[Research progress of knee-salvage treatment for knee osteoarthritis].

Objective: To review the progress of knee-salvage treatment based on the step therapy idea for knee osteoarthritis (KOA). Methods: The domestic and foreign literature in recent years was searched, and the treatments of KOA at different stages were summarized and analyzed. Results: The treatment of KOA is aimed at alleviating symptoms, delaying structural changes of joints, maintaining joint function, and improving quality of life. So the conservative treatment is still the first choice for KOA at early stage. Arthroscopic surgery can assist in the diagnosis and classification, simultaneously remove the intra-articular irritants, and limitedly repair the cartilage. Osteotomy is suitable for the KOA with abnormal lower extremity weight bearing line and articular line. And it can effectively balance the weight bearing stress of knee joint, improve the clinical symptom, and alleviate the progression of disease. Joint distraction can improve the mechanical environment of knee joint and repair the defect cartilage partly. With the technical development, unicompartmental knee arthroplasty (UKA) is back in fashion in recent years. It is a kind of real joint surface replacement, which is an important means of knee preservation method in patients with anterior medial KOA. Conclusion: At present, there are many knee-salvage treatments based on the severity of the disease. Osteotomy and UKA are the most widely used and successful surgical techniques for knee preservation. However, the indications should be properly selected, and the surgeon should accumulate enough clinical experience. Otherwise, it is difficult to achieve good results.

Research progress of knee-salvage treatment for knee osteoarthritis

Objective: To review the progress of knee-salvage treatment based on the step therapy idea for knee osteoarthritis (KOA). Methods: The domestic and foreign literature in recent years was searched, and the treatments of KOA at different stages were summarized and analyzed. Results: The treatment of KOA is aimed at alleviating symptoms, delaying structural changes of joints, maintaining joint function, and improving quality of life. So the conservative treatment is still the first choice for KOA at early stage. Arthroscopic surgery can assist in the diagnosis and classification, simultaneously remove the intra-articular irritants, and limitedly repair the cartilage. Osteotomy is suitable for the KOA with abnormal lower extremity weight bearing line and articular line. And it can effectively balance the weight bearing stress of knee joint, improve the clinical symptom, and alleviate the progression of disease. Joint distraction can improve the mechanical environment of knee joint and repair the defect cartilage partly. With the technical development, unicompartmental knee arthroplasty (UKA) is back in fashion in recent years. It is a kind of real joint surface replacement, which is an important means of knee preservation method in patients with anterior medial KOA. Conclusion: At present, there are many knee-salvage treatments based on the severity of the disease. Osteotomy and UKA are the most widely used and successful surgical techniques for knee preservation. However, the indications should be properly selected, and the surgeon should accumulate enough clinical experience. Otherwise, it is difficult to achieve good results.

Two sequential free flaps for coverage of a total knee implant.

Knee revision arthroplasty following peri-prosthetic joint infections is a formidable challenge. Patients are at a high risk of recurrent infection, and the soft tissue over the revised implant is often of questionable quality. Flap reconstruction has improved the salvage rates of infected arthroplasties, and should be considered in all cases of revision arthroplasty. We present a challenging case requiring staged reconstruction with two free latissimus dorsi flaps after the initial use of a medial gastrocnemius flap.

Two sequential free flaps for coverage of a total knee implant

Knee revision arthroplasty following peri-prosthetic joint infections is a formidable challenge. Patients are at a high risk of recurrent infection, and the soft tissue over the revised implant is often of questionable quality. Flap reconstruction has improved the salvage rates of infected arthroplasties, and should be considered in all cases of revision arthroplasty. We present a challenging case requiring staged reconstruction with two free latissimus dorsi flaps after the initial use of a medial gastrocnemius flap.

Salvage of infected intramedullary knee arthrodesis with vascularized free fibula and staged fixation.

Intramedullary knee arthrodesis is indicated when an infected total knee arthroplasty revision is failed. There is a high risk of infection after this procedure and the only option of treatment considered in these cases is AK amputation. We present an alternative to AK amputation in intramedullary arthrodesis infected cases that has been successful in all patients we have treated. From 2008 to 2012 five patients (4 men and one woman) were treated. The treatment protocol was staged: (1) debridement, removing intramedullary implant and cement, PMMa as spacer and placement of a double-frame external fixator. Gastrocnemius flap was used when there was a significant cutaneous defect. (2) Removing PMMa and transfer a contralateral free fibular osteocutaneous flap. (3) Change external fixation for an internal fixation. There was no mortality associated to the treatment protocol. There were no septic complications after the first and second stages. Two patients developed deep infection after the third stage. One patient developed stress fracture of the fibular flap. All cases showed integration of the fibular bone six to eight months postoperatively. Limb shortening was 3.8cm on average. All patients were able to walk independently with one crutch. In conclusion, although our series is short to export results, our protocol treatment is a good alternative to AK amputation. The treatment entails at least three major surgical procedures through a protracted period of time, but the avoidance of an AK amputation seems worth the risk in a fully informed and compliant patient.