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Kelly G Vince

Publications and source records attributed to Kelly G Vince.

11 recordsLinked to original sources
PubMed2006

The unstable total knee arthroplasty: causes and cures.

Surgery for the unstable total knee arthroplasty requires a deep understanding of the causes and a plan that specifically addresses them. Isolated ligament reconstructions and polyethylene insert exchanges generally do not work. Patients may experience "buckling" from pain, flexion contracture, recurvatum, or patellar problems. True mechanical instability may result from loosening, bone loss, prosthetic breakage, component size or position, fracture, wear, or collateral ligament failure. Only the last one typically requires a constrained implant. The possible modes (directions) of instability are the following: varus-valgus, recurvatum, flexion, and global. Revision surgery must eliminate deforming forces, most frequently frontal plane alignment. Prosthetic implants, no matter how well engineered, are not a substitute for diagnosis and surgical technique.

Arthroplasty, Replacement, Knee↗
PubMed2006

What would you do? Case challenges in knee surgery.

Six cases representing a variety of orthopedic issues were presented to a panel of senior surgeons. These included the following: (1) developmental patella baja with degenerative arthritis, (2) high valgus knee with attenuated medial collateral ligament, (3) degenerative arthritis with near-ankylosis, (4) depressed tibial plateau fracture with degenerative arthritis, (5) degenerative arthritis with laterally dislocating patella, and (6) degenerative arthritis with distal femoral malunion.

Aged↗
PubMed2006

Wound problems in total knee arthroplasty.

Wound problems can often be prevented with careful planning. When transverse incisions are used for knee surgery many years prior to any anticipated knee arthroplasty, no major problems are typically encountered with a conventional, anterior longitudinal incision. We recommend lateral incisions (eg, after a previous lateral tibial plateau fracture) be reused for TKA. When confronted with multiple previous incisions, surgeons would best use the most recently healed or the most lateral. We prefer soft tissue reconstruction with expanders or a gastrocnemius flap if there are multiple incisions, if the skin and scar tissue are adherent to underlying tissue, or if wound healing seems questionable. Deep infection must be determined by aspiration. When present, we believe treatment must include irrigation, débridement, polyethylene exchange if acute, and resection arthroplasty if chronic. Poor wound healing is a potentially devastating complication that may result in multiple reconstructive procedures and even amputation. Early recognition followed by expeditious débridement and soft tissue reconstruction should be used for managing wound complications after TKA.

Arthroplasty, Replacement, Knee↗
PubMed2005

Periprosthetic fractures after total knee arthroplasty.

Fractures around total knee arthroplasties are challenging clinical problems and include the following: stress fractures of the pelvis and femoral neck, supracondylar femur fractures, fractures of the proximal tibial metaphysis and diaphysis, and patellar fractures. Treatment focuses on restoration of the patient's prefracture functional status. The etiology of supracondylar femur fractures is multifactorial and treatment includes immobilization, retrograde intramedullary nailing, open reduction and internal fixation, and revision arthroplasty. The "Less Invasive Stabilization System" plate has recently been added to the list of viable fixation options. Tibial metaphyseal and diaphyseal fractures are less common and usually treated with revision arthroplasty. In the absence of maltracking or component loosening, vertical patellar fractures often respond to immobilization. Disruption of the extensor mechanism may require cerclage wiring or even extensor mechanism allografting if chronic. Conventional tension band wiring usually fails. Patellar fractures are controversial and problematic.

Arthroplasty, Replacement, Knee↗
PubMed2005

What would you do? Case challenges in knee surgery.

These knee arthroplasty cases were presented to a panel of surgeon and they represent classic clinical problems: (1) indications for unicompartmental arthroplasty; (2) total knee arthroplasty after a high tibial osteotomy complicated by infection and extensor mechanism rupture; (3) neuropathic arthropathy; (4) posttraumatic osteoarthritis with extraarticular deformity; (5) degenerative arthritis in the young patient; (6) osteoarthritis with a valgus deformity, fixed flexion contracture, degenerative scoliosis, and leg length discrepancy.

Adult↗
PubMed2004

Unicompartmental knee arthroplasty: new indications, more complications?

Despite mixed results with unicompartmental knee arthroplasty (UKA) in the 1970s, the UKA was established as a reliable procedure in the low-demand, elderly patient. Dependable results up to a decade prompted the idea that UKA may work equally well in the younger patient. Expanded indications for UKA are being evaluated: might higher failure rates and difficult revisions emerge from younger, more active patients?

Adult↗
PubMed2003

Late infection of a total knee arthroplasty with Streptococcus bovis in association with carcinoma of the large intestine.

Infection of a total knee arthroplasty with Streptococcus bovis in a 76-year-old man that led to the diagnosis of a bowel carcinoma is reported. Investigation revealed a malignancy in the ascending colon with extension into the adrenal gland. S bovis in conjunction with colonic neoplasia has been reported in several orthopedic conditions: vertebral osteomyelitis, discitis, lateral neck abscess, and osteomyelitis of the ileum. The relationship of S bovis to endocarditis, meningitis, brain abscesses, and peritonitis has also been well described. However, S bovis is a rare pathogen infecting joint prostheses and should raise the possibility of a gastrointestinal lesion.

Adenocarcinoma, Clear Cell↗
PubMed2003

Why knees fail.

Successful revision knee arthroplasty requires an accurate understanding of the cause of failure. Because a differential diagnosis is necessary, 9 causes of failure are proposed: i) aseptic loosening with or without osteolysis or progression of arthritis in a unicondylar arthroplasty; ii) tibial femoral instability because of collateral ligament instability; iii) patellar complications and malrotation; iv) no diagnosis, the so-called mystery knee; v) structural failure of the implant; vi) sepsis; vii) extensor mechanism rupture; viii) stiffness; and ix) fracture. A revision surgery should correct shortcomings in the original arthroplasty and not simply restore a mechanical situation that has failed.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

The unstable patella after total knee arthroplasty: etiology, prevention, and management.

In total knee arthroplasty, most complications related to the extensor mechanism are caused by patellar maltracking or instability. Patellar maltracking may result from component malpositioning and limb malalignment, prosthetic design, improper patellar preparation, or soft-tissue imbalance. Patellofemoral instability likely results most frequently from internal malrotation of the femoral or tibial components. Although a patellofemoral radiograph may display the lateral subluxation of the patella, only computed tomography can quantify rotational malalignment of the femoral or tibial component. Nonsurgical treatment is generally unsuccessful; major malposition of components is best managed by implant revision. In the absence of component malposition, proximal realignments (lateral patellar retinacular release with lateral advancement of the vastus medialis obliquus muscle) or tibial tubercle transfers have been used. Surgical procedures on the patellar tendon itself may risk rupture of the extensor mechanism.

Arthroplasty, Replacement, Knee↗