Periprosthetic joint infection (PJI) is a challenging complication of any arthroplasty procedure. We reviewed our use of static antibiotic-loaded cement spacers (ABLCSs) for staged management of PJI where segmental bone loss, ligamentous instability, or soft-tissue defects necessitate a static construct. We reviewed factors contributing to their failure and techniques to avoid these complications when using ABLCSs in this context. A retrospective analysis was conducted of 94 patients undergoing first-stage revision of an infected knee prosthesis between September 2007 and January 2020 at a single institution. Radiographs and clinical records were used to assess and classify the incidence and causes of static spacer failure. Of the 94 cases, there were 19 primary total knee arthroplasties (TKAs), ten revision TKAs (varus-valgus constraint), 20 hinged TKAs, one arthrodesis (nail), one failed spacer (performed elsewhere), 21 distal femoral endoprosthetic arthroplasties, and 22 proximal tibial arthroplasties.Aims
Methods
Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality. Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality.Aims
Methods
Knee arthrodesis is a potential salvage procedure
for limb preservation after failure of total knee arthroplasty (TKA) due
to infection. In this study, we evaluated the outcome of single-stage
knee arthrodesis using an intramedullary cemented coupled nail without
bone-on-bone fusion after failed and infected TKA with extensor
mechanism deficiency. Between 2002 and 2012, 27 patients (ten female,
17 male; mean age 68.8 years; 52 to 87) were treated with septic
single-stage exchange. Mean follow-up duration was 67.1months (24
to 143, n = 27) (minimum follow-up 24 months) and for patients with
a minimum follow-up of five years 104.9 (65 to 143,; n = 13). A
subjective patient evaluation (Short Form (SF)-36) was obtained,
in addition to the Visual Analogue Scale (VAS). The mean VAS score was
1.44 (SD 1.48). At final follow-up, four patients had recurrent
infections after arthrodesis (14.8%). Of these, three patients were
treated with a one-stage arthrodesis nail exchange; one of the three
patients had an aseptic loosening with a third single-stage exchange,
and one patient underwent knee amputation for uncontrolled sepsis at
108 months. All patients, including the amputee, indicated that
they would choose arthrodesis again. Data indicate that a single-stage
knee arthrodesis offers an acceptable salvage procedure after failed
and infected TKA. Cite this article:
The aim of this study was to analyse the gait
pattern, muscle force and functional outcome of patients who had undergone
replacement of the proximal tibia for tumour and alloplastic reconstruction
of the extensor mechanism using the patellar-loop technique. Between February 1998 and December 2009, we carried out wide
local excision of a primary sarcoma of the proximal tibia, proximal
tibial replacement and reconstruction of the extensor mechanism
using the patellar-loop technique in 18 patients. Of these, nine
were available for evaluation after a mean of 11.6 years (0.5 to
21.6). The strength of the knee extensors was measured using an
Isobex machine and gait analysis was undertaken in our gait assessment
laboratory. Functional outcome was assessed using the American Knee
Society (AKS) and Musculoskeletal Tumor Society (MSTS) scores. The gait pattern of the patients differed in ground contact time,
flexion heel strike, maximal flexion loading response and total
sagittal plane excursion. The mean maximum active flexion was 91°
(30° to 110°). The overall mean extensor lag was 1° (0° to 5°).
The mean extensor muscle strength was 25.8% (8.3% to 90.3%) of that
in the non-operated leg (p <
0.001). The mean functional scores
were 68.7% (43.4% to 83.3%) (MSTS) and 71.1 (30 to 90) (AKS functional
score). In summary, the results show that reconstruction of the extensor
mechanism using this technique gives good biomechanical and functional
results. The patients’ gait pattern is close to normal, except for
a somewhat stiff knee gait pattern. The strength of the extensor
mechanism is reduced, but sufficient for walking. Cite this article:
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:
