Dataset Information

Impaction Bone Grafting in Revision Total Knee Arthroplasty-Using Mesh and Cone to Contain the Defect: A Report of 3 Cases.

ABSTRACT: Uncontained tibial bone defects are a challenge in revision total knee arthroplasty. The present study reports on the results of a modified surgical technique for impaction bone grafting using metaphyseal cones and wire mesh. Three patients (2 male, 1 female; average age: 71.3 years) underwent revision total knee arthroplasty. All patients presented with uncontained medial tibial bone defects, one of the patients with an additional posterior cortical tibial split fracture. All cases were treated with a metaphyseal cone and outside mesh to create a contained defect. Between the mesh and cone, fresh frozen cancellous chips mixed with ?-tricalcium phosphate were impacted. No evidence of loosening or osteolysis was present at 3.6-year follow-up. Impaction bone grafting using an outside mesh and inside cone for defect containment provides a durable reconstruction of tibial bone defects.

SUBMITTER: Boettner F

PROVIDER: S-EPMC7419255 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Impaction Bone Grafting in Revision Total Knee Arthroplasty-Using Mesh and Cone to Contain the Defect: A Report of 3 Cases.

Boettner Friedrich F Bechler Ulrich U Springer Bernhard B Faschingbauer Martin M Jungwirth-Weinberger Anna A

Arthroplasty today 20200810 3

Uncontained tibial bone defects are a challenge in revision total knee arthroplasty. The present study reports on the results of a modified surgical technique for impaction bone grafting using metaphyseal cones and wire mesh. Three patients (2 male, 1 female; average age: 71.3 years) underwent revision total knee arthroplasty. All patients presented with uncontained medial tibial bone defects, one of the patients with an additional posterior cortical tibial split fracture. All cases were treated ...[more]

PMID: 32802928

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Project description:ObjectivesA periprosthetic joint infection (PJI) is a significant complication after total knee arthroplasty (TKA). Still there is no agreement on a perfect diagnosis and treatment algorithm. The aim of this study was to evaluate the success and revision rates after two-stage revision total knee arthroplasty (TKA) and factors that affect the success rate.Material and methods50 consecutive two-stage revision TKAs were performed between January 2011 and December 2012. We retrospectively reviewed study patient's charts including demographics, prior surgeries, comorbidities, incidence of persistent infection and revisions. At the final follow-up examination the patient's satisfaction, pain level and disorders were evaluated. A successful clinical outcome was defined as a functioning prosthesis without wound healing disorders, no sinuses tracts or other clinical evidence of a persistent infection. Results : Re-implantation of prosthesis was performed in 47 cases; three patients received a septic arthrodesis. Twelve patients had a persistent infection despite two-stage re-implantation resulting in a success rate of 76.0%. In eight of these twelve patients an infecting germ was isolated during second-stage procedure. Three patients received another two-stage revision arthroplasty and one patient an above knee amputation. A revision was performed in 23 of 50 patients (46.0%). Factors that diminish the success rate were further operations after primary TKA (p = 0.048), prior revision arthroplasties after TKA (p = 0.045), nicotine abuse (p = 0.048), Charlson comorbidity index above a score of 2 (p = 0.031) and a mixed flora during first-stage procedure (p < 0.001). Age, sex, immune status, chronic anticoagulant use, rheumatoid arthritis, body mass index and the presence of multidrug resistant germs showed no significant effect on success rate (p > 0.05). Conclusion : We found that patients who required surgery after the primary TKA, had a higher Charlson comorbidity index or were found to have mixed flora during explantation. The treatment of PJI remains difficult, both for the patient and for the treating surgeons.

Project description:ObjectivesFresh-frozen allograft is the gold-standard bone graft material used during revision hip arthroplasty. However, new technology has been developed to manufacture decellularised bone with potentially better graft incorporation. As these grafts cost more to manufacture, the aim of this cost-effectiveness study was to estimate whether the potential health benefit of decellularised bone allograft outweighs their increased cost.Study designA Markov model was constructed to estimate the costs and the quality-adjusted life years of impaction bone grafting during a revision hip arthroplasty.SettingThis study took the perspective of the National Health Service in the UK.ParticipantsThe Markov model includes patients undergoing a revision hip arthroplasty in the UK.InterventionImpaction bone grafting during a revision hip arthroplasty using either decellularised bone allograft or fresh-frozen allograft.MeasuresOutcome measures included: total costs and quality-adjusted life years of both interventions over the lifetime of the model; and incremental cost-effectiveness ratios for both graft types, using base case parameters, univariate sensitivity analysis and probabilistic analysis.ResultsThe incremental cost-effectiveness ratio for the base case model was found to be £270 059 per quality-adjusted life year. Univariate sensitivity analysis found that changing the discount rate, the decellularised bone graft cost, age of the patient cohort and the revision rate all had a significant effect on the incremental cost-effectiveness ratio.ConclusionsAs there are no clinical studies of impaction bone grafting using a decellularised bone allograft, there is a high level of uncertainty around the costs of producing a decellularised bone allograft and the potential health benefits. However, if a decellularised bone graft was manufactured for £2887 and lowered the re-revision rate to less than 64 cases per year per 10 000 revision patients, then it would most likely be cost-effective compared with fresh-frozen allograft.

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

Impaction Bone Grafting in Revision Total Knee Arthroplasty-Using Mesh and Cone to Contain the Defect: A Report of 3 Cases.

Publications

Impaction Bone Grafting in Revision Total Knee Arthroplasty-Using Mesh and Cone to Contain the Defect: A Report of 3 Cases.

Similar Datasets

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