Clinical Outcomes Following Revision Total Knee Arthroplasty: Minimum 2-Year Follow-up

Jonathan Quinn,Peter Jones,Ray Randle 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.1

Background: The longer-term outcomes of revision total knee arthroplasty are not well described in the current literature. Managing patient expectations of revision total knee arthroplasty can be challenging for orthopedic surgeons due to a paucity of data to guide decision-making. We present outcomes of revision total knee arthroplasty performed by a single surgeon over a 12-year period from 2004 through 2015. Methods: A retrospective review of hospital and private medical records demonstrated 202 revision total knee arthroplasties performed by the senior author in 178 patients from 2004 through 2015. Of these, 153 patients were available for assessment. Patients were contacted and invited to participate in a structured telephone interview to assess Oxford Knee Score (OKS) and patient satisfaction. All patients received the PFC (Depuy) prosthesis at a single institution and were followed up for minimum 2 years postoperatively at the time of review. Retrospective chart review was used to obtain other data for analysis including patient demographics, preoperative and postoperative range of motion (ROM), and intraoperative details. Results: This cohort demonstrated a 93.5% survival rate and an 85% satisfaction rate at a mean of 6.5 years postoperatively. Mean ROM improved from 100° (range, 5°–145°) to 112° (range, 35°–135°) (p < 0.001). The mean OKS was 39.25 (range, 14–48). The factors associated with improved postoperative outcomes included male sex, fewer previous revision total knee arthroplasty procedures, increased preoperative ROM, and receiving a less constrained implant. Conclusions: This study provides a comprehensive description of outcomes following revision total knee arthroplasty in a large patient cohort with a long follow-up. Although revision total knee arthroplasty is a challenging and complex aspect of arthroplasty surgery, high patient satisfaction and good functional outcomes can be achieved for the majority of patients.

Evaluation of Postoperative Range of Motion and Functional Outcomes after Cruciate-Retaining and Posterior-Stabilized High-Flexion Total Knee Arthroplasty

한창욱,한창동,양익환,이우석,박관규 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.4

Purpose: The purpose of this study was to compare postoperative range of motion and functional outcomes among patients who received high-flexion total knee arthroplasty using cruciate-retaining (CR-Flex) and posterior-stabilized (PS-Flex) type prostheses. Materials and Methods: Among 127 patients (186 knees) who underwent high-flexion total knee arthroplasty between 2005 and 2007, 92 knees were placed in the CR-Flex group, and 94 knees were placed in the PS-Flex group. After two years of postoperative follow-up, clinical and radiographic data were reviewed. Postoperative non-weight-bearing range of knee motion, angle of flexion contracture and functional outcomes based on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) functional sub-scale were assessed and compared between the two groups. Results: After the 2-year postoperative period, the mean range of motion was 131° in the CR-Flex group and 133° in the PS-Flex group. There were no significant differences in postoperative range of motion between the two groups. Only age at operation and preoperative range of motion were significantly associated with postoperative range of motion after high-flexion total knee arthroplasty. Postoperative functional outcomes based on the WOMAC functional sub-scale were slightly better in the CR-Flex group (9.2±9.1 points) than in the PS-Flex group (11.9±9.6 points); however, this difference was not statistically significant (p=non-significant). Conclusion: The retention or substitution of the posterior cruciate ligament does not affect postoperative range of motion (ROM) or functional outcomes, according to 2 years of postoperative follow-up of high-flexion total knee arthroplasty. Purpose: The purpose of this study was to compare postoperative range of motion and functional outcomes among patients who received high-flexion total knee arthroplasty using cruciate-retaining (CR-Flex) and posterior-stabilized (PS-Flex) type prostheses. Materials and Methods: Among 127 patients (186 knees) who underwent high-flexion total knee arthroplasty between 2005 and 2007, 92 knees were placed in the CR-Flex group, and 94 knees were placed in the PS-Flex group. After two years of postoperative follow-up, clinical and radiographic data were reviewed. Postoperative non-weight-bearing range of knee motion, angle of flexion contracture and functional outcomes based on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) functional sub-scale were assessed and compared between the two groups. Results: After the 2-year postoperative period, the mean range of motion was 131° in the CR-Flex group and 133° in the PS-Flex group. There were no significant differences in postoperative range of motion between the two groups. Only age at operation and preoperative range of motion were significantly associated with postoperative range of motion after high-flexion total knee arthroplasty. Postoperative functional outcomes based on the WOMAC functional sub-scale were slightly better in the CR-Flex group (9.2±9.1 points) than in the PS-Flex group (11.9±9.6 points); however, this difference was not statistically significant (p=non-significant). Conclusion: The retention or substitution of the posterior cruciate ligament does not affect postoperative range of motion (ROM) or functional outcomes, according to 2 years of postoperative follow-up of high-flexion total knee arthroplasty.

