Causes and Clinical Outcomes of Revision Total Knee Arthroplasty

PURPOSE: The purpose of this study was to evaluate causes and clinical outcomes of revision total knee arthroplasty (TKA) with a minimum 2-year follow-up. MATERIALS AND METHODS: We performed a retrospective review on the records of 225 revision TKAs performed from 2003 to 2012 at a single institution. Finally, 206 cases were conducted. To evaluate clinical outcomes, we checked the range of motion (ROM), Knee Society (KS) score, Hospital for Special Surgery (HSS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score preoperatively, 6 months postoperatively and yearly thereafter and complications after revision TKA. RESULTS: The causes of revision TKA were septic complications in 120 and aseptic complications in 86. The main aseptic complication was periprosthetic fracture in 36, followed by 25 loosening, 13 polyethylene wear and 9 instability. At the final follow-up, patients showed improvements in ROM and KS, HSS and WOMAC scores. Of the total, 7 patients underwent re-revision due to reinfection in 6 and periprosthetic fracture in 1. CONCLUSIONS: Due to development of implants and surgical techniques, mechanical complications such as aseptic loosening and instability that need a revision decreased whereas septic complications relatively increased. Therefore, we should be cautious for the occurrence of infection. Overall, revision TKA provided clinical improvement in knee function and patient satisfaction.

Causes of Aseptic Persistent Pain after Total Knee Arthroplasty

BACKGROUND: Persistent pain after total knee arthroplasty (TKA) is dissatisfying to the patient and frustrating to the surgeon. The purpose of this study is to evaluate the aseptic causes and clinical course of intractable pain following TKA. METHODS: Of the total 2,534 cases of primary TKA reviewed, 178 cases were classified as having aseptic persistent pain that was not resolved within 1 year after surgery. Except for the cases with periprosthetic fracture (56 knees), 122 cases of aseptic painful TKA were divided into two groups: intra-articular group (83 knees) and extra-articular group (39 knees). RESULTS: In the intra-articular group, the main reasons for pain were aseptic loosening (n = 40), polyethylene wear (n = 16), instability (n = 10), recurrent hemarthrosis (n = 5), patellar maltracking (n = 4), tendon ruptures (n = 4), and stiffness (n = 2). In the extraarticular group, 10 knees (25.6%) were found to have nerve entrapment in the spine, 6 knees (15.4%) were found to have hip osteoarthritis or femoral head avascular necrosis. The reasons for persistent knee pain in the remaining 23 knees (59.0%) still remain elusive. CONCLUSIONS: Persistent pain after TKA originated from pathology of extra-articular origin in a considerable number of cases in this study. Therefore, it is important to perform thorough preoperative evaluations to reduce pain resulting from extra-articular causes. Furthermore, meticulous surgical procedures and optimal alignment are required to reduce pain of intra-articular origin related to implant wear, instability, and patellar maltracking.

Robotic Total Knee Arthroplasty with a Cruciate-Retaining Implant: A 10-Year Follow-up Study

BACKGROUND: This study compared clinical and radiological results between robotic total knee arthroplasty (TKA) and conventional TKA with a cruciate-retaining implant at 10-year follow-up. The hypothesis was that robotic TKA would allow for more accurate leg alignment and component placement, and thus enhance clinical and radiological results and long-term survival rates. METHODS: A total of 113 primary TKAs performed using a cruciate-retaining implant in 102 patients from 2004 to 2007 were reviewed retrospectively. Of the 113 TKAs, 71 were robotic TKAs and 42 were conventional TKAs. Clinical outcomes (visual analogue scale pain score, Hospital for Special Surgery score, Western Ontario and McMaster University score, range of motion, and complications), radiological outcomes, and long-term survival rates were evaluated at a mean follow-up of 10 years. RESULTS: Clinical outcomes and long-term survival rates were similar between the two groups. Regarding the radiological outcomes, the robotic TKA group had significantly fewer postoperative leg alignment outliers (femoral coronal inclination, tibial coronal inclination, femoral sagittal inclination, tibial sagittal inclination, and mechanical axis) and fewer radiolucent lines than the conventional TKA group. CONCLUSIONS: Both robotic and conventional TKAs resulted in good clinical outcomes and postoperative leg alignments. Robotic TKA appeared to reduce the incidence of leg alignment outliers and radiolucent lines compared to conventional TKA.

Comparison of Microscopic Lumbar Discectomy Between under Local and General Anesthesia in Lumbar Disc Herniation

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the effectiveness of microdiscectomy under local anesthesia in comparison with general anesthesia. SUMMARY OF LITERATURE REVIEW: No co RESULTS: Between both groups there is no significant operation time difference. However, the average hospital stay duration in the general anesthesia group was 7.3 days, while it was 4.7 days in the local anesthesia group (P0.05). Three patients in the general anesthesia group and 7 patients in the local anesthesia group needed a reoperation. CONCLUSIONS: A microdiscectomy under local anesthesia shows faster recovery period. But it shows also a relative high revision rate. In patients with old age and underlying disease, local anesthesia can be used for the microdiscectomy selectively and careful exploration of the herniated disc is required.

Cementless Implant in Total Hip Arthroplasty / 대한고관절학회지

The various implants used in total hip arthroplasty can be classified according to the design and the fixation type. In general, they can be divided into two groups; cemented and cementless types. The surgeon's decision regarding which type of implant to use should be based on the goal of the arthroplasty operation, the bony deformity of the patient, the function of the involved hip joint, and the experience of the operator. When using cementless implants, primary fixation, survival rate, and successful fixation on long-term follow-up depend on the material of the implant, the bone quality, and, ultimately, the interaction between the implant and the bone. Cementless implants have shown a high success rate in primary total hip arthroplasty and relatively fine outcomes on long-term follow-up. In comparison of the two implant types, superiority has yet to be determined, however, a choice made based on the objective of the surgery, the function of the joint, the quality of the bone, and the surgeon's experience will result in a good outcome. Therefore, we reviewed the qualities of cementless implants, the application, and the various procedures involving the implant.

Minimum Two-year Results of Revision Total Knee Arthroplasty Following Infectious or Non-infectious Causes

PURPOSE: To compare clinical outcome of revision total knee arthroplasty (TKA) between the infected and non-infected groups. MATERIALS AND METHODS: This study compared the clinical and radiographic results of 21 infected and 15 non-infected revision TKAs at a minimum 2-years follow-up. Clinical evaluations were assessed using the range of motion (ROM), Hospital for Special Surgery (HSS) score, Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and Western Ontario and McMaster Universities (WOMAC) score. Radiologic evaluations were assessed using the radiographic results of the American Knee Society and joint line change. RESULTS: Patients operated for non-infectious causes had significantly better postoperative ROM than the infected group (infected group, 101.7degrees; non-infected group, 117.8degrees). The infected group achieved significantly poor HSS (79.2 vs. 85.5), KSKS (75.5 vs. 86.6), KSFS (76.9 vs. 85.5), WOMAC (30.3 vs. 21.2) scores than the non-infected group. Postoperative joint line elevation was lower in the infected versus non-infected group (0.5 mm vs. 2.1 mm), but there was no significant difference. CONCLUSIONS: Revision TKA is an effective treatment that can provide successful results in the infected as well as non-infected patients. The overall results of non-infected revision were more satisfactory than infected revision.