Surgical Technique of a Cement-On-Cement Removal System for Hip and Knee Arthroplasty Revision Surgery.
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SUBMITTER: Tovar-Bazaga M
PROVIDER: S-EPMC8217307 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundIn patients with severe osteoarthritis of the knee with prior ipsilateral hip fusion who require total knee arthroplasty (TKA), a controversial issue is whether to first convert the hip fusion to a total hip arthroplasty (THA) or to perform TKA without reconstruction of the hip. Also, immobility of the ipsilateral, fused hip adds significant technical challenge because the usual positioning of the leg requires modification in order to gain access needed for the TKA.TechniqueIn such cases, we position the patient with the knee suspended, similar to how we perform knee arthroscopy. In our experience, the ipsilateral knee has significant deformity and is best addressed with a constrained, hinged TKA.ResultsIn 3 patients with severe knee osteoarthritis with prior ipsilateral hip fusion-a 72-year-old man and a 79-year-old woman with hip arthrodesis due to posttraumatic arthritis and an 81-year-old woman with hip arthrodesis due to congenital dislocation of the hip-rotating-hinge knee prostheses were implanted due to severe knee instability. All 3 patients had satisfactory results, without complications, after follow-up of 1 to 5 years.ConclusionsWe obtained satisfactory results in the short and medium term without previously converting the hip arthrodesis to THA by positioning patients with the knee suspended, in a way similar to when knee arthroscopy is performed, and implanting rotating hinge TKAs due to severe preoperative knee instability.
| S-EPMC8753539 | biostudies-literature
Project description:As surgeons' comfort with the direct anterior approach (DAA) for total hip arthroplasty continues to increase, there is a growing interest in performing complex surgeries through this approach. Acetabular bone loss and/or pelvic discontinuity in the primary or revision setting often requires specialized implants such as a cup-cage construct. We describe our surgical technique for implanting modified cup-half cages through the DAA and show 2 case examples of how this technique was utilized in the setting of complex acetabular bone loss. In our experience, this is an effective method for complex total hip arthroplasty, with the potential added benefits of the DAA of reduced soft-tissue dissection, direct measurement of leg length, and ease of fluoroscopic navigation for implant positioning.
| S-EPMC9184889 | biostudies-literature
Project description: Not available
| S-EPMC9249566 | biostudies-literature
Project description:Purpose: Kinematic alignment (KA) for primary total knee arthroplasty (TKA) has been shown to provide equivalent or better results to mechanical alignment (MA). The use of KA in revision TKA to restore the individual knee anatomy, kinematics, and soft-tissue balance, has not been documented yet. The purpose of this study is to describe the technique for performing TKA revision using the restricted KA (rKA) protocol and to report (1) rerevision rate and adverse events, (2) patient-reported outcome measures (PROMs), and (3) radiological signs of implant dysfunction related to this technique. Methods: The rKA protocol was used in 43 selected TKA revisions cases suitable for the technique. Adverse events, reoperation, revision, and their causes were recorded. In addition, PROMs assessed by WOMAC score and radiographic evaluation to identify signs of implant dysfunction were documented at last follow-up. Results: After a mean follow-up of 4.0 years (0.9-7.7, ±2), only one rerevision (2.3%) was required for persisting instability (polyethylene liner exchange from posterior stabilized to a semi-constrained). Short-cemented stems were used for both the femur and tibia in 28 (65%) cases, for the femur alone in 13 (30%) cases, and no stems in two cases. In 31 (72%) cases, a standard posterior stabilized tibial insert was used, while 12 (28%) cases required a semi-constrained insert. The mean WOMAC score was 34.4 (0-80, ±21.7). Mean postoperative arithmetic hip-knee-ankle angle (HKA) was 0.8° varus (from 5° varus to 4° valgus), mean mechanical distal femoral angle was 1.7° valgus (from 2° varus to 5° valgus), and mean mechanical tibia proximal angle was 2.2° varus (from 5° varus to 1° valgus). No radiological evidence of aseptic loosening or periprosthetic radiolucencies were identified. Conclusion: Although current revision TKA implants are not ideal for revision TKA performed with rKA, they are an appealing alternative to MA, especially in cases of early, non-wear-related, unsuccessful MA TKAs. rKA TKA revision using short-cemented stems in conjunction with meticulous preoperative planning is safe in the mid-term. Level of evidence: IV.
| S-EPMC8428977 | biostudies-literature
Project description:Robotic arm-assisted arthroplasty was introduced in 2006 and has expanded its applications into unicompartmental knee, total knee, and total hip replacement. The first case of a revision surgery from conventional unicompartmental to total knee arthroplasty with the utilization of the robotic arm-assisted MAKO system is presented. An 87-year-old female presented with deteriorating left knee pain due to failure of medial unicompartmental knee arthroplasty at the outpatient clinic. The patient was advised to undergo revision surgery. Through medial parapatellar arthrotomy, the joint was exposed. With the use of the MAKO system, the estimated depth of the medial plateau according to CT planning was found to be 10?mm more distal than the lateral. The resection line of the remaining plateau was placed deliberately 2?mm more distal in order to achieve satisfactory replacement of the bony gap of the medial tibial condyle by a 10?mm augment. The patient had an uneventful recovery. A plethora of additional applications in the future, such as total shoulder or reverse total shoulder arthroplasty, megaprosthesis placement in oncological patients, and total hip or knee revision surgeries, may improve patient-related outcomes.
