Use of a New Knee Prosthesis as an Articulating Spacer in Two-Stage Revision of Infected Total Knee Arthroplasty

PURPOSE: To report our experience with two-stage revision using a new femoral component (NFC) spacer (Depuy Synthes) as an articulating spacer. MATERIALS AND METHODS: In this retrospective study, we reviewed 22 two-stage revisions that were performed using an NFC spacer in 22 patients suspected of having an infected total knee arthroplasty (TKA) from December 2010 to March 2013. The result was considered successful when eradication of infection was achieved using only one NFC spacer. RESULTS: The average time from primary TKA to the first stage procedure was 29.1 months and the average time from the first stage procedure until the final second stage procedure was 12.7 weeks. The average range of motion increased from 82° preoperatively to 104° postoperatively. The American Knee Society Knee score increased from 29.3 points to 66 points. The Function score increased from 29.5 points to 64 points. Four cases were reinfected after two-stage revision. The mean follow-up was 37.6 months. CONCLUSIONS: The new articulating spacer showed promising short-term results both with regard to eradication of infection and functional improvement.

Types of facets on the superior articular surface of Isan-Thai dried calcanei / Tipos de facetas de la superficie articular superior de calcáneos secos de tailandeses del nordeste

The patterns of talar articulating facets must be concerned in surgical procedure or the internal and external fixation in various diseases of the foot. The variant types of calcaneal facets on the superior articular surface have been reported in many races except in Thais. This study therefore was aimed to investigate the patterns of superior articulating facet of dried calcanei in Isan-Thais. The identified 396 Isan- Thai dried calcanei (202 males and 194 females) were carried out for variant superior facet observations. The results showed that types of facets observed could be classified into three major types (Type 1 [60.86%], Type 2 [38.64%], and Type 4 [0.51%], respectively). In sub-type classifications, there were Type 1A (24.75%), Type 1B (36.11%), Type 2A (12.88%), Type 2B (14.14%), Type 2C (2.78%), Type 2D (8.84%), and Type 4 (0.51%), respectively. Additionally, it was found that the percentage of Type 2A of male (15.84%) was much greater than that of female (9.79%) compared to those of other types. This incidence of facet types is valuable information for Thai orthologists to concern about treating in talocalcaneal joint area.

Los patrones de las facetas articulares del talus deben considerarse en los procedimientos quirúrgicos o en la fijación interna y externa en varias enfermedades del pie. Variaciones en las facetas articulares del calcáneo, correspondientes a la superficie articular superior, se han reportado en muchas razas y grupos étnicos, excepto en los tailandeses. Por tanto, este estudio tuvo como objetivo investigar los patrones de presentación de las carillas articulares de calcáneos secos en Tailandases-Isan. Se estudiaron 396 huesos calcáneos secos (202 de hombres y 194 de mujeres). Los resultados mostraron que los tipos de carillas observadas se pueden clasificar en tres tipos principales (tipo 1 [60,86%], tipo 2 [38,64%] y Tipo 4 0,51%, respectivamente). Las subclasificaciones se distribuyeron en los subtipos 1A (24,75%), 1B (36,11%), 2A (12,88%), 2B (14,14%), 2C (2,78%), 2D (8,84%), y 4 (0,51%), respectivamente. Adicionalmente, se encontró que el porcentaje del Tipo 2A de hombres (15,84%) fue mayor que en las mujeres (9,79%) en comparación con los otros tipos. Consideramos que la incidencia de aparición de los distintos tipos de facetas constituyen una información valiosa para ortopedistas tailandeses en relación a los tratamientos a desarrollar en el área de la articulación talocalcanea.

