Raj Upadhyaya
- Asian Institute of Medical Sciences, Badkal Flyover Road, Sec 21A, Faridabad, Delhi NCR India
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Mishra AS, Kumar S, Singh HK, Panda I, Cockshott S, Tambe A. Two-Stage Primary Arthroplasty in the Infected Native Knee: A Systematic Review and Pooled Analysis. Indian J Orthop 2021; 55:1256-1266. [PMID: 34824727 PMCID: PMC8586282 DOI: 10.1007/s43465-021-00402-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 03/31/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The knee is the commonest native joint to develop an infection. A two-stage primary knee replacement, with an interim stage of debridement and cement spacer application, modelled after two-stage revision for periprosthetic joint infections (PJI) has been reported for the management of chronic infections. AIMS To systematically review the literature to find the infection-free survival and outcomes of this operation and explore its indications. METHODS PRISMA guidelines were followed for this review. A systematic search of 4 online databases was conducted on 9/8/2020. After reviewing 226 abstracts and applying our selection criteria, 10 papers were selected for full-text review, and 9 included in the final synthesis. RESULTS On pooled analysis, an infection-free survival of 95.6% (CI 94.7-96.4) was found at 2 years in 139 knees, which was unchanged over the remainder of the follow-up (Mean 3.9 years). The complication rate after final implantation was 6% in those that did not develop reinfection. The mean pooled Knee Society Score (KSS) and KSS Function score among 70 patients (4 papers) was 83.4 (80.1-89.0) and 76.8 (71.5-78.0), respectively. The mean range of motion among 82 patients (6 papers) was more than 100°. CONCLUSIONS Two-stage primary knee replacement is a safe, effective and reliable procedure with good results in the short to medium term. Further studies are required to lay down precise indications and cost-effectiveness of this procedure, in comparison to other strategies for chronic infection. All joint registries should develop methods to identify patients undergoing two-stage procedures, to understand their long-term survival and outcomes.
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Affiliation(s)
- Arya S. Mishra
- Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE UK
| | - Sachin Kumar
- Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE UK
| | | | - Inayat Panda
- Bedford Hospital, Kempston Road, Bedford, MK42 9DJ UK
| | | | - Amol Tambe
- Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE UK
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Hooper J, Arora P, Kappagoda S, Huddleston JI, Goodman SB, Amanatullah DF. Articulating vs Static Spacers for Native Knee Infection in the Setting of Degenerative Joint Disease. Arthroplast Today 2021; 8:138-144. [PMID: 33748374 PMCID: PMC7966924 DOI: 10.1016/j.artd.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/17/2020] [Accepted: 01/21/2021] [Indexed: 01/15/2023] Open
Abstract
Background Patients with advanced knee arthritis who develop a septic joint are not adequately treated with irrigation and debridement and intravenous antibiotics because of antecedent cartilage damage. The gold standard treatment has been a 2-stage approach. The periprosthetic joint infection literature has demonstrated the superiority of articulating spacers, and metal-on-poly (MOP) spacers are being used with increasing frequency. The purpose of this study was to compare the postoperative outcomes of patients with infected, arthritic knees treated by a 2-stage approach to those of patients who received single-stage treatment with a MOP spacer. Methods Sixteen patients with native knee septic arthritis treated with an antibiotic spacer between 1998 and 2019 were reviewed. Demographic data, clinical data, knee motion, Knee Society score, Timed-Up-and-Go, and pain scores were collected. Survivorship of final implants was compared. Results Six of 16 knees (38%) received single-stage treatment, and 10 received 2-stage treatment (62%). Five of 6 MOP spacers (83%) were retained at a mean follow-up of 3 ± 1.2 years. Nine of 10 (90%) receiving static spacers had subsequent reconstruction, with 9 (100%) surviving at mean follow-up of 7 ± 3.2 years. The patients who received MOP spacers trended toward greater terminal flexion, higher Knee Society score, and faster Timed-Up-and-Go at final follow-up. Conclusion Infection in a native, arthritic knee may be effectively treated using single-stage MOP spacer. Postoperative outcomes of single-stage MOP spacers compare favorably to staged static spacers and with those undergoing revision surgery for other indications. Longer follow-up is needed to evaluate durability of MOP spacers.
