|
1
|
Harna B, Kapoor A, Arora A, Arya S. Long-term comparative study evaluating the screw-cement construct for tibial defects in total knee arthroplasty: our experience. INTERNATIONAL ORTHOPAEDICS 2025; 49:647-660. [PMID: 39937239 DOI: 10.1007/s00264-025-06439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 02/01/2025] [Indexed: 02/13/2025]
Abstract
PURPOSE Total knee arthroplasty (TKA) is the preferred treatment for end-stage knee osteoarthritis, but challenges arise with severe angular deformities and associated tibial bone loss. The cement screw construct has emerged as a promising technique for managing these defects, offering advantages such as cost-effectiveness, accessibility, and ease of implementation. This research evaluated the clinical, functional and radiological outcome of screw-cement construct for the tibial defects in TKA. METHOD This retrospective study aimed to evaluate the long-term functional outcomes and success rate of the cement screw construct in patients with significant tibial defects. Sixty-five patients (104 knees) undergoing TKA were divided into two groups: conventional TKA (Group A) and TKA with screw-cement construct (Group B). Demographic, clinical, and radiological data were collected, with a follow-up duration of at least eight years. RESULTS The study revealed comparable demographic characteristics between groups. Both cohorts exhibited significant postoperative improvements in knee morphology and clinical outcomes. Group B demonstrated a higher incidence of radiolucency around the tibial tray, although no progressive complications were observed. Implant survival rates were similar between groups, with complications such as aseptic loosening and infections occurring in both without significant difference. CONCLUSIONS This study emphasised the viability of the screw-cement construct for managing uncontained tibial defects during TKA, providing evidence of its efficacy, and cost-effectiveness and suggesting its potential as a standard approach for tibial defects till 20 mm.
Collapse
Affiliation(s)
- Bushu Harna
- Indus International hospital, Mohali, India.
| | | | - Anil Arora
- Max Super Speciality Hospital, Delhi, India
| | - Shivali Arya
- Government Medical College and Hospital, Chandigarh, India
| |
Collapse
|
|
2
|
Piovan G, Bori E, Padalino M, Pianigiani S, Innocenti B. Biomechanical analysis of patient specific cone vs conventional stem in revision total knee arthroplasty. J Orthop Surg Res 2024; 19:439. [PMID: 39068461 PMCID: PMC11282788 DOI: 10.1186/s13018-024-04936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND In revision total knee arthroplasty, addressing significant bone loss often involves the use of cemented or press-fit stems to ensure implant stability and long-term fixation. A possible alternative to stem was recently introduced utilizing custom-made porous metaphyseal cones, designed to reconstruct the missing tibial and femoral geometries. Early clinical and radiological assessments have shown promising results. The objective of this research was to biomechanically evaluate the performances of these custom-made cones. METHODS The biomechanical study was conducted using a validated finite element model. The bone geometries of a patient (selected for their history of four knee revisions due to infection and periprosthetic fractures, followed by a successful treatment with custom-made 3D-printed metaphyseal cones) were employed for the study. On these bone models, different revision scenarios were simulated and examined biomechanically: (A) custom-made cementless metaphyseal cones; (B) cemented stems; (C) press-fit stems; (D) distal femoral reconstruction with press-fit stem. All the models were analyzed at 0 °and 90 °of flexion, under physiological load conditions simulating daily activities; stress distribution, average Von-Mises stresses and risk of fracture were then analyzed and compared among configurations. RESULTS The use of custom-made 3D-printed cones exhibited the most favorable stress distribution in both femoral and tibial bones. Tibial bone stress was evenly distributed in custom-made cone configurations, while stress concentration was observed in distal regions for the other scenarios. Additionally, custom-made cones displayed overall homogeneity and lower stress levels, potentially contributing to limit pain. Symmetrical stress distribution was observed between the lateral and medial proximal tibia in custom-made cone models, whereas other scenarios exhibited uneven stress, particularly in the anterior tibial bone. CONCLUSIONS The biomechanical analysis of porous custom-made metaphyseal cones in re-revision arthroplasties is in agreement with the positive clinical and radiological outcomes. These findings provide valuable insights into the potential benefits of using custom-made cones, which offer more uniform stress distribution and may contribute to improve patient outcomes in revision TKA procedures. Further studies in this direction are warranted to validate these biomechanical findings.
Collapse
Affiliation(s)
- Gianluca Piovan
- Department of Orthopaedic and Traumatology, S. Cuore-Don Calabria Hospital, Negrar, Italy
| | - Edoardo Bori
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, Brussels, 1050, Belgium
- Département ECAM, Haute Ecole ICHEC-ECAM-ISFSC, Woluwe-Saint-Lambert, Belgium
| | - Marika Padalino
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, Brussels, 1050, Belgium
| | - Silvia Pianigiani
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, Brussels, 1050, Belgium
- Adler Ortho, Cormano, Milan, 20032, Italy
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, Brussels, 1050, Belgium.
| |
Collapse
|
|
3
|
Pagano A, Agostinone P, Alesi D, Caputo D, Neri MP, Grassi A, Zaffagnini S. Almost 79% survival rate at 10-year follow-up for the patellofemoral joint arthroplasty: An Italian prosthetic registry study. Knee Surg Sports Traumatol Arthrosc 2024; 32:1525-1530. [PMID: 38529690 DOI: 10.1002/ksa.12150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE The aims of the present study were (1) to evaluate the survival of patellofemoral joint (PFJ) arthroplasty in a large cohort of patients using data obtained from an Italian regional arthroplasty registry and (2) to collect clinical outcomes of a subgroup of patients, with a minimum follow-up of 4 years. The hypotheses were that PFJ arthroplasty is a procedure that had good survival and clinical outcomes, not inferior to those reported in the literature for primary total knee arthroplasty (TKA). METHODS The Register of Orthopaedic Prosthetic Implants (RIPO) of Emilia-Romagna (ER) (Italy) database was searched for the inclusion of all PFJ arthroplasties implanted between 2003 and 2019. PFJ arthroplasties were excluded if they were implanted in patients who lived outside of the ER. The survival information was extrapolated from the RIPO considering the partial or total revision of the implant as failure; moreover, a subgroup of patients was contacted and interviewed by telephone to collect clinical outcomes. Descriptive statistics were used to summarise the data. The survival curve was calculated and plotted using the Kaplan-Meier method. RESULTS A total of 126 arthroplasties in 114 patients were included in the final analysis (mean age at surgery 60.1 ± 11.5 years old). The main causes of patellofemoral arthroplasty were primary osteoarthritis (88%) and posttraumatic arthritis (7%). The survival was 90.4 ± 30.6 and 78.8 ± 51.5 at 5 and 10 years of follow-up, respectively. At the latest follow-up, 23 implants failed (18.3%). The main cause of revision was osteoarthrosis progression (34.8%). A total of 44 patients were contacted by telephone to collect clinical outcomes: Western Ontario and McMaster Universities Osteoarthritis Index, functional Knee Society Score, Forgotten Joint Score and Oxford Knee Score. These patients reported good to excellent scores at a medium follow-up of 10.3 ± 4.7 years. CONCLUSIONS The PFJ showed good survival and clinical outcomes and could be considered a valuable option for patients affected by isolated patellofemoral osteoarthritis. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Anna Pagano
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Piero Agostinone
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Domenico Alesi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Dalila Caputo
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Maria Pia Neri
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
- Dipartimento di Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italia
| |
Collapse
|
|
4
|
Förch S, Lisitano L, Mayr E. Primary Total Knee Arthroplasty for Fractures Around the Knee. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:619-627. [PMID: 35654393 DOI: 10.1055/a-1807-7668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Primary arthroplasty for fractures of the femoral neck is a very common procedure and even the gold standard for the geriatric patient. In contrast, primary arthroplasty for perigenicular fractures is a rare event. On the other hand, it can be a therapeutic option, especially for geriatric patients with prior osteoarthritis or complex fractures and severe osteoporosis.The operative procedure can be complex and requires experience in primary and revision arthroplasty as well as suitable implants and good preoperative planning.There are case series reporting primary arthroplasty in a total of approximately 200 cases of both distal femoral and proximal tibial fractures. Complication rates are between 0 and 90% and mostly concern wound healing problems and infections. From a functional point of view, predominantly good results and a range of motion of 100° can be achieved.Primary arthroplasty can be a therapeutic option for selected cases of perigenicular fractures and gives good functional results. The most frequent complications are wound healing problems and infections.
Collapse
Affiliation(s)
- Stefan Förch
- Abteilung für Unfallchirurgie, Orthopädie, plastische und Handchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Leonard Lisitano
- Abteilung für Unfallchirurgie, Orthopädie, plastische und Handchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Edgar Mayr
- Unfallchirurgie, Orthopädie, Hand- und Plastische Chirurgie, Universität Augsburg Medizinische Fakultät, Augsburg, Deutschland
| |
Collapse
|
|
5
|
Bougaud E, Canovas F, Hamoui M, Dagneaux L. Combined structural allograft and tantalum cone to manage segmental metaphyseal tibial bone defect in revision knee arthroplasty. Orthop Traumatol Surg Res 2023; 109:103606. [PMID: 36963661 DOI: 10.1016/j.otsr.2023.103606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 03/26/2023]
Abstract
Tibial bone defect remains a challenge in revision knee arthroplasty. The present innovative technique combines structural allograft and tantalum metaphyseal cone for treatment of AORI stage 2A and 2B (uncontained peripheral metaphyseal) tibial defect. The aim is to reconstitute bone stock and enhance allograft osseointegration, while limiting stress to the allograft by implanting the metaphyseal cone through the allograft and the original bone. LEVEL OF EVIDENCE: V (expert opinion).
Collapse
Affiliation(s)
- Elias Bougaud
- Department of Orthopaedic Surgery, Lower Limb Surgery Unit, Lapeyronie University Hospital, Montpellier University, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 05, France.
| | - François Canovas
- Department of Orthopaedic Surgery, Lower Limb Surgery Unit, Lapeyronie University Hospital, Montpellier University, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 05, France.
| | - Mazen Hamoui
- Department of Orthopaedic Surgery, Lower Limb Surgery Unit, Lapeyronie University Hospital, Montpellier University, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 05, France.
| | - Louis Dagneaux
- Department of Orthopaedic Surgery, Lower Limb Surgery Unit, Lapeyronie University Hospital, Montpellier University, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 05, France.
| |
Collapse
|
|
6
|
Balgazarov S, Belokobylov A, Batpen A, Ramazanov Z, Dolgov A, Rimashevskiy D, Kriklivyy A. The First Stage of Knee Revision Arthroplasty in Periprosthetic Infection with Replacement of a Large Defect Double Cementing Method: A Case Report. Int Med Case Rep J 2023; 16:513-520. [PMID: 37701537 PMCID: PMC10493111 DOI: 10.2147/imcrj.s420109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023] Open
Abstract
Aim Large bone defects in patients with chronic deep periprosthetic knee infection is a major problem. It is widely accepted that bone defects filling with polymethylmethacrylate (PMMA) cement could be used only in selected cases of small bone defects (up to 5 mm) and less than 50% of articular surface due to multiple reasons: risk of thermal bone damage, inadequate cement pressurization and bone cement shrinkage, etc. Staged cementing for preventing bone heating and over negative effects of cementing on a thick layer of bone cement has limited support in the literature. Case Presentation We present the case of 4.5 years follow up after temporary-permanent spacer implantation in a 63-year-old male with chronic deep knee PJI and tibial AORI type 3 bone defect reconstructed via double cementing method. Results Method of double (staged) cementing used for reconstruction of epiphyseal tibial bone defect in a patient with fistula form of knee PJI shows excellent clinical results at 4.5 years follow up.