Two-Stage Revision for Infected Total Knee Arthroplasty: Based on Autoclaving the Recycled Femoral Component and Intraoperative Molding Using Antibiotic-Impregnated Cement on the Tibial Side

BACKGROUND: The purpose of this study was to determine the degree of infection control and postoperative function for new articulating metal-on-cement spacer. METHODS: A retrospective study of 19 patients (20 cases), who underwent a two-stage revision arthroplasty using mobile cement prosthesis, were followed for a minimum of 2 years. This series consisted of 16 women and 3 men, having an overall mean age of 71 years. During the first stage of revision, the femoral implant and all the adherent cement was removed, after which it was autoclaved before replacement. The tibial component was removed and a doughy state, antibiotic-impregnated cement was inserted on the tibial side. To achieve joint congruency, intraoperative molding was performed by flexing and extending the knee joint. Each patient was evaluated clinically and radiologically. The clinical assessments included range of motion, and the patients were scored as per the Hospital for Special Surgery (HSS) and Knee Society (KS) criteria. RESULTS: The mean range of knee joint motion was 70degrees prior to the first stage operation and 72degrees prior to the second stage revision arthroplasty; following revision arthroplasty, it was 113degrees at the final follow-up. The mean HSS score and KS knee and function scores were 86, 82, and 54, respectively, at the final follow-up. The success rate in terms of infection eradication was 95% (19/20 knees). No patient experienced soft tissue contracture requiring a quadriceps snip. CONCLUSIONS: This novel technique provides excellent radiological and clinical outcomes. It offers a high surface area of antibiotic-impregnated cement, a good range of motion between first and second stage revision surgery for the treatment of chronic infection after total knee arthroplasty, and is of a reasonable cost.

Del rostro al texto: tras las huellas de la hiperlaxitud y la disautonomía en escritores / From the face to the text: after the fingerprints of the hyperlaxity and the dysautonomia in writers

At present there is a renew interest in delineating diagnostic criteria for the Ehlers-Danlos Syndrome type III (EDS-III), condition than even though is not serious, can produce poor quality of life, due to alteration of various organs and the presence of dysautonomia. The fragility of tissues, that causes the symptomatology, can frequently be reflected in some external signs. In this study, some authors have been selected that present facial signs that are characteristic of this syndrome and gives us the opportunity to look in their texts some tracts of this disease, by looking in their autobiographic texts or in their fiction works. This exercise of free association helps us to have a more complete view of their rich and complex personalities and helps us also to appreciate the importance in detecting and preventing the consequences of this disease, that with an adequate management can produce a notable improvement in the quality of life...

Hoy se está produciendo un renovado interés por afinar los criterios diagnósticos del síndrome de hipermovilidad articular (similar al SED-III), condición que, aunque no suele ser grave, puede traducirse en una mala calidad de vida, por trastornos en diversos órganos y la presencia de disautonomía. La debilidad de los tejidos conectivos, causante de la sintomatología, suele reflejarse también en algunos signos externos. En este estudio se seleccionan algunos escritores que presentan signos en el rostro característicos de este síndrome y que nos dan la oportunidad de buscar entre sus textos algunas pistas de esta enfermedad, ya sea en textos autobiográficos o en sus obras de ficción. Este ejercicio de libre asociación nos ayuda a tener una mirada más completa de sus ricas y complejas personalidades, y nos ayuda también a tomar conciencia de la importancia de detectar y prevenir las consecuencias de esta enfermedad, que con manejo adecuado puede traducirse en una mejoría notable de la calidad de vida...

Two-Stage Reimplantation in Infected Total Knee Arthroplasty (A Method of Reinsertion of the Autoclaved Femoral Component and a Polyethylene Liner)

PURPOSE: We wanted to evaluate the results of treating infected total knee arthroplasty with an autoclaved femoral component and polyethylene liner. MATERIALS AND METHODS: From March 2003 to March 2008, 25 knees were diagnosed as infected total knee arthroplasty (TKA) and they underwent two-stage re-implantation. These knees were treated with debridement, reinsertion of the removed femoral component and a polyethylene liner, which were autoclaved, and antibiotic cement was used as an articulating spacer during the interim period to allow maintenance of motion and function. The range of motion and the Hospital for Special Surgery (HSS) score, the Knee Society Knee Score and the Function Score were evaluated. RESULTS: The mean follow up period was 52 months. There was one recurrence of infection. Prior to revision, the average range of motion was 83degrees and the average HSS score was 60 points. At final follow-up, the average range of motion was 110degrees and the average HSS score was 86 points. The knee score and function score showed an increase from a mean of 46 and 31 points preoperatively to a mean of 82 and 50 points postoperatively. The complications during reimplantation were one medial collateral ligament rupture, one lateral condyle fracture and one femoral distal metaphyseal fracture. CONCLUSION: The articulating spacer using an autoclaved femoral component and polyethylene can improve knee function and motion in two stage revision TKA.

