scholarly journals Application of 3D Printing-Assisted Articulating Spacer in Two-Stage Revision Surgery for Periprosthetic Infection after Total Knee Arthroplasty: A Retrospective Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Lingtong Kong ◽  
Jiawei Mei ◽  
Wufei Ge ◽  
Xiansheng Jin ◽  
Xiaoxuan Chen ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
3D Printing ◽  
Bone Loss ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Complication Rates ◽  
Two Stage ◽  
Total Knee ◽  
Static Group

Background. Bone cement spacers are widely used in two-stage revision surgeries for periprosthetic joint infection (PJI) after total knee arthroplasty. Current spacer design results in insufficient release of drugs; therefore, current spacers have low efficacy. In this study, we explored a set of alternative articular spacer using 3D printing technology. This novel spacer will increase effectiveness of revision surgery for PJI. Methods. The spacer was designed using CAD software and constructed on site using 3D-printed silicone mold during debridement surgery. We carried out a retrospective study among patients undergoing treatment using traditional static and new articular spacers. Infection control rate, bone loss, difficulty of revision surgery, knee joint range of motion, function evaluation, and subjective satisfaction of the patients in the two groups were compared. Results. Forty-two patients undergoing knee revision surgery between Jan 2014 and Nov 2019 were included in this study. Twenty-two patients were treated with static antibiotic cement spacers, whereas the other twenty patients were with treated with 3D printing-assisted antibiotic loaded articulating spacers. Patients in the articular group showed significantly lower bone loss on the femur site and tibial site compared with patients in the static group. In addition, patients in the articular group showed significantly less operation time, intraoperative blood loss, and improved knee function and patient overall satisfaction compared with patients in the static group. Conclusions. The 3D printing-assisted articular spacer provides satisfactory range of motion during the interim period, prevents bone loss, facilitates second-stage reimplantation and postoperative rehabilitation, and results in low reinfection and complication rates.

scholarly journals Mid-Term Results of Two-stage Revision Total Knee Arthroplasty for Infected Total Knee Arthroplasty

2021 ◽  
Vol 1 (56) ◽  
pp. 12-18
Author(s):  
Yasin Koker ◽  
◽  
Mehmet Yuzugulen ◽  
Dogac Karaguven ◽  
Burak Akan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Knee Prosthesis ◽  
Primary Total Knee Arthroplasty ◽  
Treatment Method ◽  
Clinical Results ◽  
Two Stage ◽  
Infected Total Knee Arthroplasty ◽  
Total Knee

Introduction. Today, knee arthroplasty is one of the most common surgical procedures. Infection after endoprosthetics is the most dangerous complication in patients who have undergone total knee arthroplasty, which negatively affects the prognosis. Most cases of infection develop within the first 2 years after surgery, and the frequency is 1.5%, and after that it decreases to 0.5%. Material and Method. When a study group of 31 patients (22 female, 9 male) who were diagnosed with infected knee prosthesis and underwent two-stage revision knee prosthesis as a treatment method; the mean age of all patients (31 patients) was 68.78 years. In our study by using the American knee association scoring system; preoperative knee scores of 31 patients who underwent two-stage revision surgery were 35.43 ± 7.14, while this parameter was found to be 83.27 ± 8.89 postoperatively (p <0.01). Conclusion. We believe that two-stage revision surgery is an effective method in the treatment of infection that develops after primary total knee arthroplasty application. Restoration of the joint line in accordance with the anatomical structure will positively affect the clinical results, and the use of a long stem to increase the stability of the prosthesis is appropriate for successful results, especially in the cases with bone defects. Key words: Total Knee Arthroplasty, Two-Stage Revision Surgery, Infected Knee Prosthesis.

scholarly journals The relevance of ligament balancing in total knee arthroplasty: how important is it? A systematic review of the literature

2009 ◽  
Vol 1 (1) ◽  
pp. 26 ◽  
Author(s):  
Sina Babazadeh
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Surgery Complications ◽  
Review Of The Literature ◽  
Ligament Balancing ◽  
Total Knee ◽  
Neurovascular Damage

Ligament balancing affects many of the postoperative criteria for a successful knee replacement. A balanced knee contributes to improved alignment and stability. Ligament balancing helps reduce wear and loosening of the joint. A patient with a balanced knee is more likely to have increased range of motion and proprioception, and decreased pain. All these factors help minimize the need for revision surgery. Complications associated with ligament balancing can include instability caused by over-balancing and the possibility of neurovascular damage during or as a result of ligament balancing. This article attempts to summarize the literature, to define a balanced knee, and outline the benefits and possible complications of ligament balancing. Different techniques, sequences, and tools used in ligament balancing, and their relevance in correcting various deformities are reviewed.

