Why Are Total Knee Arthroplasties Failing Today—Has Anything Changed After 10 Years?

Sharkey, Peter F.; Lichstein, Paul M.; Shen, Chao; Tokarski, Anthony T.; Parvızı, Javad

doi:10.1016/j.arth.2013.07.024

Cited by 683 publications

(456 citation statements)

References 23 publications

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“…One of the most devastating reasons for revision TKA is PJI, which has been found responsible for 16% to 27% of all revision TKAs in recent investigations [2,17,21,22]. PJI has also been implicated as the primary culprit in early revision (\2 years) [13,17,22].…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…One of the most devastating reasons for revision TKA is periprosthetic joint infection (PJI), representing 16% to 27% of all revision TKAs in recent series [2,4,6,16,17,21,22]. Although various surgical approaches for eradicating infection are used around the world, two-stage exchange arthroplasty is the gold standard for treating TKA PJI in the United States.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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 addition, Sharkey et al reported that one of the primary, long-term causes of TKA revision was polyethylene wear, which accounted for 25% of the failures in their retrospective review of 212 consecutive TKA revisions [12]. Ten years later, a follow-up study by Sharkey et al [13] reported a remarkable decrease in revisions due to polyethylene wear and concluded that this reduction was, in part, likely due to the successful development of materials with improved wear resistance.…”

Section: Introductionmentioning

confidence: 94%

Design of an Advanced Bearing System for Total Knee Arthroplasty

2015

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Abstract:The objective of this study was to develop an advanced-bearing couple for TKA that optimizes the balance between wear resistance and mechanical properties. The mechanical and structural properties of virgin and highly crosslinked, re-melted UHMWPE were evaluated, and tibial inserts manufactured from these UHMWPE materials were tested against either oxidized zirconium (OxZr) or CoCr femoral components on a knee simulator. This study confirmed that the wear resistance of crosslinked UHMWPE improves with increasing radiation dose but is accompanied by a concomitant reduction in mechanical properties. Compared to CoCr, the ceramic surface of OxZr allows the use of a lower irradiation dose to achieve equivalent reductions in wear rates. As a result, a given wear rate can be achieved without sacrificing the mechanical properties to the same extent that is necessary with a CoCr femoral component. The advantage of ceramic counter bearing surfaces extends to both pristine and microabrasive conditions.

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“…7,9 Proper cement technique is an important factor in reducing the occurrence of aseptic loosening. It is fully accepted that dry and clean bony surfaces are of utmost importance in achieving rigid cement fixation of total knee arthroplasty components.…”

Section: Introductionmentioning

confidence: 99%