Soft-tissue expansion before total knee arthroplasty in arthrodesed joints. A report of two cases

Mahomed, N.N.; McKee, Nancy H.; Solomon, Philip; Lahoda, L. U.; Gross, A E

doi:10.1302/0301-620x.76b1.8300689

Cited by 45 publications

(14 citation statements)

References 8 publications

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“…In that series, no knee had aseptic loosening (clinically and radiographically) at the final followup. However, one study had a high revision rate for aseptic loosening (18.5% [five of 27 knees]) [16]. We had a low revision rate with a minimum 5-year followup.…”

Section: Discussionmentioning

confidence: 94%

Does TKA Improve Functional Outcome and Range of Motion in Patients with Stiff Knees?

Kim

2009

Clinical Orthopaedics &Amp; Related Research

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The main goals of TKA are pain relief and improvement of function and range of motion (ROM). To ascertain whether TKA in patients with stiff knees would relieve pain and improve functional outcome and ROM, we asked four questions: whether (1) Knee Society and WO-MAC scores would improve after TKA; (2) poor preoperative ROM would improve after TKA; (3) the revision rate of TKA in stiff knees would be high; and (4) complication rates would be high in these patients after TKA. We retrospectively reviewed 74 patients (86 knees) with stiff knees (mean age, 56.8 years) who underwent TKAs with a condylar constrained or a posterior stabilized prosthesis. The minimum followup was 5 years (mean, 9.1 years; range, 5-12 years). The mean preoperative Hospital for Special Surgery knee score and Knee Society knee and functional scores were 42, 11, and 42 points, respectively, and postoperatively they were 84, 90, and 84 points, respectively. Preoperative and postoperative total WOMAC scores were 73 and 34 points, respectively. One knee (1.2%) had aseptic loosening of the tibial component and 12 knees (14%) had complications. Despite a relatively high rate of complications, most patients had substantial improvement in function.

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Section: Discussionmentioning

confidence: 94%

Does TKA Improve Functional Outcome and Range of Motion in Patients with Stiff Knees?

Kim

2009

Clinical Orthopaedics &Amp; Related Research

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“…In order to reduce the incidence of skin necrosis, skin grafting [3], vascularised gastrocnemius flap [4,5,7] and tissue expanders [4] have been used. Mahomed et al [11] was the first to mention the use of soft-tissue expanders in AD conversion to TKA. They found that the use of soft-tissue expanders helped to provide adequate soft tissue for wound closure in their patients.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors advocate the procedure [5,6,[9][10][11], while others have expressed concern over its efficacy in the presence of the high complication rate [1,2,7,12]. Thus, a systematic review and meta-analyses of the current literature was done, to examine the role of TKA after AD of the knee and assess the clinical outcome, complications, surgical technique, patientrelated outcome measures and methodological quality.…”

Section: Introductionmentioning

confidence: 99%

Conversion from knee arthrodesis to arthroplasty: systematic review

Kernkamp

Verra

Pijls

et al. 2016

International Orthopaedics (SICOT)

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Purpose Arthrodesis (AD) of the knee reduces pain and provides stability, but has severe functional and social limitations. There has been ample discussion on the value of a conversion of an AD to a total knee arthroplasty (TKA). The aim of this study was to perform a review and meta-analysis of the current literature on conversion of an AD to TKA and assess clinical outcome, complication rate, surgical technique and overall patient-related outcome measures. Methods PubMed, Embase, Web of Science, Cochrane, CENTRAL, CINAHL, Academic Search Premier, ScienceDirect and searching by hand for papers on conversion of AD of the knee to TKA. Two reviewers independently reviewed all titles and abstracts, and extracted the available data. Study eligibility criteria were: conversion of knee AD to TKA, five cases or more and non-oncology patients. Data consisted of study characteristics, patient demographics, clinical outcome and complications. Additionally, details on surgical technique were reviewed. Results Of the 866 unique references identified, six papers were included for further analyses, comprising a total of 123 knees with conversion of AD of the knee to TKA. Mean gain of knee flexion was 80 degrees and the mean HSS score improved with 20 points. A complicated postoperative course was found in 65 % of all cases. The most frequent complication was skin necrosis (25 %), followed by arthrofibrosis (13 %), infection (11 %) and revision (11 %). Major complications such as refusion, amputation and death occurred in less than 5 % of all cases. Discussion The majority of the papers consisted of small case series of moderate methodological quality, resulting in 123 included knees. Further series are necessary to draw definitive conclusions. Conclusions This is the first systematic review and metaanalysis on conversion of a knee arthrodesis to TKA. Good clinical results can be expected after conversion, albeit at a high risk of postoperative complications.

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“…In previously surgically arthrodesed knees, despite anecdotal successful reports [4,11] our own experience with only one success without complications in five knees lead us to believe, like others [1,6], that the risks and benefits of the procedure should be carefully consider before any indication of total knee arthroplasty in this situation.…”

Section: Discussionmentioning

confidence: 80%

“…In knees with multiple incisions, the use of softtissue expansion has been proposed before the knee arthroplasty. The skin expanders help to provide adequate soft tissue for wound closure and the expander under the quadriceps help to mobilize the extensor mechanism [11].…”

Section: Complicationsmentioning

confidence: 99%

Total knee arthroplasty for the stiff knee

2008

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The underlying cause of stiffness must be carefully evaluated when considering total knee arthrolasty for the stiff knee. Any previous skin incision must be recorded as well as the state of the extensor mechanism. The choice of prosthesis constraint should be decided on the state of the soft-tissues often released extensively to gain flexion. A quadriceps release or plasty and a tibial tubercle osteotomy are the current options for exposure, soft-tissue release and bone cuts. Postoperatively, the motion should be started early combined to pain control in order to obtain an average of 65˚of flexion at follow-up. The complication rate remains high including recurrent stiffness, delayed wound healing and deep infection.

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Soft-tissue expansion before total knee arthroplasty in arthrodesed joints. A report of two cases

Cited by 45 publications

References 8 publications

Does TKA Improve Functional Outcome and Range of Motion in Patients with Stiff Knees?

Does TKA Improve Functional Outcome and Range of Motion in Patients with Stiff Knees?

Conversion from knee arthrodesis to arthroplasty: systematic review

Total knee arthroplasty for the stiff knee

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