Clinical Survivorship of Aseptic Revision Total Knee Arthroplasty Using Hinged Knees and Tantalum Cones at Minimum 10-Year Follow-Up

Abdelaziz, Hussein; Jaramillo, Rodrigo; Gehrke, Thorsten; Ohlmeier, Malte; Citak, Mustafa

doi:10.1016/j.arth.2019.06.057

Cited by 54 publications

(29 citation statements)

References 13 publications

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“…30 However, our experience with the hinged design in complex reconstructions is encouraging. 31,32 Patient satisfaction and functional outcome scores were not investigated. Lastly, a selection bias exists for all repeat septic revision studies because patients who are deemed unfit for repeat septic revision (one-or two-stage) are not included.…”

Section: Discussionmentioning

confidence: 99%

High revision rates following repeat septic revision after failed one-stage exchange for periprosthetic joint infection in total knee arthroplasty

Neufeld

Liechti

Soto

et al. 2022

The Bone & Joint Journal

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Aims The outcome of repeat septic revision after a failed one-stage exchange for periprosthetic joint infection (PJI) in total knee arthroplasty (TKA) remains unknown. The aim of this study was to report the infection-free and all-cause revision-free survival of repeat septic revision after a failed one-stage exchange, and to determine whether the Musculoskeletal Infection Society (MSIS) stage is associated with subsequent infection-related failure. Methods We retrospectively reviewed all repeat septic revision TKAs which were undertaken after a failed one-stage exchange between 2004 and 2017. A total of 33 repeat septic revisions (29 one-stage and four two-stage) met the inclusion criteria. The mean follow-up from repeat septic revision was 68.2 months (8.0 months to 16.1 years). The proportion of patients who had a subsequent infection-related failure and all-cause revision was reported and Kaplan-Meier survival for these endpoints was determined. Patients were categorized according to the MSIS staging system, and the association with subsequent infection was analyzed. Results At the most recent follow-up, 17 repeat septic revisions (52%) had a subsequent infection-related failure and the five-year infection-free survival was 59% (95% confidence interval (CI) 39 to 74). A total of 19 underwent a subsequent all-cause revision (58%) and the five-year all-cause revision-free survival was 47% (95% CI 28 to 64). The most common indication for the first subsequent aseptic revision was loosening. The MSIS stage of the host status (p = 0.663) and limb status (p = 1.000) were not significantly associated with subsequent infection-related failure. Conclusion Repeat septic revision after a failed one-stage exchange TKA for PJI is associated with a high rate of subsequent infection-related failure and all-cause revision. Patients should be counselled appropriately to manage expectations. The host and limb status according to the MSIS staging system were not associated with subsequent infection-related failure. Cite this article: Bone Joint J 2022;104-B(3):386–393.

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Section: Discussionmentioning

confidence: 99%

High revision rates following repeat septic revision after failed one-stage exchange for periprosthetic joint infection in total knee arthroplasty

Neufeld

Liechti

Soto

et al. 2022

The Bone & Joint Journal

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“…Abdelaziz et al found 75% survivorship of tantalum cones at a minimum of 10-year follow-up when implanted in combination with a rotating hinged knee construct. 15 Erivan et al reported on their medium-term outcomes using trabecular metal tibial cones. They found a 100% 5-year survivorship free of revision for aseptic loosening and 93.4% for all-cause revision.…”

Section: The Key Is the Metaphysismentioning

confidence: 99%

Zonal Fixation in Revision TKA: The Key Is Metaphyseal Fixation

Scuderi²

2021

J Knee Surg

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As the volume of primary total knee arthroplasties continues to rise, so will the volume of revision arthroplasties. Bone loss is commonly encountered in revision surgery and must be managed appropriately to optimize outcomes. The concept of zonal fixation highlights the importance of attaining secure fixation within each of the three major osseous zones: the epiphysis, the metaphysis, and the diaphysis. While each zone is important, the metaphysis carries particular significance. The development of new implants such as metaphyseal cones and sleeves has greatly expanded the orthopedic surgeon's armamentarium to allow for solid metaphyseal fixation in virtually every case.

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“…Los defectos AORI 2B y 3 son su principal indicación y se han logrado resultados prometedores a mediano y largo plazo. [13][14][15][16][17][18][19][20][21] El objetivo de este estudio fue analizar la tasa de osteointegración del implante en una serie de pacientes a quienes se les colocaron conos de metal trabecular en la cirugía de revisión de prótesis total de rodilla. Como objetivo secundario, se analizaron los resultados funcionales, las tasas de complicaciones y reoperaciones.…”

Section: Introductionunclassified

Uso de conos de metal trabecular para defectos óseos severos en cirugía de revisión de reemplazo total de rodilla

García-Mansilla

Costantini

Nicolino

et al. 2021

Rev. Asoc. Arg. Ort. y Traumatol

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Introducción: Las alternativas reconstructivas para defectos óseos severos en la cirugía de revisión de prótesis son las camisas metafisarias, los conos de metal trabecular y el injerto óseo impactado o estructural. El objetivo del estudio fue analizar la tasa de osteointegración de los conos de metal trabecular en pacientes con cirugía de revisión de prótesis total de rodilla. El objetivo secundario fue analizar los resultados funcionales, las tasas de complicaciones y reoperaciones. Materiales y Métodos: Cohorte retrospectiva de pacientes con conos de metal trabecular colocados en la cirugía de revisión de prótesis y un seguimiento mínimo de 2 años. Se evaluaron las causas de la revisión, cirugías previas, tipo de defecto óseo, cantidad y tipo de conos utilizados, y los diseños de las prótesis. Se realizó una evaluación clínico-radiográfica, se registraron las complicaciones y las revisiones ulteriores. Resultados: Se evaluó a 35 pacientes (49 conos de metal trabecular) en forma retrospectiva, con un seguimiento promedio de 32.1 meses. La mayoría de los defectos eran tibiales AORI 3, seguidos de los femorales tipo 3. La tasa de osteointegración de los conos fue del 94%; la de complicaciones, del 20% y la de reoperaciones, del 8,5%. El KSS objetivo promedio aumentó de 39 en el preoperatorio a 71 en el último control y el puntaje de la EAV promedio fue 8 y 2,5, respectivamente. Conclusión: La excelente tasa de osteointegración (94%) y los buenos resultados clínicos posicionan a los conos de metal trabecular como una alternativa para los defectos óseos severos.

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Clinical Survivorship of Aseptic Revision Total Knee Arthroplasty Using Hinged Knees and Tantalum Cones at Minimum 10-Year Follow-Up

Cited by 54 publications

References 13 publications

High revision rates following repeat septic revision after failed one-stage exchange for periprosthetic joint infection in total knee arthroplasty

High revision rates following repeat septic revision after failed one-stage exchange for periprosthetic joint infection in total knee arthroplasty

Zonal Fixation in Revision TKA: The Key Is Metaphyseal Fixation

Uso de conos de metal trabecular para defectos óseos severos en cirugía de revisión de reemplazo total de rodilla

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