Collapse
Affiliation(s)
- Serik Balgazarov
- Department of Trauma Consequences and Combustiology, National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Astana, Republic of Kazakhstan
| | - Alexey Belokobylov
- Republican Center for Endoprosthetics, National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Astana, Republic of Kazakhstan
| | - Arman Batpen
- National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Astana, Republic of Kazakhstan
| | - Zhanatai Ramazanov
- Department of Trauma Consequences and Combustiology, National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Astana, Republic of Kazakhstan
| | - Alexey Dolgov
- Postgraduate Education Department, National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Astana, Republic of Kazakhstan
| | - Denis Rimashevskiy
- Peoples Friendship University of Russia, Trauma and Orthopedic Department, Moscow, Russia
| | - Alexandr Kriklivyy
- Institute of Life Sciences, Karaganda Medical University, Karaganda, Republic of Kazakhstan
| |
Collapse
|
|
7
|
Shichman I, Oakley C, Willems JH, van Hellemondt GG, Heesterbeek P, Rozell J, Marwin S, Schwarzkopf R. Novel metaphyseal porous titanium cones allow favorable outcomes in revision total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:1537-1547. [PMID: 36243781 DOI: 10.1007/s00402-022-04645-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Loosening and migration are common modes of aseptic failure following complex revision total knee arthroplasty (rTKA). Metaphyseal cones allow surgeons to negotiate the loss of femoral and tibial bone stock while obtaining stable bony fixation. This study examines the mid-term functional and radiographic outcomes in patients undergoing rTKA utilizing a novel metaphyseal cone system with stems of variable length and fixation methods. METHODS This two-center retrospective study examined all patients who underwent rTKA with a novel porous, titanium tibial or femoral cone in combination with a stem of variable length and fixation who had a minimum follow-up of 2-years. Outcome analysis was separated into tibial and femoral cones as well as the stem fixation method (hybrid vs. fully cemented). RESULTS Overall, 123 patients who received 156 cone implants were included (74 [60.2%] tibial only, 16 [13.0%] femoral only, and 33 [26.8%] simultaneous tibial and femoral) with a mean follow-up of 2.76 ± 0.66 years. At 2-years of follow-up the total cohort demonstrated 94.3% freedom from all-cause re-revisions, 97.6% freedom from aseptic re-revisions, and 99.4% of radiographic cone osteointegration. All-cause revision rates did not differ between stem fixation techniques in both the tibial and femoral cone groups. CONCLUSION The use of a novel porous titanium femoral and tibial metaphyseal cones combined with stems in patients with moderate to severe bone defects undergoing complex revision total knee arthroplasty confers excellent results independent of stem fixation technique. LEVEL OF EVIDENCE IV, case series.
Collapse
Affiliation(s)
- Ittai Shichman
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17Th Street, New York, NY, 10003, USA
- Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Christian Oakley
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17Th Street, New York, NY, 10003, USA
| | - Jore H Willems
- Department of Orthopedic Surgery, Sint Maartensklinek, Ubbergen, Gelderland, The Netherlands
| | - Gijs G van Hellemondt
- Department of Orthopedic Surgery, Sint Maartensklinek, Ubbergen, Gelderland, The Netherlands
| | - Petra Heesterbeek
- Research Department, Sint Maartensklinek, Ubbergen, Gelderland, The Netherlands
| | - Joshua Rozell
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17Th Street, New York, NY, 10003, USA
| | - Scott Marwin
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17Th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17Th Street, New York, NY, 10003, USA.
| |
Collapse
|
|
8
|
Elkabbani M, Haidar F, Osman A, Adie Y, Dragos A, Tarabichi S. Posterior stabilized total knee arthroplasty increases the risk of postoperative periprosthetic fractures. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221082317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The Insall-Burstein posterior-stabilized knee design was first developed in 1978 by adding a central cam mechanism to the articular surface geometry of the total condylar prosthesis to correct its problems being not “rolling back”. Since then, the use of posterior-stabilized (PS) implants in total knee arthroplasty (TKA) is becoming increasingly popular. However, one of the main disadvantages of PS designs is related to the amount of bone removed during femoral box osteotomy to create the housing of the PS mechanism, the clinical value of removing more or less bone during primary TKA remains to be fully established. The objective of this study was to compare the incidence of early postoperative periprosthetic fractures in the cruciate retaining (CR) and posterior stabilized (PS) knee prosthesis. Methods An institutional high volume arthroplasty unit database was reviewed to identify all patients who sustained a postoperative periprosthetic fracture following primary TKA between January 2014 and May 2018. A retrospective chart review was performed to collect clinical, radiographic, and operative report data. A total of 352 patients with 600 primary TKAs were identified. (300 cases of cruciate retaining TKAs from 178 patients and 300 cases of posterior stabilized TKAs from 174 patients) were retrospectively reviewed. Results Eleven patients (1.83%) sustained periprosthetic fractures in the postoperative setting following primary TKA. All of the fractures were located on the femur and were treated surgically. Only one knee (one patient) from the CR group sustained a periprosthetic fracture, while 10 knees (from 10 patients) from the PS group sustained a fracture. The relative risk of sustaining a fracture in the CR group was 0.10 times relative to the PS group (RR = 0.10, 95% CI 0.0129 – 0.776). Conclusion Posterior stabilized total knee arthroplasties (TKAs) significantly increase the risk of periprosthetic fractures in obese Asian patients compared to cruciate retaining TKAs.
Collapse
Affiliation(s)
- Mohamed Elkabbani
- Department of Orthopaedic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia Governorate, Egypt
- Tarabichi center for Joint Surgery, Burjeel Hospital Dubai, Dubai, United Arab Emirates
| | - Feras Haidar
- Tarabichi center for Joint Surgery, Burjeel Hospital Dubai, Dubai, United Arab Emirates
| | - Amr Osman
- Tarabichi center for Joint Surgery, Burjeel Hospital Dubai, Dubai, United Arab Emirates
| | - Yosra Adie
- Tarabichi center for Joint Surgery, Burjeel Hospital Dubai, Dubai, United Arab Emirates
| | - Apostu Dragos
- Department of Orthopaedics and Traumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Samih Tarabichi
- Tarabichi center for Joint Surgery, Burjeel Hospital Dubai, Dubai, United Arab Emirates
| |
Collapse
|
|
9
|
Rak D, Weißenberger M, Horas K, von Hertzberg-Bölch S, Rudert M. [Mega-prostheses in revision knee arthroplasty]. DER ORTHOPADE 2021; 50:1011-1017. [PMID: 34739569 DOI: 10.1007/s00132-021-04187-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Due to a predicted increase in primary total knee arthroplasty (TKA), revision TKA will gain importance over the following years. Because the average age of patients receiving a TKA is decreasing the possible need for multiple revisions might increase as well. Despite efforts to minimize bone and soft tissue damage, the resulting bone and soft-tissue loss increases with each revision and will make the use of megaprostheses indispensable in the future. COMPLICATIONS The implantation of a mega-prosthesis must be carefully considered and planned, since mega-prostheses in particular are associated with an increased risk of infection and loosening. Mechanical complications, patient-specific problems and periprosthetic infections can be either the cause for or the result of revision surgery of a mega-prosthesis. In the case of a complication, only a salvage procedure, namely an arthrodesis, amputation or-if necessary-the installation of a permanent fistula is commonly recommended.
Collapse
Affiliation(s)
- D Rak
- Klinik König-Ludwig-Haus Würzburg, Lehrstuhl für Orthopädie, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
| | - M Weißenberger
- Klinik König-Ludwig-Haus Würzburg, Lehrstuhl für Orthopädie, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
| | - K Horas
- Klinik König-Ludwig-Haus Würzburg, Lehrstuhl für Orthopädie, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
| | - S von Hertzberg-Bölch
- Klinik König-Ludwig-Haus Würzburg, Lehrstuhl für Orthopädie, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
| | - M Rudert
- Klinik König-Ludwig-Haus Würzburg, Lehrstuhl für Orthopädie, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland.
| |
Collapse
|
|
10
|
Moreira F, Jurado M, Casaccia M. Exposure and Implant Options in Revision Total Knee Arthroplasty. EVIDENCE‐BASED ORTHOPEDICS 2021:301-305. [DOI: 10.1002/9781119413936.ch50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
|
|
11
|
Roach RP, Clair AJ, Behery OA, Thakkar SC, Iorio R, Deshmukh AJ. Aseptic Loosening of Porous Metaphyseal Sleeves and Tantalum Cones in Revision Total Knee Arthroplasty: A Systematic Review. J Knee Surg 2021; 34:1033-1041. [PMID: 32074656 DOI: 10.1055/s-0040-1701434] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Bone loss often complicates revision total knee arthroplasty (TKA). Management of metaphyseal defects varies, with no clearly superior technique. Two commonly utilized options for metaphyseal defect management include porous-coated metaphyseal sleeves and tantalum cones. A systematic review was conducted according to the international Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We combined search terms "Total knee arthroplasty" AND/OR "Sleeve," "Cone" as either keywords or medical subject heading (MeSH) terms in multiple databases according to PRISMA recommendations. All retrieved articles were reviewed and assessed using defined inclusion and exclusion criteria. A total of 27 studies (12 sleeves and 15 cones) of revision TKAs were included. In the 12 studies on sleeve implantation in revision TKAs, 1,617 sleeves were implanted in 1,133 revision TKAs in 1,025 patients. The overall rate of reoperation was 110/1,133 (9.7%) and the total rate of aseptic loosening per sleeve was 13/1,617 (0.8%). In the 15 studies on tantalum cone implantation in revision TKAs, 701 cones were implanted into 620 revision TKAs in 612 patients. The overall rate of reoperation was 116/620 (18.7%), and the overall rate of aseptic loosening per cone was 12/701 (1.7%). Rates of aseptic loosening of the two implants were found to be similar, while the rate of reoperation was nearly double in revision TKAs utilizing tantalum cones. Variability in the selected studies and the likely multifactorial nature of failure do not allow for any definitive conclusions to be made. This review elucidates the necessity for additional literature examining revision TKA implants.
