Increased Risk of Revision, Reoperation, and Implant Constraint in TKA After Multiligament Knee Surgery

Pancio, Steven I.; Sousa, Paul L.; Krych, Aaron J.; Abdel, Matthew P.; Levy, Bruce A.; Dahm, Diane L.; Stuart, Michael J.

doi:10.1007/s11999-017-5230-z

Cited by 27 publications

(25 citation statements)

References 56 publications

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“…When multi-LKS are examined, Pancio et al showed a significantly higher risk of infection and reoperation. 12 They suggested that retained hardware, poor soft tissue quality and increase surgical dissection accounted for these differences. This may necessitate the need for staged hardware removal prior to TKA.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have shown similar findings. 7,[10][11][12] This included range of motion at latest follow-up, although notably this was assessed following manipulation under anesthesia and arthroscopic lysis of adhesions, without which there may have been a significant difference. In addition, studies have shown that patients undergoing TKA with prior LKS are younger, 7,8 which may be associated with more motivation and ability to achieve better motion following rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…11 Another study of TKA following previous multi-LKS (!two ligaments) showed that 15% of patients required increased varus-valgus constraint, compared with none if there was no such prior surgery. 12 Furthermore, operative times have also shown to be prolonged in these patients. 10 Previous studies, although limited, have shown that prior LKS surgery potentially increases TKA complications and failure; however, the data remains conflicted.…”

mentioning

confidence: 98%

“…11 To date, no studies have found differences in range of motion or outcome scores in patients undergoing TKA with and without prior ACL reconstruction. 7,8,10,12 When considering prior multi-LKS, a study of 59 TKA patients found higher complications (infection and reoperation) and lower long-term survival compared with matched controls at 15 years' follow-up (42 vs. 94%, p < 0.001). 12 The primary objective of this study was to evaluate the outcomes of TKA in patients with prior LKS.…”

mentioning

confidence: 99%

“…7,8,10,12 When considering prior multi-LKS, a study of 59 TKA patients found higher complications (infection and reoperation) and lower long-term survival compared with matched controls at 15 years' follow-up (42 vs. 94%, p < 0.001). 12 The primary objective of this study was to evaluate the outcomes of TKA in patients with prior LKS. The secondary objective was to evaluate the timing, operative details, hardware management, and implants used.…”

mentioning

confidence: 99%

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Knee Arthroplasty with Prior Ligamentous Knee Surgery: A Matched Case–Control Study

et al. 2020

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We aimed to evaluate the timing, operative details, and outcomes of total knee arthroplasty (TKA) in patients with prior ligamentous knee surgery (LKS). All consecutive patients undergoing TKA with prior LKS at a single institution were identified from a large prospectively collected database. Patients were matched on a 2:1 basis according to age, sex, and body mass index to a group of patients without previous LKS undergoing primary TKA. A total of 39 patients with prior LKS and a mean age of 55.6 years (range: 42.8–76.4) were identified and matched with 78 patients without LKS with a mean age of 57.6 years (range: 44.0–79.4) undergoing primary TKA (p = 0.24). Significantly more posterior stabilized implants were used in patients with LKS compared with control patients (29 [74.3%] vs. 27 [34.6%], p < 0.001). In the LKS group, 15 patients (38.4%) required hardware removal. Postoperative complications and rate of further surgery were greater in the LCS group, but the difference was not significant (10.6 vs. 6.4%, p = 0.25). Mean difference in pre- to postoperative knee flexion and clinical outcome scores (12-item Short Form Survey, International Knee Documentation Committee, and Oxford Knee Score) were similar between the two groups, with no cases of loosening or osteolysis. TKA with prior LKS often warranted hardware removal and generally more constrained implants. Those patients with prior LKS undergoing subsequent TKA have higher complication rates and an increased rate of subsequent surgery related to post-TKA stiffness.

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Section: Discussionmentioning

confidence: 99%