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. 3 main challenges encountered in
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
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
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
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
Patients with severe knee instability remain a surgical challenge. Furthermore, in the presence of extensive bone loss, constrained condylar implants may be unsuitable. Hinged knee replacements have served an important role in the management of such complex knee pathologies. A combined prospective and retrospective study of 138 consecutive hinge knee arthroplasties (42 primary and 96 revisions) of 8 different models performed in our institution between 2004 and 2010 at a mean follow up of 4.2years. Outcomes were reviewed and knee scores preoperatively and postoperatively at 1, 2 and 5 years using the American knee scoring system. The mean preoperative American knee score of 31 improved to 87 postoperatively. Complication rate was 19%, 15% of which required re-revisions for: loosening (4%), Infection (4%), periprosthetic fracture (3%), Implant fracture (2%), Component disassembly (1%) and dislocation (1%). Overall implant failure rate was 9% and implant survivorship was greater than 80% at 4 years. In our study, hinge prostheses provided good stability and symptom relief with a lower complication rate compared to some previous studies. In addition, we believe hinge prostheses can also serve as reasonable alternatives to amputation and arthrodesis in many complex knees cases.
Restoration of bone loss is a major challenge of revision TKA surgery. It is critical to achieve of a stable construct to support implants and achieve successful results. Major bone defects of the femoral and/or tibia (AORI type IIB/III) have been reconstructed using impaction grafting, structural allografts or tumor prostheses. The major concerns with structural allograft are graft resorption, mechanical failure, tissue availability, disease transmission, considerable surgical skill required and prolonged operative time. Porous tantalum metaphyseal cones, are becoming the established method of choice to correct large bone defects with several recent studies demonstrating promising results. The high coefficient of friction of these implants provides structural support for femoral and tibial components. The high degree of porosity has excellent potential for bone ingrowth and long-term biologic fixation. Several published series, although with relatively small cohorts of patients, have reported good short-term results with trabecular metal cones for major femoral and tibial bony defects in revision TKA. In a recent study, 16 femoral and 17 tibial cones were reviewed at an average follow up of 33 months (range, 13 to 73 months) the mean Knee Society Score improved from 42 pre-operatively to 83 at last follow up with an improvement of the functional score from an average of 34 to 66 (p<0.0001). Radiological follow up revealed no evidence of loosening or migration of the constructs. No evidence of complications were noted in correlation with the use of trabecular metal cones.
Patients with severe knee instability and extensive bone loss remain a surgical challenge. In such cases, regular knee implants and constrained condylar implants may not be suitable or have been attempted and failed. Hinged knee replacements have developed an important role in the management of such complex knee cases. They also have an increasingly important role in cases such as rheumatoid arthritis and other cases of severe joint destruction. We present a review of 138 consecutive hinge knee arthroplasties of 8 different Hinge models performed in our unit between 2004 and 2010. Combined prospective and retrospective study of 138 (42 primary and 96 revisions) consecutive cases of Hinge knee replacements at a mean follow up of 4.2 years. Outcomes were recorded and scored using the American knee score preoperatively, 1, 2 and 5 years. Complications, re-revisions, implant failures and survivorship were also assessed.Introduction
Method
Polymethyl methacrylate spacers are commonly used during staged revision knee arthroplasty for infection. In cases with extensive bone loss and ligament instability, such spacers may not preserve limb length, joint stability and motion. We report a retrospective case series of 19 consecutive patients using a custom-made cobalt chrome hinged spacer with antibiotic-loaded cement. The “SMILES spacer” was used at first-stage revision knee arthroplasty for chronic infection associated with a significant bone loss due to failed revision total knee replacement in 11 patients (58%), tumour endoprosthesis in four patients (21%), primary knee replacement in two patients (11%) and infected metalwork following fracture or osteotomy in a further two patients (11%). Mean follow-up was 38 months (range 24–70). In 12 (63%) patients, infection was eradicated, three patients (16%) had persistent infection and four (21%) developed further infection after initially successful second-stage surgery. Above knee amputation for persistent infection was performed in two patients. In this particularly difficult to treat population, the SMILES spacer two-stage technique has demonstrated encouraging results and presents an attractive alternative to arthrodesis or amputation.
Aim. Aim was to compare revision rates when using single versus dual antibiotic loaded cement (ABLC) in hip fracture arthroplasty and aseptic revision hip or knee arthroplasty using data from the Dutch national joint registry (LROI). Methods. All primary cemented (hemi-)arthroplasties for acute hip fractures and cemented aseptic hip or
The incidence of PJI in knee replacements is 2.8% and slightly lower with hip replacement surgery. PJI make up 15% (or even more) of
Periprosthetic joint infection (PJI) in geriatric and/or multimorbid patients is an enormous challenge for orthopaedic surgeons. Revision procedures have also been demonstrated to expose patients to higher infection risks. Prior patient stratification according to presumed infection risks, followed by a more potent local antibiotic prophylaxis protocol with selective use of DALBC, is an interesting strategy to decrease the burden of PJI in high risk patients. The PubMed & EMBASE databases were screened for publications pertaining to the utilization of DALBC in cement for infection prophylaxis & prosthesis fixation. 6 preclinical & 7 clinical studies were identified which met the inclusion criteria and were stratified by level of clinical evidence. Only those studies were considered which compared the PJI outcome in the DALBC vs the SALBC group. (1). DALBC have been shown to exert a much stronger and longer lasting inhibition of biofilm formation on many PJI relevant bacteria (gram-positive and gram-negative pathogens) than single gentamicin-only containing cements. (2). DALBC use (COPAL G+C) in the intervention arm of 7 clinical studies has led to a significant reduction of PJI cases in a) cemented hemiarthroplasty procedures (3 studies, evidence level I and III), in b) cemented septic revision surgeries (2 studies, evidence level III), in c) cemented aseptic
Aim. In 10% of the presumed aseptic hip or