Collapse
Affiliation(s)
- Ryan P Roach
- Department of Orthopaedic Surgery, New York University Langone Medical Center, New York University Langone Orthopedic Hospital, New York, New York
| | - Andrew J Clair
- Department of Orthopaedic Surgery, New York University Langone Medical Center, New York University Langone Orthopedic Hospital, New York, New York
| | - Omar A Behery
- Department of Orthopaedic Surgery, New York University Langone Medical Center, New York University Langone Orthopedic Hospital, New York, New York
| | - Savyasachi C Thakkar
- Department of Orthopaedic Surgery, New York University Langone Medical Center, New York University Langone Orthopedic Hospital, New York, New York
| | - Richard Iorio
- Department of Orthopaedic Surgery, Brigham Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ajit J Deshmukh
- Department of Orthopaedic Surgery, New York University Langone Medical Center, New York University Langone Orthopedic Hospital, New York, New York
| |
Collapse
|
|
12
|
Savov P, Tuecking LR, Windhagen H, Ettinger M. Individual Revision Knee Arthroplasty Is a Safe Limb Salvage Procedure. J Pers Med 2021; 11:jpm11060572. [PMID: 34207165 PMCID: PMC8234866 DOI: 10.3390/jpm11060572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/13/2021] [Accepted: 06/16/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: Revision total knee arthroplasty after multiple pre-surgeries is challenging. Due to severe bone defects, standard implants for metaphyseal and diaphyseal anchoring may no longer be suitable. The primary aim of this case series is to evaluate the early complication rate for individual knee implants with custom-made cones and stems after two-stage revision with severe bone defects. Methods: Ten patients who were treated with custom-made 3D-printed knee revision implants were included. Inclusion criteria were a two-stage revision due to late-onset or chronic periprosthetic joint infection as well as aseptic loosening. All severe bone defects were AORI type III. All procedure-related complications were evaluated. Postoperative range of motion after one year was measured. The time between the two surgeries was evaluated. Results: The mean follow-up was 21 months (range: 12–40). The mean time between the two-stage surgeries was 71.6 days. No fractures were observed intra- and postoperatively. Two patients were revised without changing metal components due to persistent hematoma (three weeks post-surgery) and persistent PJI (three months post-surgery). The mean passive postoperative range of motion was 92° (range: 80–110°). Conclusions: Individual custom-made implants for rTKA provide a safe procedure for patients with huge bone defects after several pre-surgeries. If standard knee systems with standard cones or sleeves are not suitable anymore, custom-made treatment offers the patient the last option for limb preservation. However, this is associated with increased costs.
Collapse
|
|
13
|
Hernandez NM, Hinton ZW, Wu CJ, Ryan SP, Bolognesi MP. Mid-term results of tibial cones : reasonable survivorship but increased failure in those with significant bone loss and prior infection. Bone Joint J 2021; 103-B:158-164. [PMID: 34053275 DOI: 10.1302/0301-620x.103b6.bjj-2020-1934.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Tibial cones are often utilized in revision total knee arthroplasty (TKA) with metaphyseal defects. Because there are few studies evaluating mid-term outcomes with a sufficient cohort, the purpose of this study was to evaluate tibial cone survival and complications in revision TKAs with tibial cones at minimum follow-up of five years. METHODS A retrospective review was completed from September 2006 to March 2015, evaluating 67 revision TKAs (64 patients) that received one specific porous tibial cone during revision TKA. The final cohort was composed of 62 knees (59 patients) with five years of clinical follow-up or reoperation. The mean clinical follow-up of the TKAs with minimum five-year clinical follow-up was 7.6 years (5.0 to 13.3). Survivorship analysis was performed with the endpoints of tibial cone revision for aseptic loosening, tibial cone revision for any reason, and reoperation. We also evaluated periprosthetic joint infection (PJI), risk factors for failure, and performed a radiological review. RESULTS The rate of cone revision for aseptic loosening was 6.5%, with an eight-year survival of 95%. Significant bone loss (Anderson Orthopaedic Research Institute grade 3) was associated with cone revision for aseptic loosening (p = 0.002). The rate of cone revision for any reason was 17.7%, with an eight-year survival of 84%. Sixteen percent of knees developed PJI following revision. A pre-revision diagnosis of reimplantation as part of a two-stage exchange protocol for infection was associated with both PJI (p < 0.001) and tibial cone revision (p = 0.001). CONCLUSION Mid-term results of tibial cones showed a survivorship free of cone revision for aseptic loosening of 95%. Patients with significant bone loss were more likely to have re-revision for tibial cone failure. Infection was common, and patients receiving cones at reimplantation were more likely to develop PJI and undergo cone revision. Cite this article: Bone Joint J 2021;103-B(6 Supple A):158-164.
Collapse
Affiliation(s)
- Nicholas M Hernandez
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zoe W Hinton
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Christine J Wu
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Sean P Ryan
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| |
Collapse
|
|
14
|
Mékidèche T, Armoiry X, Sautet P, Dussart C, Mandy B. [Economic evaluation of porous metal cones in total knee arthroplasty]. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 80:81-88. [PMID: 33961827 DOI: 10.1016/j.pharma.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/02/2021] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The use of porous metal cones (PMC) to fill bone loss during knee replacements is increasing, but these medical devices are not reimbursed in addition to diagnosis related tariffs (DRTs). The economic impact of PMC may be significant for hospitals. MATERIAL AND METHODS This multicenter observational study includes all patients who benefited of a total knee prosthesis, with reconstruction by PMC, between June 2014 and June 2019, in two French university hospitals. The costs of each diagnosis related group (DRG) was evaluated using the "étude nationale des coûts à méthodologie commune (ENC)". The PMC costs were compared with the amounts of DRG and with the fares perceived by the hospital from the French sickness fund (DRTs). RESULTS 96 patients (103 stays) benefited from the implantation of 195 cones. The hospital incomes were 10,970±1401€ /stay. Spending associated with PMC represented 35% of DRGs and 44% of DRTs. The average additional cost related to the cones was 2709±1138€ /stay. If the reconstructions had been performed by allograft, the average gain for hospitals would have been 108€ /stay. CONCLUSION If PMC have clinical benefits for surgeons in reducing the incidence of revision, this study shows the inadequacy of the funding of these devices for French hospitals. This suggests the need to expand the possibilities of supporting innovative technologies.
Collapse
Affiliation(s)
- T Mékidèche
- Hôpital de la Timone, université Aix-Marseille, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - X Armoiry
- UMR-CNRS 5510, ISPB/hôpital Édouard-Herriot, université de Lyon, Lyon, France
| | - P Sautet
- Institut du mouvement et de l'appareil locomoteur, hôpitaux Sud, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - C Dussart
- Laboratoire Parcours santé systémique, université de Lyon, Lyon, France
| | - B Mandy
- Hôpital Renée Sabran, hospices civils de Lyon, Hyères, France.
| |
Collapse
|
|
15
|
Tibial bone loss in revision TKA: Options for management without sleeves and cones -a schematic review. J Orthop 2021; 23:191-198. [PMID: 33551612 DOI: 10.1016/j.jor.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/08/2020] [Indexed: 11/22/2022] Open
|
|
16
|
Trabecular Metal Cones Combined With Short Cemented Stem Allow Favorable Outcomes in Aseptic Revision Total Knee Arthroplasty. J Arthroplasty 2021; 36:657-663. [PMID: 32978026 DOI: 10.1016/j.arth.2020.08.058] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare the functional outcomes and implant survivorship at a minimum of 5 years of follow-up of several reconstruction techniques with or without metaphyseal cone and stems of variable length. METHODS A retrospective comparative matched analysis was performed from 2 prospectively collected databases. Only patients who underwent revision total knee arthroplasty procedures for aseptic causes using a single design of rotating hinge knee with a minimum of 5 years of follow-up were analyzed. Patients were separated into 3 groups: trabecular metal (TM) cones + short cemented stems (TM + short stem [SS]), TM cones + long uncemented stems (TM + long stem [LS]), and no cone (NC) + long uncemented stems (NC + LS). A matching process based on age (±5 years) was realized. RESULTS About 99 patients were included; 33 in the TM + SS group, 33 in the TM + LS group, and 33 in the NC + LS group. The mean time of follow-up was 9.3 years. A significant difference of the improvement of subscale pain, symptom, activities of daily living, quality of life of the Knee Injury and Osteoarthritis Outcome score and knee, function of the Knee Society Score was observed in favor of TM + SS group compared with the 2 other groups. At 8 years of survivorship, the components free of revision for any cause were 90.9% for the TM + SS group, 84.9% for the TM + LS group, and 90.6% for the NC + LS group. CONCLUSION The use of a short cemented tibial stem combined with a TM cone in revision total knee arthroplasty offers identical survival rate with better functional outcome compared with the use of a long uncemented stem associated with TM cones or metallic augments at a minimum of 5 years of follow-up.
Collapse
|
|
17
|
Huten D, Pasquier G, Lambotte JC. Techniques for filling tibiofemoral bone defects during revision total knee arthroplasty. Orthop Traumatol Surg Res 2021; 107:102776. [PMID: 33321231 DOI: 10.1016/j.otsr.2020.102776] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/28/2020] [Indexed: 02/03/2023]
Abstract
There are a variety of options for filling defects during revision total knee arthroplasty: cement with or without screws, structural or morselized allograft, highly porous cones and sleeves, massive bone allograft or megaprostheses. Our goal is to describe the techniques for these procedures and their indications. Any necrotic bone, fibrous tissue or granulomas must be excised, and the bone freshened. The height of the joint line must be restored using trial components stabilized by stems. The defect is the space between the bone and each of the two components. Whether contained or not, it can be evaluated using the AORI classification. Cement alone or supplemented with screws, which is pressurized to penetrate the bone, is now only used in small defects less than 10mm in diameter, especially contained one. It is preferable to use morselized compacted bone graft instead. Augments are used to fill AORI type 2 defects less than 10 mm deep in a condyle. They can also be used to position the femoral component and sometimes the tibial one. For type 2 and 3 defects, bone allografts aim to reconstruct the skeleton. They can be used as trimmed fragments, as described by Engh who did hemispheric reaming to embed a femoral head into the defect. One can also compact or pack morselized bone graft around a stem. These reconstruction procedures are long and difficult. They are being done less and less since porous cones and sleeves were introduced, which are impacted after bone preparation. These sterile components are secured to the stem either mechanically or with cement, saving time. Once in place, bone grows into them. They provide metaphyseal anchoring that helps to reduce the stem's length. When the epiphysis is nearly all gone, the choices are a massive bone allograft or a megaprosthesis, although both have a high risk of infection and mechanical failure. The allograft must be trimmed to restore the height of the joint line and achieve a stable connection with the host bone. A long stem, always cemented into the allograft, is essential. In older patients, a megaprothesis is simpler to use and faster. The femur is better suited to massive reconstruction than the tibia, where coverage must be ensured along with extensor mechanism continuity. LEVEL OF EVIDENCE: V; expert opinion.