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Affiliation(s)
- Jessica Hooper
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - Prerna Arora
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - Shanthi Kappagoda
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
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Risk Factors for Failure and Optimal Treatment of Total Joint Arthroplasty for Septic Arthritis. J Arthroplasty 2021; 36:892-896. [PMID: 33059964 DOI: 10.1016/j.arth.2020.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with native joint septic arthritis are one of the highest risk groups for developing complications following total joint arthroplasty (TJA), especially periprosthetic joint infection(PJI). There is a paucity of information on the risk factors for developing PJI and the optimal treatment modality of the native septic joint that can mitigate that risk. This multicenter study aimed to determine these risk factors, including prior treatment. METHODS A retrospective study of 233 TJAs performed, following prior septic arthritis at five institutions, was conducted. Comorbidities, organism profile, prior surgery, etiology of septic arthritis, and other relevant variables were reviewed. The primary outcome was the development of PJI, defined by Musculoskeletal Infection Society criteria. Bivariate and multivariate analyses were performed to identify risk factors for PJI. RESULTS Overall, the PJI rate was 12.4% in patients who underwent TJA after native septic arthritis. Predisposing risk factors for PJI included antibiotic-resistant organisms, male gender, diabetes, and a postsurgical cause of septic arthritis eg open reduction internal fixation. When controlling for potential confounders, multivariate analysis revealed that male gender, diabetes, and a postoperative etiology were predictors of PJI. The definitive treatment modality for the septic joint did not affect the rate of PJI for both arthroscopy vs irrigation and debridement (I&D), and two-stage exchange vs single-stage procedure. DISCUSSION This study has identified several risk factors for developing PJI in patients with prior septic joint arthritis, some of which are modifiable. The initial treatment modality of the native septic joint has no bearing on the development of PJI after TJA.
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Kriechling P, Bouaicha S, Andronic O, Uçkay I, Bock D, Wieser K. Limited improvement and high rate of complication in patients undergoing reverse total shoulder arthroplasty for previous native shoulder infection. J Shoulder Elbow Surg 2021; 30:34-39. [PMID: 32807379 DOI: 10.1016/j.jse.2020.04.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The outcomes of reverse total shoulder arthroplasty (RTSA) surgery for the sequelae of former septic native joint shoulder arthritis are unknown but might be inferior to patients without prior bacterial arthritis. METHODS We performed a single-center case-control study embedded in our prospective RTSA cohort. We matched all patients with prior infections in a 1:1 ratio with patients who underwent RTSA for other indications. The matching variables were indication for surgery, age, sex, dominant/nondominant shoulder, and body mass index. We evaluated outcomes by Constant score and active function. RESULTS Among 1249 patients in the RTSA cohort, 14 were operated for sequelae of previous native shoulder joint infections. Although both groups significantly improved from preoperative to postoperative values, the outcome of postinfectious patients was clearly inferior in comparison with the control group (absolute [38 ± 17 vs. 75 ± 8, P < .01], relative Constant score [47 ± 19 vs. 88 ± 9, P < .01], Constant pain score [11.0 ± 3.1 vs. 14.3 ± 1.3, P < .01], subjective shoulder value [43 ± 26 vs. 85 ± 10, P < .01], abduction [70 ± 43 vs. 148 ± 29°, P = .001], and elevation [82 ± 49° to 131 ± 16°, P = .02]). Moreover, in the postinfectious group, overall surgical complications occurred in 36%, with the need for revision in 21%. There was, however, no recurrence of infection in any of the patients' shoulders. CONCLUSION RTSA for end-stage postinfectious joint disease is associated with a high number of complications and reoperations. Clinical outcomes are inferior to those without past infection.
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Affiliation(s)
- Philipp Kriechling
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland.
| | - Samy Bouaicha
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Octavian Andronic
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Ilker Uçkay
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland; Department of Infectiology, Balgrist University Hospital, Zürich, Switzerland
| | - David Bock
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
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Choi YJ, Seo DK, Lee KW, Ra HJ, Kang HW, Kim JK. Results of total knee arthroplasty for painless, stiff knees. Knee Surg Relat Res 2020; 32:61. [PMID: 33203479 PMCID: PMC7672965 DOI: 10.1186/s43019-020-00081-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background Stiff knees, like completely ankylosed or arthrodesed knees, can be painless. Total knee arthroplasty (TKA) for these painless, stiff knees is technically demanding. However, it can correct the alignment and advance the range of motion to improve quality of life. So, we reviewed the preoperative and postoperative results of functional and pain scores, range of motion (ROM) and complications in painless, stiff knees treated by TKA. Methods Fifteen painless, stiff knees underwent TKA from January 1998 to January 2017. The mean follow-up period was 15.4 (2.4–22.2) years. All the knees were completely ankylosed or arthrodesed. Clinical outcome and complications were evaluated using medical record review, serial plan radiography, ROM assessment, Knee Society score (KSS), Knee Society function score (FS), and a visual analog scale for pain (VAS). Results All patients were satisfied with their operated knees. Mean KSS and FS scores were improved from 36 and 50.9 to 76.9 and 67.2, respectively (P < 0.001 and P = 0.01). The mean ROM increased from 0º preoperatively to 77.6º (15–130) at the final follow-up (P < 0.001). The mean VAS had worsened from 0 preoperatively to 0.2 postoperatively, however it was not significant (P = 0.1). Major postoperative complications were reported in five of the knees (33.3%). Conclusions The results of TKA for painless, stiff knees were satisfactory with improved ROM and quality of life. Although some patients had mild pain and complications postoperatively, they were satisfied with the result. However, our study recommends that surgeons should consider the high rate of complications in the completely ankylosed or arthrodesed knees. Level of evidence A retrospective case series, Level IV.
