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1
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Two-stage Reimplantation in Infected Total Knee Arthroplasty by Using Resterilized Femoral and Tibial Components with a New Polyethylene Insert: Report of 4 Cases with at Least 15 Years’ Follow-up

100%
Öztürk A., Çevik N., Akalın Y., Çetin O., Avci Ö., Kaya A. Ö.
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vol. 23(6)
411-416
EN
Background. This study evaluates 15 years’ results of the implantation of autoclaved femoral and tibial prosthesis components together with a new same brand polyethylene insert which were used as a temporary articulating spacer in patients with periprosthetic infection of total knee arthroplasty (TKA) in a two-stage reimplantation procedure in 6 patients.  Material and methods. The femoral and tibial prostheses of 6 patients with deep chronic periprosthetic infection of TKA who underwent elective two-stage exchange arthroplasty were autoclaved and reinserted with a new polyethylene insert of the same brand and bone cement mixed with tecoplanin in 2004. Results. Four patients were followed for 15 years. They were all female and between 47-70 years old. The infectious agent was meticillin-resistant Staphylococcus aureus (MRSA) in 3 and coagulase negative Staphylococcus in one patient. Patients were invited for second stage reimplantation, but they refused to undergo the second stage. Three of them had their second stage reimplantation after 15, 13 and 10 years while one patient was reinfected after 5 years, in 2009, and arthrodesis was performed. They were all happy with the result and infection free at last follow-up.  Conclusions. 1. Regarding the results of our patients, reinsertion of autoclaved femoral and tibial prostheses together with a new same brand polyethylene insert with teicoplanin loaded bone cement can be used cautiously in the management of periprosthetic deep infection of TKA. 2. That is because patients might not want the second stage reimplantation. 3. We believe that the refusal of patients to undergo the surgery shows that the single-stage treatment is effective.
2
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An Assessment of Factors That Influence Outcome Following Fixation of Periprosthetic Distal Femur Fractures Associated with Total Knee Arthroplasty

100%
Fakoya K., Sedarous R., Seifo M., Okoro T.
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vol. 24(3)
193-199
EN
Background. Periprosthetic distal femur fractures following total knee arthroplasty (PDFFTKA) are increasingly common [1], mainly in elderly patients with significant co-morbidities [2]. Surgical management usually requires balancing prompt fixation for early mobilization with the need to consider the least physiologically demanding option [3].The aim of this study was to assess predictors of clinical and radiological outcome in patients with PDFFTKA treated with open reduction and internal fixation (ORIF). Materials and methods. A retrospective cohort study of patients managed for PDFFTKA over the last 21 years in the Trauma & Orthopaedics Department of the Royal Shrewsbury Hospital (RSH) was carried out. Radiological images, pre- and post-operatively, were assessed for fracture related parameters. Last known functional status was evaluated using the most recent outpatient review letters. After assessment of normality of data, evaluation of predictors of clinical and radiological outcome was made using correlation analyses. Results. There was no statistically significant correlation between age, primary TKA to fracture interval, and length of intact medial cortex vs clinical outcome for the parametric variables evaluated. For non-parametric variables assessed, there was a statistically significant correlation between clinical outcome and evidence of callus formation (Spearman rho value -0.476; p=0.022). In stratifying the patients with ‘poor’ and ‘good’ outcome, there was no difference noted in primary TKA to fracture interval, or length of intact medial cortex (mm) between both groups. In terms of the number of comminuted fragments and anterior flange to fracture distance (mm), there was also no difference noted between the ‘poor’ and ‘good’ functional groups. Conclusions. 1. There was no observed correlation in pre-operative patient and fracture related variables with outcome in this population of patients with PDFFTKA. 2. Post-operative evidence of callus formation appears to be directly related to better clinical outcomes.
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Method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing

