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A Modified Technique for Artificial Fusion in Unreconstructable Revision Total Knee Arthroplasty.

ABSTRACT: 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.

SUBMITTER: Sarzaeem MM

PROVIDER: S-EPMC8332371 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

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A Modified Technique for Artificial Fusion in Unreconstructable Revision Total Knee Arthroplasty.

Sarzaeem Mohammad Mahdi MM Bonakdar Moein M Ramezani Keyvan K Omrani Farzad Amouzadeh FA Omidian Mohamadmahdi M Mortazavi S M Javad SMJ

Arthroplasty today 20210726

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 ...[more]

PMID: 34381855

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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.

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.

Dataset Information

A Modified Technique for Artificial Fusion in Unreconstructable Revision Total Knee Arthroplasty.

Publications

A Modified Technique for Artificial Fusion in Unreconstructable Revision Total Knee Arthroplasty.

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