Our objective is to describe early and midterm results with the use of a new knee prosthesis as an articulating spacer in planned two-stage management for infected total knee arthroplasty. As a second objective, we compared outcomes between the group with a retained first stage and those with a completed 2-stage revision. Forty-seven patients (48 knees) from January 2012 and November 2017 underwent a 2-stage exchange with an articulating spacer with new implants was used for a chronic knee periprosthetic joint infection with a mean follow-up of 3.7 years (2–6.5 years). The most frequently identified infecting organism was MSSA (31%), MRSA (21%) or MRSE (20%). At the first stage, a new PS femoral component and a new all-polyethylene posterior stabilized (PS) tibial component or a standard PS tibial liner were cemented with antibiotic-cement, typically 3.6 gm tobramycin and vancomycin 1.5 gm. IV antibiotics for six weeks were administered. The planned reimplantation was at 3 months, but ninetteen spacers (14 all poly tibias and 5 tibial liner) were retained for over 12 months. Postoperative assessment included knee range of motion (ROM), quality of life (QOL) scores (SF-12, WOMAC, KOOS, Oxford, and UCLA scores), and a satisfaction scale from 0–100%.Introduction
Methods
Our objective is to describe our early and mid-term results with the use of a new simple primary knee prosthesis as an articulating spacer in planned two-stage management for infected knee arthroplasty. As a second objective, we compared outcomes between the group with a retained first stage and those with a complete two-stage revision. We included 47 patients (48 knees) with positive criteria for infection, with a minimum two-year follow-up, in which a two-stage approach with an articulating spacer with new implants was used. Patients with infection control, and a stable and functional knee were allowed to retain the initial first-stage components. Outcomes recorded included: infection control rate, reoperations, final range of motion (ROM), and quality of life assessment (QoL) including Western Ontario and McMaster Universities osteoarthritis index, Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score, 12-Item Short-Form Health Survey questionnaire, and University of California Los Angeles (UCLA) activity score and satisfaction score. These outcomes were evaluated and compared to additional cohorts of patients with retained first-stage interventions and those with a complete two-stage revision. Mean follow-up was 3.7 years (2.0 to 6.5).Aims
Methods
The number of medial unicompartmental knee replacements (UKR) performed for arthritis has increased and as such, revisions to total knee replacement (TKR) is increasing. Previous studies have investigated survivorship of UKR to TKR revision and functional outcomes compared to TKR to TKR revision, but have failed to detail the surgical considerations involved in these revisions. Our objectives are to investigate the detailed surgical considerations involved in UKR to TKR revisions. This study is a retrospective comparative analysis of a prospectively collected database. From 2005 to 2017, 61 revisions of UKR to TKR were completed at a single center. Our inclusion criteria included: revision of UKR to TKR or TKR to TKR with minimum 1 year follow-up. Our exclusion criteria include: single component and liner revisions and revision for infection. The 61 UKR to TKR revisions were matched 2:1 with respect to age, ASA and BMI to a group of 122 TKR to TKR revisions. The following data was collected: indication for and time to revision, operative skin to skin surgical time, the use of specialized equipment (augment size/location, stem use), intraoperative and postoperative complications, re-operations and outcome scores (WOMAC, Oxford 12, SF 12, satisfaction score).Introduction
Methods
Pseudotumor or high grade ALVAL (aseptic lymphocyte-dominated vasculitis-associated lesion) development around total hip replacements secondary to local metal debris generation – especially in the setting of metal-on-metal bearings – is a well-recognised histopathologic phenomenon. Recent work has suggested a strong genetic correlation with an individual's risk of such lesion development following metal exposure. Emerging data have highlighted a similar potential concern around total knee replacements (TKRs), particularly with increasing construct modularity. To date, the body-of-knowledge pertaining to TKR-associated ALVALs has largely been limited to individual case reports or small retrospective case series’, with no large-scale investigation looking at this potential complication. This study sought to establish the preliminary prevalence of pseudotumor or high grade ALVAL formation seen at the revision of primary TKRs and to establish the correlation between histologic ALVAL grade and patient-reported functional outcomes. Findings of 1263 consecutive patients undergoing revision knee surgery, at a high-volume referral center, were reviewed. 161 cases of active infection were excluded. Complete histopathology reports were subsequently available for 321 (29.1%) non-infective cases. Each case was independently histologically-classified using a previously validated scoring system reflecting ALVAL grade. Post-operative patient-reported outcomes measures (PROMs) were available for 134 patients (41.7%), allowing direct correlation between functional performance and the established histopathology results.Background
Methods
Fractures around total knee arthroplasties pose
a significant surgical challenge. Most can be managed with osteosynthesis
and salvage of the replacement. The techniques of fixation of these
fractures and revision surgery have evolved and so has the assessment
of outcome. This specialty update summarises the current evidence
for the classification, methods of fixation, revision surgery and
outcomes of the management of periprosthetic fractures associated
with total knee arthroplasty. Cite this article:
Antibiotic impregnated articulating spacers are
used in two-stage revision total knee arthroplasty to deliver local antibiotic
therapy while preserving function. We have observed infection control
in greater than 95% of cases with functional outcomes approaching
those seen in revision for aseptic loosening. Higher failure has
been observed with methicillin resistant organisms.