Collapse
Affiliation(s)
- Denis Huten
- Service de chirurgie orthopédique et réparatrice, hôpital Pontchaillou, 2, rue H-Le-Guilloux, 35000 Rennes, France.
| | - Gilles Pasquier
- Clinique d'orthopédie-traumatologie, Hôpital Roger-Salengro, CHRU de Lille, avenue du Professeur Emile-Laine, 59037 Lille, France
| | - Jean-Christophe Lambotte
- Service de chirurgie orthopédique et réparatrice, hôpital Pontchaillou, 2, rue H-Le-Guilloux, 35000 Rennes, France
| |
Collapse
|
|
18
|
Tampere T, Ollivier M, Jacquet C, Fabre-Aubrespy M, Parratte S. Knee arthroplasty for acute fractures around the knee. EFORT Open Rev 2020; 5:713-723. [PMID: 33204515 PMCID: PMC7608576 DOI: 10.1302/2058-5241.5.190059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Results of open reduction and internal fixation for complex articular fractures around the knee are poor, particularly in elderly osteoporotic patients. Open reduction and internal fixation may lead to an extended hospital stay and non-weight-bearing period. This may lead to occurrence of complications related to decubitus such as thrombo-embolic events, pneumonia and disorientation. Primary arthroplasty can be a valuable option in a case-based and patient-specific approach. It may reduce the number of procedures and allow early full weight-bearing, avoiding the above-mentioned complications. There are four main indications:
1) Elderly (osteoporotic) patients with pre-existing (symptomatic) end-stage osteoarthritis. 2) Elderly (osteoporotic) patients with severe articular and metaphyseal destruction. 3) Pathological fractures of the distal femur and/or tibia. 4) Young patients with complete destruction of the distal femur and/or tibia. The principles of knee (revision) arthroplasty should be applied; choice of implant and level of constraint should be considered depending on the type of fracture and involvement of stabilizing ligaments. The aim of treatment is to obtain a stable and functional joint. Long-term data remain scarce in the literature due to limited indications. Cite this article: EFORT Open Rev 2020;5:713-723. DOI: 10.1302/2058-5241.5.190059
Collapse
Affiliation(s)
- Thomas Tampere
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Matthieu Ollivier
- Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France
| | - Christophe Jacquet
- Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France
| | - Maxime Fabre-Aubrespy
- Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France
| | - Sébastien Parratte
- Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France.,Department of Orthopaedic Surgery, International Knee and Joint Centre, Abu Dhabi, UAE
| |
Collapse
|
|
19
|
Managing bone defects in primary total knee arthroplasty: options and current trends. Musculoskelet Surg 2020; 105:31-38. [PMID: 33058073 DOI: 10.1007/s12306-020-00683-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/03/2020] [Indexed: 12/31/2022]
Abstract
While tackling with bone deficiencies in the context of total knee arthroplasty, it is imperative for the arthroplasty surgeon to arm himself with an in-depth knowledge on the various management options available and to use the right option for the right type of defect in the right patient. Aim of this review paper is to focus on the various options available and discuss the evolving concepts and recent trends with regard to the implications and treatment of bone deficiencies, in primary total knee arthroplasty. Relevant literature is evaluated with specific focus on the modality used for managing a defect, their clinical and radiological outcomes and failure rates. Out of various classifications described, Anderson Orthopaedic Research Institute (AORI) system is universally employed to classify the bone defects. The currently available management options include more tibial resection, the use of bone cement to fill the defect, with or without augmentation with screws, bone grafting which may be autograft or allograft, metal augments, metaphyseal cones and sleeves. There is no single option which can be applied universally; each has its own advantages, disadvantages and specific indications with regard to application in specific types of defects, in specific patients as outlined in this article.
Collapse
|
|
20
|
Mozella ADP, Cobra HADAB. Bone Defects in Revision Total Knee Arthroplasty. Rev Bras Ortop 2020; 56:138-146. [PMID: 33935308 PMCID: PMC8075647 DOI: 10.1055/s-0040-1713392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/15/2020] [Indexed: 12/14/2022] Open
Abstract
The increase in the number of revision total knee arthroplasty surgeries has been observed in recent years, worldwide, for several causes. In the United States, a 601% increase in the number of total knee arthroplasties, between 2005 and 2030, is estimated. Among the enormous challenges of this complex surgery, the adequate treatment of bone defects is essential to obtain satisfactory and lasting results. The adequate treatment of bone defects aims to build a stable and lasting support platform for the implantation of the definitive prosthetic components and, if possible, with the reconstruction of bone stock. Concomitantly, it allows the correct alignment of the prosthetic and limb components, as well as restoring the height of the joint interline and, thus, restoring the tension of soft parts and load distribution to the host bone, generating a joint reconstruction with good function, stable, and painless. There are several options for the management of these bone defects, among them: bone cement with or without reinforcement with screws, modular metallic augmentations, impacted bone graft, structural homologous graft and, more recently, metal metaphyseal cones, and metaphyseal sleeves. The objective of the present article was to gather classic information and innovations about the main aspects related to the treatment of bone defects during revision surgeries for total knee arthroplasty.
Collapse
Affiliation(s)
- Alan de Paula Mozella
- Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil.,Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil
| | | |
Collapse
|
|
21
|
Shi W, Jiang Y, Wang C, Zhang H, Wang Y, Li T. Comparative study on mid- and long-term clinical effects of medial pivot prosthesis and posterior-stabilized prosthesis after total knee arthroplasty. J Orthop Surg Res 2020; 15:421. [PMID: 32943092 PMCID: PMC7500020 DOI: 10.1186/s13018-020-01951-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/09/2020] [Indexed: 01/31/2023] Open
Abstract
Objective The purpose of this study was to explore the mid-and long-term clinical effects of Chinese patients with medial pivot (MP) prosthesis and posterior-stabilized (PS) prosthesis after total knee arthroplasty (TKA), to provide a reference for the recommendation of clinical prostheses. Methods A retrospective analysis of 802 patients who received TKA was performed from June 2010 to December 2013. A total of 432 patients received a MP prosthesis (MP group) and 375 patients received a PS prosthesis (PS group). Postoperative range of motion (ROM), clinical scores including the knee scoring system (KSS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), the forgotten joint score (FJS), and postoperative complications were compared between the two groups. Results A total of 527 patients were followed up, including 290 in the MP group and 237 in the PS group. Both groups achieved satisfactory results in terms of KSS score, WOMAC score, and postoperative ROM, which were significantly improved compared with those before surgery, but the difference between the groups was not statistically significant (P > 0.05). The FJS scores of the MP group and the PS group were satisfactory and no significant difference was observed (P = 0.426). Postoperative complications occurred in 5 and 11 patients in the MP group and PS group, respectively. Conclusion The clinical results of TKA with MP or PS in Chinese patients at mid- and long-term are encouraging, and no significant differences were observed between the two types of prostheses. Studies have also shown that both prostheses are safe for Chinese patients.
Collapse
Affiliation(s)
- Weipeng Shi
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China.,Medical Department of Qingdao University, Qingdao, 266071, Shandong, China
| | - Yaping Jiang
- Department of Oral Implantology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Changyao Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China
| | - Yingzhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China.
| | - Tao Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China.
| |
Collapse
|
|
22
|
Sepehri A, Masri BA. Short-Term Tibial Baseplate Fracture After Total Knee Arthroplasty in the Absence of Osteolysis and Implant Loosening: A Case Report. JBJS Case Connect 2020; 10:e2000109. [PMID: 32910580 DOI: 10.2106/jbjs.cc.20.00109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE The patient is a 62-year-old man with early tibial baseplate failure involving fracture and subsidence of the posteromedial metal implant, only 3 years after primary total knee replacement. Although this mode of failure is frequently observed secondary to polyethylene wear and osteolysis, this case was likely because of suboptimal tibial baseplate size and positioning with lack of cortical support that underwent accelerated fatigue, given the high activity level of the patient. CONCLUSION This case demonstrates rare sequelae of inadequate tibial coverage and cortical structural support of the baseplate. Tibial coverage is influenced by implant sizing, implant positioning, and variations in patient anthropometrics.
Collapse
Affiliation(s)
- Aresh Sepehri
- 1Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | | |
Collapse
|
|
23
|
Vecchini E, Berti M, Micheloni GM, Maluta T, Magnan B, Ricci M. Clinical and radiological results of a stemmed medial pivot revision implant in aseptic total knee revision arthroplasty. Knee 2020; 27:1190-1196. [PMID: 32711881 DOI: 10.1016/j.knee.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/09/2020] [Accepted: 05/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Constraint choice in revision total knee arthroplasty depends on the stability of the collateral ligaments and on the severity of bone loss, but the least degree of constraint necessary is recommended. The purpose of this retrospective matched-paired study was to compare clinical results, radiographic outcome and the survival of a stemmed medial pivot revision implant in aseptic revision TKA vs. medial pivot implant in primary TKA. METHODS Records were reviewed for 69 cases of aseptic revision TKA using Advance® Medial Pivot Stemmed Revision Knee system between 2002 and 2016. These patients were then matched in a 1:2 ratio control group of patients who received a primary TKA with Advance® Medial Pivot system. American Knee Society Score and Visual Analogue Scale pain score were recorded. Alignment, loosening, and incidence of radiolucent lines were evaluated on X-rays. Implant survival was assessed by Kaplan-Meier survival analysis. RESULTS The primary TKA group had significant superior AKSS clinical and functional score at baseline (52.3 and 68.2 points, respectively) and at last follow up (84.6 and 68.6 points) compared with the revision TKA group (47.9 and 40.9 points; 78.4 and 59.9 points; P < 0.05). No significant difference was observed in the mean change from baseline to last follow up of AKSS score between the two groups (P > 0.05). Radiographical outcome and implant survival were similar in the two groups (P > 0.05). CONCLUSION The authors support the use of this revision system in knees with collateral ligaments competence and mild-to-moderate bone defect.
Collapse
Affiliation(s)
- Eugenio Vecchini
- Orthopedic and Traumatologic Unit, Integrated University Hospital of Verona, Verona, Italy
| | - Mattia Berti
- Orthopedic and Traumatologic Unit, Integrated University Hospital of Verona, Verona, Italy.
| | | | - Tommaso Maluta
- Orthopedic and Traumatologic Unit, Integrated University Hospital of Verona, Verona, Italy
| | - Bruno Magnan
- Orthopedic and Traumatologic Unit, Integrated University Hospital of Verona, Verona, Italy
| | - Matteo Ricci
- Orthopedic and Traumatologic Unit, Integrated University Hospital of Verona, Verona, Italy
| |
Collapse
|
|
24
|
|
|
25
|
Du YQ, Sun JY, Ni M, Zhou YG. Re-revision surgery for re-recurrent valgus deformity after revision total knee arthroplasty in a patient with a severe valgus deformity: A case report. World J Clin Cases 2019. [DOI: 10.12998/wjcc.v7.i21.3545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
|
26
|
Du YQ, Sun JY, Ni M, Zhou YG. Re-revision surgery for re-recurrent valgus deformity after revision total knee arthroplasty in a patient with a severe valgus deformity: A case report. World J Clin Cases 2019; 7:3562-3568. [PMID: 31750338 PMCID: PMC6854397 DOI: 10.12998/wjcc.v7.i21.3562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/17/2019] [Accepted: 09/25/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A recurrent valgus deformity was a common complication after total knee arthroplasty (TKA) in patients with valgus deformity. However, re-revision surgery for re-recurrent valgus deformity after revision TKA in patients with valgus deformity before primary TKA was uncommon.