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Affiliation(s)
- Young-Joon Choi
- Department of Orthopaedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung, Gangwon-do, 25440, South Korea
| | - Dong-Kyo Seo
- Department of Orthopaedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung, Gangwon-do, 25440, South Korea.
| | - Ki Won Lee
- Department of Orthopaedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung, Gangwon-do, 25440, South Korea
| | - Ho Jong Ra
- Department of Orthopaedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung, Gangwon-do, 25440, South Korea
| | - Hyun Wook Kang
- Department of Orthopaedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung, Gangwon-do, 25440, South Korea
| | - Jin Kyung Kim
- Department of Orthopaedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung, Gangwon-do, 25440, South Korea
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Aalirezaie A, Arumugam SS, Austin M, Bozinovski Z, Cichos KH, Fillingham Y, Ghanem E, Greenky M, Huang W, Jenny JY, Lazarovski P, Lee GC, Manrique J, Manzary M, Oshkukov S, Patel NK, Reyes F, Spangehl M, Vahedi H, Voloshin V. Hip and Knee Section, Prevention, Risk Mitigation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S271-S278. [PMID: 30348568 DOI: 10.1016/j.arth.2018.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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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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Sultan AA, Cantrell WA, Rose E, Surace P, Samuel LT, Chughtai M, Khlopas A, Newman JM, Moskal JT, Mont MA. Total knee arthroplasty in the face of a previous tuberculosis infection of the knee: what do we know in 2018? Expert Rev Med Devices 2018; 15:717-724. [DOI: 10.1080/17434440.2018.1520633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Assem A. Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Emily Rose
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Peter Surace
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Linsen T. Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jared M. Newman
- Department of Orthopedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Joseph T. Moskal
- Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, VA, USA
| | - Michael A. Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York City, NY, USA
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Rajgopal A, Panda I, Dahiya V. A Comparative Study on the Long-Term Outcome of Total Knee Arthroplasty Performed for Knees Stiff in Extension and Those Stiff in Flexion. J Arthroplasty 2017; 32:3396-3403. [PMID: 28705546 DOI: 10.1016/j.arth.2017.06.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/28/2017] [Accepted: 06/14/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patients with chronic stiff knee with extremely restricted arc of motion (AOM ≤ 20°) may present with stiffness either in extension (stiff in extension [SE]) or in flexion (stiff in flexion [SF]). The difference in the functional outcome after total knee arthroplasty between these 2 groups has not been elaborated in literature. METHODS We retrospectively analyzed 96 patients (115 knees), who had undergone total knee arthroplasty between January 1990 and December 2010 for stiff or spontaneously ankylosed knees (AOM ≤ 20°). This included 51 knees in SE group and 64 knees in SF group. RESULTS The average duration of follow-up was 9.7 years (2-17.5 years). The total AOM improved from an average of 10.9° ± 7.4° preoperatively to 86.5° ± 13.5° postoperatively in SE group and 8.7° ± 6.8° to 92.2° ± 16.8° in the SF group. The mean Knee Society Score in the SE group improved from 23.2 ± 5.7 preoperatively to 74.1 ± 8.9 postoperatively and that of SF group from 14 ± 5.2 to 71.2 ± 12.5. At 3 months follow-up, Knee Society Score for SE group were higher than that for SF group (P = .03). This difference was not noted beyond 1 year. Complications were noted in 24 (20.9%) knees-10 (23.5%) in SE group and 14 (21.9%) in SF group. CONCLUSION The maximum mean AOM achieved was higher in SF group but the incidence of residual flexion contracture was also higher as compared to SE group. The long-term functional outcome scores in SE and SF groups are similar.
