Conversion Total Knee Arthroplasty After Failed Osteochondral Allograft Reconstruction: Similar Functional Performance With Lower Patient Satisfaction.

BACKGROUND: This study presents surgical techniques used in conversion total knee arthroplasty (cTKA) following early failure of large osteochondral allograft joint replacement and compares postoperative patient reported outcomes measures (PROMs) and satisfaction scores with a contemporary primary total knee arthroplasty (pTKA) cohort. METHODS: We retrospectively evaluated 25 consecutive cTKA patients (26 procedures) to define the utilized surgical techniques, radiographic disease severity, preoperative and postoperative PROMs (visual analog scale [VAS] pain, knee injury and osteoarthritis outcome score for joint replacement [KOOS-JR], University of California Los Angeles Activity), expected improvement and postoperative satisfaction (5-point Likert), and reoperations in comparison with an age and body mass index propensity matched cohort of 50 pTKA performed for osteoarthritis (52 procedures). RESULTS: Revision components were used in 12 cTKA cases (46.1%), with 4 cases requiring augmentation (15.4%), and 3 cases utilizing varus-valgus constraint (11.5%). While no significant differences were noted in expectation level or in other PROMs, mean patient reported satisfaction was lower in the conversion group (4.4 ± 1.1 versus 4.8 ± 0.5 points, P = .02). High cTKA satisfaction was associated with a higher postoperative KOOS-JR (84.4 versus 64.2 points, P = .01) and a trend towards higher University of California Los Angeles activity (6.9 versus 5.7 points, P = .08). Four patients in each group underwent manipulation (15.3 versus 7.6%, P = .42), and 1 pTKA patient was treated for early postoperative infection (0 versus 1.9%, P = 1.0). CONCLUSION: cTKA following failed biological replacement was associated with similar postoperative improvement as in pTKA. Lower patient-reported cTKA satisfaction was associated with lower postoperative KOOS-JR scores.

Sciatic Nerve Palsy After Distal Femoral Traction for Vertically Unstable Pelvic Fracture in a Neurologically Intact Patient.

Vertically unstable fractures of the pelvis require a notable amount of energy to cause disruption of the posterior elements of the pelvic ring. Superior migration of the hemipelvis demonstrates the inherent instability of this fracture pattern. Surgical fixation is required in most cases, but while resuscitation efforts are underway, placing the patient in skeletal traction to reduce the hemipelvis is often recommended. Although skeletal traction has been described in many sources, no consensus exists on the amount of weight that should be used. This has led to anecdotal recommendations that vary between institutions. Without clear guidelines for treatment, a vertically translated hemipelvis was overreduced and subsequently sustained a sciatic nerve palsy in a patient who was neurologically intact on presentation. We aim to describe a rare complication of skeletal traction and propose a treatment algorithm to reduce the incidence of future complications.