CASE SUMMARY We reported a 72-year-old female patient with two recurrent valgus deformities after TKA for a valgus knee deformity who underwent two revision surgeries to rectify the deformity. In the re-revision surgery, bone defects were successfully reconstructed by the augments and cement in combination with screws and a sleeve. An appropriate neutral alignment of the lower limb was restored by the perfect femoral entry point and the long diaphyseal cementless stem. Adequate fixation of the metaphysis and diaphysis of the femur was obtained by the sleeve and long diaphyseal cementless stem. The patient was pain-free and deformity-free for 2.5 years.
CONCLUSION The management of bone defects, the choice of the stem and the femoral entry point were of vital importance in the revision or re-revision TKA for a recurrent valgus deformity.
Collapse
Affiliation(s)
- Yin-Qiao Du
- Department of Orthopedics, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China
| | - Jing-Yang Sun
- Department of Orthopedics, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China
| | - Ming Ni
- Department of Orthopedics, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China
| | - Yong-Gang Zhou
- Department of Orthopedics, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China
| |
Collapse
|
|
27
|
Rosso F, Cottino U, Dettoni F, Bruzzone M, Bonasia DE, Rossi R. Revision total knee arthroplasty (TKA): mid-term outcomes and bone loss/quality evaluation and treatment. J Orthop Surg Res 2019; 14:280. [PMID: 31462273 PMCID: PMC6714451 DOI: 10.1186/s13018-019-1328-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/18/2019] [Indexed: 11/17/2022] Open
Abstract
Background Revision total knee arthroplasty (rTKA) is a demanding procedure, with a high complication and failure rate and a high rate of bone losses and poor bone quality. Different classifications for bone losses have been proposed, but they do not consider bone quality, which may affect implant fixation. The aim of this study is to describe the outcomes of a consecutive series of rTKA. Furthermore, a modified bone loss classification will be proposed based also on bone quality. Finally, the association between radiolucent line (RLL) development and different risk factors will be evaluated. Methods All the patients who underwent rTKA between 2008 and 2016 in the same institution were included. rTKAs were performed by the same surgeon according to the three-step technique. Bone losses were classified according to the proposed classification, including bone quality evaluation. The Knee Scoring System (KSS), the Hospital for Special Surgery Knee Score (HSS), and the SF-12 were used for the clinical evaluation. Radiological evaluation was performed according to the Knee Society Roentgenographic Evaluation System. Different possible risk factors (i.e., gender, age, amount of bone losses) associated to RLL development were identified, and this association was evaluated using logistic regression. Results Fifty-one patients (53 knees) were included (60.8% female, average age 71.5 years). The average follow-up was 56.6 months (range 24–182). The most frequent cause of failure was aseptic loosening (41.5%). 18.9% of the cases demonstrated poor bone quality. Bone losses were treated according to the proposed algorithm. In all the cases, there was a significant improvement in all the scores (P < 0.05). The average post-operative range of motion was 110.5° (SD 10.7). At the radiological evaluation, all the implants resulted well aligned, with 15.1% of non-progressive RLL. There were 2 failures, with a cumulative survivorship of 92.1% at the last follow-up (SD 5.3%). At the logistic regression, none of the evaluated variables resulted associated to RLL development. Conclusion rTKA is a demanding procedure, and adequate treatment of bone losses is mandatory to achieve good results. However, also bone quality should be taken into consideration when approaching bone losses, and the proposed classification may need surgeons after an adequate validation. Level of evidence Level IV
Collapse
Affiliation(s)
- Federica Rosso
- Department of Orthopedics and Traumatology, AO Ordine Mauriziano, Largo Turati 62, 10128, Turin, Italy.
| | - Umberto Cottino
- Department of Orthopedics and Traumatology, AO Ordine Mauriziano, Largo Turati 62, 10128, Turin, Italy
| | - Federico Dettoni
- Department of Orthopedics and Traumatology, AO Ordine Mauriziano, Largo Turati 62, 10128, Turin, Italy
| | - Matteo Bruzzone
- Department of Orthopedics and Traumatology, AO Ordine Mauriziano, Largo Turati 62, 10128, Turin, Italy
| | - Davide Edoardo Bonasia
- Department of Orthopedics and Traumatology, AO Ordine Mauriziano, Largo Turati 62, 10128, Turin, Italy
| | - Roberto Rossi
- Department of Orthopedics and Traumatology, AO Ordine Mauriziano, Largo Turati 62, 10128, Turin, Italy.,Department of Surgery, University of Turin, Via Po 8, 10100, Turin, Italy
| |
Collapse
|
|
28
|
Lei PF, Hu RY, Hu YH. Bone Defects in Revision Total Knee Arthroplasty and Management. Orthop Surg 2019; 11:15-24. [PMID: 30809942 PMCID: PMC6430493 DOI: 10.1111/os.12425] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/19/2016] [Accepted: 09/28/2016] [Indexed: 11/29/2022] Open
Abstract
This article reviews the recent updates in revision of total knee arthroplasty (RTKA). We reviewed the recent articles on RTKA in databases including PubMed, Google Scholar, and SCOPUS. Total knee arthroplasty (TKA) involves the replacement of all three compartments of the knee in surgery of the knee joint to restore capacity and function. TKA is one of the most common and reliable surgical treatment options for the treatment of knee diseases. However, some patients require revision of TKA (RTKA) after primary TKA for various reasons, including mechanical wear, implant loosening or breakage, malalignment, infection, instability, periprosthetic fracture, and persistent stiffness. Unfortunately, the overall outcome of RTKA is not as satisfactory as for primary TKA due to the uncertainty regarding the actual success rate and the risk factors for failure. Cementation, modular metal augmentation, bone grafting, autologous bone grafting, allogenic bone grafting, impactation bone grafting, structural bone allografting, metaphyseal fixation, using porous titanium coated press fit metaphyseal sleeves and porous tantalum structural cones, and megaprostheses or customized prostheses are the currently available management options for RTKA. However, most of the management systems possess specific complications. Novel approaches should be developed to improve functional capacity, implant survival rates, and quality of life in a cost‐efficient manner.
Collapse
Affiliation(s)
- Peng-Fei Lei
- Department of Orthopaedic Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Ru-Yin Hu
- Department of Orthopaedic Surgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yi-He Hu
- Department of Orthopaedic Surgery, Xiangya Hospital of Central South University, Changsha, China
| |
Collapse
|
|
29
|
Innocenti B, Fekete G, Pianigiani S. Biomechanical Analysis of Augments in Revision Total Knee Arthroplasty. J Biomech Eng 2018; 140:2694847. [PMID: 30098138 DOI: 10.1115/1.4040966] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/08/2022]
Abstract
Augments are a common solution for treating bone loss in revision total knee arthroplasty and industry is providing to surgeons several options, in terms of material, thickness and shapes. Actually, while the choice of the shape and the thickness is mainly dictated by the bone defect, no proper guidelines are currently available to select the optimal material for a specific clinical situation. Nevertheless, different materials could induce different bone responses and, later, potentially compromise implant stability and performances. Therefore, in this study, a biomechanical analysis is performed by means of finite element modelling about existing features for augment designs. Based upon a review of available products at present, the following augments features were analyzed: position (distal/proximal and posterior), thickness (5, 10 and 15 mm) and material (bone cement, porous and solid metal). For all analyzed configurations, bone stresses were investigated in different regions and compared among all configurations and the control model for which no augments were used. Results show that the use of any kind of augment usually induces a change in bone stresses, especially in the region close to the bone cut. The porous metal presents result very close to cement ones; thus it could be considered as a good alternative for defects of any size. Solid metal has the least satisfying results inducing the highest changes in bone stress. The results of this study demonstrate that material stiffness of the augment should be as close as possible to bone properties for allowing the best implant performances.
Collapse
Affiliation(s)
- Bernardo Innocenti
- BEAMS Department, Université Libre De Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050 Bruxelles, Belgium
| | - Gusztáv Fekete
- Savaria Institute of Technology, Faculty of Informatics, Eötvös Loránd University, Károlyi Gáspár 4, 9700 Szombathely, Hungary
| | - Silvia Pianigiani
- BEAMS Department, Université Libre De Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050 Bruxelles, Belgium
| |
Collapse
|
|
30
|
Divano S, Cavagnaro L, Zanirato A, Basso M, Felli L, Formica M. Porous metal cones: gold standard for massive bone loss in complex revision knee arthroplasty? A systematic review of current literature. Arch Orthop Trauma Surg 2018; 138:851-863. [PMID: 29671089 DOI: 10.1007/s00402-018-2936-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Revision knee arthroplasty is increasing, and in that case, bone loss management is still a challenging problem. In the last years, the body of literature and interest surrounding porous metal cones has grown, but few systematic evaluations of the existing evidence have been performed. The aim of our systematic review is to collect and critically analyze the available evidence about metal cones in revision knee arthroplasty especially focusing our attention on indications, results, complications, and infection rate of these promising orthopaedic devices. MATERIALS AND METHODS We performed a systematic review of the available English literature, considering the outcomes and the complications of tantalum cones. The combinations of keyword were "porous metal cones", "knee revision", "bone loss", "knee arthroplasty", "periprosthetic joint infection", and "outcome". RESULTS From the starting 312 papers available, 20 manuscripts were finally included. Only one included study has a control group. The main indication for metal cones is type IIb and III defects according AORI classification. Most of the papers show good clinical and radiological outcomes with low rate of complications. CONCLUSION The examined studies provide encouraging clinical and radiological short-to-mid-term outcomes. Clinical studies have shown a low rate of aseptic loosening, intraoperative fractures, infection rate and a lower failure rate than the previous treatment methods. Higher quality papers are needed to draw definitive conclusions about porous metal cones.