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Affiliation(s)
- Ashok Rajgopal
- Fortis Bone and Joint Institute, Fortis Escorts Research Centre, Okhla, New Delhi, India
| | - Inayat Panda
- Fortis Bone and Joint Institute, Fortis Escorts Research Centre, Okhla, New Delhi, India
| | - Vivek Dahiya
- Fortis Bone and Joint Institute, Fortis Escorts Research Centre, Okhla, New Delhi, India
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Kalson NS, Borthwick LA, Mann DA, Deehan DJ, Lewis P, Mann C, Mont MA, Morgan-Jones R, Oussedik S, Williams FMK, Toms A, Argenson JN, Bellemans J, Bhave A, Furnes O, Gollwitzer H, Haddad FS, Hofmann S, Krenn V. International consensus on the definition and classification of fibrosis of the knee joint. Bone Joint J 2017; 98-B:1479-1488. [PMID: 27803223 DOI: 10.1302/0301-620x.98b10.37957] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 06/07/2016] [Indexed: 12/12/2022]
Abstract
AIMS The aim of this consensus was to develop a definition of post-operative fibrosis of the knee. PATIENTS AND METHODS An international panel of experts took part in a formal consensus process composed of a discussion phase and three Delphi rounds. RESULTS Post-operative fibrosis of the knee was defined as a limited range of movement (ROM) in flexion and/or extension, that is not attributable to an osseous or prosthetic block to movement from malaligned, malpositioned or incorrectly sized components, metal hardware, ligament reconstruction, infection (septic arthritis), pain, chronic regional pain syndrome (CRPS) or other specific causes, but due to soft-tissue fibrosis that was not present pre-operatively. Limitation of movement was graded as mild, moderate or severe according to the range of flexion (90° to 100°, 70° to 89°, < 70°) or extension deficit (5° to 10°, 11° to 20°, > 20°). Recommended investigations to support the diagnosis and a strategy for its management were also agreed. CONCLUSION The development of standardised, accepted criteria for the diagnosis, classification and grading of the severity of post-operative fibrosis of the knee will facilitate the identification of patients for inclusion in clinical trials, the development of clinical guidelines, and eventually help to inform the management of this difficult condition. Cite this article: Bone Joint J 2016;98-B:1479-88.
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Affiliation(s)
| | - L A Borthwick
- Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - D A Mann
- Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - D J Deehan
- Freeman Hospital, Newcastle Hospitals NHS Trust, High Heaton, Newcastle upon Tyne, NE7 7DN, UK
| | - P Lewis
- South Australian Health and Medical Institute, Adelaide, South Australia, Australia
| | - C Mann
- Norfolk and Norwich University NHS Trust, Norwich, UK
| | - M A Mont
- Cleveland Clinic , Cleveland, Ohio, USA
| | | | - S Oussedik
- Institute of Sport, Exercise and Health, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK
| | - F M K Williams
- King's College London, St Thomas' Hospital, London SE1 7EH, UK
| | - A Toms
- Royal Devon and Exeter Hospital, Exeter, UK
| | - J N Argenson
- Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France
| | | | - A Bhave
- Sinai Hospital, Baltimore, Maryland, USA
| | - O Furnes
- University of Bergen, Bergen, Norway
| | - H Gollwitzer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität, Ismaninger Str. 22, 81675 Munich, Germany
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London NW1 2BU, UK
| | - S Hofmann
- LKH Stolzalpe Hospital & Teaching Hospital University Clinic Graz, Austria
| | - V Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany
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Herry Y, Boucher F, Neyret P, Ferry T, Lustig S. Three-step sequential management for knee arthroplasty after severe ballistic injury: Two cases. Orthop Traumatol Surg Res 2016; 102:131-4. [PMID: 26774900 DOI: 10.1016/j.otsr.2015.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/13/2015] [Accepted: 08/25/2015] [Indexed: 02/02/2023]
Abstract
Management of knee bone loss after gunshot trauma requires a multidisciplinary approach. Two cases of knee arthroplasty after devastating ballistic trauma are reported. Treatment comprised several steps: sampling, bone resection, reinforced cement spacer, latent sepsis control, and prosthetic reconstruction. The patients showed no neurovascular disorder and had a functioning extensor mechanism. At follow-up of at least 2 years, results were satisfactory, with return to unaided walking and mean International Knee Society (IKS) score improved from 18 to 59 points. In light of these observations, knee reconstruction arthroplasty using a sequential strategy can provide satisfactory functional outcome after severe ballistic trauma.
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Affiliation(s)
- Y Herry
- Centre Albert-Trillat, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - F Boucher
- Service de chirurgie plastique, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Centre de référence des infections ostéo-articulaires complexes Rhône Alpes Auvergne, hospices civils de Lyon, 69004 Lyon, France
| | - P Neyret
- Centre Albert-Trillat, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Centre de référence des infections ostéo-articulaires complexes Rhône Alpes Auvergne, hospices civils de Lyon, 69004 Lyon, France
| | - T Ferry
- Service de maladie infectieuse, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Centre de référence des infections ostéo-articulaires complexes Rhône Alpes Auvergne, hospices civils de Lyon, 69004 Lyon, France
| | - S Lustig
- Centre Albert-Trillat, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Centre de référence des infections ostéo-articulaires complexes Rhône Alpes Auvergne, hospices civils de Lyon, 69004 Lyon, France.
