The Super Obese Knee

Tria, Alfred J.; Papas, Paraskevi Vivian; Cushner, Fred D.; Wong, Jeffrey J.; Geller, Jeffrey A.

doi:10.1007/978-3-319-69380-4_6

Cited by 5 publications

(17 citation statements)

References 45 publications

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“…FFD must be corrected to full extension at the time of surgery (21). In many circumstances, the magnitude of the flexion deformity will reduce with the induction of anesthesia intraoperatively (22). Initially the surgeon must decide which surgical technique will be utilized.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…establishment of the posterior knee recess (4,5,22,24,26). A curved osteotome and curettes may be used to remove posterior osteophytes with the knee positioned in flexion (Figure 3).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…The tight soft tissues need to be appropriately released in stepwise fashion and balanced to achieve optional range of motion. It is recommended to correct the knee to full extension at the time of surgery because residual flexion contractures will not improve over time postoperatively (21,22). Moderate or grade II FFD are managed in a similar manner as described for grade I deformities (4).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Additionally, a posterior capsulotomy may be performed. At that point electrocautery or a scalpel may be used to pie crust or perform a transverse release in the posterior capsule until the appropriate tension is achieved (22).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Aggressive physical therapy programs must ensure that full extension is maintained. Dynamic splinting and braces may be utilized (16,21,22). It is important to have postoperative protocols in place to combat residual flexion contractures (6).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Correction of Sagittal Deformity with Bone Resection and Soft Tissue Releases

Stephens

Lombardi

2023

J Knee Surg

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Fixed flexion deformities (FFD) present several unique challenges in total knee arthroplasty (TKA) and require careful consideration to achieve optimal outcomes. FFD alters normal knee biomechanics and increases energy expenditure (1). They may be attributed to both bony deformities and fibrosed soft tissues, which must be addressed in stepwise fashion at the time of surgery. A literature review was conducted utilizing key words “fixed flexion deformity TKA”. This review article aims to discuss the anatomy and pathology, preoperative evaluation, classification system, surgical techniques for addressing deformity, implant selection considerations, postoperative protocols, clinical outcomes, and potential complications associated with correcting FFD. By comprehensively addressing these aspects, surgeons can optimize surgical planning and improve outcomes in patients with FFD undergoing TKA.

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Section: Accepted Manuscriptmentioning

confidence: 99%

“…establishment of the posterior knee recess (4,5,22,24,26). A curved osteotome and curettes may be used to remove posterior osteophytes with the knee positioned in flexion (Figure 3).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

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Correction of Sagittal Deformity with Bone Resection and Soft Tissue Releases

Stephens

Lombardi

2023

J Knee Surg

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The Role of Poly(Methyl Methacrylate) in Management of Bone Loss and Infection in Revision Total Knee Arthroplasty: A Review

Hasandoost¹,

Rodríguez²,

Alhalawani³

et al. 2024

Preprint

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Poly(methyl methacrylate) (PMMA) is widely used in joint arthroplasty to secure an implant to the host bone. Complications including fracture, bone loss and infection might cause failure of total knee arthroplasty (TKA), resulting in the need for revision total knee arthroplasty (rTKA). The goals of this paper are: (1) to identify the most common complications, outside of sepsis, arising from the application of PMMA following rTKA, (2) to discuss the current applications and drawbacks of employing PMMA in managing bone loss, (3) to review the role of PMMA in addressing bone infection following complications in rTKA. Papers published between 1970 to 2018 have been considered through searching in Springer, Google Scholar, IEEE Xplore, Engineering village, PubMed and weblinks. This review considers the use of PMMA as both a bone void filler and as a spacer material in two-stage revision. To manage bone loss, PMMA is widely used to fill peripheral bone defects whose depth is less than 5 mm and covers less than 50% of the bone surface. Treatment of bone infections with PMMA is mainly for two-stage rTKA where antibiotic-loaded PMMA is inserted as a spacer. This review also shows that using antibiotic-loaded PMMA might cause complications such as toxicity to surrounding tissue, incomplete antibiotic agent release from the PMMA, roughness and bacterial colonization on the surface of PMMA. Although PMMA is the only commercial bone cement used in rTKA, there are concerns associated with using PMMA following rTKA. More research and clinical studies are needed to address these complications.

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Modification of Glass Poly(alkenoate) Cement for Revision Total Knee Arthroplasty

Hasandoost

2023

Preprint

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Poly(methyl methacrylate) (PMMA) bone cement is employed as a void filler in revision total knee arthroplasty (rTKA). The first phase of this thesis investigates the role of PMMA in managing bone loss and infection in rTKA. Treating bone defects with PMMA can result in complications such as bone necrosis and implant loosening. Additionally, toxicity, roughness, and bacterial colonization on PMMA surface were identified as some complications of using antibiotic-impregnated PMMA spacers in rTKA. These concerns are driving the development of alternative bone cements. The second phase of this thesis relates to the modification of glass polyalkenoate cement (GPC) for use in rTKA. Modified GPCs (mGPCs) based on the glass system SiO2-ZnO2CaO-SrO-P2O5-X TA2O5 containing 1, 5, and 15 wt.% calcium sulfate (CaSO4) were characterized. Working and setting times, scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS), Fourier transform infrared spectroscopy (FTIR), pH, ion release, compressive strength and biaxial flexural strength (BFS) of each composition were assessed. The mGPCs were found to have a shorter setting time, higher initial compressive strength, and ion release than the control GPC (naive of CaSO4). Moreover, CaSO4 addition led to the formation of pores on the surface of GPC which can increase osseointegration. In the next phase, the in vivo properties of two GPCs (GPCA and GPCB) were evaluated using three sheep. After comparing handling, compressive strength, ion release and cytotoxicity results of each GPC formulation, three sets of GPCA samples were used for implantation. Clinical CT scans and Micro-CT images obtained at 0, 6 and 12 weeks revealed the varied radiological responses of sheep bone to GPCA. Excessive Zn2+ ion release and low pH were identified as possible causes of the resorption surrounding some GPCA implants. Further investigation on modifying GPC formulations with the focus on reducing the rate of Zn2+ release and pH is required.

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The Super Obese Knee

Cited by 5 publications

References 45 publications

Correction of Sagittal Deformity with Bone Resection and Soft Tissue Releases

Correction of Sagittal Deformity with Bone Resection and Soft Tissue Releases

The Role of Poly(Methyl Methacrylate) in Management of Bone Loss and Infection in Revision Total Knee Arthroplasty: A Review

Modification of Glass Poly(alkenoate) Cement for Revision Total Knee Arthroplasty

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