RESUMO
BACKGROUND: There are limited data on the utility of a standard primary total knee arthroplasty (TKA) femoral component with an all polyethylene tibia as a functional prosthetic spacer in place of a conventional all cement spacer for the management of periprosthetic joint infection (PJI). The aim of this multicenter study was to retrospectively review (1) ultimate treatment success; (2) reimplantation rates; (3) reoperation rates; and (4) change in knee range of motion in patients managed with functional prosthetic spacers following TKA PJI. METHODS: A retrospective review was performed for patients at 2 tertiary care centers who underwent a functional prosthetic spacer implantation as part of a functional single-stage (n = 57) or all cement spacer conventional two-stage (n = 137) revision arthroplasty protocol over a 5-year period. Outcomes including reinfection, reimplantation, and reoperation rates, success rate as defined by the Delphi criteria, and final range of motion were compared between the 2 cohorts at a minimum of 2-year follow-up. RESULTS: There was no significant difference in reinfection (14.0 vs 24.1%), reoperation (19.3 vs 27.7%), or success rates (78.9 vs 70.8%; P > .05 for all) between the one-stage and two-stage revision TKA cohorts. Mean final total arc of motion was also similar between the 2 groups (105.8 vs 101.8 degrees, respectively). CONCLUSION: Functional prosthetic spacers offer the advantage of a single procedure with decreased overall hospitalization and improved cost-effectiveness with analogous success rates (78.9%) compared with two-stage exchange (70.8%) at mid-term follow-up. Although long-term data are required to determine its longevity and efficacy, the outcomes in this study are encouraging. LEVEL OF EVIDENCE: 3.
Assuntos
Artrite Infecciosa/cirurgia , Artroplastia do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Reoperação/instrumentação , Idoso , Antibacterianos/administração & dosagem , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/etiologia , Artroplastia do Joelho/instrumentação , Cimentos Ósseos , Feminino , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/etiologia , Amplitude de Movimento Articular , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Anterior knee pain (AKP) remains a complex issue affecting patient satisfaction after total knee arthroplasty. Several radiographic parameters have been shown to be causative factors with various designs. The aim of this study is to evaluate the known radiographic parameters of AKP and clinical outcomes (ie, AKP) in the setting of a modern prosthesis with an anatomic patella button. METHODS: Between July 2012 and December 2013, 90 total knee arthroplasties received 3 skyline views taken at 30°, 45°, and 60°. A patient-administered questionnaire was administered at 2-year follow-up to assess the incidence of AKP, painless noise, and satisfaction. Radiographs were analyzed for patellofemoral overstuffing, patellar tilt, and patellar displacement, and evaluated the patella resection angle. RESULTS: On the patient-administered questionnaire, 10 (11.1%) patients reported AKP of a mild-to-moderate nature. Thirty-one had the best view at 30 Merchant views, 24 had best views at 45, and 35 had best views at 60. We found that patellar resection angle correlated with AKP (odds ratio 1.21, P = .044) and painless noise (odds ratio 1.22, P = .034). Patellar displacement and patellofemoral stuffing did not correlate with AKP or painless noise. No radiographic measurements correlated with changes in Knee Society Score pain or function scores or range of motion. CONCLUSION: We found that a patellar resection angle correlated with the incidence of AKP and painless noise at 2-year follow-up. We failed to find any correlation with patellofemoral overstuffing, patellar displacement, or patellar tilt with clinical outcomes. We recommend the use of 3 Merchant views to fully evaluate the patellofemoral joint.
Assuntos
Artroplastia do Joelho/efeitos adversos , Articulação do Joelho/diagnóstico por imagem , Prótese do Joelho , Dor Pós-Operatória/etiologia , Patela/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Dor/cirurgia , Dor Pós-Operatória/diagnóstico por imagem , Patela/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Satisfação do Paciente , Desenho de Prótese , Radiografia , Amplitude de Movimento Articular , Inquéritos e Questionários , Resultado do TratamentoRESUMO
BACKGROUND: Total knee arthroplasty (TKA) for the majority of patients with severe knee osteoarthritis provides relief of symptoms and improved function. However, there remains a subset of dissatisfied patients despite an unremarkable workup. A corticosteroid injection (CSI) is a commonly used nonsurgical treatment for painful knee osteoarthritis but its efficacy in a replaced knee remains unknown. METHODS: A retrospective chart review identified primary TKA patients who subsequently received a CSI into a replaced knee from 2015 to 2016 by a single surgeon. Patients receiving a CSI underwent clinical examination, laboratory analysis to rule out infection, and radiographic evaluation before CSI. Patient variables were recorded and a patient satisfaction survey assessed the efficacy of the injection. The survey response rate was 70.1%. RESULTS: Of the 129 responders, 82.9% remembered the injection. The average time from index arthroplasty to injection was median 5.3 months (interquartile range, 2.1-23.4) and 30.8% of patients received more than 1 injection (range, 1-5). Overall, 76.6% reported decreased pain, 57.9% reported increased motion, and 65.4% reported long-term decreased swelling. Improvement lasted greater than 1 month for 56.1% of patients, and overall 84.1% reported improvement (slight to great) in the knee following CSI. No patient developed a periprosthetic joint infection (PJI) within 1 year of injection. CONCLUSION: This study suggests that certain patients following TKA may benefit from a CSI. However, this should only be performed once clinical, radiographic, and laboratory examination has ruled out conditions unlikely to improve long term from a CSI.
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Corticosteroides/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Idoso , Feminino , Humanos , Injeções Intra-Articulares/métodos , Injeções Intra-Articulares/estatística & dados numéricos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Dor/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Patients who develop acute kidney injury (AKI) have an increased risk for progression to chronic kidney disease, end-stage renal disease, and increased mortality. The outcomes of total knee arthroplasty (TKA) patients who develop AKI have remained controversial. The purpose of this review was to summarize and identify the current literature focused on 1) major risk factors, 2) short-term outcomes, and 3) costs associated with the development of perioperative AKI after TKA. MATERIALS AND METHODS: A literature search was performed using PubMed and Ovid to find literature relevant to AKI in TKA. All abstracts found via literature search were screened for relevancy to the study topics: (1) risk factors, (2) short-term outcomes, and (3) cost. RESULTS: A total of 447 abstracts were initially identified. Irrelevant abstracts and those not in English were excluded from the study (n=336). Forty-five papers focused on risk factors associated with AKI, six papers focused on short-term outcomes, and seven discussed cost savings. Increased body mass index, metabolic syndrome, perioperative antibiotics, antihypertensive medications, and antibiotic-impregnated cement spacers are amongst the many modifiable patient and drug-induced risk factors associated with AKI after TKA. Perioperative renal injury is associated with increased inpatient and long-term mortality with increased length of stay and extended care facility discharge. CONCLUSION: Increased length of stay and comorbidities have shown higher cost utilization and readmission rates. Inpatient and long-term complications and mortality are associated with postoperative AKI and a multidisciplinary perioperative approach is necessary to appropriately identify and, ultimately, prevent patients at higher risk for acute renal failure.