Comparação da atividade eletromiográfica dos músculos masseter direito e esquerdo em atletas de softbol durante gesto esportivo de rebatida / Comparison of the electromyographic activity of muscle massete right and left in athletes of softballl in gest sports rebate _ case study

Introdução: As disfunções temporomandibulares têm sido objeto de estudo crescente, no entanto, estão somente relacionadas com a má oclusão bucal, lesões por contato nos esportes, entre outros. Neste estudo, uma nova visão das disfunções foi observada, uma vez que a analise eletromiográfica dos músculos masseteres foi coletada durante o gesto esportivo da rebatida do baseball, o que pode possibilitar a verificação de possíveis alterações funcionais das disfunções. Objetivo: Analisar a atividade elétrica do músculo masseter em atletas de beisebol durante realização do gesto esportivo de rebatida. Materiais e Métodos: Foram avaliadas 5 atletas de beisebol, sexo feminino, idade média de 21 anos, selecionadas para a seleção brasileira a disputar o pan-americano 2007, sem lesões previas ou disfunções diagnosticadas. Cada atleta realizou 5 repetições do gesto esportivo enquanto a atividade eletromiográfica dos masseteres eram coletadas comeletromiógrafo. Resultados: Após análise estatística dos dados, foi observado que as atletas realizam uma contração dos músculos masseteres durante o gesto esportivo de rebatida estatisticamente significativa com p > 0,5 utilizando Teste-t. Sendo que duas das cinco atletas avaliadas, apresentaram uma atividade elétrica do músculo muito diferente da média, sendo uma bem acima e outra bem abaixo da média do grupo. Conclusão: As atletas realizaram contração muscular do músculo masseter durante o gesto esportivo e o desequilíbrio muscular entre os dois músculos masseteres teve uma diferença significativa, o que em longo prazo pode causar uma disfunção temporomandibular.

Introduction: The dysfunctions temporomandibulares object of study have been growing, however, are only related to the poor occlusion mouth, by injuries in contact sports, among others. In this study, a new vision of dysfunction has been observed since the EMG analysis of muscles masseters was collected during sporting gesture of the baseball refuted, which can allow the verification of possible changes of functional disorders. Objective: To analyze the electrical activity of muscle Sciurognathi athletes in baseball during the completion of sporting gesture of refuted. Materials and Methods: There were assessed five athletes from softball, women, average age 21 years, selected for the team to enjoy the Pan-American 2007, without injury or dysfunction diagnosed previas. Each athlete held five repetitions of the sporting gesture while the EMG activity of masseters were collected with EMG. Results: After statistical analysis of the data has been observed that the athletes will masseters contraction of the muscles during sporting gesture from refuted statistically significant with p> 0.5 using t-test. Given that two of the five athletes evaluated, had a electrical activity of muscle very different from the average, well above one another and well below the average of the group. Conclusion: The athletes performed muscle contraction of the masseter muscle in the sporting gesture and muscle imbalance between the two masseter muscles had a significant difference, which in the long term can cause a temporomandibular dysfunction.