Is simultaneous bilateral unicompartmental knee arthroplasty and total knee arthroplasty better than simultaneous bilateral total knee arthroplasty?

( Naosuke Nagata ),( Takafumi Hiranaka ),( Koji Okamoto ),( Takaaki Fujishiro ),( Toshikazu Tanaka ),( Anjiki Kensuke ),( Daiya Kitazawa ),( Ken Kotoura ) 대한슬관절학회 2023 대한슬관절학회지 Vol.35 No.-

Introduction This retrospective study aims to clarify if there are benefits of performing unicompartmental knee arthroplasty (UKA) on just one indicated side in patients who undergo simultaneous bilateral knee arthroplasty. Materials and methods We compared 33 cases of simultaneous bilateral UKA/total knee arthroplasty (TKA) (S-UT) with 99 cases of simultaneous bilateral TKA (S-TT). Comparison included blood tests [C-reactive protein (CRP), albumin, and D-dimer], the incidence of deep vein thrombosis (DVT), range of motion (ROM), and clinical scores before and 1 year after surgery. Results Clinical scores were not significantly different between the groups. The postoperative flexion angle was significantly better in UKA sides. Blood tests showed that the S-UT had a significantly higher albumin value at 4 and 7 days after surgery. The CRP value at 4 and 7 days, and the D-dimer value at 7 and 14 days after surgery were significantly lower in the S-UT. The S-UT had significantly lower incidence of DVT. Conclusions In cases of bilateral arthroplasty, if there is an indication on only one side, a better flexion angle can be obtained by UKA on that side, and with less surgical invasion. Moreover, the incidence of DVT is low, which is considered to be a benefit of performing UKA on just one side.

Results of Revision Surgery and Causes of Unstable Total Knee Arthroplasty

송인수,선두훈,전재건,장성원,선동혁 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.2

Background: The aim of this study was to evaluate causes of unstable total knee arthroplasty and results of revision surgery. Methods: We retrospectively reviewed 24 knees that underwent a revision arthroplasty for unstable total knee arthroplasty. The average follow-up period was 33.8 months. We classified the instability and analyzed the treatment results according to its cause. Stress radiographs, postoperative component position, and joint level were measured. Clinical outcomes were assessed using the Hospital for Special Surgery (HSS) score and range of motion. Results: Causes of instability included coronal instability with posteromedial polyethylene wear and lateral laxity in 13 knees, coronal instability with posteromedial polyethylene wear in 6 knees and coronal and sagittal instability in 3 knees including post breakage in 1 knee, global instability in 1 knee and flexion instability in 1 knee. Mean preoperative/postoperative varus and valgus angles were 5.8°/3.2° (p = 0.713) and 22.5°/5.6° (p = 0.032). Mean postoperative α, β, γ, δ angle were 5.34°, 89.65°, 2.74°, 6.77°. Mean changes of joint levels were from 14.1 mm to 13.6 mm from fibular head (p = 0.82). The mean HSS score improved from 53.4 to 89.2 (p = 0.04). The average range of motion was changed from 123° to 122° (p = 0.82). Conclusions: Revision total knee arthroplasty with or without a more constrained prosthesis will be a definite solution for an unstable total knee arthroplasty. The solution according to cause is very important and seems to be helpful to avoid unnecessary over-constrained implant selection in revision surgery for total knee instability.

