Midterm Assessment of Causes and Results of Revision Total Knee Arthroplasty

Hossain, Fahad S; Patel, Shelain; Haddad, Fares S.

doi:10.1007/s11999-009-1204-0

Cited by 197 publications

(188 citation statements)

References 30 publications

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“…PJI has also been implicated as the primary culprit in early revision (\2 years) [13,17,22]. Although various methods are used, two-stage exchange arthroplasty with an interim articulating or static antibiotic-laden bone cement spacer remains the gold standard for treating PJI in the United States.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Lichstein

Hedlund

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Two-stage exchange arthroplasty is a standard approach for treating total knee arthroplasty periprosthetic joint infection in the United States, but whether this should be performed with a static antibiotic spacer or an articulating one that allows range of motion before reimplantation remains controversial. It is unclear if the advantages of articulating spacers (easier surgical exposure during reimplantation and improved postoperative flexion) outweigh the disadvantages of increased cost and complexity in the setting of similar rates of infection eradication. Questions/purposes The purposes of this study were (1) to determine the ultimate range of motion; and (2) to determine the proportion of patients who remained free of infection at a minimum 2 years after treatment with static antibiotic spacers as part of a two-stage revision TKA for the treatment of periprosthetic joint infection. Methods Between 1999 and 2011, we treated 121 patients with chronically infected TKAs, of whom three had medical comorbidities precluding a two-stage exchange, four had died before 2-year followup for reasons other than the surgical intervention, and seven were lost to followup. The remaining 107 patients (109 knees; 53 men and 54 women) were treated using a two-stage approach with static spacers and are evaluated here at a mean of 3.7 years (range, 2.0-9.8 years); no patients were treated with articulating spacers during this study period. Twenty-five percent (27 of 109) of the organisms isolated the first-stage procedure were resistant to methicillin and/or vancomycin. Median age at the time of reimplantation was 67 years (range, 42-89 years). Range of motion was measured by an independent physical therapist with a standard goniometer. Knee Society knee and function scores were calculated before the first stage and at the 2-year mark. Because many of these patients were treated before consensus definitions Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at Stanford University Medical Center, Stanford, CA, USA. of infection were established, we made ...

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Section: Discussionmentioning

confidence: 99%

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Lichstein

Hedlund

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…In order to improve the durability of the procedure, the failure mechanisms of primary and revision total knee arthroplasty in this population must be identified 6 . While authors of papers in the existing literature drew conclusions about the failure modes of revision knee arthroplasty in all age groups, we believe that this young population may have unique revision failure modes that surgeons must take into account when considering surgical risks and fixation methods [30][31][32] . The purpose of this study was to define the reasons for total knee arthroplasty revision and re-revision in patients fifty years of age or younger and determine the survivorship of revision total knee arthroplasty and isolate risk factors for failure of revision total knee arthroplasty in that population.…”

Section: Discussionmentioning

confidence: 99%

“…arthroplasty 18,23,26,30,32,33 . Hossain et al, who reviewed 349 cases of revision total knee arthroplasty in patients with an average age of 67.8 years, reported periprosthetic infection as the cause of revision in >30% of cases 32 .…”

Section: Revision Total Knee Arthroplasty I N T H E Young Pat I E N Tmentioning

confidence: 99%

“…Hossain et al, who reviewed 349 cases of revision total knee arthroplasty in patients with an average age of 67.8 years, reported periprosthetic infection as the cause of revision in >30% of cases 32 . In perhaps the largest series of revision knee arthroplasties to date (60,355 in patients with an average age of 65.8 years), Bozic et al found infection to be the reason for revision in 25.2% of cases 33 .…”

Section: Revision Total Knee Arthroplasty I N T H E Young Pat I E N Tmentioning

confidence: 99%

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Revision Total Knee Arthroplasty in the Young Patient: Is There Trouble on the Horizon?

Aggarwal

Goyal

Deirmengian

et al. 2014

Journal of Bone and Joint Surgery

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“…Primary TKA is one of the most effective procedures in modern surgical history to improve patients' symptoms, quality of life, knee ROM, and function [1,16,19,39]. With the steady increase in primary TKAs performed annually, revision procedures are expected to increase substantially in coming years, with a projected increase of 601% from 2005 to 2030 [17,31].…”

Section: Introductionmentioning

confidence: 99%

Cementless Revision TKA with Bone Grafting of Osseous Defects Restores Bone Stock with a Low Revision Rate at 4 to 10 years

Hanna

Aston

Roeck

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Addressing bone loss in revision TKA is challenging despite the array of options to reconstruct the deficient bone. Biologic reconstruction using morselized loosely-packed bone graft potentially allows for augmentation of residual bone stock while offering physiologic load transfer. However it is unclear whether the reconstructions are durable. Questions/purposes We therefore sought to determine (1) survivorship and complications, (2) function, and (3) radiographic findings of cementless revision TKA in combination with loosely-packed morselized bone graft to reconstruct osseous defects at revision TKA. Patients and MethodsWe retrospectively reviewed 56 patients who had undergone revision TKAs using cementless long-stemmed components in combination with morselized loose bone graft at our institution. There were 26 men and 30 women with a mean age of 68.3 years (range, 56-89 years). Patients were followed to assess symptoms and function and to detect radiographic loosening, component migration, and graft incorporation. The minimum followup was 4 years (mean, 7.3 years; range, 4-10 years). Results Cumulative prosthesis survival, with revision as an end point, was 98% at 10 years. The mean Oxford Knee Scores improved from 21 (36%) preoperatively to 41 (68%) at final followup. Five patients (9%) had reoperations for complications. Conclusions Our observations suggest this technique is reproducible and obviates the need for excessive bone resection, use of large metal augments, mass allografts, or custom prostheses. It allows for bone stock to be reconstructed reliably with durable midterm component fixation.

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Midterm Assessment of Causes and Results of Revision Total Knee Arthroplasty

Abstract: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 197 publications

References 30 publications

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Revision Total Knee Arthroplasty in the Young Patient: Is There Trouble on the Horizon?

Cementless Revision TKA with Bone Grafting of Osseous Defects Restores Bone Stock with a Low Revision Rate at 4 to 10 years

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