Total knee replacement with tibial tubercle osteotomy in rheumatoid patients with stiff knee

Nassar, Wael A.M.; Fayyad, Tamer A

doi:10.1007/s00264-016-3167-6

Cited by 12 publications

(9 citation statements)

References 34 publications

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“…Similarly, in a study by Eid et al, a case of DVT was reported in RA patients after total knee replacement. 13 Also, two cases of nonunion without translation were found; restoration was not required in the final follow-up.…”

Section: Discussionmentioning

confidence: 84%

Acute Total Knee Replacement in Rheumatoid Arthritis Patients with Proximal Tibial Fractures: A Case Series

et al. 2020

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Management of proximal tibial fractures is a challenging issue in patients with rheumatoid arthritis (RA). In the present study, we aimed to describe our experience of acute total knee replacement in RA patients.This case series included 11 RA patients with simultaneous insufficiency fractures of the proximal tibia, who were treated by acute total knee replacement. Midterm functional results, severity of pain, Hospital for Special Surgery (HSS), and Knee Society Score (KSS) parameters were evaluated in this study. The patients were followed up for 24 months.Eleven women with proximal tibial fractures and history of RA (mean age: 54.3 ± 4.7 years) were enrolled in this study. The mean score of Tegner activity scale was 2.2 ± 1.4 preoperatively, which significantly improved to 4.3 ± 1.4 postoperatively (p < 0.001). The two sections of KSS (knee and function section) averaged 88.7 ± 5.4 and 59.4 ± 8.2, respectively. There wasn't poor outcome and excellent result was in knee section 54.5% and function section 36.3% based on KSS. The mean score of pain severity during normal activity before fracture was 65.2 ± 12.3, which significantly reduced to 35.5 ± 11.3 in the final follow-up (p = 0.02). The score of HSS scale improved from 42 (range: 16–58) in the preoperative stage to 78 (range: 72–91) after surgery (p < 0.001). In the 6-month follow-up, deep vein thrombosis was reported in two patients. The time required to return to normal activity was 5.5 ± 2.3 months.Based on the findings, total knee replacement therapy in patients with RA and proximal tibial fractures produced excellent clinical outcomes, which led to rapid return to normal activity. This is a Level IV, therapeutic study.

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Section: Discussionmentioning

confidence: 84%

Acute Total Knee Replacement in Rheumatoid Arthritis Patients with Proximal Tibial Fractures: A Case Series

et al. 2020

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“…Twenty-one articles were excluded from the meta-analysis of TTO because they did not include a control group ( Table 5 ) [ 5 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ]. For reattachment osteotomy, most authors used cerclage wires [ 56 , 64 , 67 , 68 , 69 , 70 , 73 , 74 , 75 , 77 ], the second most common type of fixation were screws [ 62 , 63 , 65 , 66 , 70 , 71 , 76 ] and only two studies reported suture repair [ 72 , 78 ]. TTO approach was applied in both primary TKA, for knees with severe valgus deformity [ 69 , 73 , 76 , 77 ], patella disease [ 62 , 65 , 74 ] or revision surgery (aseptic or septic) [ 63 , 64 , 65 ,…”

Section: Resultsmentioning

confidence: 99%

Osteotomies and Total Knee Arthroplasty: Systematic Review and Meta-Analysis

Kulinski

Tramś

Pomianowski

et al. 2022

Life

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Total knee replacement (TKA) is a frequent modality performed in patients with osteoarthritis. Specific circumstances can make it much more difficult to execute successfully, and additional procedures such as osteotomy may be required. The aim of this study was to perform a meta-analysis and systematic review of osteotomies combined with TKA. Methods: In June 2022, a search PubMed, Embase, Cochrane, and Clinicaltrials was undertaken, adhering to PRISMA guidelines. The search included the terms “osteotomy” and “total knee arthroplasty”. Results: Two subgroups (tibial tubercle osteotomy and medial femoral condyle osteotomy) were included in the meta-analysis. Further subgroups were described as a narrative review. The primary outcome showed no significant difference in favor to TTO. Secondary outcomes showed improved results in all presented subgroups compared to preoperative status. Conclusion: This study showed a significant deficit of randomized control trials treated with osteotomies, in addition to TKA, and a lack of evidence-based surgical guidelines for the treatment of patients with OA in special conditions: posttraumatic deformities, stiff knee, severe varus, and valgus axis or patella disorders.

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“…To prevent these complications, an additional procedure may be added to the usual arthrotomy. Ahmed et al reported good results of TKA using a tibial tubercle osteotomy in patients with rheumatoid arthritis [ 11 ]. Twenty-three knees with a flexion contracture of ≥ 15º and/or < 75º range of flexion were treated and showed a good result.…”

Section: Discussionmentioning

confidence: 99%

Results of total knee arthroplasty for painless, stiff knees

Choi

Seo

Lee

et al. 2020

Knee Surg & Relat Res

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Background Stiff knees, like completely ankylosed or arthrodesed knees, can be painless. Total knee arthroplasty (TKA) for these painless, stiff knees is technically demanding. However, it can correct the alignment and advance the range of motion to improve quality of life. So, we reviewed the preoperative and postoperative results of functional and pain scores, range of motion (ROM) and complications in painless, stiff knees treated by TKA. Methods Fifteen painless, stiff knees underwent TKA from January 1998 to January 2017. The mean follow-up period was 15.4 (2.4–22.2) years. All the knees were completely ankylosed or arthrodesed. Clinical outcome and complications were evaluated using medical record review, serial plan radiography, ROM assessment, Knee Society score (KSS), Knee Society function score (FS), and a visual analog scale for pain (VAS). Results All patients were satisfied with their operated knees. Mean KSS and FS scores were improved from 36 and 50.9 to 76.9 and 67.2, respectively (P < 0.001 and P = 0.01). The mean ROM increased from 0º preoperatively to 77.6º (15–130) at the final follow-up (P < 0.001). The mean VAS had worsened from 0 preoperatively to 0.2 postoperatively, however it was not significant (P = 0.1). Major postoperative complications were reported in five of the knees (33.3%). Conclusions The results of TKA for painless, stiff knees were satisfactory with improved ROM and quality of life. Although some patients had mild pain and complications postoperatively, they were satisfied with the result. However, our study recommends that surgeons should consider the high rate of complications in the completely ankylosed or arthrodesed knees. Level of evidence A retrospective case series, Level IV.

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Total knee replacement with tibial tubercle osteotomy in rheumatoid patients with stiff knee

Abstract: Tibial tubercle osteotomy during TKA in patients with RA and stiff knee is technically demanding yet proved to be effective in improving post-operative range of movement and minimising the complication of patellar ligament avulsion.

Cited by 12 publications

References 34 publications

Acute Total Knee Replacement in Rheumatoid Arthritis Patients with Proximal Tibial Fractures: A Case Series

Acute Total Knee Replacement in Rheumatoid Arthritis Patients with Proximal Tibial Fractures: A Case Series

Osteotomies and Total Knee Arthroplasty: Systematic Review and Meta-Analysis

Results of total knee arthroplasty for painless, stiff knees

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