Diabetes mellitus does not increase the risk of knee stiffness after total knee arthroplasty: a meta-analysis of 7 studies including 246 053 cases

( Christopher Jump ),( Rayaz A. Malik ),( Anoop Anand ),( Charalambos P. Charalambous ) 대한슬관절학회 2019 대한슬관절학회지 Vol.31 No.1

Purpose: The association of diabetes mellitus with knee stiffness after total knee arthroplasty is still being debated. The aim of this study was to assess through meta-analysis the impact of diabetes mellitus on the prevalence of postoperative knee stiffness after total knee arthroplasty. Methods: We conducted a literature search for terms regarding postoperative knee stiffness and diabetes mellitus on Embase, CINAHL, and PubMed NCBI. Results: Of 1142 articles, seven were suitable for analysis. Meta-analysis showed that diabetes mellitus does not confer an increased risk of primary or revision total knee arthroplasty-induced postoperative knee stiffness when compared to nondiabetic patients (primary total knee arthroplasty, estimated odds ratio [OR] 1.474 and 95% confidence interval [CI] 0.97-2.23; primary and revision total knee arthroplasty, OR 1.340 and 95% CI 0.97-1.83). Conclusion: There is no strong evidence that diabetes mellitus increases the risk of knee stiffness after total knee arthroplasty. The decision to proceed with total knee arthroplasty, discussion as part of the consent process, and subsequent rehabilitation should not differ between patients with and without diabetes mellitus with regards to risk of stiffness. Level of evidence: Level III (meta-analysis)

Intra-operative fractures in primary total knee arthroplasty - a systematic review

Purudappa Prabhudev Prasad,Ramanan Sruthi Priyavadhana,Tripathy Sujit Kumar,Varatharaj Sushrruti,Mounasamy Varatharaj,Sambandam Senthil Nathan 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

Background: One of the rare complications of primary total knee arthroplasty is intra-operative fracture. Intraoperative fracture during revision knee arthroplasty has been well-documented but there is limited literature on fractures occurring during primary knee arthroplasty. We conducted a systematic review of the literature to compare and contrast the various studies to clearly define the predisposing factors, incidence, and characteristics of the fracture itself and to arrive at a consensus on the management and prevention of intra-operative fractures during primary knee arthroplasty. Methods: The PubMed/Medline, Cochrane, Scopus and Embase databases were searched using keywords “intraoperative fracture”, “distal femoral fracture”, “tibial fracture”, “patella fracture” and “primary total knee arthroplasty”. A total of 158 articles were retrieved and after further filtration and exclusion processing, 10 articles that evaluated intra-operative fractures in primary total knee arthroplasty were included for the review. Results: The reported incidence of intra-operative fractures varied from 0.2% to 4.4%. A higher incidence in female patients with a male to female ratio of 0.4 was reported. Posterior stabilized (PS) total knee arthroplasty was associated with higher risk of intra-operative femoral fractures by many authors in this review. Timing of occurrence and location of the intra-operative fractures can vary widely, with femoral fractures occurring more commonly during bone preparation, trialing and impaction of the final implant and tibial fractures occurring during preparation for the tibial keel and impaction of the tibial component. Conclusions: Intra-operative fractures during primary total knee arthroplasty are rare with higher risk associated with osteoporosis, rheumatoid arthritis, advanced age, female gender, chronic steroid use, metabolic bone disorders, PS type of femoral implant and difficult surgical exposure of the knee joint due to severe deformities. A plethora of management options have been utilized according to surgeon preference. Standard principles of fracture fixation and arthroplasty principles should be followed to achieve stable internal fixation and any unstable fracture site should be bypassed with the utilization of stemmed components. Satisfactory radiographic and functional outcome can be expected with appropriate treatment.

슬관절 전치환술 후 발생한 피부 괴사부의 재건

안희창,임영수,김창연,황연중,Ahn, Hee Chang,Lim, Young Soo,Kim, Chang Yeon,Hwang, Weon Joong 대한성형외과학회 2005 Archives of Plastic Surgery Vol.32 No.1

In spite of proper maneuver of total knee replacement arthroplasty, some patients suffer from skin necrosis just above the implant. From Mar. 2000 to Jan. 2004, the authors performed reconstruction of knee skin defects after total knee replacement athroplasty. Total 6 cases of flap surgery were performed and patients ranged between 43-years-old to 82-years-old. Rectus femoris perforator based reversed adipofascial flaps were used in 2 cases, medial gastrocnemius muscular island flaps were used in 2 cases and sural artery based on adipofascial rotation flap was used in 1 case. One patient with extended necrosis underwent reconstruction with dual flaps of sural artery based adipofascial rotation flap and medial gastrocnemius muscular island flap. There were no distinctive complication needing additional procedure in all cases during the long term follow up. Reconstruction of necrosis following total knee replacement arthroplasty had several characteristics different from simple knee defect. The patients might have the history of long term steroid usages, excessive skin tension due to implants, underlying disease such as diabetes, rheumatoid disease, and etc. In addition, the early ambulation is mandatory in these patients of total knee replacement arthroplasty. With regards to these special considerations, a single stage and reliable operation must be needed. The authors introduce various reconstruction methods and algorithm that may aid easy decision making.

