This was a multicenter, randomized, clinical trial to compare the 90-day 1) incidence of surgical site complications (SSC); 2) health care utilization (the number of dressing changes, readmission, and reoperation); and 3) the patient-reported outcomes (PRO) in high-risk patients undergoing revision total knee arthroplasty (rTKA) with postoperative closed incision negative pressure wound therapy (ciNPT) versus a standard of care (SOC) silver-impregnated occlusive dressing. A total of 294 rTKA patients (15 centers) at high-risk for wound complications were prospectively randomized to receive either SOC or ciNPT (n = 147 each). The ciNPT system was adjusted at 125 mmHg of suction. Investigated outcomes were assessed weekly up to 90 days after surgery. A preset interim analysis was conducted at 50% of the intended sample size, with planned discontinuation for clear efficacy/harm if a significance of Aim
Method
Two-stage revision arthroplasty for PJI may make use of an antibiotic-loaded cement spacer (ACS), as successful long- term prevention of reinfection have been reported using this technique.[i] However, there is little data on systemic complications of high-dose antibiotic spacers. Acute kidney injury (AKI) is of clinical significance, as the drugs most commonly utilized, vancomycin and aminoglycosides, can be nephrotoxic. We intended to determine the incidence of AKI in patients that underwent staged revision arthroplasty with an ACS, as well as to identify potential predisposing risk factors for the disease. Local databases of six different orthopaedic surgeons were retrospectively reviewed for insertion of either a static or articulating antibiotic cement spacer by from 2007–2017. Dose of antibiotic powder implanted, as well as IV antibiotic used, was collected from operative records. Demographics, comorbidities, and preoperative and postoperative creatinine and hemoglobin values were recorded from the EHR. AKI was defined by a more than 50% rise in serum creatinine from preoperative baseline to at least 1.4 mg/dL, as described by Menge et al.[ii] Variables were analyzed for the primary outcome of AKI within the same hospital stay as insertion of the ACS. Categorical variables were analyzed with Chi-Square test, and continuous variables with univariate logistic regression.INTRO
METHODS
High-dose antibiotic cement spacers are commonly used to treat prosthetic joint infections following knee arthroplasties. Several clinical studies have shown a high success rate with antibiotic cement spacers, however there is little data on the systemic complications of high-dose antibiotic spacers, particularly acute kidney injury (AKI). This study aims to determine the incidence of AKI and identify risk factors predisposing patients undergoing staged revision arthroplasty with antibiotic cement spacers. A single-institution, retrospective review was used to collect and analyze clinical and demographic data for patients who underwent staged revision total knee arthroplasty with placement of an antibiotic-impregnated cement spacer from 2006 to 2016. A search was made through specific procedure (DRG) and diagnostic (CD) codes. Baseline descriptive data were collected for all patients including age, sex, medical comorbidities, type and quantity of antibiotics used in the cement spacer, pre- and postoperative hemoglobin (Hg), BMI, smoking status, peak creatinine levels, and random vancomycin levels. Acute kidney injury was defined as a more than 50% rise in serum creatinine from a preoperative baseline within 90 days postoperatively.BACKGROUND
METHODS
Stiffness after total knee arthroplasty (TKA) has been reported to occur due to component malpositioning and/or oversizing, improper femoral component (FC) flexion and tibial component (TC) slope, tight extension gap, inaccurate joint line placement, deficient posterior osteophyte resection, heterotopic ossification (HO), poor patellofemoral joint reconstruction, poor posterior condylar offset restoration, and/or posterior cruciate ligament (PCL) under-resection or retraction. However, the importance of these potential factors for stiffness are not well documented in the medical literature. The aim of this study was therefore to evaluate specific radiographic parameters in patients who had stiffness after primary TKA. An IRB-approved retrospective chart review was performed to identify patients that were revised due to stiffness after TKA. We defined stiffness as 15º or more of flexion contraction, less than 75º of flexion or a range of motion (ROM) of 90º with the chief complaint of limited ROM and pain. Patients with history of previous revisions and/or ORIF, infection, or isolated polyethylene exchange were excluded. Patients with a minimum of 1 year radiographic follow-up were included. Radiographic measurements were performed as described by the Knee Society TKA Roentgenographic Evaluation System (KSRES). Two blinded observers performed all measurements. Descriptive data is reported as mean (range). Inter-observer correlations were reported using Intraclass correlations coefficient (ICC).Introduction
