Two-stage Conversion of Fused Knee to Total Knee Arthroplasty

Cho, Se Hyun; Jeong, Soon Taek; Park, Hyung Bin; Hwang, Sun Chul; Kim, Dong Hee

doi:10.1016/j.arth.2007.06.013

Cited by 22 publications

(12 citation statements)

References 9 publications

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“…No problems with wound dehiscence or skin sloughing were seen and they stated that the extensor mechanism might have been better mobilised due to using the expanders aiding for excellent ROM. This was confirmed in the study carried out by Cho et al [6]. Adequate exposure can also be difficult as the patella is often fused to the femur requiring an osteotomy; in addition, a tibial tubercle osteotomy is often necessary.…”

Section: Discussionmentioning

confidence: 72%

“…With knees in fixed extension, a posterior cruciate ligament (PCL) sacrificing design should be anticipated in order to allow release of the PCL and maximise the flexion potential. It has been advocated to use a constrained prosthesis to substitute for absent or deficient collateral ligaments [6,7]. In case of collateral ligament instability, care should be taken not to use polyethylene thicker than 18 mm, as this has been shown to elevate the joint line, increase patellar instability and to complicate skin closure [4].…”

Section: Discussionmentioning

confidence: 99%

“…Conversion of the AD to a total knee arthroplasty (TKA) is an option for patients with AD. The conversion of a fused knee to a TKA is not only a challenging surgical procedure [3] but it is also associated with a high incidence of complications [2,[4][5][6][7]. Sufficient soft tissue and an intact extensor mechanism are important factors in achieving good clinical results of a conversion.…”

Section: Introductionmentioning

confidence: 99%

“…Some authors advocate the procedure [5,6,[9][10][11], while others have expressed concern over its efficacy in the presence of the high complication rate [1,2,7,12]. Thus, a systematic review and meta-analyses of the current literature was done, to examine the role of TKA after AD of the knee and assess the clinical outcome, complications, surgical technique, patientrelated outcome measures and methodological quality.…”

Section: Introductionmentioning

confidence: 99%

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Conversion from knee arthrodesis to arthroplasty: systematic review

Kernkamp

Verra

Pijls

et al. 2016

International Orthopaedics (SICOT)

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Purpose Arthrodesis (AD) of the knee reduces pain and provides stability, but has severe functional and social limitations. There has been ample discussion on the value of a conversion of an AD to a total knee arthroplasty (TKA). The aim of this study was to perform a review and meta-analysis of the current literature on conversion of an AD to TKA and assess clinical outcome, complication rate, surgical technique and overall patient-related outcome measures. Methods PubMed, Embase, Web of Science, Cochrane, CENTRAL, CINAHL, Academic Search Premier, ScienceDirect and searching by hand for papers on conversion of AD of the knee to TKA. Two reviewers independently reviewed all titles and abstracts, and extracted the available data. Study eligibility criteria were: conversion of knee AD to TKA, five cases or more and non-oncology patients. Data consisted of study characteristics, patient demographics, clinical outcome and complications. Additionally, details on surgical technique were reviewed. Results Of the 866 unique references identified, six papers were included for further analyses, comprising a total of 123 knees with conversion of AD of the knee to TKA. Mean gain of knee flexion was 80 degrees and the mean HSS score improved with 20 points. A complicated postoperative course was found in 65 % of all cases. The most frequent complication was skin necrosis (25 %), followed by arthrofibrosis (13 %), infection (11 %) and revision (11 %). Major complications such as refusion, amputation and death occurred in less than 5 % of all cases. Discussion The majority of the papers consisted of small case series of moderate methodological quality, resulting in 123 included knees. Further series are necessary to draw definitive conclusions. Conclusions This is the first systematic review and metaanalysis on conversion of a knee arthrodesis to TKA. Good clinical results can be expected after conversion, albeit at a high risk of postoperative complications.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Conversion from knee arthrodesis to arthroplasty: systematic review

Kernkamp

Verra

Pijls

et al. 2016

International Orthopaedics (SICOT)

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“…Hence, trials of two-staged approach have been implemented using a soft tissue expander in the first stage to enhance soft tissue flexibility and excursion. This was followed by conversion of the arthrodesis to arthroplasty using a fully constrained rotating hinge knee and a final range of movement of 95 degrees in flexion has been reported [98]. Kim et al .…”

Section: Secondary Proceduresmentioning

confidence: 99%

Salvage Procedures for Management of Prosthetic Joint Infection After Hip and Knee Replacements

Mahmoud¹,

Sukeik²,

Alazzawi³

et al. 2016

TOORTHJ

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Background:The increasing load placed by joint replacement surgery on health care systems makes infection, even with the lowest rates, a serious concern that needs to be thoroughly studied and addressed using all possible measures.Methods:A comprehensive review of the current literature on salvage procedures for recurrent PJIs using PubMed, EMBASE and CINAHL has been conducted.Results:Prolonged suppressive antibiotic therapy (PSAT), resection arthroplasty and arthrodesis were the most common procedures performed. Suppressive antibiotic therapy is based on the use of well tolerated long term antibiotics in controlling sensitive organisms. Resection arthroplasty which should be reserved as a last resort provided more predictable outcomes in the hip whereas arthrodesis was associated with better outcomes in the knee. Various methods for arthrodesis including internal and external fixation have been described.Conclusion:Despite good union and infection control rates, all methods were associated with complications occasionally requiring further surgical interventions.

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