Two-Stage Reimplantation of Infected Total Knee Arthroplasty with Antibiotic-Loaded Bone Cement Spacer: Comparison of the Types of Antibiotic-Loaded Cement Spacer / 대한정형외과학회잡지

PURPOSE: The treatment results of a two-stage reimplantation of infected total knee arthroplasty with either the articulating or non-articulating types of antibiotic-loaded bone cement spacers were compared and analyzed. MATERIALS AND METHODS: Between July 1995 and October 2005, this study reviewed 29 patients who underwent two-stage reimplantation of infected total knee arthroplasty and were followed up for at least 2 years. Of the 29 cases, 12 used articulating and 17 used the non-articulating type. RESULTS: Fifteen cases (52%) showed bacterial growth in the preoperative and intraoperative bacterial culture, and 14 cases (48%) had no growth. 27 cases showed no evidence of reinfection until the last follow up after two-stage reimplantation. One out of the 12 cases in the articulating group and 1 out of the 17 cases in the non-articulating group had a reinfection. The range of motion (ROM) of the knee joint and HSS knee rating scale increased more significantly in the articulating group than in the non-articulating group, and the degree of increase in the ROM of the knee joint and HSS knee rating scale was significantly larger in the articulating group. CONCLUSION: The two-stage reimplantation with an antibiotic-loaded bone cement spacer showed a 93.1% of success rate. The articulating group showed better results in the knee ROM and HSS knee rating scale than the non-articulating group

An Articulating Versus Non-articulating Spacer for 2-Stage Reimplantation Patients Who Undergo in Infected Total Knee Arthroplasty

PURPOSE: We compared the results between an articulating spacer and a non-articulating spacer for 2-stage reimplantation when performing infected total knee arthroplasty (TKA). MATERIALS AND METHODS: From 1998 to 2007, for 22 patients with infected TKA, we retrospectively evaluated 23 knees that were treated with debridement, component removal and insertion of a non-articulating or articulating spacer, followed by second-stage TKA revision. Non-articulating spacers were used in 13 knees and articulating spacers were used in 10 knees. The most common infecting organism was Staphylococcus aureus in 9 cases, but the infecting organism could not be found in 10 cases. The average length of follow-up was 24 months. RESULTS: The eradication rate was 100% (0 infections in 10 knee) in the articulating group compared with 92.3% (1 infection in 13 knee) in the non-articulating group. The average range of motion before removal of the implant was 60.3degrees for the articulating group and 61degrees for the non-articulating group. After revision arthroplasty, the average range of motion was 104.3degrees for the articulating group and 92.3degrees for the non-articulating group. The rectus snip was done for 3 cases in the articulating group and in 13 cases for the non-articulating group. Yet there were no functional differences between the two groups during the final follow-up period. CONCLUSION: We conclude that the articulating spacer can maintain knee mobility during between the interval stages and improve knee flexion without an increased risk of infection at the final follow-up period.

Short-term Results of Two-stage Reimplantation Using Antibiotic-loaded Articulating Cement Spacer in Infected Total Knee Arthroplasty

PURPOSE: We reviewed the short-term clinical results of two-stage reimplantation using antibiotic-loaded articulating cement spacer in infected total knee arthroplasty (TKA). MATERIALS AND METHODS: Nineteen consecutive patients (20 knees) with chronic indolent infection after TKA from July, 2004 were treated by two-stage reimplantation using articulating antibiotic spacer and were followed them with a minimum of 18 months. We assessed infecting organism, response of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level following insertion of antibiotic spacer, elapsed time to reimplantation, and duration of parenteral antibiotics therapy. And we also evaluated clinical results using Hospital for Special Surgery (HSS) score, range of motion (ROM) and reinfection rate. RESULTS: The most common was methicillin-resistant staphylococcus epidermidis (8 patients, 53.3%) among the infecting organisms identified in 15 patients. Average ESR and CRP level were 28.9 mm/hr and 3.0 mg/L, each before reimplantation. The elapsed time to reimplantation was 9.7 weeks and the mean duration of parenteral antibiotics was 5.4 weeks. The ROM before spacer insertion was 72.5degrees, increasing to 103.3degrees and HSS score also improved from 47.8 preoperatively to 88.8 without evidence of reinfection at latest follow-up. CONCLUSION: Two-stage reimplantation using articulating antibiotic spacer in infected TKA is thought to be veryeffective surgical option to achieve excellent clinical results through controlling infection and permitting active joint motion.

