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ABSTRACT Objective: This article reports the range of motion, failure rate, and complications of patients with extensor mechanism injury after total knee arthroplasty (TKA) treated with extensor mechanism allograft with mid-term follow-up. Methods: Patients undergoing post-ATJ extensor mechanism transplantation from 2009 to 2018 were retrospectively evaluated. Demographics, the reason for transplantation, elapsed time from arthroplasty to transplantation, related surgical factors, immobilization time, range of motion, transplant failure, and complications were collected. The minimum follow-up was 24 months. Results: Twenty patients were evaluated. The mean follow-up was 70.8 +/- 33.6 months. The most common cause of extensor mechanism rupture was traumatic in 10 (50%) cases. Six patients underwent associated surgeries, one case of medial ligament complex reconstruction, and 5 cases of TKA revision. Eleven patients (55%) had transplant-related complications. The most common complication was an infection. Five cases presented transplant failure. Conclusion: Patients who underwent extensor mechanism allograft transplantation after total knee arthroplasty had a 25% failure rate with a mean follow-up of 6 years. Although there was no loss of flexion with the procedure and prolonged immobilization, the complication rate was not low. Level of evidence IV; case series .
RESUMO Objetivo: O objetivo do estudo foi relatar amplitude de movimento, taxa de falha e complicações de pacientes com lesão do mecanismo extensor após artroplastia total do joelho (ATJ) tratados com aloenxerto do mecanismo extensor com acompanhamento no médio prazo. Métodos: Pacientes submetidos a transplante de mecanismo extensor pós-ATJ de 2009 a 2018 foram avaliados retrospectivamente. Foram avaliados dados demográficos, motivo do transplante, tempo decorrido da artroplastia ao transplante, fatores cirúrgicos relacionados, tempo de imobilização, arco de movimento, falha do transplante e complicações. O acompanhamento mínimo foi de 24 meses. Resultados: Vinte pacientes foram avaliados. O tempo médio de acompanhamento foi de 70,8 +/- 33,6 meses. A causa mais comum de ruptura do mecanismo extensor foi traumática em 10 (50%) casos. Seis pacientes foram submetidos a cirurgias associadas, um caso de reconstrução do complexo ligamentar medial e 5 casos de revisão de ATJ. Onze pacientes (55%) tiveram complicações relacionadas ao transplante. A complicação mais comum foi a infecção. Cinco casos apresentaram falha do transplante. Conclusão: Pacientes submetidos a transplante de aloenxerto de mecanismo extensor após artroplastia total de joelho apresentam taxa de falha de 25% com seguimento médio de 6 anos. Embora não tenha havido perda de flexão com o procedimento e com a imobilização prolongada, o índice de complicações não foi baixo. Nível de evidênvia IV; série de casos .
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PURPOSE: To compare and analyze the surgical procedure and clinical results of two-stage re-implantation using both articulating and static spacers at infected total knee arthroplasties(TKA). MATERIALS & METHODS: A total of 14 cases were selected for subject of this study in which patients had been diagnosed as infected TKA and had undergone two-stage re-implantation(7 using static spacers and remaining 7 using articulating spacers) from March 1999 to March 2006. RESULTS: In the group using static spacers, ROM improved from 70 degrees in average preoperatively to 98 degrees postoperatively. In the group using articulating spacers, ROM improved from 74 degrees to 105 degrees (p=0.532). HSS score showed an increase from 43 scores in average preoperatively to 81 postoperatively for static spacers and from 41 to 83 for articulating spacers(p=0.780). There was no significant difference in the hour spent for the 1st surgery. The 2nd operation time was shortened to 241 minutes in case of static spacers, and 208 minutes in articulating spacers. One case of relapse was reported with static spacers but none with articulating spacers. CONCLUSION: Two-stage re-implantation of infected TKA using both static and articulating spacers has been found to be effective ways of treatment, requiring, however, long term follow-ups.
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Humans , Arthroplasty , Knee , RecurrenceABSTRACT
0.05).Conclusion:Modified osteotomy can not improve operative effect.
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Hip and knee replacement arthroplasty is one of the important causes of pulmonary embolism, of which the incidence was reported to be from 2 to 16% But, there are no reports about the incidence of pulmonary embolism after these operations in Korea. The authors' intention was to study the incidence and clinical manifestations of pulmonary embolism after hip and knee surgery. Lung perfusion scans and inhalation scans were done preoperatively and 7 days postoperatively for 139 hip or knee replacement arthrosplasty patients in Asan Medical Center. We studied 62 cases of avascular necrosis of the femoral head, 33 cases of femur neck fractures, 45 cases of degenerative arthritis of the hip and knee joints and 17 cases of other diseases. In this study, hip replacement arthroplasties were done in 114 cases, knee replacement arthrosplasties in 25 cases. On preoperative lung scan, high or intermediate probability findings of pulmonary embolism were shown in 18 cases and all of them were asymptomatic. 139 cases showed normal or low probability on preoperative lung scan, of which 5 cases were changed to high probability and 7 cases to intermediate probability on postoperative lung scan. Four of the 7 intermediate probability cases were confirmed to be pulmonary embolism on pulmonary angiography. Of these 9 cases, hip replacement arthroplasties were done in 6 cases and knee replacement arthroplasties in 3 cases. There were 5 cases of osteoarthritis of hip and knee, 3 cases of avascular necrosis of femoral head and 1 case of femoral neck fracture. We concluded that preoperative and postoperative incidences of pulmonary embolism in Korea were similar to those in western countires. Most of the pulmonary embolism patients were asymptomatic and so lung perfusion scans and inhalation scans were helpful in the early diagnosis of pulmonary embolism.