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Shi GG, Huh J, Gross CE, Adams SB, Easley ME, DeOrio JK, Nunley JA. Total Ankle Arthroplasty Following Prior Infection About the Ankle. Foot Ankle Int 2015; 36:1425-9. [PMID: 26231198 DOI: 10.1177/1071100715597430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We evaluated whether a history of prior infection about the native ankle joint, bone, or soft tissues was associated with a higher rate of infection following total ankle arthroplasty (TAA) when compared with that of primary TAA in the general population. METHODS This is a retrospective review of our institution's TAA registry to identify all patients who reported a prior history of ankle joint sepsis or osteomyelitis and who were subsequently treated with TAA with at least 1-year follow-up. The primary outcome measure was re-infection rate. Secondary outcome measures were patient-reported outcome scores, implant survival, and complications. Twenty-two TAAs were performed in 22 patients, consisting of 9 men and 13 women, with a mean age of 58.4 years (range = 30-80 years). Patients were followed for a mean of 29.3 months (range = 11.4-83.8 months). The length of complete symptom-free interval between the index infection to time of TAA was 8.8 years (range = 0-44 years). These patients had a mean 2.7 (range = 0-13) procedures involving the ipsilateral ankle joint prior to TAA. RESULTS No deep infection was observed in this series. Eleven patients were followed for more than 2 years, with postoperative visual analog scale scores decreasing from 53.1 (range = 12-90) to 20.6 (range = 0-89) of 100. Ten of the 11 ankles also had AOFAS ankle-hindfoot and SF-36 scores. Their AOFAS ankle-hindfoot score increased from 38.9 (range = 10-61) to 70.1 (range = 29-90), and SF-36 score improved from 40.6 (range = 3.3-76.4) to 67.6 (range = 36.4-85.4). CONCLUSION Single-stage TAA can be a viable option to treat arthritic ankle pain for those patients with resolved bone or ankle joint infection, producing improved outcomes in pain and function.
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Affiliation(s)
- Glenn G Shi
- Duke University Medical Center, Durham, NC, USA
| | - Jeannie Huh
- Duke University Medical Center, Durham, NC, USA
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Total knee arthroplasty in advanced tuberculous arthritis of the knee. INTERNATIONAL ORTHOPAEDICS 2015; 40:1433-9. [PMID: 26578080 DOI: 10.1007/s00264-015-3050-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Controversies regarding the treatment of advanced tuberculosis of the knee still exist. We retrospectively investigated protocols of total knee arthroplasty (TKA) and their efficacy in patients with advanced tuberculosis. METHODS Nine TKAs associated with advanced tuberculosis were performed at our institution between 2008 and 2013, with a mean follow-up of 4.4 years (range 2-7 years). In four cases with elevated inflammatory biomarkers, patients received three months of antitubercular drug treatment followed by two-stage TKA. In the remaining five cases with normal biomarkers, patients received one-stage TKA with no pre-operative drug therapy. All patients received antitubercular therapy for one year post-operatively. Clinical and radiological data during follow-up were gathered to evaluate the effects of treatment. RESULTS There was no tuberculosis reactivation and all cases demonstrated marked improvement in function and favorable states of prostheses. Specifically, the mean Hospital for Special Surgery (HSS) knee score increased from 44.8 (range 30-60) preoperatively to 82.7 (range 64-92) at last follow-up (P < 0.05). The average range of motion was 56° (range 10° to 90°) before surgery and 94° (range 80-110) at final follow-up (P < 0.05). Elevated erythrocyte sedimentation rates (ESR) and C-reactive protein (CRP) levels returned to normal in a mean of 4.0 months (range 3-5 months) and 3.9 months (range 3-6 months) post-operatively, respectively. CONCLUSION Although a consensus of views regarding surgical timing, prosthesis selection, and peri-operative antitubercular therapy has not been reached, our results suggest that TKA can be performed for advanced tuberculous arthritis.
