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Revision knee

Richard J Holleyman, David J Deehan, Lucy Walker, Andre Charlett, Julie Samuel, Mark D F Shirley, Paul N Baker
INTRODUCTION: This study aimed to (1) report the rates of resistance against a variety of antibiotics for pure Staphylococcal infections, and (2) examine the impact of ALBC use at primary surgery has on resistance patterns for patients undergoing first-time revision of primary hip and knee arthroplasty for indication of infection. MATERIALS AND METHODS: Data from the National Joint Registry database for England and Wales were linked to microbiology data held by Public Health England to identify a consecutive series of 258 primary hip and knee arthroplasties performed between April 2003 and January 2014 that went on to have a revision for Staphylococcal deep periprosthetic infection...
March 15, 2019: Archives of Orthopaedic and Trauma Surgery
Michael J Cook, Antony K Sorial, Mark Lunt, Tim N Board, Terence W O'Neill
OBJECTIVE: To determine whether the timing and also duration of statin exposure following total hip/knee arthroplasty (THA/TKA) influences the risk of revision arthroplasty. METHODS: Subjects from the Clinical Practice Research Datalink, a large population-based clinical database, who had THA/TKA from 1988-2016 were included. Propensity score adjusted Cox regression models were used to determine the association between statin exposure and the risk of revision THA/TKA, i) at any time and ii) if first exposed 0-1, 1-5, or >5 years following THA/TKA...
March 15, 2019: Journal of Rheumatology
Lingfei Guo, Yinqiao Du, Mingchao Zhang, Jingyang Sun, Zhigang Jin, Yawen Peng, Junmin Shen, Yonggang Zhou
Objective: To evaluate short-term effectiveness of revision total knee arthroplasty (TKA) with porous-coated metaphyseal Sleeve and MBT implant. Methods: A clinical data of 23 patients (24 knees) who underwent revision TKA by using porous-coated metaphyseal Sleeve combined with MBT implant between March 2015 and April 2017 was retrospectively analyzed. There were 8 males (8 knees) and 15 females (16 knees). The age ranged from 48 to 85 years (mean, 65.4 years). The cause of revision TKA included infection in 14 knees, aseptic loosening in 8 knees, instability in 1 knee, and stiff knee in 1 knee...
March 1, 2019: Chinese Journal of Reparative and Reconstructive Surgery
Andrew S Chung, Matthew C Niesen, Taylor J Graber, Adam J Schwartz, Christopher P Beauchamp, Henry D Clarke, Mark J Spangehl
BACKGROUND: Historically, infection control rates with debridement and component retention have been poor in the management of acute prosthetic joint infections. We previously described a 2-stage debridement with prosthesis retention protocol for acute periprosthetic joint infection and reported a 90% success rate in a sample of 20 patients. METHODS: A retrospective review of 83 patients who underwent a 2-stage debridement with implant retention with a minimum 1-year follow-up was performed...
February 16, 2019: Journal of Arthroplasty
Blake J Schultz, Malcolm R DeBaun, James I Huddleston
Morbidly obese patients undergoing total knee arthroplasty have worse functional outcomes and implant survival, and increased revision rates compared with nonobese patients. In addition to increased medical comorbidities and difficult exposure, increased stress on the tibial implant and altered kinematics of knee motion contribute to aseptic loosening and medial collapse. Increased implant fixation, including use of a stemmed tibial implant, may be a way to help avoid these complications. While there is limited data on tibial stems in the morbidly obese patients specifically, cemented stemmed tibial implants should be strongly considered in these patients, especially if bone quality is poor...
March 12, 2019: Journal of Knee Surgery
Azeem Tariq Malik, Thomas J Scharschmidt, Mengnai Li, Nikhil Jain, Safdar N Khan
Relative value units (RVUs) are used for ensuring that physicians are appropriately reimbursed based on case complexity. While past research has elucidated that surgeons are reimbursed at a higher rate for primary total knee arthroplasty (TKA) versus revision TKA, no study has explored differences in reimbursements between single-component and double-component revisions, considering a double-component revision is likely to require more effort/skill as compared with single-component revision. The 2015 to 2016 American College of Surgeons National Surgical Quality Improvement Program files were queried using Current Procedural Terminology (CPT) codes for single-component revision TKA (CPT-27486) and double-component revision TKA (CPT-27487)...
