Peri-implant fracture after dual-plating knee arthrodesis for failed total knee arthroplasty: case series.
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ABSTRACT:
SUBMITTER: Ransone M
PROVIDER: S-EPMC6921173 | biostudies-literature | 2019 Dec
REPOSITORIES: biostudies-literature
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Project description:Total knee arthroplasty (TKA) in the setting of previous hip fusion is rare with a paucity of evidence in the orthopaedic literature. Traditionally, TKA is performed supine, with the aid of knee-positioning devices allowing for hip flexion and range of motion of the knee to facilitate ease of surgical intervention. However, TKA using traditional positioning would not be possible in the presence of ipsilateral hip arthrodesis preventing hip motion. This case report describes a TKA performed for a 72-year-old woman with end-stage osteoarthritis of the right knee, ipsilateral hip arthrodesis, and leg-length discrepancy as the sequelae of slipped capital femoral epiphysis. We describe novel surgical positioning to be used to facilitate TKA in the absence of ipsilateral hip motion with bed modifications and the use of an extremity positioning device.
| S-EPMC7527288 | biostudies-literature
Project description:The number of revision total knee arthroplasty procedures performed annually is increasing and, subsequently, so is the number of patients presenting following a failed revision. Rerevising a total knee arthroplasty after one or more failed revision procedures presents many challenges, including diminished bone stock for prosthetic fixation. "Off the shelf" implants may not offer the best alternative for reconstruction. We present the case of a 55-year-old patient who required a rerevision total knee arthroplasty following multiple failed revisions with severe femoral and tibia bone loss. We describe a novel technique we employed to improve component fixation within the compromised bone stock.
| S-EPMC5365413 | biostudies-literature
Project description:Ischaemic preconditioning is a method of protecting tissue against ischaemia-reperfusion injury. It is an innate protective mechanism that increases a tissue's tolerance to prolonged ischaemia when it is first subjected to short burst of ischaemia and reperfusion. It is thought to provide this protection by increasing the tissue's tolerance to ischaemia, therby reducing oxidative stress, inflammation and apoptosis in the preconditioned tissue. We used microarrays to investigate the genomic response induced by ischaemic preconditioning in muscle biopsies taken from the operative leg of total knee arthroplasty patients in order to gain insight into the ischaemic preconditioning mechanism. Patients undergoing primary knee arthroplasty were randomised to control and treatment (ischaemic preconditioning) groups. Patients in the treatment group received a preconditioning stimulus immediately prior to surgery. The ischaemic preconditioning stimulus consisted of three five-minute periods of tourniquet insufflation on the lower operative limb, interrupted by five minute periods of reperfusion. All patients had a tourniquet applied to the lower limb after the administration of spinal anaesthesia, as per normal protocol for knee arthroplasty surgery. Muscle biopsies were taken from the quadriceps muscle of the operative knee at the immediate onset of surgery (T0) and at 1 hour into surgery (T1). Total RNA was extracted from biospies of four control and four treatment patients and hybridised to the Affymetrix Human U133 2.0 chip.
2010-04-12 | E-GEOD-21164 | biostudies-arrayexpress
Project description:Oxidized zirconium was introduced as an alternative bearing surface to decrease polyethylene wear and reduce aseptic mechanical failure of hip and knee arthroplasties. Oxidized zirconium combines the strength of a metal with wear properties of ceramic, proposing increased survivorship of implant components, and possible decreased rate of revision. Despite a harder surface than cobalt-chromium, the substrate of zirconium is a softer metal. Although uncommon, prior reports have described accelerated wear and severe metallosis after femoral head dislocation in oxidized zirconium total hip arthroplasty; however, this has not been described in total knee arthroplasty. We report a case of an oxidized zirconium total knee arthroplasty failure in a patient with knee instability. This is the first report of catastrophic failure of an oxidized zirconium total knee arthroplasty implant.
| S-EPMC7397700 | biostudies-literature
Project description:Failures unique to posterior cruciate-substituting total knee prostheses rarely include polyethylene post fractures but have been described. We report a case involving a fracture of the distal insert cone of a rotating-platform (RP) polyethylene liner in a primary total knee arthroplasty. This case highlights a 67-year-old male presenting with new-onset knee pain and recurrent effusions with osteolysis 11 years following placement of a posterior-stabilized, RP total knee arthroplasty. At the time of revision surgery, the polyethylene insert cone was found to be fractured just below the junction between cone and the body of the insert. Liner exchange, synovectomy, and osteolytic-defect curettage and cement packing were performed. One year following revision surgery, the patient is without pain and has returned to function without limitations. Clinicians must be aware of this possible failure with RP prostheses in the setting of pain with a stable knee, recurrent aseptic effusions, and osteolysis.
