Complicated Cases of Knee Arthroplasty

Abstract

Experience in treatment of 190 patients (mean age 61 years) with marked (> 15°) knee deformity due to various pathology (idiopathic gonarthrosis, rheumatoid arthritis, posttraumatic gonarthrosis) is presented. In 19 cases revision interventions for aseptic instability of implant were performed. In all cases «Smith & Nephew» RT-PLUS system of either standard or modular modification was used. In 183 (96.3%) cases satisfactory results were noted: steady remission of chronic pain syndrome was achieved, limb axis, joint mobility and weight bearing ability were restored, conditions for early loading and mobilization were provided. All that promoted the improvement of patients’ life quality. Complications included 1 case of periprosthetic fracture, 5 cases of deep purulent inflammation 2 of which required implant removal with creation of arthrodesis in functionally favorable position, and 3 cases of arthrofibrosis. As a whole the achieved results enable to recommend the use of RT-PLUS system in complicated cases of arthroplasty.

Keywords

knee joint deformity / total ligamentous instability / revision surgery / pain syndrome

References

[1] Morrey B.F., Berry D.J. Kai-Nan An, Kitaoka H.B., Pagnano M.W., eds. Joint replacement arthroplasty: basic science, hip, knee and ankle. 4th ed. Lippincott Williams & Wilkins; 2011: 805-15.

[2] Kurtz S.M., Ong K.L., Schmier J., Zhao K., Mowart F., Lau E. Primary and revision arthroplasty surgery caseloads in the United States from 1990 to 2004. J. Arthroplasty. 2009; 24: 195-203.

[3] Lonner J.H., Booth R.E. Jr. Total knee arthroplasty in outliers. In: Barrack R.L., Booth R.E. Jr., Lonner J.H., McMarthy J.C., Mont M.A., Rubash H.E., eds. Orthopedic knowledge update: hip and knee reconstruction. 3rd ed. Rosemont, IL: American Academy of Orthopedic Surgeons; 2006: 111-21.

[4] Чрагян Г.А., Загородний Н.В., Нуждин В.И., Кудинов О.А., Бачиашвили В.М., Кузьмин Ф.А., Николаев И.А., Бухтин К.М. Опыт 500 тотальных эндопротезирований коленного сустава. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2012; 2: 40-7.

[5] Barrack R.L., Smith P., Munn B., Engh G., Rorabeck C. The Ranawat Award. Comparison of surgical approaches in total knee arthroplasty. Clin. Orthop. Relat. Res. 1988; 356: 16-21.

[6] Scott W.N., ed. Insall & Scott surgery of the knee. 5th ed. Elsevier. 2012: 1029-31; 1100-1107; 1207-1216.

[7] Bianchi G., Staals E.L., Donati В., Mercuri M. The use of unicondylar osteoarticular allografts in reconstructions around the knee. Knee. 2009; 16: 1-5.

[8] Cuckler J.M. Bone loss in total knee arthroplasty: graft augments and options. J. Arthroplasty 2004; 19 (4 Suppl 1): 56-8.

[9] Dorr L.D., Ranawat C.S., Sculco T.P., McKaskill B., Orisek B.S. Bone graft for tibial defects in total knee arthroplasty. Clin. Orthop. Relat. Res. 1986; 205: 153-65.

[10] Huff T.W., Scuico T.P. Management of bone loss in revision total knee arthroplasty. J. Arthroplasty. 2007; 22 (7): 32-6.

[11] Fehring T.K., Peindl R.D., Humble R.S., Harrow M.E., Frick S.L. Modular tibial augmentations in total knee arthroplasty. Clin. Orthop. Relat. Res. 1996; 327: 207-17.

[12] Engh G.A., Ammeen D.J. Uses of structual allograft in revision total knee arthoplasty in knees with sever tibial bone loss. J. Bone Joint Surg. Am. 2007; 89: 2640-7.

[13] Fehring T.K., Odum S., Griffin W.L., Mason J.B., Nadaud M. Early failures in total knee arthroplasty. Clin. Orthop. Relat. Res. 2001; 392: 315-8.

[14] Smith T.O., Sexton D., Mann C., Donell S. Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis. Br. Med. J. 2010; 340: c1199

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