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

목적: 동일인에서 동반된 내반 및 외반 변형에 대해 인공관절 치환술을 시행하였고 이러한 변형을 가진 환자의 임상적 특징을 조사하고 술전 변형양상에 따라서 임상결과에 차이가 있는가를 규명하고자 하였다. 대상 및 방법: 2002년 3월부터 2005년 5월까지 한쪽 슬관절 내반변형과 반대편 슬관절 외반변형에 대해 인공 슬관절 전치환술을 시행한 환자 중 1년 이상 추시가 가능하였던 14명을 대상으로 하였다. 평균연령은 64.6세였고 평균 추시기간은 18.4개월이었다. 최종추시상의 방사선결과를 측정하였고 HSS 수치로 임상적 결과를 분석하였다. 결과: 술전 9명에서는 내반슬에, 2명에서는 외반슬에 통증이 심하였으며 8명에서 척추 측만증이 관찰되었고, 이 중 7명에서 외반슬 부위와 연관되었다. 2명에서 외반슬과 동측부위의 고관절 변형이 관찰되었다. 평균연령은 64.6세였고, 평균 추시기간은 18.4개월이었다. 술전 평균 외반변형각도는 10.5도였고 내반변형각도는 7.8도였다. 술후 평균 외반 및 내반각도가 각각 6.8도와 6.0도로 교정되었고, 술전 외반슬의 HSS 점수는 평균 술전 64.7점에서, 추시상 86.0점으로 향상되었으며, 내반슬은 술전 61.5점에서 추시상 86.9점으로 향상되었다. 수술 후 1예의 외반변형슬쪽에 patellar clunk 증상이 있어 관절경적 절제술 시행 후 완전 회복되었다. 결론: 동일인에서의 내반슬과 동반된 외반슬에 대한 인공관절 전치환술은 환자의 통증 감소, 기능향상 및 방사선적 결과에서 만족스러운 결과를 보였다. 변형의 원인으로 추정되는 척추 측만증과 동측의 고관절 변형이 관찰되었고 술전 변형양상과 동반변형으로 인한 임상적 결과는 차이를 보이지 않았다. 향후 더 많은 증례와 장기간의 추시가 필요할 것이다. 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 시 선택적 슬개골 치환술의 결과 비교

정영복(Young-Bok Jung),박세진(Se-Jin Park),정호중(Ho-Joong Jung),장기웅(Ki-Woong Chang) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.1