Material and Methods
A stiff total knee arthroplasty (TKA) is an uncommon but disabling problem because it causes pain and limited function. Revision surgery has been reported as a satisfactory treatment option for stiffness with modest benefits. The aim of this study was to evaluate the results of revision surgery for the treatment of stiffness after TKA. We defined stiffness as 15 degrees or more of flexion contracture or less than 75º of flexion or a range of motion of 90º or less presenting with a chief complain of limited range of motion and pain. We evaluated the results of forty-two revisions performed by one of four orthopedic surgeons due to stiffness after TKA. Patients with history of infection or isolated polyethylene insert exchange were excluded.Introduction
Methods
Symptomatic instability following total knee arthroplasty (TKA) is a leading cause of early failure. Despite numerous reports on instability, standardized diagnostic and treatment protocols for these patients continue to remain unclear. Most reports recommend component revision as the preferred treatment, because of poor outcomes and high failure rates associated with isolated tibial polyethylene insert exchange (ITPIE). However, modern implant systems and standardized protocols may potentially change this teaching. We performed an IRB-approved, retrospective review of 90 consecutive patients with minimum 2 years follow-up who underwent revision TKA for instability by one of four arthroplasty surgeons at a single institution. Mean age was 62.0 years (range, 41 to 83 years), and 73% of patients were women. Charts were reviewed for relevant preoperative clinical and physical exam findings, as well as pertinent intraoperative findings. Radiographs were analyzed for femoral and tibial component positioning. Pre- and post-operative Knee Society Scores (KSS) were calculated.Introduction
Methods
Smaller increments in the antero-posterior dimensions of femoral components allows significant improvements in balancing of the knee after TKA with restoration of more normal soft-tissue stability. The soft-tissue stability of the knee after TKA is often compromised by the fact that only a finite set of implantable component sizes is available to match bony anatomy. While this could be overcome with custom components, a more practical solution is a set of femoral components with smaller increments in the antero-posterior (AP) dimension. However, this results in a larger assortment of sizes of both implants and trial components. This study was performed to determine whether smaller increments in the AP sizing of knee prostheses would lead to real benefits in restoration of normal knee function and stability after TKA.Summary:
Introduction:
The purpose of this study was to determine the efficacy of a multi-modal blood conservation protocol that involved pre–operative autologous blood donations (2 units) in conjunction with erythropoietin supplementation as well as intra-operative conservation modalities. A retrospective chart review of 90 patients with simultaneous bilateral total knee arthroplasty done between 2006–2009 by one of the 3 senior authors was performed. Patients donated two units of blood 4 weeks prior to surgery and also received erythropoietin injections (40,000 units: 3 weeks, 2 weeks and 1 week prior to surgery). Intra- operative blood management included use of pneumatic tourniquet, re-infusion drains, local epinephrine injections and fibrin spray. Post-operatively, autologous transfusions were provided based on symptoms. Pre-donation blood levels, peri-operative hemoglobin and hematocrit levels along with transfusion records were assessed.Introduction
Methods
The new Knee Society Score has been developed and validated, in part, to characterize better the expectations, components of satisfaction, and the physical activities of the younger, more diverse modern population of TKA patients. This study aims to reveal patients' activity levels' post-TKA and to determine how it contributes to their subjective evaluation of the surgery. As part of a multi-centered and regionally diverse study sponsored by the Knee Society, the new Knee Society Score (KSS) was administered 243 patients (44% male; avg 66.4years; 56% female, avg 67.7years) following primary TKA (follow up > 1year, avg. 25mos). The new, validated KSS questionnaire consists of a traditional objective component, as well as subjective components inquiring into patient symptoms, satisfaction, expectations and activity levels as well as a survey of three physical activities that are viewed as important to the patients. Responses were analyzed as a whole group and as subgroups of male and female and as younger (<65) and older (>65).Introduction
Methods