| S-EPMC7037895 | biostudies-literature
Project description:BackgroundIn cemented primary total knee arthroplasty (TKA), aseptic loosening remains a major cause for failure. Cementing techniques and characteristics of a chosen cement play a key role for good fixation and implant survival. A pastry bone cement was developed to facilitate the cement preparation and to rule out most of preparation-associated application errors. The pastry bone cement was compared to a conventional polymethyl methacrylate cement in a TKA setting.MethodsStandardized implantations of total knee endoprostheses were performed in bilateral knee cadavers to investigate handling properties, variables of cement application, working time, and temperature development. Mechanical aspects and cementation quality were assessed by pull-out trials and microscopic interface analysis.ResultsBoth cements expressed similar characteristics during preparation and application, only the curing time of the pastry cement was about 3 min longer and the temperature peak was lower. Fractures of the conventional cement specimens differed from the pastry cement specimens in the tibial part, while no differences were found in the femoral part. Penetration depth of the pastry cement was similar (tibia) or deeper (femur) compared to the conventional cement.ConclusionsThe pastry cement facilitates the feasibility of cemented TKA. The pre-clinical tests indicate that the pastry bone cement fulfills the requirements for bone cement in the field of knee arthroplasty. A clinical trial is needed to further investigate the approach and ensure patient safety.
| S-EPMC8247244 | biostudies-literature
Project description:Knee arthrodesis is an acceptable treatment that leads to a stable joint with a lower rate of recurrence of infection in periprosthetic joint infections. One of the major problems in some revision cases is the bone loss that interferes with the bony union; therefore, some studies suggest artificial arthrodesis, which does not require bony union. The present descriptive retrospective study was conducted by reviewing the medical records of patients with periprosthetic joint infection complications. Patient satisfaction was evaluated after artificial arthrodesis, based on the visualized analog scale score and Oxford Knee Score. The mean Oxford Knee Score was 28, and the mean limb length discrepancy was 11 mm. In this new method, the length of hospitalization and leg length discrepancy was reduced, limb alignment and rotation was adjustable, and periprosthetic joint infection was controlled in nearly all patients.
| S-EPMC8332371 | biostudies-literature
Project description:Total knee arthroplasty (TKA) without soft tissue balance can create a balanced knee to a mechanical axis of near neutral with bone cuts, and remove osteophytes thoroughly. In this study, the authors present detailed steps for performing TKA. The attached video demonstrates the TKA procedure. The patient is a 77-year-old man who had suffered from knee pain for 12 years. Physical examination showed the Apley test to be positive and that the range of motion (ROM) decreased. An X-ray filmed at the positive lateral of the knee joint and the double lower extremity revealed a progression of degenerative osteoarthritis with genu varum. The key point of no soft tissue release is to make a rectangular extensional space by osteotomy. In addition, the osteophytes, especially syndesmophytes, should be removed thoroughly. As a result, the ligaments can achieve ideal length and the flexion contracture can also be remedied. Moreover, in surgeries without soft tissue release, bone mass and normal tissue are retained. Patients are satisfied to the surgery not only with less blood loss, anterior knee pain and DVT, but also faster rehabilitation. In summary, TKA without soft tissue balance is an efficient procedure for patients with knee osteoarthritis which can result in good prognosis.
| S-EPMC6584677 | biostudies-literature
Project description:This study presents a surgical technique for kinematically aligned medial unicompartmental knee arthroplasty with the MOTO (Medacta Corporate, Switzerland) partial knee implant. This technique aims to replicate the native medial femoral and tibial morphology by providing caliper-verified bone resections and kinematic alignment principles. The paper provides a comprehensive overview of the surgical steps and discusses the implications for implant longevity.
| S-EPMC11345933 | biostudies-literature
Project description:Extraction of a well-fixed ceramic liner during revision total hip arthroplasty can be technically challenging, particularly when acetabular fixation screws prevent en bloc removal of the shell and insert without causing collateral damage to the adjacent pelvic bone. It is also important to remove the ceramic liner intact, as ceramic debris left in the joint may cause third body wear with premature articular wear of the revised implants. We describe a novel technique to extract an incarcerated ceramic liner when previously described strategies prove ineffective. Knowledge of this technique will help surgeons avoid unnecessary damage to the acetabular bone and optimize prospects for stable implantation of revision components.
| S-EPMC10185739 | biostudies-literature