목적: 슬관절 전치환술에서 슬개골 보존군과 치환군 사이의 임상적 그리고 방사선학적 결과를 비교분석하려 한다. 대상 및 방법: 1993년 7월부터 1999년 12월까지 본원에서 슬관절 전치환술을 시행 받은 환자 중 최소 7년 이상 추시 관찰이 가능하였던 총 54명 73예에 대해 슬개골 보존군과 치환군의 결과를 비교하였다. 슬개골의 두께가 22 ㎜보다 얇은 경우, 슬개골의 관절연골이 정상에 가까운 경우, 수술 전 대퇴슬개 동통이 거의 없었거나 슬개골 골질이 불량한 경우, 60세 이하인 환자의 경우를 슬개골 보존의 적응증으로 삼았다. 슬개골을 보존할 경우에는 슬개골 골극 절제술 및 변연부 소작술을 시행하였고 슬개골의 아탈구나 기울임이 있을 경우는 이를 교정하였다. 슬관절 보존군은 32명 41예였으며 치환군은 22명 32예였다. 평균 추시 기간은 보존군이 106.7개월, 치환군이 93.6개월이었다. 슬관절 점수와 기능 점수(American knee society의 knee rating system) 및 HSS 점수(Hospital for Special Surgery의 knee arthroplasty rating system)와 대퇴슬개 점수, 무릎관절 운동 범위, 그리고 국제 슬관절 학회의 방사선 분류법(knee society's radiographical evaluation system)을 이용하여 술 후 마지막 추시 관찰 시의 방사선 사진을 평가하였고, 대퇴슬개 관절의 적합성을 확인하기 위해 Keblish 방법을 이용하여 확인하였다. 결과: 슬개골 보존군에서 마지막 추시의 슬관절 점수 및 기능 점수는 90.4/75.5, 슬개골 치환군에서는 86.1/70.0이였으며(p=0.29, p=0.27), HSS 점수는 각각 85.2과 84.8로 평균값은 보존군에서 약간 좋은 결과를 보였으나 Bristol의 슬개골 점수와 Lonner의 대퇴-슬개 점수는 보존군에서 8.7과 82.0, 치환군에서 8.8와 85.6으로 치환군에서 더 좋은 결과를 보였다. 그러나 이러한 점수들은 통계적으로 의미가 없었으며 무릎 관절 운동 범위와 방사선 평가상에서도 유의한 차이를 보이지 않았다. 마지막 추시의 대퇴슬개간 적합성은 전체 평균이 95.0%이었고, 보존군에서는 평균 95.8%이며 이중 100% 완전 적합성을 갖는 환자가 80%이었으며, 치환군에서 대퇴슬개간 적합성은 평균 94.4%이며 이중 100% 대퇴슬개간 적합성을 갖는 환자가 81%이었다. 결론: 본문에서 제시한 슬개골 보존 적응증에 의거해 슬관절 전치환술을 시행한 경우 슬개골 보존군과 치환군에서 술 후 최소 7년 후에 평가한 임상적 및 방사선학적 결과는 통계적으로 유의한 차이 없이 양호하였으며 적절한 슬개골 보존 적응증을 기준으로 선택적 슬개골 치환술을 시행한다면 술 후 결과는 양쪽 모두 만족스러울 것으로 생각된다. Purpose: To evaluate and report the clinical and radiological results of patients that had undergone patellar retention and resurfacing during total knee arthroplasty. Materials and Methods: From July 1993 to December 1999, 54 patients (73 cases) underwent total knee arthroplasty by one surgeon. We divided these patients into the patellar retention group and patellar resurfacing group, and compared the clinical and radiological results of the two groups. The indications of patellar retention were a small patella, nearly normal articular cartilage, minimal preoperative patellofemoral pain, poor patellar bone quality, and young patient age. In these cases, osteophytes of the patella were removed and marginal electrocauterization was performed. There were 32 patients (41 cases) in the patellar retention group and 22 patients (32 cases) in the patellar resurfacing group. The mean follow-up period was 106.7 months in the patellar retention group and 93.6 months in the patellar resurfacing group. We evaluated the patients using the knee rating system of the American Knee Society (knee score and functional score), knee arthroplasty rating system of the Hospital for Special Surgery (HSS score), patellofemoral score, range of motion of the knee joint, and performed a radiological evaluation by use of the radiographical evaluation system of the Knee Society at the last follow-up period. Also, to evaluate patellofemoral congruence, we used Keblish's method. Results: At the last follow-up, the mean knee score and functional score were 90.4 and 75.5 for the patellar retention group, and 86.1 and 70.0 for the patellar resurfacing group, respectively (p=0.29, p=0.27). The HSS score was 85.2 for the patellar retention group and 84.8 for the patellar resurfacing group (p=0.30). The Bristol patellar score and Lonner Patellofemoral score were 8.7 and 82.0 for the patellar retention group and 8.8 and 85.6 for the patellar resurfacing group, repectively (p=0.86, p=0.86). The mean value of the patellofemoral score was slightly higher in the patellar resurfacing group, but statistically there was no difference between the two groups. There were also no statistically differences in the others parameters. Conclusion: We obtained favorable results by selective patellar resurfacing total knee arthroplasty, although there were no significant differences for both the patellar retention and resurfacing group. We believe that it may be better to select a proper indication than to just follow the preference of the surgeon for patellar resurfacing.

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.