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Abstract
King Philip II was the father of Alexander the Great. He suffered a notorious penetrating wound by a lance through his leg that was nearly fatal and left him lame in 339 B.C.E. (i.e., 3 y before his assassination in 336 B.C.E.). In 1977 and 1978 two male skeletons were excavated in the Royal Tombs II and I of Vergina, Greece, respectively. Tomb I also contained another adult (likely a female) and a newborn skeleton. The current view is that Philip II was buried in Tomb II. However, the male skeleton of Tomb II bears no lesions to his legs that would indicate lameness. We investigated the skeletal material of Tomb I with modern forensic techniques. The male individual in Tomb I displays a conspicuous case of knee ankylosis that is conclusive evidence of lameness. Right through the overgrowth of the knee, there is a hole. There are no obvious signs that are characteristic of infection and osteomyelitis. This evidence indicates that the injury was likely caused by a severe penetrating wound to the knee, which resulted in an active inflammatory process that stopped years before death. Standard anthropological age-estimation techniques based on dry bone, epiphyseal lines, and tooth analysis gave very wide age ranges for the male, centered around 45 y. The female would be around 18-y-old and the infant would be a newborn. It is concluded that King Philip II, his wife Cleopatra, and their newborn child are the occupants of Tomb I.
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Seo JG, Moon YW, Park SH, Han KY, Kim SM. Primary total knee arthroplasty in infection sequelae about the native knee. J Arthroplasty 2014; 29:2271-5. [PMID: 24703782 DOI: 10.1016/j.arth.2014.01.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 10/25/2013] [Accepted: 01/14/2014] [Indexed: 02/01/2023] Open
Abstract
The aim of this study is to assess the results of primary total knee arthroplasty (TKA) after bone or joint sepsis about the native knee and to analyze the risk factors of periprosthetic infection. Sixty-two patients (62 knees), considered to have prior sepsis history to be resolved, underwent primary TKA and were followed during a mean of 6.1years (range, 2-10.4years). Of the 62 patients, periprosthetic infection occurred in 6 after primary TKA (9.7%). Five of 6 patients grew the same organism as prior infection. The number of prior surgeries undertaken for deep infection was found to be an independent risk factor of periprosthetic infection.
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Affiliation(s)
- Jai-Gon Seo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wan Moon
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Hoon Park
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Ilsan, Korea
| | - Kye-Young Han
- Department of Orthopaedic Surgery, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sang-Min Kim
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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21
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Total knee arthroplasty for the management of joint destruction in tuberculous arthritis. Knee Surg Sports Traumatol Arthrosc 2014; 22:1076-83. [PMID: 23515832 DOI: 10.1007/s00167-013-2473-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 03/04/2013] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate our experience to clarify the suggestion that there should be a significant disease-free interval before total knee arthroplasty (TKA) and to determine the correct timing of surgery for reconstruction of the joint destruction in patients suffering from tuberculous arthritis. METHODS Twelve patients with advanced joint destruction and tuberculous arthritis of the knee with recent onset were reviewed in this study. The time interval from our diagnosis of active infection to arthroplasty averaged 4 ± 1.5 months. Histopathology of the biopsy specimens revealing granulomatous lesions, including epithelioid histiocytes surrounded by lymphocytes, confirmed the diagnosis of each patient. A primary knee prosthesis was performed in seven knees. In five knees, there was severe bone loss after the extensive debridement of the entire joint, and thereafter, revision prosthesis was preferred to preserve the joint line. Patients were given post-operative antituberculous treatment for a total of 1 year, whereas for three patients, whose erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values remained above normal by the sixth month, the chemotherapy was continued for up to 18 months. The Knee Society TKA roentgenographic evaluation and scoring system was used for radiological evaluation of the knees. Clinical evaluation of the knees was done preoperatively and at the time of the most recent follow-up using the American Knee Society Scoring System. RESULTS Within the average follow-up period of 6.1 ± 1.8 years, no reactivation of tuberculous infection was found in any of the patients. ESR was normal, less than 20 mm/h, after a mean time of 5.5 ± 2.0 months. The CRP was normal, less than 0.8 mg/dl, after a mean time of 4.6 ± 1.3 months. At the most recent follow-up, the average knee score improved from 32.4 ± 19.4 to 83.4 ± 14.0 points (p < 0.05), and the average function score improved from 33.3 ± 11.9 to 86.6 ± 7.7 points (p < 0.05). Ten knees showed good integrity, and no radiolucent lines were found in the bone-prosthesis interface in relation to any component. Radiolucent lines were apparent on the tibial side in two knees. They were less than 1 mm thick and non-progressive, and clinically, there was no evidence of loosening of the component. Culture specimens were positive for five patients. CONCLUSIONS TKA is a safe procedure for tuberculous arthritis with recent onset providing symptomatic relief, functional improvement and early return to activity when performed in correct time. A long disease-free interval should not be a prerequisite for arthroplasty. Wide surgical debridement is the mainstay to eradicate the disease, and post-operative antituberculous chemotherapy controls the residual foci. LEVEL OF EVIDENCE IV.
