Extensor Mechanism Allograft Reconstruction for Extensor Mechanism Failure Following Total Knee Arthroplasty

Abstract

Extensor mechanism disruption following total knee arthroplasty is a difficult complication to treat, with modest outcomes. Extensor mechanism allograft reconstruction is a reasonable option; however, patients must be informed regarding the substantial risk of complications, and although initial extensor mechanism function may be restored, expectations regarding longer-term outcomes are more guarded.

High Failure Rates of Concomitant Periprosthetic Joint Infection and Extensor Mechanism Disruption

“…This is not inconsistent with the prior literature of the ten major papers on reconstruction of EMD. [7,8,10,12,[20][21][22][23] These papers report on a total of 196 patients and note that 12 were failures due to infection. Though treatment and outcomes were not always delineated in these studies, approximately half of these failures were noted to have had prior infection that had recurred and the other half appeared to have developed a first time infection as a result of the EMD.…”

“…However, the reoperation rate was high at 58% with the most common reason for reoperation being development of PJI at 26% . [12] Patients presenting with both chronic PJI and EMD pose a significant challenge.…”

“…functional limitations associated with arthrodesis have led many to attempt reconstruction/re-implantation in the hopes of maintaining greater function. [13,14] To date there is little data in the literature to guide surgeons and patients on the outcomes of patients that end up with both of these devastating complications [12]. We performed a multicenter study to evaluate the outcomes of patients that have concomitant PJI and EMD.…”

“…Overall 12 of the 53 patients (23%) had a successful reimplantation of their TKA, defined as presence of a functional and continuous extensor mechanism and no ongoing clinical evidence for PJI based on the defined criteria. The majority of those with a successful outcome (7 of 12) had prior EMD and repair/reconstruction and subsequently developed PJI (Group A) treated with a two-stage exchange reconstruction.These patients underwent an average of 3.5 surgeries (range 2-7) between diagnosis and last surgery.Forty-one of fifty-three patients (77%) were considered failures and averaged five intervening surgeries (range[1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The primary mode of failure was recurrence of infection in 80% of patients (33/41), 8 for failed extensor mechanism reconstruction (20%).…”

Revizyon diz artroplastisinde ekstansör mekanizma sorunları

“…[18] Tendon rüptürüne patellar parçalanmanın eşlik etmesi ve onarılamayacak kadar kötü kemik varlığı ya da herhangi bir nedenle tüm bu yöntemlerin uygulanamadığı durumlarda, Helito ve arkadaşları ile Brown ve arkadaşlarının önerdiği şekilde, ekstansör mekanizma allogrefti kullanılabilir. [19][20][21] Bahsedilen tedavi seçenekleri, patellar tendon rüptürlerinde tam restorasyonu genellikle sağlayamamaktadır. Bu noktada en iyi tedavinin, bu durumun önlenmesi olduğu unutulmamalıdır.…”