Comparison of Articular Spacer Versus Static Spacer in the Treatment of Infected Total Knee Arthroplasty

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.

Two Stage Revision using Custom Articulating Spacer in an infected TKA: A Novel Method for an Intraoperative Construction of an Articulating Spacer / 대한정형외과학회잡지

PURPOSE: This paper reports a novel technique to create an antibiotic spacer for the treatment of infected total knee replacements (TKA) with surface contours similar to that of the original TKA. MATERIALS AND METHODS: This new technique involved the intra-operative construction of a custom mold made from bone cement along with the removed implant. Twelve consecutive patients treated with this technique were reviewed in the aspect of the degree of flexion, difficulty in exposure at the 2nd stage reimplantation, and complications related to the technique. The functional status was evaluated using the Knee Society score. RESULTS: The degree of flexion was 85 (40-130) preoperatively and 100 (70-110) prior to reimplantation. The postoperative flexion was 112 (90-140) at 6 weeks, 108 (70-140) at 3 months, and 110 (75-140) at 1 year postoperatively. A rectus snip was required in 8 out of 12 cases. Other extensile approaches were not needed. The knee society score was significantly improved from 30/24 to 87/80. No specific complications were noted at the final follow-up. CONCLUSION: This technique allows the immediate stability and mobility after the first stage of reimplantation. This technique offers ease and convenience of surgical technique without considerable increase in surgical cost or time. In addition, it eliminates the requirement for costly commercial mold or special pre-manufactured implants.

Two Stage Reimplantation in Infected Total Knee Arthroplasty Using an Articulating Antibiotics Impregnated Cement Spacer: Surgical Technique

PURPOSE: To evaluate the clinical result of two stage reimplantation of infected total knee arthroplasties, using an antibiotics impregnated articulating cement spacer. MATERIALS AND METHODS: Out of total 7 cases with infected total knee arthroplasties, 4 cases treated with two stage reimplantation, using an antibiotics impregnated articulating cement spacer were included in this study. After the treatment of infected total knee arthroplasties, the treatment of infection was evaluated by physical examination, radiologic studies, and hematologic studies. The results were evaluated using the Hospital for Special Surgery Knee Score (HSS). RESULTS: As results, 4 infected knee cases treated with two stage reimplantation did not have reinfection at the time of the follow up, and physical, laboratory, and radiologic studies were all within normal range. The range of motion of the reimplanted knees were from -5degrees in extension to 130 degrees in flexion, with an average of 117 degrees. The average score of the Hospital for Special Surgery Knee Score was 87. CONCLUSION: In conclusion, two stage arthroplasties, using antibiotics impregnated articulating cement spacer was an effective therapy not only for the treatment of the infection after the total knee arthroplasty but also effectiveness for recovery of the knee function.

Role of Articulating Spacer in Two Stage Reimplantation of Infected Total Knee Arthroplasty

The objective of this study is to assess the role of articulating spacer in two stage reimplantation of infected TKA. Fifteen patients with deep infected total knee arthroplasties were treated by two stage reimplantation protocol between Jan. 1987 and Oct. 1997. Seven cases in Group A were treated by debridement, removal of the prosthesis and placement of antibiotic impregnated cement spacer before reimplantation. Eight cases in Group B were treated by debridement, and reinsertion of the retrieved implant after autoclaving with antibiotic impregnated cement fixation. The average follow-up period was 77 months(range, 28-141 months) in group A, and 25 months(range, 12-63 months) in group B. The average knee flexion after revision was 82 degrees in group A, and 106 degrees in group B. The average HSS knee rating score was 80 points in group A, and 88 points in group B. No patient had recurrence of infection during the follow-up period. In conclusion, our method using articulating spacer allowed emly range of motion and partial weight bearing during the spacer phase. This methods also delivered high local concentration of antibiotics and kept the functional joint before a second-stage reimplantation.