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Removing a well-fixed femoral sleeve during revision total knee arthroplasty.

ABSTRACT: The following surgical technique describes a case of a 51-year-old man with severe juvenile rheumatoid arthritis that required a 2-stage revision of an infected revision total knee implant. The patient had previously been implanted with a revision rotating platform, constrained condylar device which gained excellent fixation through the use of diaphyseal-engaging stems, and a well-ingrown, fully porous-coated femoral metaphyseal sleeve. To avoid intraoperative complications while removing the femoral sleeve, a novel technique for femoral sleeve extraction was used. Using this technique, the femoral sleeve was successfully removed without intraoperative fracture or substantial bone loss.

SUBMITTER: Martin JR

PROVIDER: S-EPMC5247518 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Removing a well-fixed femoral sleeve during revision total knee arthroplasty.

Martin J Ryan JR Watters Tyler S TS Levy Daniel L DL Jennings Jason M JM Dennis Douglas A DA

Arthroplasty today 20160702 4

The following surgical technique describes a case of a 51-year-old man with severe juvenile rheumatoid arthritis that required a 2-stage revision of an infected revision total knee implant. The patient had previously been implanted with a revision rotating platform, constrained condylar device which gained excellent fixation through the use of diaphyseal-engaging stems, and a well-ingrown, fully porous-coated femoral metaphyseal sleeve. To avoid intraoperative complications while removing the fe ...[more]

PMID: 28326423

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Project description:BACKGROUND:The study of localized immune-related factors has proven beneficial for a variety of conditions, and one area of interest in the field of orthopaedics is the impact of implants and localized infections on immune response. Several cytokines have shown increased systemic concentrations (in serum/plasma) in response to implants and infection, but tissue-level cytokines have not been investigated as thoroughly. METHODS:This exploratory study investigated tissue-level cytokines in a cohort of patients (N?=?17) in response to total knee arthroplasty and total knee revision to better understand the immune response to implants and localized infection (e.g., prosthetic joint infection). The overall goal of this study was to provide insight into the localized cytokine response of tissues and identify tissue-level markers specific to inflammation caused by implants vs. inflammation caused by infection. Tissues were collected across several anatomical locations and assayed with a panel of 20 human inflammatory cytokines to understand spatial differences in cytokine levels. RESULTS:In this study, six cytokines were elevated in implanted joints, as compared to native joints: IL-10, IL-12p70, IL-13, IL-17A, IL-4, and TNF-? (p?<?0.05). Seven cytokines showed infection-dependent increases in localized tissues: IL-1?, IL-1?, IL-6, IL-8, MCP-1, MIP-1?, and MIP-1? (p?<?0.05). CONCLUSIONS:This study demonstrated that differences exist in tissue-level cytokines in response to presence of implant, and some cytokines were specifically elevated for infection; these responses may be informative of overall tissue health. These results highlight the utility of investigating localized cytokine concentrations to offer novel insights for total knee arthroplasty and total knee revision procedures, as well as their complications. Ultimately, this information could provide additional, quantitative measurements of tissue to aid clinical decision making and patient treatment options.

Dataset Information

Removing a well-fixed femoral sleeve during revision total knee arthroplasty.

Publications

Removing a well-fixed femoral sleeve during revision total knee arthroplasty.

Similar Datasets

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