동일인에의 내반변형슬과 동반된 외반변형슬에 대한 슬관절 전치환술

송인수 ( In Soo Song ),전재균 ( Je Gyun Chon ),김준범 ( Jun Beom Kim ) 대한슬관절학회 2008 대한슬관절학회지 Vol.20 No.2

Purpose: We have performed total knee arthroplasty for treating valgus and varus in the knees of one person. We investigated the clinical characteristics of these patients and the relationship between the kind of deformity and the postoperative result. Materials and Methods: From March 2002 to May 2005, fourteen patients who had simultaneous varus and valgus knee deformities underwent total knee arthroplasties and they were followed for more than 12 months, and these were the subjects of our study. The average age was 64.6.years and the average follow-up period was 18.4 months. Follow-up imaging assessments were done and the clinical outcomes were evaluated using the HSS score at the last follow-up. Results: Nine cases had more pain in the varus knee preoperatively and two cases had more pain in the valgus knee preoperatively. In 8 cases, degenerative scoliosises were associated with the knee deformity and among these cases, seven cases had vlagus deformities in the right knees. In two cases, hip deformities were noted in the ipsilateral side of the valgus deformity. The preoperative mean valgus angle and varus angle was 10.5 degrees and 7.8 degrees, respectively. The postoperative valgus and varus angle improved to 6.8 and 6.0 degree, respectively. The HSS score improved from 64.7 to 86.0 points for the valgus deformities and from 61.5 to 86.9 points for the varus deformities. Postoperative patellar clunk syndrome was identified in one valgus knee and arthroscopic resection was then performed. The knee had completely recovered on the last follow-up. Conclusion: Simultaneous or staged total knee arthroplasties in patients with simultaneous varus and contralateral valgus knee deformities achieved satisfactory outcomes with regard to the objective orthopedic criteria as well as the overall patient satisfaction in terms of pain relief and function. We found that scoliosis and ipsilateral hip deformities concurred with knee deformities, and this indicated that hip deformity and scoliosis are related with knee deformities. We found no significant difference between the kind of deformity and the postoperative result, yet a prospective study with more cases and longer follow-up is recommended in the future to reaffirm our findings.

슬관절 전치환술(Total Knee Arthroplasty)후 슬개골 접선방향촬영에 대한 고찰: Modify Merchant View와 Modify Weight-bearing Axial View 비교

강성일(Seong-Il Kang),윤영민(Yeong-Min Yun),김병기(Byeong-Ki Kim),임우택(Woo-Taek Lim),이민우(Min-Woo Lee),김순배(Soon-Bae Kim) 대한영상의학기술학회 2013 대한영상의학기술학회 논문지 Vol.2013 No.-