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Debette C, Lustig S, Servien E, Lording T, Villa V, Demey G, Neyret P. Total knee arthroplasty of the stiff knee: three hundred and four cases. INTERNATIONAL ORTHOPAEDICS 2013; 38:285-9. [PMID: 24363046 DOI: 10.1007/s00264-013-2252-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to analyse the results of total knee arthroplasty (TKA) in stiff knees (flexion ≤90° and/or flexion contracture ≥20°). Our hypothesis was that despite having poorer results than those obtained in a "standard" population and a high rate of complications, TKA was a satisfactory treatment in patients with osteoarthritis of the knee associated with significant stiffness. METHODS Three hundred and four consecutive primary HLS TKAs (Tornier), whose data were prospectively collected between October 1987 and October 2012, were retrospectively analysed at a mean of 60 months (range, 12-239) postoperatively. Two groups, those with a "flexion contracture" and those with a "flexion deficit", were assessed for postoperative range of motion (as integrated to the Knee Society score [KSS]), physical activity level and patient satisfaction. RESULTS At the latest follow-up, range of motion was significantly improved, as was the KSS. Ninety-four percent of patients were satisfied or very satisfied, and activity levels were increased after surgery. The complication rate, however, was high in patients with a preoperative flexion deficit (17%). Pain and residual stiffness were the most common complications. CONCLUSION TKA provides satisfactory results in patients with knee osteoarthritis associated with significant pre-operative stiffness. The surgical plan should be adapted to anticipate complications, which are particularly frequent in the presence of a flexion deficit.
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Affiliation(s)
- Caroline Debette
- Department of Orthopaedic Surgery, Hôpital de la Croix-Rousse, Centre Albert Trillat, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France,
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Ashraf MO, Asumu T. Bilateral knee replacements for treatment of acute septic arthritis in both knees. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 23 Suppl 2:S247-50. [PMID: 23412206 DOI: 10.1007/s00590-012-1074-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 08/20/2012] [Indexed: 10/27/2022]
Abstract
A case report of bilateral acute septic arthritis of knees is presented, which was managed with staged total knee replacements for both knees. A literature review on septic arthritis treated with knee arthroplasty is also presented.
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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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25
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Massin P, Bonnin M, Paratte S, Vargas R, Piriou P, Deschamps G. Total knee replacement in post-traumatic arthritic knees with limitation of flexion. Orthop Traumatol Surg Res 2011; 97:28-33. [PMID: 21167802 DOI: 10.1016/j.otsr.2010.06.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/23/2010] [Accepted: 06/29/2010] [Indexed: 02/02/2023]
Abstract
UNLABELLED The objective of this study is to investigate the results of total knee arthroplasty (TKA) in traumatic osteoarthritis cases with flexion restriction and to describe the technical details of their management. A multicentre series comprising 40 patients with limitation of flexion less than or equal to 90° was selected from 152 cases of post-traumatic knee arthritis with malunion. We hypothesized that the arthroplasty complication rate would be higher than in other etiologies of limitation of flexion and would require specific management strategies. PATIENTS In 23 cases, intra-articular malunion was present, in 15 cases extra-articular, and in two cases combined. The mean flexion was 72±23°, extension was 6±6°, and total range of motion (ROM) 66±23°. Eight cases of flexion restriction were severe (flexion<50°), six intermediate (flexion, 50-70°) and 26 moderate. In 14 cases, the anterior tibial tuberosity was osteotomized (43% intra-articular malunion and 6% extra-articular malunion). Five simultaneous realignment osteotomies were necessary. In severe cases of limitation of flexion, five extensive quadriceps releases were associated. RESULTS Four mobilizations under general anesthesia were performed. In the cases of severe limitation of flexion, we noted three avulsions of the patellar tendon, two cases of cutaneous necrosis, one of which was associated with deep infection, and another case of deep infection. In the cases of moderate limitation of flexion, we noted one case of nonunion of the tibial tuberosity and two cases were revised for loosening, one aseptic and the other septic. With a mean follow-up of 5±4 years, the mean flexion was 99.4°±23 for a gain of 26.7±20°. The final flexion and the gain in flexion were correlated with preoperative flexion (r=0.62 and r=-0.47, respectively). The final amplitude was 99±27° for a gain of 33±21°. The flexion gains were comparable for both types of malunion, whether they were intra- or extra-articular. DISCUSSION Arthroplasty provided a substantial gain in flexion. Osteotomy of the tibial tuberosity and the realignment osteotomies should be performed if necessary, with no risk of compromising the result. Superior gains can be sought in severe cases of limitation of flexion by releasing the extensor apparatus, in absence of cutaneous scar tissue retractions and recent infection. LEVEL OF EVIDENCE Level 4. Noncomparative retrospective study.