Collapse
Affiliation(s)
- Stefano Divano
- U.O. Clinica Ortopedica e Traumatologica, Ospedale Policlinico San Martino IST, largo R. Benzi 10, 16132, Genoa, GE, Italy.
| | - Luca Cavagnaro
- U.O. Clinica Ortopedica e Traumatologica, Ospedale Policlinico San Martino IST, largo R. Benzi 10, 16132, Genoa, GE, Italy
| | - Andrea Zanirato
- U.O. Clinica Ortopedica e Traumatologica, Ospedale Policlinico San Martino IST, largo R. Benzi 10, 16132, Genoa, GE, Italy
| | - Marco Basso
- U.O. Clinica Ortopedica e Traumatologica, Ospedale Policlinico San Martino IST, largo R. Benzi 10, 16132, Genoa, GE, Italy
| | - Lamberto Felli
- U.O. Clinica Ortopedica e Traumatologica, Ospedale Policlinico San Martino IST, largo R. Benzi 10, 16132, Genoa, GE, Italy
| | - Matteo Formica
- U.O. Clinica Ortopedica e Traumatologica, Ospedale Policlinico San Martino IST, largo R. Benzi 10, 16132, Genoa, GE, Italy
| |
Collapse
|
|
31
|
Parratte S, Ollivier M, Argenson JN. Primary total knee arthroplasty for acute fracture around the knee. Orthop Traumatol Surg Res 2018; 104:S71-S80. [PMID: 29199087 DOI: 10.1016/j.otsr.2017.05.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 02/02/2023]
Abstract
Relatively poor results have been reported with open reduction and internal fixation of complex fractures around the knee in elderly osteoporotic patients, and primary total knee arthroplasty (TKA) has been proposed as an alternative solution. While limiting the number of procedures, it meets two prerequisites: (1) to save the patient's life, thanks to early weight-bearing, to limit decubitus complications; and (2) to save knee function and patient autonomy, thanks to early knee mobilization. There are 3 main indications: complex articular fractures in elderly patients with symptomatic osteoarthritis prior to fracture; complex articular fractures of the tibial plateau in elderly patients whose bone quality makes internal fixation hazardous; and major destruction of the distal femur in younger patients. Although admitted in emergency, these patients require adequate preoperative management, including a multidisciplinary approach to manage comorbidities, control of anemia and pain, and assessment and management of vascular and cutaneous conditions. Preoperative planning is crucial, to order appropriate implants and materials that may be needed intraoperatively. Surgical technique is based on the basic principles of revision surgery as regards choice of implant, steps of reconstruction, bone defect management and implant fixation. For complex fractures of the distal femur, primary temporary reduction is a useful "trick", to determine the level of the joint line and femoral rotation. Complementary internal fixation may be required in case of diaphyseal extension of the fracture and to prevent inter-prosthetic fractures. In the literature, the results of primary TKA for fracture are encouraging and better than for secondary TKA after failure of non-operative treatment or internal fixation, with lower rates of revision and complications, earlier full weight-bearing and better functional results. Loss of autonomy is, however, frequent, and 1-year mortality is high, especially following complex femoral fractures in the elderly.
Collapse
Affiliation(s)
- S Parratte
- CNRS, ISM UMR 7287, Aix-Marseille université, 13288 Marseille cedex 09, France; Service de chirurgie orthopédique, institut du mouvement et de l'appareil locomoteur, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France.
| | - M Ollivier
- CNRS, ISM UMR 7287, Aix-Marseille université, 13288 Marseille cedex 09, France; Service de chirurgie orthopédique, institut du mouvement et de l'appareil locomoteur, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - J-N Argenson
- CNRS, ISM UMR 7287, Aix-Marseille université, 13288 Marseille cedex 09, France; Service de chirurgie orthopédique, institut du mouvement et de l'appareil locomoteur, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| |
Collapse
|
|
32
|
Yoon JR, Seo IW, Shin YS. Use of autogenous onlay bone graft for uncontained tibial bone defects in primary total knee arthroplasty. BMC Musculoskelet Disord 2017; 18:502. [PMID: 29187180 PMCID: PMC5706337 DOI: 10.1186/s12891-017-1826-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/10/2017] [Indexed: 11/16/2022] Open
Abstract
Background The use of autogenous bone graft is a well–known technique for reconstruction of tibial bone defects in primary total knee arthroplasty (TKA). In cases where the size of the bone graft is inappropriate, the stability of bone graft fixation and subsequent bone graft to host bone incorporation may be compromised. We describe a simple and reliable technique of reconstruction in a proximal tibia bone defect at the time of primary TKA by using autogenous onlay bone graft (AOBG). Methods Records were reviewed of 19 patients (mean age, 72 years) who underwent primary TKA using AOBG without the additional allogenous bone or metal augments, between August 2013 and August 2014. Results Mean Knee Society score (KSS) in the 22 knees was significantly higher postoperatively than preoperatively (92 ± 4 vs. 30 ± 7, P < 0.001). The mean range of motion (ROM) in the 22 knees, which was 106 ± 12° preoperatively, improved to 112 ± 10° at last follow-up, but this this difference was not significant (P = 0.32). No migration of implants and presence of radiolucent lines at the bone cement-prosthesis interface were observed. Furthermore, the serial radiographs of 19 patients had a mean time of 3.2 months (range, 2.7–4.4 months) for solid union with cross trabeculation between the proximal tibial bone and graft. Conclusions This simple AOBG supplement technique may biologically promote graft to host bone healing by enhancing fixation stability without the additional fixatives and assist the surgeon in managing the varying nature of uncontained bone defects. Trial registration Trial registration number: KCT0002328, May 15, 2017.
Collapse
Affiliation(s)
- Jung-Ro Yoon
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, Korea
| | - In-Wook Seo
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, Korea.
| |
Collapse
|
|
33
|
Quilez MP, Seral B, Pérez MA. Biomechanical evaluation of tibial bone adaptation after revision total knee arthroplasty: A comparison of different implant systems. PLoS One 2017; 12:e0184361. [PMID: 28886100 PMCID: PMC5590921 DOI: 10.1371/journal.pone.0184361] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 08/22/2017] [Indexed: 11/19/2022] Open
Abstract
The best methods to manage tibial bone defects following total knee arthroplasty remain under debate. Different fixation systems exist to help surgeons reconstruct knee osseous bone loss (such as tantalum cones, cement, modular metal augments, autografts, allografts and porous metaphyseal sleeves) However, the effects of the various solutions on the long-term outcome remain unknown. In the present work, a bone remodeling mathematical model was used to predict bone remodeling after total knee arthroplasty (TKA) revision. Five different types of prostheses were analyzed: one with a straight stem; two with offset stems, with and without supplements; and two with sleeves, with and without stems. Alterations in tibia bone density distribution and implant Von Mises stresses were quantified. In all cases, the bone density decreased in the proximal epiphysis and medullary channels, and an increase in bone density was predicted in the diaphysis and around stem tips. The highest bone resorption was predicted for the offset prosthesis without the supplement, and the highest bone formation was computed for the straight stem. The highest Von Mises stress was obtained for the straight tibial stem, and the lowest was observed for the stemless metaphyseal sleeves prosthesis. The computational model predicted different behaviors among the five systems. We were able to demonstrate the importance of choosing an adequate revision system and that in silico models may help surgeons choose patient-specific treatments.
Collapse
Affiliation(s)
- María Paz Quilez
- M2BE-Multiscale in Mechanical and Biological Engineering, Departamento de Ingeniería Mecánica, Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Belen Seral
- University Clinic Hospital “Lozano Blesa”, Aragón Institute of Health Science (IACS), University of Zaragoza, Zaragoza, Spain
| | - María Angeles Pérez
- M2BE-Multiscale in Mechanical and Biological Engineering, Departamento de Ingeniería Mecánica, Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
- * E-mail:
| |
Collapse
|
|
34
|
Survivorship and functional outcomes of patellofemoral arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25:2622-2631. [PMID: 26590562 DOI: 10.1007/s00167-015-3878-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/10/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Historically poor results of survivorship and functional outcomes of patellofemoral arthroplasty (PFA) have been reported in the setting of isolated patellofemoral osteoarthritis. More recently, however, fairly good results of PFA were reported, but the current status of PFA outcomes is unknown. Therefore, a systematic review was performed to assess overall PFA survivorship and functional outcomes. METHODS A search was performed using PubMed, Embase and Cochrane systems, and the registries were searched. Twenty-three cohort studies and one registry reported survivorship using Kaplan-Meier curve, while 51 cohort studies reported functional outcomes of PFA. RESULTS Twelve studies were level II studies, while 45 studies were level III or IV studies. Heterogeneity was mainly seen in type of prosthesis and year the cohort started. Nine hundred revisions in 9619 PFAs were reported yielding 5-, 10-, 15- and 20-year PFA survivorships of 91.7, 83.3, 74.9 and 66.6 %, respectively, and an annual revision rate of 2.18. Functional outcomes were reported in 2587 PFAs with an overall score of 82.2 % of the maximum score. KSS and Knee Function Score were 87.5 and 81.6 %, respectively. CONCLUSION This systematic review showed that fairly good results of PFA survivorship and functional outcomes were reported at short- and midterm follow-up in the setting of isolated patellofemoral osteoarthritis. Heterogeneity existed mainly in prosthesis design and year the cohort started. CLINICAL RELEVANCE These results provide a clear overview of the current status of PFA in the setting of isolated patellofemoral osteoarthritis. LEVEL OF EVIDENCE IV.
Collapse
|
|
35
|
Completo A, Fonseca F, Ramos A, Simões J. Comparative assessment of different reconstructive techniques of distal femur in revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:2559-2566. [PMID: 26025074 DOI: 10.1007/s00167-015-3652-2] [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: 12/10/2014] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Bone loss is often encountered in revision total knee arthroplasty. In particular, when the cortex of distal femur is breached, the surgical decision on the reconstructive options to be taken is challenging due to the variety of defects and the lack of data from clinical or experimental studies that can support it. The aim of the present work was to test the hypothesis that for an identical defect and bone condition, each reconstructive technique option has a dissimilar stress and stability behaviour, which may be related to differing longevity of the revision procedure. METHODS Triaxial strain gauges and video extensometer were used to measure distal cortex strains and implant stability in eight reconstructive techniques replicated with synthetic femur under a load of 2030N. To assess the cancellous bone strains, finite element models were developed and validated. RESULTS The measured strains showed that the distal cortex is not immune to the different reconstructive techniques, when applied to an identical defect; however, significant differences (P < 0.05) were found only between bone graft and metal augment on the 12-mm larger distal defect. The stem addition improves the stability of all reconstructive techniques; however, significant differences (P = 0.03) were found only on the bone-graft technique. CONCLUSIONS Cement-fill and metal-augment techniques, applied to the 4-mm smaller defect, are not associated with different structural behaviour, while for the 12-mm larger defect, the metal-augment and bone-graft techniques presented distinct biomechanical effects. These effects, by themselves, may not be sufficient to be associated with a different longevity of the revision procedure among techniques, when the stem is added to the bone-graft technique. These findings, based on independent scientific understanding and advanced prediction tools, can improve the surgical decision-making process, when the peripheral cortex of the distal femur is breached.
