ABSTRACT
We compared a cohort of patients undergoing revision of a minimal resection resurfacing unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) with a cohort of patients undergoing primary TKA. Both cohorts were matched in terms of age, sex, and body mass index. We collected data on preoperative and postoperative range of motion, International Knee Society scores, and radiologic data. We also collected data on the modes of failure of the primary UKA. There were 55 patients in each cohort. The average time the UKA was in place was 48.3 months. The average follow-up period from the time of revision was 39.2 months. The most common reason for revision was subsidence of the tibial base plate (58%). Forty percent of patients required particulate bone grafting for contained defects. Two patients required metal augments, and 1 required stems. There was no significant difference between the 2 groups in terms of range of motion, functional outcome, or radiologic outcomes. Revision of these types of implants to TKA is associated with similar results to primary TKA and is superior to revision of other forms of UKA.
Subject(s)
Arthroplasty, Replacement, Knee , Hemiarthroplasty , Knee Joint/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Knee Joint/diagnostic imaging , Male , Middle Aged , Prosthesis Design , Radiography , ReoperationABSTRACT
We report on 13 cases of periprosthetic stress fracture at the sleeve/stem junction using the Sivash-Range of Motion femoral prosthesis. Radioisotope bone scans confirmed the incidence of fracture, and review of the lateral radiographs revealed anteromedial notching of the distal sleeve on the metaphyseal throat of the femur. Treatment in all cases was expectant with full resolution of symptoms. However, there were 3 cases of recurrence, 1 of which needed revision to a more distally loading stem. This is a rare complication when using this prosthesis, but we recommend a slight alteration of the entry point for the femoral reamer when using this stem and advise nonsurgical management if it occurs, as the natural history is for the condition to settle.
Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Fractures, Stress/epidemiology , Fractures, Stress/etiology , Hip Prosthesis/adverse effects , Periprosthetic Fractures/epidemiology , Periprosthetic Fractures/etiology , Adult , Aged , Arthroplasty, Replacement, Hip/methods , Female , Femur Head Necrosis/surgery , Fractures, Stress/diagnostic imaging , Hip Dislocation, Congenital/surgery , Humans , Incidence , Male , Middle Aged , Osteoarthritis, Hip/surgery , Periprosthetic Fractures/diagnostic imaging , Prosthesis Design , Prosthesis Failure , Radiography , Retrospective StudiesABSTRACT
The "Tobruk" technique of plaster augmentation of a Thomas' splint can be used for the treatment of femoral shaft fractures in children. The radiological and clinical data of 118 patients treated using this method were reviewed over a consecutive 3-year period. The mean age of the patients was 4.25 years. Mean hospital stay was 14.11 days. Mean time spent in the "Tobruk" splint was 44.77 days. Loss of reduction during splintage occurred in 9.32% of patients. Skin complications occurred in 5 patients (4.2%), and cast repairs were necessary in 3 patients. "Tobruk" splinting is a relatively safe and effective way of treating femoral shaft fractures in children. Although its use is not widespread, especially in the United States, until better results are achieved with spica casting and elastic stable intramedullary nails, it does provide a valid option in the treatment of these fractures. A controlled randomized prospective trial with long-term follow-up is needed to fully elucidate its value.