March 12, 2019: Journal of Knee Surgery
Kevin B Fricka, Craig J McAsey, Supatra Sritulanondha
BACKGROUND: The optimal mode of fixation in total knee arthroplasty is a continuing subject of debate. METHODS: Previously, we reported 2-year results for this prospective, randomized trial. Knee Society Scores, Oxford scores, and pain visual analog scales were collected pre-operatively and post-operatively. Minimum 5-year follow-up has been obtained with radiographic analysis for 85 patients. RESULTS: Mean Knee Society Scores and Oxford scores and patient-reported outcomes were similar in both groups...
February 21, 2019: Journal of Arthroplasty
Derek F Amanatullah, Paul M Lichstein, William G Lundergan, Wendy W Wong, William J Maloney, Stuart B Goodman, James I Huddleston
BACKGROUND: Suboptimal implant rotation has consequences with respect to knee kinematics and clinical outcomes. We evaluated the functional outcomes of revision total knee arthroplasty (TKA) for poor axial implant rotation. METHODS: We retrospectively reviewed 42 TKAs undergoing aseptic revision for poor axial implant rotation. We assessed improvements in Knee Society Score (KSS) and final range of motion (ROM). Subgroup analyses were performed for preoperative instability and stiffness, as well as the number of components revised and level of implant constraint used...
February 14, 2019: Journal of Arthroplasty
Tyler J Uppstrom, Meghan Price, Sheena Black, Elizabeth Gausden, Jonathan Haskel, Daniel W Green
PURPOSE: The purpose of this study was to assess the physeal safety associated with the use of an epiphyseal femoral socket for paediatric medial patellofemoral ligament (MPFL) reconstruction. METHODS: Fifty-four knees in 49 skeletally immature patients underwent physeal-sparing MPFL reconstruction performed by 1 surgeon at a tertiary care academic medical centre from 2007 to 2016. A femoral socket distal to the femoral physis was used for graft fixation in all the patients...
March 9, 2019: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Qiang Yu, Mayao Luo, Shaoyu Wu, Anli Lai, Yang Sun, Qinyuan Hu, Yi He, Jing Tian
PURPOSE: To assess the infection eradication rate when using two types of articulating spacers (prosthetic articulating spacers and all-cement articulating spacers) in two-stage revision of infected total knee arthroplasty (TKA). METHODS: We comprehensively searched PubMed, Embase, and the Cochrane Library databases and performed a systematic review and meta-analysis of retrospective comparative studies assessing two types of articulating spacers. A quality assessment of the included studies was performed following the STROBE statement...
March 8, 2019: Archives of Orthopaedic and Trauma Surgery
J R A Phillips, L Al-Mouazzen, R Morgan-Jones, J R Murray, A J Porteous, A D Toms
PURPOSE: There is considerable variation in practice throughout Europe in both the services provided and in the outcomes of Revision Knee Surgery. In the UK, a recent report published called get it right first time (GIRFT) aims to improve patient outcomes through providing high quality, cost-effective care, and reducing complications. This has led to the development of a classification system that attempts to classify the complexity of revision knee surgery, aiming to encourage and support regional clinical networking...
March 8, 2019: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Christopher Hohmann, Guido Michels, Matthias Schmidt, Roman Pfister, Navid Mader, Myriam Ohler, Lara Blanke, Nathalie Jazmati, Clara Lehmann, Jan Rybniker, Sarah M Fünger, Gerd Fätkenheuer, Norma Jung
PURPOSE: Despite developments in both imaging and microbiological techniques, the final diagnosis of IE often remains challenging. In this single-center cohort study, we aimed to identify the specific indications for request of 18 F-FDG-PET/CT in clinical practice and to evaluate the diagnostic benefit of this nuclear imaging technique. METHODS: A total of 235 patients with possible (n = 43) or definite (n = 192) IE according to the revised Duke criteria were prospectively studied from July 2013 until December 2016...
February 13, 2019: Infection
Alexander Roth, Anton Khlopas, Jaiben George, Jessica L Churchill, Robert Molloy, Michael A Mont, Nicolas S Piuzzi, Carlos A Higuera
BACKGROUND: We aimed to explore the effect of body mass index (BMI) on 30-day complications after aseptic revision total knee arthroplasty (rTKA) and aseptic revision total hip arthroplasty (rTHA), considering BMI as both a categorical and continuous variable. METHODS: A total of 18,866 patients (9093 rTHA and 9773 rTKA) patients were included for analysis using the American College of Surgeons National Surgical Quality Improvement Project database. Thirty-day rates of readmissions, reoperations, and major and minor complications were compared between different weight categories (overweight: BMI >25 and ≤30 kg/m2 ; obese: BMI >30 and ≤40 kg/m2 ; morbidly obese: BMI >40 kg/m2 ) and the normal weight category (BMI >18...
