Painful knee arthroplasty: current practice

Cottino, Umberto; Rosso, Federica; Pastrone, Antonio; Dettoni, Federico; Rossi, Roberto; Bruzzone, Matteo

doi:10.1007/s12178-015-9296-5

Cited by 12 publications

(11 citation statements)

References 104 publications

(86 reference statements)

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“…All patients underwent serum ESR and CRP evaluation, and if significantly elevated according to the criteria proposed by Parvizi et al, joint aspiration was performed to evaluate white cells’ count and polymorphonucleate percentage [15, 16]. Radiographic evaluation including long leg, standing anteroposterior, lateral, and Merchant views were performed to evaluate for aseptic loosening, patello-femoral disorders (i.e., patella baja), extensor mechanism rupture, implant failure, malalignment, or periprosthetic fracture [17, 18]. CT scan was performed in selected patients when component malrotation was suspected or if more accurate evaluation of bone loss was required [18].…”

Section: Methodsmentioning

confidence: 99%

“…Radiographic evaluation including long leg, standing anteroposterior, lateral, and Merchant views were performed to evaluate for aseptic loosening, patello-femoral disorders (i.e., patella baja), extensor mechanism rupture, implant failure, malalignment, or periprosthetic fracture [17, 18]. CT scan was performed in selected patients when component malrotation was suspected or if more accurate evaluation of bone loss was required [18]. Clinical evaluation was performed focusing on tibiofemoral stability, patellofemoral tracking, and range-of-motion (ROM).…”

Section: Methodsmentioning

confidence: 99%

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Revision total knee arthroplasty (TKA): mid-term outcomes and bone loss/quality evaluation and treatment

et al. 2019

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Background Revision total knee arthroplasty (rTKA) is a demanding procedure, with a high complication and failure rate and a high rate of bone losses and poor bone quality. Different classifications for bone losses have been proposed, but they do not consider bone quality, which may affect implant fixation. The aim of this study is to describe the outcomes of a consecutive series of rTKA. Furthermore, a modified bone loss classification will be proposed based also on bone quality. Finally, the association between radiolucent line (RLL) development and different risk factors will be evaluated. Methods All the patients who underwent rTKA between 2008 and 2016 in the same institution were included. rTKAs were performed by the same surgeon according to the three-step technique. Bone losses were classified according to the proposed classification, including bone quality evaluation. The Knee Scoring System (KSS), the Hospital for Special Surgery Knee Score (HSS), and the SF-12 were used for the clinical evaluation. Radiological evaluation was performed according to the Knee Society Roentgenographic Evaluation System. Different possible risk factors (i.e., gender, age, amount of bone losses) associated to RLL development were identified, and this association was evaluated using logistic regression. Results Fifty-one patients (53 knees) were included (60.8% female, average age 71.5 years). The average follow-up was 56.6 months (range 24–182). The most frequent cause of failure was aseptic loosening (41.5%). 18.9% of the cases demonstrated poor bone quality. Bone losses were treated according to the proposed algorithm. In all the cases, there was a significant improvement in all the scores ( P < 0.05). The average post-operative range of motion was 110.5° (SD 10.7). At the radiological evaluation, all the implants resulted well aligned, with 15.1% of non-progressive RLL. There were 2 failures, with a cumulative survivorship of 92.1% at the last follow-up (SD 5.3%). At the logistic regression, none of the evaluated variables resulted associated to RLL development. Conclusion rTKA is a demanding procedure, and adequate treatment of bone losses is mandatory to achieve good results. However, also bone quality should be taken into consideration when approaching bone losses, and the proposed classification may need surgeons after an adequate validation. Level of evidence Level IV

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Revision total knee arthroplasty (TKA): mid-term outcomes and bone loss/quality evaluation and treatment

et al. 2019

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“…Pain is the most common indicator of implant failure. 26 When patients present with extra-articular pain post-implant, synovial hyperplasia should be considered within the differential diagnosis. 27 From a treatment perspective, synovial hyperplasia may be managed with arthroscopic debridement of the extensor mechanism of the hyperplastic synovium with modest pain-relieving effects.…”

