Post traumatic knee arthritis: Navigated total knee replacement without hardware removal

Manzotti, Alfonso; Pullen, Chris; Cerveri, Pietro; Chemello, Cesare; Confalonieri, Norberto

doi:10.1016/j.knee.2012.06.008

Cited by 14 publications

(11 citation statements)

References 17 publications

(31 reference statements)

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“…Compared to the literature reporting CAN-TKAs with retained implants [5,9,14,[19][20][21], our study is the first to specifically present the usefulness of free-hand techniques of proximal tibia and distal femur cuts in these complicated TKAs with retained implant. The outcomes in our series prove the mentioned ideas useful in the presence of retained hardware around the knee.…”

Section: Discussionmentioning

confidence: 90%

“…It is a great challenge to perform primary TKA for patients suffering post-traumatic knee arthritis, the retained implants, residual extra-articular deformity and even the compromised femoral canal, which all hinder the use of current intramedullary guiding system to obtain accurate alignment. [5] However, there is still no clear evidence that implants should be removed or retained in patients receiving TKA with periarticular hardware. Conversion TKA, defined as Primary TKA with periarticular implants removed simultaneously or in stage, was reported to have increased wound problems and readmission rate.…”

Section: Discussionmentioning

confidence: 99%

“…[4,6] TKA without hardware removal, including intra-operative navigation or patient specific instruments, were reported to be of value in these complicated scenarios. [5,9,13,14] In this study, a simplified but facile extramedullary guiding method was proposed as alternative to perform primary TKAs in patients with arthritic knee and retained implant once computer-assisted devices were unavailable.…”

Section: Discussionmentioning

confidence: 99%

“…[3,4] For technical difficulty, retained implants frequently hinder the passage of guiding rods of current intramedullary guided TKA, which may require staged removal of prior implant before the index procedure. [5] Ideals of new coding for conversion TKA were proposed due to more complicated condition for staged or simultaneous removal of implants. [4,6] Even though, excessive surgical procedures prior to knee replacement predispose the later arthrofibrosis and infection.…”

Section: Introductionmentioning

confidence: 99%

“…[4,8] In current practice, modern devices like computer-assisted navigation (CAN) or premade patientspecific block (PSB), had been reported to be of value in these complex situations without hardware removal. [5,9] However, extra expenditure on these equipment and devices delayed their propagation and wild acceptance. [10] After reviewing related literatures about primary TKAs with retained hardware, we acknowledge that the key is to execute the required bony cuts using reliable extramedullary (EM) referencing methods.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

A facile extramedullary method to perform primary total knee arthroplasty in patients without hardware removal: a case series

Tseng¹,

Chen²,

Chang³

et al. 2020

Preprint

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Background It is technical demanding to execute primary total knee arthroplasty (TKA) for post-traumatic knee arthritis with periarticular implants. Our purpose is to present a simple extramedullary guide technique and report the clinical results of our series of primary TKAs in patients with post-traumatic arthritis without hardware removal. Methods Between April 2014 and March 2019, a series of seven patients with post-traumatic knee arthritis and retained hardware were included. All the surgeries were performed by the same surgeon. The mean age of the patients was 67 years. All the index procedures were performed with primary TKAs by the same surgeon according to simple extramedullary technique. The parallelism between the distal femoral and proximal tibial cuts as well as the required limb alignments were verified intra-operatively. Radiographic measurements and clinical outcomes were reviewed retrospectively. Results Overall, there was a good restoration of postoperative mechanical alignment in all cases. The mean post-operative Hip-Knee-Ankle (HKA) angle was 179.4°. No patient required allogenic blood transfusion or prolonged hospital stays. No surgical site-specific complications were noted by chart review. In the last follow-up, no implant failure was found. Clinical assessments according to knee society score showed good knee scores (89.1), functional scores (87.9) and motion arc (112.9). Conclusions Our results show that post-traumatic knee arthritis can be safely managed with this extramedullary method without hardware removal.

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