February 13, 2019: Journal of Arthroplasty
Emanuel Kuner, Jens Arne Jöckel, Rene Orler, Reto Nüesch
INTRODUCTION: Periprosthetic joint infections are a major challenge for treating physicians. Musculoskeletal infections with Mycobacterium bovis are extremely rare, with an assumed incidence of 0.08-0.1%. Consequently, periprosthetic joint infections with Mycobacterium bovis are even less frequent. Fungal periprosthetic joint infections are very rare. No cases of Candida guilliermondii infection of implanted prostheses are described in the literature. CASE PRESENTATION: An 87-year-old Swiss man with German ethnic origin suffered from symptoms of osteoarthritis of the knee...
March 8, 2019: Journal of Medical Case Reports
Alistair J Maney, Chuan K Koh, Christopher M Frampton, Simon W Young
BACKGROUND: Surgeons may "usually" resurface the patella during total knee arthroplasty (TKA), "rarely" resurface, or "selectively" resurface on the basis of certain criteria. It is unknown which of these 3 strategies yields superior outcomes. Utilizing New Zealand Joint Registry data, we investigated (1) what proportion of surgeons employs each of the 3 patellar resurfacing strategies, (2) which strategy is associated with the lowest overall revision rate, and (3) which strategy is associated with the highest 6-month and 5-year Oxford Knee Score (OKS)...
March 6, 2019: Journal of Bone and Joint Surgery. American Volume
Nikhil Jain, John L Brock, Azeem Tariq Malik, Frank M Phillips, Safdar N Khan
BACKGROUND: Preoperative opioid use results in adverse outcomes and higher costs after elective surgery. However, duration thresholds for higher risk are not entirely known. Therefore, the purpose of our study was to determine the number and duration of preoperative opioid prescriptions in order to estimate the risk of postoperative adverse events after major joint replacement and lumbar fusion. METHODS: National insurance claims data (2007 to September 30, 2015) were used to identify primary total knee arthroplasties (TKAs), total hip arthroplasties (THAs), and 1 or 2-level posterior lumbar fusions (PLFs) performed for degenerative disease...
March 6, 2019: Journal of Bone and Joint Surgery. American Volume
M Hanus, M Handl, A Stančák, T Trč
PURPOSE OF THE STUDY The authors present the clinical use of the new instrumentation set for the anterior cruciate ligament (ACL) reconstruction using the hamstring tendons (HS). The positionning of the femoral tunnel and the fixation of the graft play an important role for the results of the surgery. The aim of the study was to confirm the proposed surgical technique and the methods of the graft fixation, especially from the point of view of the clinical midterm results at the evaluation up to eight years after the surgery...
2019: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Ersin Kuyucu, Ahmet M Bülbül, Adnan Kara, Ferhat Say, Mehmet Erdil
As it is mentioned in the literature, rates of complications and revision are higher in the obese compared to non-obese patients, although obesity does not a contraindication for unicompartmental knee arthroplasty and successful outcomes are achieved. However, there is not any study in the literature comparing the outcomes of fixed and mobile unicompartmental prostheses which are applied in the obese patients. Objective of this study was to compare outcomes of our obese patients who we applied fixed or mobile unicompartmental arthroplasty and followed up for 8 years and over...
September 2018: Acta Orthopaedica Belgica
Alexander Dodds, Richard Crowley, Tony Menz, Tony Spriggins, Greg Keene, Adrian Bauze
Although patellectomy is a rarely performed surgical procedure, patients may still progress to develop osteoarthritis of the tibiofemoral compartments leading to total knee replacement surgery. Due to the mechanical disadvantage of a previous patellectomy, it has previously been suggested that a prosthesis with more constraint should be used, however, there are conflicting reports in the literature. We aimed to assess the effects of stability following total knee replacement in patellectomised knee with revision as a primary endpoint...
September 2018: Acta Orthopaedica Belgica
Jan Dauwe, Hilde Vandenneucker
The use of rotating-hinge systems in total knee arthroplasty is most often seen in revision setting where excessive bone loss, ligamentous instability and/ or extensor mechanism dysfunction may necessitate an increased level of component constraint. However, this implant type is also being increasingly used in the primary setting. The aim of this study is to review literature concerning the use of third generation rotating-hinge devices focusing on the indications for primary cases. Literature was searched for following search terms: total knee arthroplasty, primary indication, constraint, rotating hinge knee, knee prosthesis, hinged knee, total knee replacement...
September 2018: Acta Orthopaedica Belgica
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