Management of large bone defects in total knee arthroplasty (TKA) usually has involved modular prostheses with metal augments, structural allografts, and megaprostheses. We retrospectively reviewed the outcome of treatment of major bone defects for 74 patients (79 knees) who had revision TKAs with structural allografts; nine patients were lost to followup before 5 years, leaving 65 patients (70 knees, or 88%) followed for a minimum of 5 years or until revision or death. Medical records, radiographs, patient surveys, and correspondence were used for all data. Sixteen patients (22.8%) had failed reconstructions and underwent additional revision surgery; eight of the 16 were secondary to allograft failure, three were secondary to failure of a component not supported by allograft, and five were secondary to infection. In patients not requiring revision surgery, the Knee Society score improved from 49 preoperatively to 87 postoperatively. We observed revision-free survival of 80.7% (95% confidence interval, 71.7-90.8) at 5 years and 75.9% (95% confidence interval, 65.6-87.8) at 10 years. Our data support the selective use of structural allograft for large cavitary defects encountered during TKA. However, the rates of complications and reoperations suggest efforts to improve results or develop more durable alternative methods are warranted for these challenging reconstructions.
BackgroundHip fractures account for 350,000 fractures annually and the projected incidence is expected to exceed 6.3 million by 2050. As the number of hip fractures continues to increase as a result of the aging American population, the importance of limiting and preventing complications is magnified.MethodsThis study demonstrated the clinical effects of a continuous fascia iliaca compartment block placed pre-operatively when combined with a comprehensive pain protocol. All patients who presented to our institution with a hip fracture were given the option of having a continuous fascia iliaca compartment block for pain control versus usual pain management (non-opioids, opioids, and ice therapy). The block was monitored by the pain service until the day of discharge from the hospital. Data was collected regarding mean pain scores, average length of stay and opioid medication use.ResultsThere were eighteen males and twenty four females. The pain score on post-operative day zero was reduced from a 2010 annual average of 4.1 to 1.7 in the pilot study group on the visual analog score. On post-operative day one, the 2010 annual average was 2.9 compared to 1.4 in the pilot study group. The length of stay was decreased from the 2010 annual average of 5.9 days to 4.8 days in the pilot study group. The patients used an average of 18mg of morphine equivalent medications during the average infusion time of 40.7 hours. There were no falls or infections noted within our pilot study group.ConclusionsOverall, it has been noticed that the reduction in opioid usage in this elderly patient population, with an average age of seventy five years, has produced alert and mobile patients often as early as post-operative day one. The length of stay has decreased along with the average pain score in the pilot sample of forty two patients.KeywordsHip fracture; Fascia Iliaca Compartment Block; Pain Score
Background High-flexion TKA prostheses are designed to improve flexion and clinical outcomes. Increased knee flexion can increase implant loads and fixation stresses, creating concerns of premature failure. Whether these goals can be achieved without premature failures is unclear. Questions/purposes We assessed pain relief, knee motion, function, incidence of premature failure, and radiographic appearance in patients with a mobile-bearing high-flexion TKA and determined whether preoperative knee flexion affects postoperative knee flexion. Patients with preoperative flexion of less than 120°had a greater improvement in KSS (62 versus 48). Posterior femoral radiolucent lines were observed in 43% without evidence of prosthetic loosening. Conclusions Our data were similar to those reported in patients implanted with traditional and other designs of high-flexion TKA. We found no increased incidence of premature failure, although a higher than expected incidence of posterior femoral radiolucent lines merit continued observation. Patients with less preoperative motion were more likely to benefit from a high-flexion TKA. Patients and Methods
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