scholarly journals A novel technique to preserve range of motion in two-stage revision of infected total knee arthroplasty

2013 ◽  
Vol 37 (6) ◽  
pp. 1069-1074 ◽  
Author(s):  
Christian Carulli ◽  
Marco Villano ◽  
Roberto Civinini ◽  
Fabrizio Matassi ◽  
Lorenzo Nistri ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Two Stage ◽  
Novel Technique ◽  
Infected Total Knee Arthroplasty ◽  
Total Knee

scholarly journals Total knee arthroplasty using hinge joints: Indications and results

2019 ◽  
Vol 4 (4) ◽  
pp. 121-132 ◽  
Author(s):  
E. Carlos Rodríguez-Merchán
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Loss ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Soft Tissue Release ◽  
Complication Rates ◽  
Flexion Extension ◽  
Rotating Hinge ◽  
Total Knee ◽  
Rotating Hinge Knee

Possible indications for a rotating hinge or pure hinge implant in primary total knee arthroplasty (TKA) include collateral ligament insufficiency, severe varus or valgus deformity (> 20°) with relevant soft-tissue release, relevant bone loss, including insertions of collateral ligaments, gross flexion-extension gap imbalance, ankylosis and hyperlaxity. The use of hinged implants in primary TKA should be limited to the aforementioned selected indications, especially for elderly patients. Potential indications for a rotating hinge or pure hinge implant in revision TKA include infection, aseptic loosening, instability and bone loss. Rotating hinge knee implants have a 10-year survivorship in the range of 51% to 92.5%. Complication rates of rotating hinge knee implants are in the range of 9.2% to 63%, with infection and aseptic loosening as the most common complications. Although the results reported in the literature are inconsistent, clinical results generally depend on the implant design, appropriate technical use and adequate indications. Considering that the revision of implants with long cemented stems can be challenging, in the future it would be better to use shorter stems in modular versions of hinged knee implants.Cite this article: EFORT Open Rev 2019;4:121-132. DOI: 10.1302/2058-5241.4.180056

scholarly journals The Role of Poly(Methyl Methacrylate) in Management of Bone Loss and Infection in Revision Total Knee Arthroplasty: A Review

2020 ◽  
Vol 11 (2) ◽  
pp. 25 ◽  
Author(s):  
Leyla Hasandoost ◽  
Omar Rodriguez ◽  
Adel Alhalawani ◽  
Paul Zalzal ◽  
Emil H. Schemitsch ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Loss ◽  
Methyl Methacrylate ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Surrounding Tissue ◽  
Two Stage ◽  
Poly Methyl Methacrylate ◽  
Total Knee

Poly(methyl methacrylate) (PMMA) is widely used in joint arthroplasty to secure an implant to the host bone. Complications including fracture, bone loss and infection might cause failure of total knee arthroplasty (TKA), resulting in the need for revision total knee arthroplasty (rTKA). The goals of this paper are: (1) to identify the most common complications, outside of sepsis, arising from the application of PMMA following rTKA, (2) to discuss the current applications and drawbacks of employing PMMA in managing bone loss, (3) to review the role of PMMA in addressing bone infection following complications in rTKA. Papers published between 1970 to 2018 have been considered through searching in Springer, Google Scholar, IEEE Xplore, Engineering village, PubMed and weblinks. This review considers the use of PMMA as both a bone void filler and as a spacer material in two-stage revision. To manage bone loss, PMMA is widely used to fill peripheral bone defects whose depth is less than 5 mm and covers less than 50% of the bone surface. Treatment of bone infections with PMMA is mainly for two-stage rTKA where antibiotic-loaded PMMA is inserted as a spacer. This review also shows that using antibiotic-loaded PMMA might cause complications such as toxicity to surrounding tissue, incomplete antibiotic agent release from the PMMA, roughness and bacterial colonization on the surface of PMMA. Although PMMA is the only commercial bone cement used in rTKA, there are concerns associated with using PMMA following rTKA. More research and clinical studies are needed to address these complications.

Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

2020 ◽  
Author(s):  
Antonio Klasan ◽  
Sven Edward Putnis ◽  
Wai Weng Yeo ◽  
Darli Myat ◽  
Brett Andrew Fritsch ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Selection ◽  
Knee Arthroplasty ◽  
Major Complication ◽  
The Elderly ◽  
Complication Rates ◽  
Bilateral Total Knee Arthroplasty ◽  
Proper Patient Selection ◽  
Patient Reported ◽  
Total Knee

AbstractDespite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

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