Aim. Our aim was to evaluate the prevalence and impact of unexpected intraoperative cultures on the outcome of total presumed aseptic knee and hip revision surgery. Method. Data regarding patients prospectively recruited in our center, who had undergone elective complete hip and
To wake up in the morning facing a complex total hip revision can be unpleasant. Modern designs have greatly facilitated dealing with the most difficult revision situations both on the acetabular and femoral side. The surgeon faces blood loss, dislocation, infection, and a litany of other potential complications. Our advances in total hip revision have been outstanding but can pose very complex issues. Total
Introduction. Bone loss management represents one of the most challenging issues for the orthopaedic surgeon. In most cases, stems, structural allograft, TMcones, and sleeves are adequate to allow optimal implant stability and durable fixation. In selected cases of wide metadiaphyseal bone defects, these devices do not provide proper intraoperative stability. In such scenarios, further steps are needed and include complex modular reconstruction, substitution with megaprosthesis (exposing patients at high risk of early failure) or joint arthrodesis that can yield unacceptable results. The aim of this paper is to present early results obtained with a new custom-made implant for complex metadiaphyseal bone defects management in
Introduction. The legion
Introduction:
Introduction. 3 main challenges encountered in
Increasing age and a higher level of mobility lead to an increasing incidence in revision arthroplasty after total knee replacement and tumor surgery. So far, the reconstruction of large defects in bony and soft tissue environments can be accomplished by the modern modular components of revision implants. The consecutive reconstruction of the extensor mechanism in extended revision has its own drawbacks and is often associated with significant functional limitations for the patient. Specially designed implants and methods are required to generate good functional. Results: The modular
The designs available today have greatly improved our ability as surgeons to perform successful total
This is a prospective review of consecutive patients who underwent
Aim. Femoral or tibial massive bone defects (AORI F2B-F3 / T2B-T3) are common in septic total knee replacement. Different surgical techniques are described in literature. In our study we show clinical and radiological results associated with the use of tantalum metaphyseal cones in the management of cavitary bone defects in two-stage complex
Aims: To determine the anthropometric measurements of bony landmarks in the knee using MR scans and so assist revision knee surgeons in prostheses placement. Methods: We analysed 100 MR scans of patients aged 16–50 (50 male, 50 female) which were performed for meniscal pathology, patellar dislocation and ACL injury. Those over the age of 50 or with symptoms suggestive of general osteoarthritis, or where the epiphyses had not yet fused were excluded. All measurements recorded were to the level of joint line and are shown below. Results:(Tables removed). Conclusions: To ensure near normal knee mechanics are achieved during
Aim. One of the most challenging problems in total knee arthroplasty (TKA) is periprosthetic infection. A major problem that arises in septic revision TKA (RTKA) are extended bone defects. In case of extended bone defects revision prostheses with metaphyseal sleeves are used. Only a few studies have been published on the use of metaphyseal sleeves in RTKA - none were septic exclusive. The aim of our study was to determine the implant survival, achieved osseointegration as well as the radiological mid-term outcomes of metaphyseal sleeve fixation in septic two-stage
Aims: To determine the anthropometric measurements of bony landmarks in the knee using MR scans and so assist revision knee surgeons in prostheses placement. Methods: We analysed 100 MR scans of patients aged 16–50 (50 male, 50 female) which were performed for meniscal pathology, patellar dislocation and ACL injury. Those over the age of 50 or with symptoms suggestive of general osteoarthritis, or where the epiphyses had not yet fused were excluded. All measurements recorded were to the level of joint line and are shown below. Conclusions: To ensure near normal knee mechanics are achieved during
Introduction. We discuss the use of the SMILES (Stanmore Modular Individualised Lower Extremity System) in salvage
Revision surgery for total knee replacement is a complex procedure, carrying an increased risk for the patient and cost for hospitals. As well as increased cost of peri-operative investigations, blood transfusions, surgical instrumentation, implants and theatre time, there is a well documented increased length of stay (LOS), accounting for the majority of actual costs associated with surgery. We compared revision surgery for infection vs. other causes (aseptic loosening, dislocation, mal-alignment). Clinical, demographic and economic data were obtained for 180 consecutive revision total knee replacements performed at a tertiary referral centre between 2003 and 2012. Actual costs and National Health Service tariffs were compared per patient and mean difference calculated. Mean age was 66 years (range 17–87) with 62 male and 117 female patients. Mean LOS for aseptic cases was 10 days (range 1–62) and 20 days (range 4–103) for infection. Mean cost difference in aseptic cases (n = 125) was £−933 (SD = £12,204), and £−3907 (SD = £7,256) for infection (n = 54). Surgery for infection was associated with increased operating times, blood loss and complications compared to revision for aseptic causes. LOS for infection was on average double that for aseptic cases (p < 0.05). Current NHS tariffs do not fully reimburse the increased costs associated with providing a
