Meta-analysis Comparing Allograft to Synthetic Reconstruction for Extensor Mechanism Disruption after Total Knee Arthroplasty.

Extensor mechanism disruption following total knee arthroplasty (TKA) is a devastating complication that causes high failure rates. There is controversy on what is the best way to do an extensor mechanism reconstruction. This study aims to compare both allograft and synthetic reconstructive techniques for success, reoperation, and infection rates and functional outcomes. The search on PubMed, MEDLINE, Embase, BIOSIS, and Cochrane databases was performed on March 15, 2019, using the following keyword groups: (1) "extensor mechanism" and "total knee arthroplasty," (2) "extensor mechanism" and "knee arthroplasty," (3) "extensor mechanism" and "revision total knee arthroplasty," and (4) "extensor mechanism" and "revision knee arthroplasty". Only studies on extensor mechanism disruption after TKA that included sufficient data to compare these two surgical techniques were included. Meta-analysis was performed with random effect model using the DerSimonian-Laird method. Thirty studies were included. The overall success rate of the reconstruction was 73.3% (95% confidence interval [CI]: 0. 651, 0.814). The success rate of allograft (72.8%, 95% CI: 0.626, 0.829) was not significantly different from synthetic material (78%, 95% CI: 0.707, 0.852, p = 0.416). There was no significant difference in revision rates between allograft (14.2%, 95% CI: 0.095, 0.189) and synthetic material (16%, 95% CI: 0.096, 0.223, p = 0.657). The overall relative risk of infection was 4.301 (95% CI: 1.885, 9.810). There was no significant difference in relative risk of infection between allograft (3.886, 95% CI: 1.269, 11.903) and synthetic material (4.851, 95% CI: 1.433, 16.419, p = 0.793). No statistically significant difference was found in mean postoperative Knee Society score (73.109 [95% CI: 67.296, 78.922] vs. 72.679 [95% CI: 69.184, 76.173], p = 0.901) between allograft and mesh reconstruction groups. There were no significant differences in overall failures, infections, functional outcomes, or revision reconstructions between allograft and synthetic material extensor mechanism reconstructions. Our results demonstrate the difficulty in treating this serious injury, independent of technique, as well as the significant risk for overall failure and infection.

Clinical evaluation of an allogeneic bone matrix containing viable osteogenic cells in patients undergoing one- and two-level posterolateral lumbar arthrodesis with decompressive laminectomy.

BACKGROUND: Trinity Evolution® cellular bone allograft (TE) possesses the osteogenic, osteoinductive, and osteoconductive elements essential for bone healing. The purpose of this study is to evaluate the radiographic and clinical outcomes when TE is used as a graft extender in combination with locally derived bone in one- and two-level instrumented lumbar posterolateral arthrodeses. METHODS: In this retrospective evaluation, a consecutive series of subject charts that had posterolateral arthrodesis with TE and a 12-month radiographic follow-up were evaluated. All subjects were diagnosed with degenerative disc disease, radiculopathy, stenosis, and decreased disc height. At 2 weeks and at 3 and 12 months, plain radiographs were performed and the subject's back and leg pain (VAS) was recorded. An evaluation of fusion status was performed at 12 months. RESULTS: The population consisted of 43 subjects and 47 arthrodeses. At 12 months, a fusion rate of 90.7 % of subjects and 89.4 % of surgical levels was observed. High-risk subjects (e.g., diabetes, tobacco use, etc.) had fusion rates comparable to normal patients. Compared with the preoperative leg or back pain level, the postoperative pain levels were significantly (p < 0.0001) improved at every time point. There were no adverse events attributable to TE. CONCLUSIONS: Fusion rates using TE were higher than or comparable to fusion rates with autologous iliac crest bone graft that have been reported in the recent literature for posterolateral fusion procedures, and TE fusion rates were not adversely affected by several high-risk patient factors. The positive results provide confidence that TE can safely replace autologous iliac crest bone graft when used as a bone graft extender in combination with locally derived bone in the setting of posterolateral lumbar arthrodesis in patients with or without risk factors for compromised bone healing. TRIAL REGISTRATION: Because of the retrospective nature of this study, the trial was not registered.