Collapse
Affiliation(s)
- A Completo
- Department of Mechanical Engineering, University of Aveiro, 3810-193, Aveiro, Portugal.
| | - F Fonseca
- Department of Orthopaedics, Coimbra University Hospital, 3000-075, Coimbra, Portugal
| | - A Ramos
- Department of Mechanical Engineering, University of Aveiro, 3810-193, Aveiro, Portugal
| | - J Simões
- Department of Mechanical Engineering, University of Aveiro, 3810-193, Aveiro, Portugal
| |
Collapse
|
|
36
|
Mancuso F, Beltrame A, Colombo E, Miani E, Bassini F. Management of metaphyseal bone loss in revision knee arthroplasty. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017. [PMID: 28657571 PMCID: PMC6178990 DOI: 10.23750/abm.v88i2-s.6520] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: Revision total knee arthroplasty (TKA) is usually made more complex by the presence of bone defects, which may be caused by periprosthethic infection, polyethylene wear, implant loosening or fractures. The main aim of the present work is to review the available literature to understand the current options to manage with the bone loss during knee revisions. Methods: Available English literature for bone defects in revision TKAs has been evaluated looking at treatment options and their results in terms of clinical and radiological outcomes and failure rates. Results: Anderson Orthopaedic Research Institute (AORI) classification is the most frequently used because it helps in the choice of the most suitable treatment. Several options are available in the management of metaphyseal bone loss in revision knee arthroplasty. For small and contained defects (AORI type 1) cement with or without screws and auto- or allograft morcellized bone are available. In uncontained but mild defects (AORI type 2A) metal augments should be use while large and uncontained defects (AORI type 2B and 3) are best addressed with structural allograft or metal filling devices (cones and sleeves). Stemmed components, either cemented or cementless, are recommended to reduce the strain at the interface implant-host. Conclusions: The treatment of bone defects in revision TKAs has evolved during the last years providing different options with good results at a short/medium term follow up. With the increasing revision burden, further scientific evidence is requested to identify the best approach for each patient. Long-term clinical outcome as well as implant survival after revision TKA are still sub-optimal and depend upon many factors including cause for revision, surgical approach, type of implants used and various patient factors. (www.actabiomedica.it)
Collapse
|
|
37
|
Mancuso F, Beltrame A, Colombo E, Miani E, Bassini F. Management of metaphyseal bone loss in revision knee arthroplasty. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:98-111. [PMID: 28657571 DOI: 10.23750/abm.v88i2 -s.6520] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIM OF THE WORK Revision total knee arthroplasty (TKA) is usually made more complex by the presence of bone defects, which may be caused by periprosthethic infection, polyethylene wear, implant loosening or fractures. The main aim of the present work is to review the available literature to understand the current options to manage with the bone loss during knee revisions. METHODS Available English literature for bone defects in revision TKAs has been evaluated looking at treatment options and their results in terms of clinical and radiological outcomes and failure rates. RESULTS Anderson Orthopaedic Research Institute (AORI) classification is the most frequently used because it helps in the choice of the most suitable treatment. Several options are available in the management of metaphyseal bone loss in revision knee arthroplasty. For small and contained defects (AORI type 1) cement with or without screws and auto- or allograft morcellized bone are available. In uncontained but mild defects (AORI type 2A) metal augments should be use while large and uncontained defects (AORI type 2B and 3) are best addressed with structural allograft or metal filling devices (cones and sleeves). Stemmed components, either cemented or cementless, are recommended to reduce the strain at the interface implant-host. CONCLUSIONS The treatment of bone defects in revision TKAs has evolved during the last years providing different options with good results at a short/medium term follow up. With the increasing revision burden, further scientific evidence is requested to identify the best approach for each patient. Long-term clinical outcome as well as implant survival after revision TKA are still sub-optimal and depend upon many factors including cause for revision, surgical approach, type of implants used and various patient factors.
Collapse
|
|
38
|
Bozkurt M, Tahta M, Gursoy S, Akkaya M. Total and intercondylar notch bone resection in posterior stabilized knee arthroplasty: analysis of five manufacturer designs. Knee Surg Sports Traumatol Arthrosc 2017; 25:1731-1735. [PMID: 26578304 DOI: 10.1007/s00167-015-3864-5] [Citation(s) in RCA: 5] [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] [Received: 05/27/2015] [Accepted: 11/05/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE The study aimed to volumetrically measure and compare the bone amount removed through the intercondylar femoral notch and the total bone amount removed through five different brands of implant design in order to provide orthopaedic surgeons with opinions in respect of implant selection. METHODS Ten implants from five different total knee arthroplasty implant manufacturers, namely Nex-Gen Legacy, Genesis 2 PS, Vanguard, Sigma PS and Scorpio NRG PS, were applied to a total of 50 sawbone models. Equal or the closest sizes of each brand on the anteroposterior plane were selected, and cuts were made following the standard technique. The removed bone pieces were measured in terms of volume and length in three planes, and were statistically analysed. RESULTS The comparison made by excluding femoral notch cuts did not produce any statistically significant difference between the amounts of bone removed. The following data were volumetrically obtained from the intercondylar femoral notch cut: Vanguard (3.6 ± 0.4 cm3), Nex-Gen (3.7 ± 0.5 cm3), Sigma (5.7 ± 0.4 cm3), Genesis 2 (6.3 ± 0.3 cm3) and Scorpio NRG (6.7 ± 0.7 cm3). There was no statistical difference between Genesis 2 and Scorpio NRG (n.s.), or between Nex-Gen and Vanguard (n.s.). The smallest volumetric value measured in the removed intercondylar femoral notch cut was obtained using Vanguard. CONCLUSION There are significant differences between implant designs in terms of preserving bone stock, and a large proportion of the difference arises from the intercondylar femoral notch cut.
Collapse
Affiliation(s)
- Murat Bozkurt
- Department of Orthopedics and Traumatology, Ankara Atatürk Training and Research Hospital, 06800, Ankara, Turkey.
| | - Mesut Tahta
- Department of Orthopedics and Traumatology, İzmir Bozyaka Training and Research Hospital, 35170, Izmir, Turkey
| | - Safa Gursoy
- Department of Orthopedics and Traumatology, Ankara Atatürk Training and Research Hospital, 06800, Ankara, Turkey
| | - Mustafa Akkaya
- Department of Orthopedics and Traumatology, Ankara Atatürk Training and Research Hospital, 06800, Ankara, Turkey
| |
Collapse
|
|
39
|
Girerd D, Parratte S, Lunebourg A, Boureau F, Ollivier M, Pasquier G, Putman S, Migaud H, Argenson JN. Total knee arthroplasty revision with trabecular tantalum cones: Preliminary retrospective study of 51 patients from two centres with a minimal 2-year follow-up. Orthop Traumatol Surg Res 2016; 102:429-33. [PMID: 27052939 DOI: 10.1016/j.otsr.2016.02.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 02/10/2016] [Accepted: 02/16/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Successful management of large bone defects is of crucial importance when performing revision total knee arthroplasty (TKA). Trabecular tantalum cones may improve prosthesis fixation via their potential for reconstructing a stable metaphyseal support. The objective of this study was to evaluate the clinical and radiological outcomes and the complications of tantalum cones in revision TKA. HYPOTHESIS Trabecular tantalum cones provide stable and durable metaphyseal reconstruction when used during revision TKA. MATERIAL AND METHODS Trabecular Metal™ cones (Zimmer, Warsaw, IN, USA) were used for 52 revision TKAs in 51 patients (mean age, 68±9 years) managed in two centres between 2008 and 2013. A rotating hinge prosthesis was chosen for 38 (73%) knees and a condylar constrained knee prosthesis for 14 (27%) knees, with 37 tibial and 34 femoral cones. The two most common reasons for revision surgery were aseptic loosening (n=22, 42%) and infection (n=19, 37%). The bone loss was severe in most cases. At each centre, after a mean follow-up of 34 months (range, 24-52 months), two independent observers assessed the Knee Society Score (KSS), range of motion, mechanical axis, and osteo-integration for each patient. RESULTS Mean KSS increased from 46 preoperatively to 77 (P=0.001) at last follow-up and the mean KSS function from 39 to 57 (P=0.007). Mean range of motion improved from 93° (45°-120°) to 110° (65°-130°) (P=0.001). Mean postoperative mechanical axis was 180° (172°-190°). Radiographic evaluation showed evidence of osteo-integration for all cones. Four revisions were performed for recurrence of infection but none for mechanical failure. DISCUSSION The findings of our study confirm the biomechanical and biological reliability of Trabecular Metal™ cones used to fill metaphyseal bone defects during revision TKA. LEVEL OF EVIDENCE IV, retrospective therapeutic study.
Collapse
Affiliation(s)
- D Girerd
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - S Parratte
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France.
| | - A Lunebourg
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - F Boureau
- Centre Hospitalier Régional Universitaire, Service de chirurgie orthopédique et traumatologie, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille, rue Paul-Duez, 59000 Lille, France
| | - M Ollivier
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - G Pasquier
- Centre Hospitalier Régional Universitaire, Service de chirurgie orthopédique et traumatologie, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille, rue Paul-Duez, 59000 Lille, France
| | - S Putman
- Centre Hospitalier Régional Universitaire, Service de chirurgie orthopédique et traumatologie, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille, rue Paul-Duez, 59000 Lille, France
| | - H Migaud
- Centre Hospitalier Régional Universitaire, Service de chirurgie orthopédique et traumatologie, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille, rue Paul-Duez, 59000 Lille, France
| | - J N Argenson
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| |
Collapse
|
|
40
|
Sculco PK, Abdel MP, Hanssen AD, Lewallen DG. The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment. Bone Joint J 2016; 98-B:120-4. [PMID: 26733657 DOI: 10.1302/0301-620x.98b1.36345] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The treatment of bone loss in revision total knee arthroplasty has evolved over the past decade. While the management of small to moderate sized defects has demonstrated good results with a variety of traditional techniques (cement and screws, small metal augments, impaction bone grafting or modular stems), the treatment of severe defects continues to be problematic. The use of a structural allograft has declined in recent years due to an increased failure rate with long-term follow-up and with the introduction of highly porous metal augments that emphasise biological metaphyseal fixation. Recently published mid-term results on the use of tantalum cones in patients with severe bone loss has reaffirmed the success of this treatment strategy.
Collapse
Affiliation(s)
- P K Sculco
- Mayo Clinic, 200 First Street S.W., Rochester, Minnesota, 55905, USA
| | - M P Abdel
- Mayo Clinic, 200 First Street S.W., Rochester, Minnesota, 55905, USA
| | - A D Hanssen
- Mayo Clinic, 200 First Street S.W., Rochester, Minnesota, 55905, USA
| | - D G Lewallen
- Mayo Clinic, 200 First Street S.W., Rochester, Minnesota, 55905, USA
| |
Collapse
|
|
41
|
Rastetter BR, Wright SJ, Gheduzzi S, Miles AW, Clift SE. The influence of tibial component malalignment on bone strain in revision total knee replacement. Proc Inst Mech Eng H 2016; 230:561-8. [PMID: 27006420 DOI: 10.1177/0954411916638684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 02/19/2016] [Indexed: 11/16/2022]
Abstract
Revision total knee replacement is a challenging surgical procedure typically associated with significant loss of bone stock in the proximal tibia. To increase the fixation stability, extended stems are frequently used for the tibial component in revision surgery. The design of the tibial stem influences the load transfer from tibial component to the surrounding bone and is cited as a possible cause for the clinically reported pain in the location of the stem-end. This study aimed to analyse the strain distribution of a fully cemented revision tibial component with a validated finite element model. The model was developed from a scanned composite tibia (Sawbones), with an implanted, fully cemented stemmed tibial component aligned to the mechanical axis of the tibia. Loading was applied to the tibial component with mediolateral compartment load distributions of 60:40 and 80:20. Three strain gauged composite tibias with implanted tibial components of the same design using the same loading distribution were tested to obtain experimental strains at five locations in the proximal tibia. The finite element model developed was validated against strain measurements obtained in the experimental study. The strains displayed similar patterns (R(2) = 0.988) and magnitudes with those predicted from the finite element model. The displacement of the stem-end from the natural mechanical axis in the finite element model demonstrated increased strains in the stem-end region with a close proximity of the distal stem with the cortical bone. The simulation of a mediolateral compartment load of 80:20 developed peak cortical strain values on the posterior-medial side beneath the stem. This may possibly be related to the clinically reported pain at the stem-end. Furthermore, stem positioning in close proximity or contact with the posterior cortical bone is a contributory factor for an increase in distal strain.