A limited number of investigations with conflicting results have described perivascular lymphocytic infiltration (PVLI) in the setting of total knee arthroplasty. The purpose of this study was to determine if PVLI found in total knee replacements at the time of aseptic revision surgery was associated with worse clinical outcomes and survivorship. A retrospective review was conducted on 617 patients that underwent aseptic total knee arthroplasty revision who had histologic analysis for PVLI at the time of surgery. Clinical and radiographic data was obtained pre and postoperatively, 6 weeks post operatively, and then every year thereafter.Background
Methods
Due to medical and organizational factors, it occurs in everyday practice that spacers are left in place longer than originally planned during a two-stage prosthesis exchange in the case of prosthetic joint infections. Patients are severely restricted in their mobility and, after initial antibiotic administration, the spacer itself only acts as a foreign body. The aim of this study is to analyze whether the duration of the spacer in situ has an influence on the long-term success of treatment and mortality. We retrospectively studied all 204 two-stage prosthesis replacements of the hip and knee from 2012 to 2016 with a minimum follow-up of two years at an arthroplasty center with 3 main surgeons. The duration of the spacer interval was divided into two groups. Patients replanted within ten weeks (as is standard in multiple algorithms) after systemic antibiotic treatment were assigned to the ‘Regular Spacer Interval (< 70 days)’ group. If the spacer interval was longer, they were assigned to the ‘Long Spacer Interval (≥ 70 days)’ group.Aim
Method
PSI technology have proved helpful in difficult primary Total Knee Replacement. However applying it to revision was impossible due to multiple factor. To Start with the landmark We usually destroy it. There is an extensive damage at the bone at the epiphysis, the implant prevent an accurate visualization and debridement usually change the surface of the bone as well which make applying the psi dyed impossible, we are proposing a new way of using psi in revision where we don't depend on the all masses adjusted in primary. However we depend on the metaphysical area of the bone. We have reviewed 56 MRI &CT scans for cases posted for revision and showed clearly that in spite of the extensive bony destruction and metal presence the MRI / CT scan we were able to visualize well the metaphysical area in the intramedullary canal in both tibial and femoral · we have established a special external guide that depends on the outside surface of the metaphysis of the femur. We have tried this model on six plastic bone and showed that this external guide can give the accurate details that the surgeon is looking for in a revision surgeryIntroduction
Material & method
The Dual Articular Knee (Biomet®) is a modular revision prosthesis with a mobile bearing. We performed 24 operations on 23 patients: 16 female and 7 male patients. The average age at revision was 71.6 years, range 42–84 y, the average time span between primary TKR and revision was 8 years, range 1–19 y. The average follow up was 25 months, range 3–68 months. Diagnoses at primary TKR were: Osteoarthritis 19, Rheumatoid arthritis 1, Post-traumatic arthrosis 2, s/a medial Unicondylar 1, s/a High Tibial Osteotomy 1. Primary Implants were: Total Condylar (Howmedica) 4 (3 with metal trays and 1 all PE tibia); IB 2 (Zimmer) 9, IB 1 (Zimmer) 2, Miller Galante (Zimmer) 1, AGC (Biomet) 5, Sigma (J&
J) 2, Sigma RP (J&
J) 1. Inciations for revision were: Aseptic loosening and PE wear 20, Infection 4 (Organisms: MRSA 1, Enterococcus Faeconium 1, Streptococcus Gr.6 1, Negative Culture 1).
Good results were obtained in 19 knees, fair in 2, failure due to late infection in one knee. One patient was lost for follow up, one patient died 6 months after surgery of an unrelated cause.
A computer assisted technique for TKA Revision is presented. It is based on the use of a navigation system, RTKANav consisting of anl optical localizer, a dedicated software specifically done for TKA revision and some navigated tools developed for this application. The system doesn’t use any patient model derived from medical images, but on the system interface patient anatomy model is represented with dots and lines corresponding to acquired landmarks and data derived from them. These data describe the main anatomical features and provide the surgeon with the main references for the intervention; angles between the mechanical axes can be controlled and monitored at any time. Even if during acquisition phase some specific points can not be identified, since for each prosthetic component several criteria to set each degree of freedom are considered and compared, the system is always able suggest an intervention plan. The system provides the surgeon with tools to analyse and modify the proposed plan, and to reproduce it on the patient. Navigated technique validation is under development. Till now it was used on two patients by an expert surgeon. Computer guidance showed early promising results providing the surgeon with useful indications achieve a satisfactory prosthesis implant.