TKA for Posttraumatic Osteoarthritis Is More Complex and Needs More Surgical Resources

Dexel, Julian; Beyer, Franziska; Lützner, Cornelia; Kleber, Christian; Lützner, Jörg

doi:10.3928/01477447-20160509-11

Cited by 16 publications

(11 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…J. Dexel et al demonstrated that patients with PTOA were significantly younger at the time of surgery than those with primary OA (62 vs. 71 years, p< 0.001). In addition, operative time was significantly longer for both of the PTOA group compared with primary OA (p<0.001) [6]. This study was similar to the previous study [6] to both ages when performed TKA (56.5 vs. 63.8 years, p<0.0001), including the [17] showed the improvement of knee score from 51 to 80 degrees and knee range of motion (ROM) from 87 to 105 degrees, preoperative and postoperative, respectively in TKA with the previous history of open reduction and internal fixation of fractures of the tibial plateau.…”

Section: Discussionmentioning

confidence: 96%

“…Malunion, malalignment, intra-articular osseous defects, retained internal fixation devices, and compromised soft tissues may affect the outcome of total knee replacement (TKR) [1]. On average, patients affected by posttraumatic OA were approximately 10 years younger than those affected by primary knee osteoarthritis of the knee (Primary knee OA) [5,6]. Additionally, tibial plateau fracture fixation, in older patients, is more likely to require TKR [7].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

TKR after posttraumatic and primary knee osteoarthritis: a comparative study

et al. 2021

View full text Add to dashboard Cite

Background A few literatures reported that the outcomes of total knee replacement (TKR) in posttraumatic osteoarthritis (PTOA) were lower compared to TKR in primary osteoarthritis (primary OA). The study’s purpose was to compare the comorbidity and outcome of TKR among fracture PTOA, ligamentous PTOA, and primary OA. The secondary aim was to identify the effect of postoperatively lower limb mechanical axis on an 8-year survivorship after TKR between PTOA and primary OA. Methods Seven hundred sixteen patients with primary OA, 32 patients with PTOA (knee fracture subgroup), and 104 PTOA (knee ligamentous injury subgroup) were recruited. Demography, comorbidities, Charlson Comorbidity Index (CCI), operative parameters, mechanical axis, functional outcome assessed by WOMAC, and complications were compared among the three groups. Results PTOA group was significantly younger (p<0.0001) with a higher proportion of men (p=0.001) while the primary OA group had higher comorbidities than the PTOA group, including anticoagulant usage (p=0.0002), ASA class ≥3 (p<0.0001), number of diseases ≥ 4 (p<0.0001), and CCI (p<0.0001). Both the fracture PTOA group (p<0.0001) and ligamentous PTOA group (p = 0.009) had a significantly longer operative time than the primary OA group. The fracture PTOA group had significantly lower pain components and stiffness components than the primary OA group. There was no significant difference in the rate of an aligned group, outlier group, and an 8-year survivorship in both groups. Conclusion The outcome following TKR in the fracture PTOA was poorer compared to primary knee OA in the midterm follow-up. However, no difference was detected between the ligamentous PTOA and primary knee OA. The mechanical axis alignment within the neutral axis did not affect the 8-year survivorship after TKR in both groups. Level of evidence Level III; retrospective cohort study

show abstract

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

TKR after posttraumatic and primary knee osteoarthritis: a comparative study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…However, implementation of a TKA in patients with PTOA and limb deformity is technically challenging. Extended operation time and implant systems with higher constraint and modular options are often required. Patients undergoing a TKA for PTOA often have increased rates of revision, postoperative infection, additional procedures, and complications compared with patients undergoing a TKA for primary osteoarthritis.…”

Section: Discussionmentioning

confidence: 99%

Medial Open‐wedge Osteotomy with Double‐plate Fixation for Varus Malunion of the Distal Femur