88%
Yulou S., Yanqin X., Yongjun X.
Open Medicine
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2014
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vol. 10
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issue 1
EN
To discuss the method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing. Clinical data of 80 patients from October 2013 to December 2014 was selected with a retrospective method. All patients have undergone total knee arthroplasty. Then the X-rays plain film in weight loading was measured before and after operation and osteotomy was performed accurately according to the knee joint scores and the conditions of lower limb alignments. The average angle of tibial plateau osteotomy of postoperative patients was 4.3°, and the corrective angle of soft tissue balancing was 10.7°; the postoperative patients’ indicies including range of joint motion, knee joint HSS score, angle between articular surfaces, tibial angle, femoral-tibial angle and flexion contracture were distinctly better than the preoperative indicies (p<0.05) and the differences were statistically significant; the postoperative patients’ flexion contracture and range of joint motion were distinctly better than the preoperative indicies (p<0.05) and the differences were statistically significant. The effective release of the soft tissue of the posterior joint capsule under direct vision can avoid excess osteotomy and get satisfactory knee replacement space without influencing the patients’ joint recovery.
4
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Anatomical knee endoprostheses – does a better-fit lead to better outcomes? A review article

75%
Maciąg B. M., Budzińska M., Żarnovsky K., Adamska O., Stolarczyk A.
Chirurgia Narządów Ruchu i Ortopedia Polska
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2023
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vol. 88
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issue 1
13-16
PL
Wstęp. Endoprotezoplastyka całkowita stawu kolanowego jest uznawana za najskuteczniejszą metodę leczenia zaawansowanej choroby zwyrodnieniowej stawu kolanowego. Celem operacji jest zmniejszenie bólu kolan, przywrócenie zakresu ruchu i poprawa jakości życia pacjentów. Projekt protez jest wciąż modyfikowany i udoskonalany dzięki współpracy ortopedów i inżynierów. Jednymi z najnowocześniejszych rozwiązań mających na celu maksymalne dopasowanie do anatomii pacjentów są anatomiczne systemy kolanowe. Materiał i metody. Dokonano przeglądu literatury i przeanalizowano artykuły związane z tą tematyką. W bazach PubMed, Cochrane i Google Scholar przeszukano publikacje zawierające słowa kluczowe takie jak całkowita endoprotezoplastyka stawu kolanowego, implanty anatomiczne, implanty morfometryczne. Wszystkie dane zostały dobrane i zweryfikowane indywidualnie. Analizę i syntezę badań przygotowano osobno. Wyniki. Wiele artykułów opisuje przewagę protez anatomicznych nad modelami protez standardowych. Protezy anatomiczne posiadają szerszy wachlarz dostępnych rozmiarów przez co oferują lepsze pokrycie dalszego końca kości udowej oraz bliższego piszczelowej, pozwalają na resekcję mniejszej ilości tkanki kostnej co jest korzystne w przypadku możliwej w przyszłości konieczności rewizji endoprotezy, umożliwiają lepsze dobranie rotacji elementu piszczelowego przez lepsze dopasowanie do plateau piszczeli co wpływa na alignment i tor ruchu rzepki, a także budowa bruzdy dla rzepki wpływa korzystnie na tor ruchu rzepki i zmniejsza ryzyko rozwoju dysplazji. Wnioski. Implanty anatomiczne umożliwiają lepsze dopasowanie elementów protezy do natywnej struktury kości. Dzięki zastosowaniu tych modeli możliwe jest uzyskanie większego zakresu ruchu w stawie, a w rezultacie lepszych wyników funkcjonalnych. Implanty anatomiczne pozwalają także na mniejszą resekcję tkanki kostnej.
EN
Introduction. Total knee replacement is the most efficient method of treating end-stage osteoarthritis of the knee joint. The surgery aims to relieve patients of pain, restore range of motion and improve patients’ quality lives. Prostheses design is still being modified and improved through cooperation between orthopaedic surgeons and engineers. Some of the most modern solutions aimed to fit native patients’ anatomy as much as possible are anatomic knee systems. Materials and methods. The literature was reviewed, and articles related to the subject were researched. Therefore, publications including keywords such as total knee replacement, anatomic implants and morphometric implants were searched in the PubMed, Cochrane and Google Scholar databases. All data was selected and verified individually. Analysis and synthesis of studies were prepared separately. Results. Many studies describe the advantages of anatomic prostheses over standard prostheses. Anatomical prostheses have a broader range of available sizes, thus providing better coverage of the distal end of the femur and the proximal tibia, allowing for the resection of less bone tissue, which is beneficial in the event of a possible need for a future revision of the endoprosthesis, enabling better selection of the tibial element rotation by better matching to the tibial plateau, which affects the alignment and patellar movement, and the structure of the trochlear geometry that also affects the patellar movement and reduces the risk of trochlear dysplasia. Conclusions. Anatomical implants enable better alignment of the prosthesis elements and the native femoral and tibial bone. Using these models makes it possible to obtain a greater range of motion and, consequently, improved functional outcomes compared to non-anatomical ones. It also enables less bone resection and better radiological outcomes.
5
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Pain management in total knee arthroplasty. A comprehensive review

