Dataset Information

Intra- operative fractures in primary Total Knee Arthroplasty.

ABSTRACT:

Background

Intraoperative fracture during primary Total Knee Arthroplasty (TKA) is very rare and there is little literature available which has defined the possible reasons for the occurrence of these fractures. Further, no study till date has defined the various management options available to treat these fractures. This study aims to define (1) the possible reasons for different fracture patterns occurring intraoperatively, (2) the ideal management options for each type of fracture geometry, (3) whether this intraoperative complication affects the physiotherapy protocol and long term outcomes.

Methods

Out of 3168 primary TKA done between 2010 and 2017, 19 patients developed intraoperative fracture, whose data was evaluated retrospectively. Patients were assessed radiologically to determine the time to union and clinical outcomes were assessed using Knee Society Score.

Results

Out of the 19 intraoperative fractures, 19 were in Tibia and 4 in Femur. Majority of fractures occurred during cementing and final implantation (8 cases), followed by exposure and bone preparation (6 cases) and the least during trialing (4 cases). Out of 15 Tibia fracture, 9 fractures involved the Tibial cortex which were managed with screws (4 cases), sutures and bone cement (5 cases). Stemmed tibial component was used for all Plateau type fracture patterns (6 cases). Out of 4 distal femur fractures, condylar type fracture pattern were fixed with plates and screws (3 cases) and epicondyle avulsion with screws alone (1 case). All the cases showed union (average union time 8.9 weeks) and good KSS scores which remained till their last follow-up. None of the patient developed any other complications or required revision surgery.

Conclusions

Intraoperative fracture during TKA, although rare but a significant complication which can affect the outcome, if not managed properly. We have shown methods of management for such cases, which have given excellent results.

SUBMITTER: Agarwala S

PROVIDER: S-EPMC6492217 | biostudies-literature | 2019 May-Jun

REPOSITORIES: biostudies-literature

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Publications

Intra- operative fractures in primary Total Knee Arthroplasty.

Agarwala Sanjay S Bajwa Supreet S Vijayvargiya Mayank M

Journal of clinical orthopaedics and trauma 20181019 3

<h4>Background</h4>Intraoperative fracture during primary Total Knee Arthroplasty (TKA) is very rare and there is little literature available which has defined the possible reasons for the occurrence of these fractures. Further, no study till date has defined the various management options available to treat these fractures. This study aims to define (1) the possible reasons for different fracture patterns occurring intraoperatively, (2) the ideal management options for each type of fracture geo ...[more]

PMID: 31061592

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Project description:Arthrofibrosis is characterized by excessive extracellular matrix (ECM) deposition that results in restricted joint motion after total knee arthroplasty (TKA). Current surgical and pharmacologic treatment options are limited. Therefore, an in vitro model for joint myofibroblastogenesis is valuable to investigate the arthrofibrotic process and identify diagnostic biomarkers and treatment options. In this study, we obtained intraoperative posterior capsule (PC), quadriceps tendon (QT), and suprapatellar pouch (SP) tissue from knees of four patients undergoing primary TKA for osteoarthritis and characterized primary outgrowth cells from these tissues in the absence and presence of transforming growth factor beta 1 (TGFβ1), a pro-myofibroblastic cytokine. Light microscopy of knee outgrowth cells revealed spindle-shaped cells while immunofluorescence (IF) established staining for the fibroblast-specific antigen TE-7 and Vimentin, which are characteristics of fibroblasts. These fibroblasts differentiate readily into myofibroblasts as highlighted by enhanced alpha smooth muscle actin (ACTA2) mRNA and protein expression and increased collagen mRNA (i.e., collagen type 1 (COL1A1) and collagen type 3 (COL3A1)) expression and collagenous matrix deposition in the presence of TGFβ1. Of note, these studies also revealed that knee-derived fibroblasts are more sensitive to TGFβ1-mediated myofibroblastogenesis than adipose-derived mesenchymal stem cells. Importantly, while outgrowth fibroblasts isolated from four patients and three anatomical regions exhibit similar gene expression profiles, these knee fibroblasts form a unique gene expression cluster within the fibroblast niche as revealed by RNA-sequencing analysis. In conclusion, our study provides a fibroblast/myofibroblast model of outgrowth knee cells derived from patients undergoing primary TKA that can be employed to assess myofibroblast-related processes and test novel pharmacological strategies in vitro for arthrofibrosis.

Dataset Information

Intra- operative fractures in primary Total Knee Arthroplasty.

Background

Methods

Results

Conclusions

Publications

Intra- operative fractures in primary Total Knee Arthroplasty.

Similar Datasets

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