| S-EPMC5994790 | biostudies-other
Project description:IntroductionAnkle arthrodesis is one of the managements for a significantly unstable Charcot ankle. Some of the methods of internal fixation for ankle arthrodesis include the use of intramedullary nails, screws, and plates. Ankle arthrodesis using intramedullary nails has become more popular. However, studies evaluating the use of plate fixation, particularly double posterior lateral plating, are limited. We report the clinical and radiological outcomes of double posterior lateral plating ankle arthrodesis in three diabetic Charcot ankle patients.Presentation of caseThree patients, aged 73, 67, and 65 years old, complained of ankle pain and with a history of type 2 diabetes mellitus. The physical examination revealed swelling and erythema without a sign of active infection. The radiological examination showed ankle deformity, and the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scores were 5, 10, and 0, respectively. All patients were diagnosed with a diabetic Charcot ankle and underwent ankle arthrodesis using double posterior lateral plating. Four months and six months follow up revealed talus union, improved ankle deformity, and improved AOFAS Ankle-Hindfoot scores to 70, 76, and 73, respectively.DiscussionVarious methods of ankle arthrodesis are retrograde intramedullary nails, screws, and plates. In this report, we opt for plate fixation because it allows for stable internal fixation, adequate compression, high angular stability, and a lower irreversible deformation in osteoporotic bone.ConclusionDouble posterior lateral plating ankle arthrodesis provided satisfactory clinical and radiological outcomes. This method can be an alternative for patients with Charcot ankle requiring ankle arthrodesis.
| S-EPMC8091877 | biostudies-literature
Project description:Ischaemic preconditioning is a method of protecting tissue against ischaemia-reperfusion injury. It is an innate protective mechanism that increases a tissue's tolerance to prolonged ischaemia when it is first subjected to short burst of ischaemia and reperfusion. It is thought to provide this protection by increasing the tissue's tolerance to ischaemia, therby reducing oxidative stress, inflammation and apoptosis in the preconditioned tissue. We used microarrays to investigate the genomic response induced by ischaemic preconditioning in muscle biopsies taken from the operative leg of total knee arthroplasty patients in order to gain insight into the ischaemic preconditioning mechanism.
2010-04-02 | GSE21164 | GEO
Project description:Tibial baseplate fracture following primary total knee arthroplasty is a rare complication, particularly with modern implants and surgical techniques. This case details the first known report of mid-range follow-up catastrophic failure of a cementless modular, trabecular metal tibial baseplate. This failure highlights the importance of continued follow-up for novel implants, to include cementless knee arthroplasty designs, particularly if new symptoms arise or periarticular bone loss is identified on radiograph.
| S-EPMC6920728 | biostudies-literature
Project description:BackgroundAseptic loosening has long been an associated etiology for revision total knee arthroplasty (TKA).MethodsThis case series investigates commonalities between 9 patients who underwent revision TKA and were found to have complete debonding at the cement-implant interface of a femoral and/or tibial component within the past 2 years.ResultsOnly 3 preoperative radiographs were indicative of aseptic loosening, and all patients had an infectious etiology ruled out.ConclusionsThis case series and other similar reports suggest that there may be a growing concern for debonding as a modern form of aseptic loosening. Further research through American Joint Replacement Registry and other national databases will need to be conducted to better understand if this is truly a new cause for concern after TKA and how it may be best prevented.
| S-EPMC7772444 | biostudies-literature
Project description:Intravenous tranexamic acid (IV TXA) is one of the most effective agents in use for reducing blood loss following total knee arthroplasty (TKA) but its safety regarding venous thromboembolic events (VTEs) remains in question. The direct, local application of TXA may reduce systemic toxicity whilst maintaining good or better bleeding control compared to IV TXA. The topical application of TXA via Hemovac drains has been reported previously with good results. However, there are no data on peri-articular TXA injections during TKA.We conducted an open randomized, pilot study of peri-articular vs. IV TXA in 60 patients undergoing TKA. 30 patients received either: (i) 750 mg peri-articular TXA into the medial, lateral capsules and the quadriceps tendon prior to capsular closure and tourniquet deflation (group1), or (ii) 750 mg of IV TXA just before tourniquet deflation. Blood loss in the hemovac drain and hemoglobin (Hb) concentrations were measured at 24 and 48 h (h), and the number of blood transfusions and leg circumference measurements were recorded.At 48 h, the total blood loss in the hemovac drain was 445 mL in group 1 vs. 520 mL in group 2 (p?=?0.081) and the corresponding declines in Hb were 1.85 g/dL vs. 1.87 g/dL (p?=?0.84). 16 patients received blood transfusions: 9 vs. 7 in groups 1 and 2, respectively (p?=?0.928). There were no differences in thigh and lower leg circumferences, pain scores, knee flexion at discharge date and lengths of hospital stay. There were no clinically detected venous thromboembolic events.This pilot study has shown promising results for peri-articular TXA during TKA. Additional, larger studies are needed to confirm our results and be powered to show differences in efficacy and safety of peri-articular vs. IV TXA.ClinicalTrials.gov Identifier NCT02829346 . Retrospectively registered: 07/11/2016.
| S-EPMC4960744 | biostudies-literature