51%
Domagalska M., Reysner T.
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vol. 87
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issue 4
173-180
PL
Całkowita alloplastyka stawu kolanowego (TKA) jest jedną z najczęściej wykonywanych operacji w celu złagodzenia bólu stawów kolanowych u pacjentów ze schyłkową chorobą zwyrodnieniową lub reumatycznym zapaleniem stawu kolanowego. Ból pooperacyjny występujący po alloplastyce stawu kolanowego ma nasilenie od umiarkowanego do ciężkiego, co wpływa na rehabilitację pooperacyjną, zadowolenie pacjenta i ogólne wyniki leczenia. W przeszłości opioidy były szeroko stosowane w leczeniu bólu okołooperacyjnego po TKA. Jednak stosowanie opioidów wiąże się z różnymi działaniami niepożądanymi, takimi jak nudności, depresja oddechowa czy zatrzymanie moczu, co ogranicza ich zastosowanie w codziennej praktyce klinicznej. Celem tej pracy było omówienie aktualnych schematów leczenia bólu pooperacyjnego po TKA. Nasz przegląd piśmiennictwa wykazał, że analgezja multimodalna jest uważana za optymalny sposób leczenia bólu okołooperacyjnego po TKA. Ta metoda leczenia dzięki połączeniu kilku rodzajów leków o różnych mechanizmach działania, a także stosowaniu analgezji z wyprzedzeniem, a zwłaszcza analgezji regionalnej, ze szczególnym uwzględnieniem blokad nerwów obwodowych, zapewnia doskonałą ulgę w bólu, sprzyja regeneracji stawu kolanowego oraz zmniejsza zużycie opioidów i związane z nimi działania niepożądane u pacjentów poddawanych TKA.
EN
Total knee arthroplasty (TKA) is one of the most common surgeries performed to relieve joint pain in patients with end-stage osteoarthritis or rheumatic arthritis of the knee. However, TKA is followed by moderate to severe postoperative pain that affects postoperative rehabilitation, patient satisfaction, and overall outcomes. Historically, opioids have been widely used for the perioperative pain management of TKA. However, opioids are associated with undesirable adverse effects, such as nausea, respiratory depression, and urine retention, which limit their application in daily clinical practice. This review aimed to discuss the current postoperative pain management regimens for TKA. Our review of literature demonstrated that multimodal analgesia is considered the optimal regimen for perioperative pain management of TKA and improves clinical outcomes and patient satisfaction, through a combination of several types of medications, including preemptive analgesia, especially local infiltration analgesia and peripheral nerve blockade. Multimodal analgesia provides superior pain relief, promotes knee recovery, and reduces opioid consumption and related adverse effects in patients undergoing TKA.
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