Collapse
Affiliation(s)
- Benjamin R Rastetter
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Samantha J Wright
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Sabina Gheduzzi
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Anthony W Miles
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Sally E Clift
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, UK
| |
Collapse
|
|
42
|
Hoffart HE, Dinges H, Kolbeck S, Ritschl P, Hommel H. Novel computer-assisted method for revision arthroplasty of the knee. World J Orthop 2015; 6:821-828. [PMID: 26601064 PMCID: PMC4644870 DOI: 10.5312/wjo.v6.i10.821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/25/2015] [Accepted: 08/03/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To introduce the navigation system of software and instruments designed specifically for revision total knee arthroplasty (TKA).
METHODS: We present an imageless navigation system for revision TKA, with optical point and tracker identification to assess kinematic and anatomical landmarks. The system automatically positions the cutting guides with a motorized cutting unit. The cutting unit is placed on the distal femur with a femoral clamp and acts as a rigid body and the base for all femoral cuts. The surgical technique for using the navigation system for revision TKA is based on the technique used in primary TKA. However, there are some important differences. The most notable are: (1) differences in estimation of the position of the primary implant relative to the bone and the mechanical axes; (2) the specific possibilities the revision navigation software offers in terms of optimal joint level positioning; and (3) the suggested “best fit” position, in which the clock position, stem position and offset, femoral component size, and mediolateral position of the femoral component are taken into account to find the optimal femoral component position. We assessed the surgical technique, and accompanying software procedural steps, of the system, identifying any advantages or disadvantages that they present.
RESULTS: The system aims to visualize critical steps of the procedure and is intended as a tool to support the surgeon in surgical decision-making. Combining a computer-assisted cutting device with navigation makes it possible to carry out precise cuts without pinning. Furthermore, the femoral clamp provides a stable fixation mechanism for the motorized cutting unit. A stable clamp is paramount in the presence of periarticular bony defects. The system allows the position of the primary implant relative to the bone and mechanical axes to be estimated, at which point any malalignments can be corrected. It also offers an optimal joint level position for implantation, and suggests a “best fit” position, in which the clock position, stem position and offset, femoral component size, and mediolateral position of the femoral component are considered. The surgeon can therefore make decisions intraoperatively to maximise alignment and, hence, outcomes. Based on the intraoperative findings of joint stability, the surgeon can modify the preoperative plan and switch from a constrained condylar system to a hinged version, or vice versa.
CONCLUSION: The system is flexible and easy to learn and allows improvements in workflow during TKA.
Collapse
|
|
43
|
Quílez M, Pérez M, Seral-García B. Biomechanical study of the tibia in knee replacement revision. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
|
44
|
Boureau F, Putman S, Arnould A, Dereudre G, Migaud H, Pasquier G. Tantalum cones and bone defects in revision total knee arthroplasty. Orthop Traumatol Surg Res 2015; 101:251-5. [PMID: 25755068 DOI: 10.1016/j.otsr.2014.11.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/15/2014] [Accepted: 11/21/2014] [Indexed: 02/02/2023]
Abstract
Management of bone loss is a major challenge in revision total knee arthroplasty (TKA). The development of preformed porous tantalum cones offers new possibilities, because they seem to have biological and mechanical qualities that facilitate osseointegration. Compared to the original procedure, when metaphyseal bone defects are too severe, a single tantalum cone may not be enough and we have developed a technique that could extend the indications for this cone in these cases. We used 2 cones to fill femoral bone defects in 7 patients. There were no complications due to wear of the tantalum cones. Radiological follow-up did show any migration or loosening. The short-term results confirm the interest of porous tantalum cones and suggest that they can be an alternative to allografts or megaprostheses in case of massive bone defects.
Collapse
Affiliation(s)
- F Boureau
- Service d'orthopédie D, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France; Université Lille Nord de France, 59000 Lille cedex, France.
| | - S Putman
- Service d'orthopédie D, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France; Université Lille Nord de France, 59000 Lille cedex, France
| | - A Arnould
- Service d'orthopédie D, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France; Université Lille Nord de France, 59000 Lille cedex, France
| | - G Dereudre
- Service d'orthopédie D, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France; Université Lille Nord de France, 59000 Lille cedex, France
| | - H Migaud
- Service d'orthopédie D, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France; Université Lille Nord de France, 59000 Lille cedex, France
| | - G Pasquier
- Service d'orthopédie D, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France; Université Lille Nord de France, 59000 Lille cedex, France
| |
Collapse
|
|
45
|
Parratte S, Abdel MP, Lunebourg A, Budhiparama N, Lewallen DG, Hanssen AD, Argenson JN. Revision total knee arthroplasty: the end of the allograft era? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:621-2. [DOI: 10.1007/s00590-015-1615-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/27/2015] [Indexed: 11/30/2022]
|
|
46
|
Beckmann NA, Mueller S, Gondan M, Jaeger S, Reiner T, Bitsch RG. Treatment of severe bone defects during revision total knee arthroplasty with structural allografts and porous metal cones-a systematic review. J Arthroplasty 2015; 30:249-53. [PMID: 25445853 DOI: 10.1016/j.arth.2014.09.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/12/2014] [Accepted: 09/11/2014] [Indexed: 02/01/2023] Open
Abstract
Aseptic loosening and focal osteolysis are the most common reasons for knee arthroplasty failure. The best treatment remains unclear. We reviewed the literature on the treatment of revision knee arthroplasty using bony structural allografts (476 cases) and porous metal cones (223 cases) to determine if a difference in the revision failure rates was discernable. The failure rates were compared using a logistic regression model with adjustment for discrepancies in FU time and number of grafts used (femoral, tibial, or both). In this analysis, the porous implant shows a significantly decreased loosening rate in AORI 2 and 3 defects. The overall failure rate was also substantially lower in the porous metal group than the structural allograft group; little difference in the infection rates was noted.
Collapse
Affiliation(s)
- Nicholas A Beckmann
- Department of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Mueller
- Department of Traumatology, Department of Surgery, University Hospital Basel, Basel, Switzerland
| | | | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, University of Heidelberg, Heidelberg, Germany
| | - Tobias Reiner
- Department of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Rudi G Bitsch
- Department of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
|
47
|
Quílez MP, Pérez MA, Seral-García B. Biomechanical study of the tibia in knee replacement revision. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:365-71. [PMID: 25650079 DOI: 10.1016/j.recot.2014.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022] Open
Abstract
The best management of severe bone defects following total knee replacement is still controversial. Metal augments, tantalum cones and porous tibial sleeves could help the surgeon to manage any type of bone loss, providing a stable and durable knee joint reconstruction. Five different types of prostheses have been analysed: one prosthesis with straight stem; two prostheses with offset stem, with and without supplement, and two prostheses with sleeves, with and without stem. The purpose of this study is to report a finite element study of revision knee tibial implants. The main objective was to analyse the tibial bone density changes and Von Misses tension changes following different tibial implant designs. In all cases, the bone density decreases in the proximal epiphysis and medullary channels, with a bone density increase also being predicted in the diaphysis and at the bone around the stems tips. The highest value of Von Misses stress has been obtained for the straight tibial stem, and the lowest for the stemless metaphyseal sleeves prosthesis.
Collapse
Affiliation(s)
- M P Quílez
- Investigación, Universidad de Zaragoza, Zaragoza, España
| | - M A Pérez
- Departamento de Ingeniería Mecánica, Instituto de Investigación Sanitaria de Aragón (IIS), Universidad de Zaragoza, Zaragoza, España
| | - B Seral-García
- Instituto de Investigación Sanitaria de Aragón (IIS), Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico Universitario, Zaragoza, España.
| |
Collapse
|
|
48
|
Indelli PF, Marcucci M, Graceffa A, Charlton S, Latella L. Primary posterior stabilized total knee arthroplasty: analysis of different instrumentation. J Orthop Surg Res 2014; 9:54. [PMID: 25037275 PMCID: PMC4223625 DOI: 10.1186/s13018-014-0054-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/16/2014] [Indexed: 11/30/2022] Open
Abstract
Background Intercondylar femoral bone removal during posterior stabilized (PS) total knee arthroplasty (TKA) makes many cruciate substituting implant designs less appealing than cruciate retaining implants. Bone stock conservation is considered fundamental in the prevision of future revision surgeries. The purpose of this study was to compare the quantity of intercondylar bone removable during PS housing preparation using three contemporary PS TKA instrumentations. Method We compared different box cutting jigs which were utilized for the PS housing of three popular PS knee prostheses. The bone removal area from every PS box cutting jig was three-dimensionally measured. Results Independently from the implant size, the cutting jig for a specific PS TKA always resected significantly less bone than the others: this difference was statistically significant, especially for small- to medium-sized total knee femoral components. Conclusion This study does not establish a clinical relevance of removing more or less bone at primary TKA, but suggests that if a PS design is indicated, it is preferable to select a model which possibly resects less distal femoral bone.
Collapse
|
|
49
|
Abstract
INTRODUCTION The management of bone loss is a crucial aspect of the revision knee arthroplasty. Bone loss can hinder the correct positioning and alignment of the prosthetic components, and can prevent the achievement of a stable bone-implant interface. There is still controversy regarding the optimal management of knee periprosthetic bone loss, especially in large defects for which structural grafts, metal or tantalum augments, tantalum cones, porous metaphyseal sleeves, and special prostheses have been advocated. The aim of this review was to analyze all possible causes of bone loss and the most advanced strategies for managing bony deficiency within the knee joint reconstruction. MATERIALS AND METHODS Most significant and recent papers about the management of bone defects during revision knee arthroplasty were carefully analyzed and reviewed to report the most common causes of bone loss and the most effective strategies to manage them. RESULTS Modular metal and tantalum augmentation showed to provide more stable and durable knee revisions compared to allografts, limited by complications such as graft failure, fracture and resorption. Moreover, modular augmentation may considerably shorten operative times with a potential decrease of complications, above all infection which has been frequently associated to the use of allografts. CONCLUSIONS Modular augmentation may significantly reduce the need for allografting, whose complications appear to limit the long-term success of knee revisions.
Collapse
|