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Affiliation(s)
- P Massin
- Department of Orthopaedic Surgery and Traumatology, Bichat-Claude-Bernard Teaching Hospital center, Paris-Diderot University, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
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Bauer T, Lacoste S, Lhotellier L, Mamoudy P, Lortat-Jacob A, Hardy P. Arthroplasty following a septic arthritis history: a 53 cases series. Orthop Traumatol Surg Res 2010; 96:840-3. [PMID: 21035418 DOI: 10.1016/j.otsr.2010.06.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 05/31/2010] [Accepted: 06/01/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The most feared complication of arthroplasty after septic arthritis (active or quiescent) on a degenerative joint is septic failure, but this risk is difficult to assess. The aim of the present study was to analyze the results of arthroplasties after septic arthritis of native knee and hip joints, in terms of functional results and infection control and to seek eventual risk factors of failure. PATIENTS AND METHODS Fifty-three cases of septic arthritis treated by arthroplasty (31 knees and 22 hips) were retrospectively included. In case of evolutive septic arthritis (30 cases: 17 knees and 13 hips) failing to react to conservative treatment, arthroplasty was performed in a 2-stage procedure (a mean interval of 6 weeks between stages, and an associated antibiotic therapy for a mean 3 months were routinely respected). In case of previous arthritis considered to be cured (23 cases: 14 knees and nine hips), arthroplasty was performed with a 1-stage procedure, observing a mean interval of 5 years after the initial septic arthritis, and antibiotic therapy maintained until definitive microbiological results were obtained from joint cultures samples at surgery. No patients were lost to follow-up; minimum follow-up was 2 years, for a mean of 5 years. The final results were assessed in terms of functional outcome (on PMA functional score for hips and IKS score for knees) and successful eradication of infection. RESULTS Two-stage arthroplasty was successful in 26 of the 30 cases of evolutive septic arthritis (87%), while the 1-stage procedure was successful in 22 of the 23 cases of quiescent septic arthritis (95%) (NS). Functional results were very good. No significant difference in functional outcome or successful eradication of infection was found between the 1- and 2-stage procedures. No significant difference in final outcome in terms of infection eradication was found between knees and hips. No clinical, microbiological or treatment-related criteria emerged as risk factors for septic failure. DISCUSSION Arthroplasty after septic arthritis of the knee or hip using the present protocol (2-stage implantation in case of evolutive septic arthritis and a 1-stage procedure in case of quiescent septic arthritis) achieved very good functional results with a success rate of 87% for sepsis control in evolutive septic arthritis and of 95% in quiescent septic arthritis. LEVEL OF EVIDENCE Level IV retrospective or historical series.
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Affiliation(s)
- T Bauer
- Orthopedic and Traumatological Surgery Department, Ambroise-Paré Hospital, West Paris-Île-de-France University, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France.
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Massin P, Lautridou C, Cappelli M, Petit A, Odri G, Ducellier F, Sabatier C, Hulet C, Canciani JP, Letenneur J, Burdin P. Total knee arthroplasty with limitations of flexion. Orthop Traumatol Surg Res 2009; 95:S1-6. [PMID: 19442596 DOI: 10.1016/j.otsr.2009.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED Does total knee arthroplasty (TKA) increase mobility in stiff knees, where flexion is restricted due to degenerative changes associated with osteoarthritis, inflammatory disease, hemophilia, or post-traumatic sequelae also affecting soft tissue? The results of one hundred twenty eight TKA from five specialized centers were retrospectively reviewed. Only knees with pre-operative flexion less than 90 degrees were included. Forty six of these also had severe flexion contracture (>20 degrees). As a result of the arthroplasty, the flexion increased by 23+/-17 degrees in group 1 (stiff flexion only, 82 cases), and by 17+/-15 degrees in group 2 (combined stiffness), in which the total range of motion (ROM) increased by 39+/-21 degrees. Improvements in mobility were greater in the cases with severe pre-operative stiffness. One-year functional results did not correlate with final flexion. Flexion at last follow-up did not depend on pre-operative flexion; however, in group 2, final postoperative ROM did correlate with pre-operative ROM. Complications concerned mainly those cases with severe stiffness, in which extensive quadriceps release was performed (two cases of skin necrosis, one infection and one rupture of the patellar tendon), or the patients of group 2 (one skin necrosis, two femoral fractures, one infection and one sciatic nerve palsy). Hemophilia was a factor of poor prognosis. Overall, TKA provided significant flexion gain. It often required tibial tuberosity osteotomy, to improve exposure and prevent injury to the extensor mechanism. Extensive quadriceps release should be reserved to post-traumatic cases with intact skin and no recent infection. TYPE OF STUDY level 4 retrospective.
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Affiliation(s)
- P Massin
- Orthopedic Surgery Department, Teaching Hospital, 4, rue Larrey, 49033 Angers cedex 09, France.
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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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