목 적 : 슬관절 전치환술(total knee arthroplasty, 이하 TKA) 환자에서 슬개골 접선방향 촬영법을 변화(modify)시켜 수술 환자의 상태에 맞는 가장 효율적인 검사방법을 찾고, 유동적인 merchant 보조기구의 유용성을 평가 하고자 하였다. 대상 및 방법 : 2012년 10월부터 12월까지 슬관절 전치환술(TKA)을 받은 환자 중 merchant view로 추적 검사(F/U)를 시행한 환자 20명(남:5, 여:15, 평균70.4세)을 대상으로 하였다. 슬개골 접선방향 촬영법으로 merchant 검사를 시행하였고, 유동적인 merchant 촬영 보조기구를 이용하여 슬관절을 30°,45°,75°로 굴곡(flexion)하여 각각 검사를 진행하였다. 그리고 환자를 세운뒤 무릎을 45° 구부리고 modified weight-bearing axial view검사를 시행하였다. 이렇게 획득된 영상은 일치각(congruence angle)과 구각(sulcus angle)의 값을 구하여 정량적으로 평가하였다. 통계프로그램은 SPSS ver20.을 사용하였다. 그리고 정성적 평가는 슬개골의 외측 및 내측 가장 자리의 겹침 여부, 대퇴활차구와 경골 조면의 겹침 여부, 슬개골 융기 첨부의 겹침 여부를 방사선사 5명이 아주 나쁨(1점), 나쁨(2점), 보통(3점), 좋음(4점), 아주 좋음(5점)으로 5점 척도로 평가 분석 하였다. 결 과 : 정성적 분석은 modified weight-bearing axial view가 평균 3.9로 가장 좋은 결과를 보였으며 merchant 30°, merchant 45°, merchant 75° 순위였고, 정량적 분석에서 구각(sulcus angle)은 modified weight-bearing axial view에서 146.36±3.0으로 merchant 30°, merchant 45°은 각각 147.87±2.5, 145.88±2.8으로 나타났으며(p>0.05), merchant 75°에서는 143.18±2.8으로 차이를 보였다(p<0.05). 일치각(congruence angle)은 modified weight-bearing axial view에서 21.33±8.1으로 merchant 30°, merchant 45°, merchant 75°에서 각각 21.26±13.64, 17.81±10.77, 17.12±11.15으로 나타났다(p>0.05). 결 론 : modified weight-bearing axial view 검사에서 우수한 영상을 얻었으나 수술 후 거동이 불편한 환자에게 많은 부담을 안겨 주며, 업무효율성의 저하 또한 우려된다. 하지만 merchant 보조기구를 이용하여 다양하게 무릎을 굴곡 시켜 검사한다면 환자의 상태에 따라 가장 좋은 영상을 얻을 수 있어 simple x-ray 영상에서도 슬관절 전치환술(TKA) 환자의 슬대퇴 관절의 평가에 도움을 줄 수 있을 것이라 사료된다. Purpose : Radiography by varying the tangential patella in total knee arthroplasty(TKA) surgery patients, looking for the most efficient exam method according to the status of surgical patients, and to evaluate the usefulness of merchant device. Materials and methods : During 2 months from October to December 2012, total 20 patients(5 males and 15 female, average age 70.4 years) who underwent total knee arthroplasty(TKA). we performed tangential knee tests with the change of the knee angle ;30°,45°,75° using a Merchant device. we performed modified weight-bearing axial view tests to patients on erect position at 45 degree flexion of knee. The quantitative evaluation of the sulcus angle and the congruence angle each. Qualitative analysis was evaluated visually using a five point rating scale by the five radiologic technologists Result : Results show modified weight-bearing axial view is the best on average3.9, merchant30 °, merchant45 °,is the degree merchant 75°, qualitative analysis, Sulcus angle from the quantitative analysis of modified weight-bearing axial view and 146.36±3.0, merchant 30 ° 147.87±2.5 merchant 45° 145.88±2.8(p>0.05), and merchant 75° differed 143.18± 2.8(p<0.05). congruence angle, the modified weight-bearing axial view from 21.33±8.1, merchant 30°, merchant 45°, merchant 75° from each was 21.26±13.64, 17.81±10.77, 17.12±11.15 as(p> 0.05). Conclusion : When by flexion the knee examined using various merchant device, can get the best image according to the state of the patient. Is considered to be able to help through the evaluation of femoral joint through a patient s total knee arthroplasty in image of simple x-ray.

Does contralateral knee range of motion predict postoperative knee range of motion after total knee arthroplasty?

Burnham Robert R.,Bialek Samantha E.,Wozniak Amy,Brown Nicholas M. 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

Purpose: The aim of this study was to determine if contralateral knee range of motion is associated with postoperative range of motion in the operative knee after total knee arthroplasty. Methods: Contralateral (nonoperative) knee range of motion was compared to postoperative knee range of motion after total knee arthroplasty using linear regression models in 59 patients who had undergone primary total knee arthroplasty with a minimum of 4 months postoperative follow-up data (range 4–13 months). Results: A strong linear relationship was observed between contralateral knee ranges of motion of 115° or greater and postoperative knee ranges of motion after total knee arthroplasty (slope 0.93, 95% CI 0.58–1.29, P < 0.0001), with a mean difference of −7.44° (95% CI −10.3 to −4.63, P < 0.0001). However, there was no association between contralateral knee range of motion and postoperative knee range of motion when contralateral knee range of motion was less than 115°. Conclusion: Contralateral knee range of motion of 115° or greater correlates linearly with postoperative range of motion after total knee arthroplasty, and thus may be predictive in such cases.