Section: Discussionmentioning

confidence: 99%

Pathological analysis of periprosthetic soft tissue and modes of failure in revision total joint arthroplasty patients

et al. 2021

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Objectives: Implant failure leading to revision total joint arthroplasty can occur through a variety of different mechanisms which are typically associated with a soft tissue response adjacent to the implant that provide insight into the underlying etiology of implant failure. The objective of this study was to elucidate mechanisms of implant failure as they relate to histological classification and findings of adjacent periprosthetic tissue. Methods: Histological analysis of soft tissue adjacent to the implant was performed in 99 patients with an average age of 64 years old and grouped into four categories based on the study conducted by Morawietz et al.: Type I (N = 47) Wear particle induced type Type II (N = 7) Infectious type Type III (N = 19) Combined type I and II Type IV (N = 26) Indeterminant type Modes of failure were categorized into five groupings based on the study conducted by Callies et al.: Instability (N = 35), Aseptic Loosening (N = 24), Hardware and/or Mechanical Failure (N = 15), Septic (N = 13), and Other failures (N = 12). We calculated odds ratios and conducted regression analysis to assess the relationship between modes of failure and histological findings as well as modes of failure and comorbidities. Results: Hardware/mechanical failure was independently correlated with histological findings of anucleate protein debris, histiocytes, Staphylococcus epidermidis, and synovitis. Furthermore, hardware/mechanical failure was independently correlated with osteosarcoma as a co-morbidity. Septic failure was associated with histological findings of Enterococcus, granulation tissue, and tissue necrosis as well as comorbidities of Crohn’s disease, deep venous thrombosis, lung disease, and rheumatoid arthritis. Infection was 5.8 times more likely to be associated with Type II histology. Aseptic loosening was associated with histologic findings of synovitis. Conclusion: Our findings support the existing literature on periprosthetic tissue analysis in revision total joint arthroplasty which may improve surgeon understanding of the patholophysiological mechanisms that contribute to implant failure and revision surgery.

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“…12,13 There can be issues such as recurrence of varus deformity and can also lead to revision to total knee arthroplasty due to persistent pain. 14 Uni-condylar knee replacement is another procedure in the management of medial compartment arthritis of the knee which has produced mixed results according to various studies in the literature. 15,16 This procedure could be associated with problems such as poly wear, progression of arthritis, or loosening of components.…”

Section: Discussionmentioning

confidence: 99%

How does medial compartment osteoarthritis of knees respond to proximal fibular osteotomy at one year ? – A prospective analysis of 26 knees

Ss¹,

Manivannan²,

Jeyaraman³

2021

IJOR

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Introduction: Knee osteoarthritis (OA) is a chronic, progressive degenerative disease with joint pain, stiffness, and deformity. Knee OA is a common joint disease, with an incidence of 30% of the population older than 60 years. High tibial osteotomy and total knee arthroplasty are the 2 commonly used methods for treating knee OA. Total knee Arthroplasty (TKA), which aims to relieve pain and improve joint function and mobility, primal fibular osteotomy (PFO) is the main surgical alternative in this patient population. Materials and Methods: From September 2017 to September 2019, the PFO was performed for patients presenting with medial compartment osteoarthritis. Preoperative and postoperative weight-bearing whole lower extremity radiographs were obtained to analyze the alignment of the lower extremity and the ratio of the knee joint spaces (medial/lateral compartment) were ascertained. Knee pain was assessed using a visual analog scale (VAS), and knee ambulation activities were evaluated using the Knee Society Score (KSS).Results: A total of 20 patients and 26 knees were followed-up for a minimum period of one year. Of these, 7 were male and 13 were female patient. The average age was 57 years. According to Kellgren Lawrence grading, there were 18 knees of grade 2 and 2 knees of grade 3. The average preoperational VAS score and KSS were 6.3 and 33.5 respectively. The average postoperative VAS score and KSS improved significantly to 2.8 (P<0.01) and 83.7 (p=0.002) respectively. The medial joint space opening has improved significantly from preoperatively 1.15mm to postoperatively 3.4mm. Conclusion : PFO is a promising alternative procedure in the management of medial compartment osteoarthritis of the knee being a simple and cost-effective alternative to the traditional total knee or unicondylar knee replacements. A longer period of follow-up is necessary to evaluate whether the beneficial effects of PFO are sustained over a period of time. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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Painful knee arthroplasty: current practice

Cited by 12 publications

References 104 publications

Revision total knee arthroplasty (TKA): mid-term outcomes and bone loss/quality evaluation and treatment

Revision total knee arthroplasty (TKA): mid-term outcomes and bone loss/quality evaluation and treatment

Pathological analysis of periprosthetic soft tissue and modes of failure in revision total joint arthroplasty patients

How does medial compartment osteoarthritis of knees respond to proximal fibular osteotomy at one year ? – A prospective analysis of 26 knees

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