Wang

Sun

et al. 2019

Orthopaedic Surgery

View full text Add to dashboard Cite

Objective To present our clinical experience of treating varus malunion of the distal femur through a medial open‐wedge osteotomy with double‐plate fixation. Methods A prospective cohort study was performed. From January 2005 to February 2015, 15 consecutive patients with varus malunion following distal femur fractures were surgically treated at a single level I trauma center. The coronal and sagittal deformity were corrected by a medial open‐wedge osteotomy of the distal femur. A medial buttress plate was used to maintain the realignment. A lateral locking plate was additionally used as a protection plate. The mean age of patients at the time of the surgery was 35.5 years (range, 22–58 years). The radiographical evaluation included the mechanical femorotibial angle, the mechanical lateral distal femoral angle, the anatomic posterior distal femoral angle, and the leg length discrepancy. Clinical outcome evaluation consisted of the range of motion (ROM) and Hospital for Special Surgery (HSS) score. Results Mean follow‐up was 7.4 years (range, 4–11.5 years). Varus and flexion malalignment and limb discrepancy were adequately corrected in all patients. The mechanical femorotibial angle, the mechanical lateral distal femoral angle, and the anatomic posterior distal femoral angle were restored from 17.5° (range, 13°–25°) to 2.3° (range, − 2°–7°), 102.3° (range, 95°–112°) to 85.2° (range, 81°–92°), and 77.1° (range, 65°–87°) to 82.7° (range, 76°–88°), respectively. The leg length discrepancy was diminished from 3.4 cm (range, 2.4–4.5 cm) to 0.8 cm (range, 0–1.7 cm). The average bone healing time was 4.1 months (range, 2.5–6 months). The average ROM of the affected knees at 24‐month follow‐up was 3.4°–112.55°. The score of HSS at 4‐years follow‐up was 76.1 (range, 64–88). No internal fixation failure or secondary operation was noted until the last follow‐up. Conclusion Medial open‐wedge osteotomy can adequately correct the posttraumatic varus malunion of the distal femur. With fixation of the double plate, non‐displaced bone healing and good functional outcome are expected.

show abstract

“…Traumatic injuries of the joint-related soft tissue, intra-articular fractures and direct cartilage impact were found to represent a crucial initiator of PTOA pathogenesis. Studies have been shown that patients suffering from PTOA are predominantly active in sports and considerably younger than the average OA patients [80,81]. Due to the mechanical impact, the ECM and embedded chondrocytes are exposed to a supraphysiological compression, causing immediate necrosis of cells [82,83].…”

Section: Pathogenesis Of Posttraumatic Osteoarthritis: Inflammation mentioning

confidence: 99%

“…Due to the still limited lifespan of the prosthetic devices and an increased risk for a revision surgery in younger patients [167], arthroplasty is often not appropriate for PTOA patients, which have an approximately 10-year earlier need for joint replacement as compared to other OA patients [80], emphasizing the urgent need for novel treatment strategies. Despite of the growing trend in regenerative medicine, including cell-based approaches, such as autologous-chondrocyte implantation (ACI) [168], injections of MSC or MCS-derived exosomes [169,170], as well as tissue engineering, combining cells, biomimetic matrices and bioactive components [171][172][173][174], this review will primarily focus on current pharmacological approaches allowing modulation of chondrocyte's behavior and fate.…”

Section: General Therapeutic Approaches In Oamentioning

confidence: 99%

Pathomechanisms of Posttraumatic Osteoarthritis: Chondrocyte Behavior and Fate in a Precarious Environment

Riegger

2020

IJMS

View full text Add to dashboard Cite

Traumatic injuries of the knee joint result in a wide variety of pathomechanisms, which contribute to the development of so-called posttraumatic osteoarthritis (PTOA). These pathogenetic processes include oxidative stress, excessive expression of catabolic enzymes, release of damage-associated molecular patterns (DAMPs), and synovial inflammation. The present review focuses on the underlying pathomechanisms of PTOA and in particular the behavior and fate of the surviving chondrocytes, comprising chondrocyte metabolism, regulated cell death, and phenotypical changes comprising hypertrophy and senescence. Moreover, possible therapeutic strategies, such as chondroanabolic stimulation, anti-oxidative and anti-inflammatory treatment, as well as novel therapeutic targets are discussed.

show abstract

TKA for Posttraumatic Osteoarthritis Is More Complex and Needs More Surgical Resources

Cited by 16 publications

References 29 publications

TKR after posttraumatic and primary knee osteoarthritis: a comparative study

TKR after posttraumatic and primary knee osteoarthritis: a comparative study

Medial Open‐wedge Osteotomy with Double‐plate Fixation for Varus Malunion of the Distal Femur

Pathomechanisms of Posttraumatic Osteoarthritis: Chondrocyte Behavior and Fate in a Precarious Environment

Contact Info

Product

Resources

About