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PubMed2001

Paratibial cyst associated with wear debris after total knee arthroplasty.

We present a case in which a synovial cyst arose from the proximal tibia and expanded in the calf of a patient after total knee arthroplasty. A cystogram showed a direct communication between the joint cavity and the cyst, apparently associated with a screw that penetrated the tibial cortex. Histologic examination of the cyst showed an inflammatory reaction, including macrophages, foreign body giant cells, and metal and polyethylene particles. To our knowledge, this is the first case report illustrating a paraosseous cyst that developed after total knee arthroplasty. Wear debris from the total knee prosthesis may have been responsible for this unusual cyst.

Arthroplasty, Replacement, Knee↗
PubMed1992

The Attenborough and Gallannaugh knee prostheses for total knee arthroplasty. A comparison and survival analysis.

The characteristic feature of the Attenborough knee prosthesis was a stabilizing link rod, designed to act in place of the cruciate ligaments and to supplement the function of the collateral ligaments when damaged by disease. However, the reported long-term results obtained with this prosthesis have not been satisfactory, and survival analysis of 505 arthroplasties in which this prosthesis was used demonstrates a cumulative 14-year success rate of only 44.9%. In 1982, a new design incorporating the link rod was developed and the results of 149 knees in which this prosthesis was used show a cumulative seven-year success rate of 98.4%, compared with 70.1% in the Attenborough series. The clinical results of the Gallannaugh series are presented in this study. Knee function has been separated from patient activity, the patients being categorized in groups according to their physical state. Thus, the result of the knee operation can be assessed even in those disabled by age and infirmity. The Gallannaugh prosthesis is of particular value in circumstances where the use of an unconstrained prosthesis would be impractical.

Aged↗
PubMed1996

Quantifying the kinematics of natural and prosthetic knee flexion.

A new method has been developed for quantifying knee kinematics during flexion. This method was used to measure knee kinematics from lateral radiographs taken at different angles of flexion with the two femoral condyles superimposed in each image, thus standardizing the plane of flexion-extension. When applied to the radiogaphs of five healthy male volunteers (age range 21-26 years), it showed that flexion was accompanied by translation between the articular surfaces. Knee kinematics were also measured in five patients after total knee replacement (TKR) surgery with a Kinemax Modular Total Knee prosthesis (Howmedica, Warsaw, Indiana). In the TKR patients, a translation was detected in three out of the five patients. This indicates that the prosthesis is capable of restoring normal kinematics, but does not always do so.

Adult↗
PubMed1991

[Single-compartment arthroplasty of the knee using the Marmor-Cartier method. Apropos of a series of 100 cases].

100 unicompartmental knee prosthesis type Marmor-Cartier with 86 replacements of the medial compartment have been followed for a period of 5 to 15 years. Contrary to the reaxation osteotomies, a moderate hypocorrection about 3 to 5 degrees has to be respected in unicompartmental knee replacement. The two major complications are degradation of the contralateral compartment due to hypercorrection; and loosening of the tibial plateau due to hypocorrection over 5 degrees or anterior laxity or convex side laxity or misalignment of the prosthetic device. The unicompartmental knee arthroplasty is a trustful surgical procedure as long as precise indications for this method and a rigorous surgical technique are respected.

Adult↗
PubMed1997

Management of infected total knee arthroplasty.

BACKGROUND: Deep wound infection after total knee arthroplasty is an infrequent but very serious complication. Treatment is difficult and challenging. Antibiotic therapy alone can not replace surgery in the management of infected total knee arthroplasty. METHODS: Fourteen infected total knee arthroplasties in 13 patients were treated by the author. Nine patients underwent two-stage reimplantation, one patient one-stage reimplantation, one patient arthroscopic debridement, and one patient knee fusion. Four knees in three patients were excluded because of less than 12 months follow-up. This study retrospectively analyzed the results of treatment in 10 infected total knee arthroplasties in 10 patients. RESULTS: All patients were followed up for 12 months or longer. The length of follow-up ranged from 12 months to 69 months with an average of 28 months. All infections were successfully controlled, and there was no recurrence of infection. However, only 67% of the patients showed satisfactory functional results. CONCLUSION: Based upon the results in this study, most of the infection after total knee arthroplasty could be successfully controlled by combined surgical treatment and intravenous antibiotic therapy. The result of two-stage reimplantation was more consistent and predictable. The functional result of infected total knee arthroplasty was less satisfactory as compared with that of the non-infected counterpart. Furthermore, the impact of infection or the longevity of total knee prosthesis could only be determined by long-term follow-up.

Aged↗
PubMed2002

[Validation of an experimental protocol of an optoelectronic analysis of continuous active knee kinematics in vitro].

PURPOSE OF THE STUDY: In vitro experiments are particularly useful for studying kinematic changes in the normal knee exposed to experimental conditions simulating different disease states. We developed an experimental protocol allowing a kinematic analysis of the femorotibial and femoropatellar joints in healthy knees and after implantation of a knee prosthesis, using a central pivot to simulate active loaded movement from the standing to sitting position. EXPERIMENTAL SETUP: An experimental device was designed to apply force to the femur of a cadaveric specimen including the femur, the patella and the tibia. The tibia was angled in the sagittal plane and the femur was free to move in space in response to the geometric movement of the knee joint, the capsuloligamentary structures, the quadriceps tendon and gravity. Variation in the length of the quadriceps tendon controlled the flexion-extension movement. The experimental setup included computer-controlled activation allowing continuous coordinated movement of the femur relative to the tibia and of the tibia relative to the ground. Standard activations simulated movement from the standing to the sitting position. STUDY PROTOCOL: Five pairs of fresh-frozen cadaver specimens including the entire femur, patella, tibia and fibula, the capsuloligamentary and intra-articular structures of the knee, the superior and inferior tibiofibular ligaments and the quadriceps tendon were studied. The quadriceps tendon was connected to the computer-guided activation device. Reflectors were fixed onto the anterior aspect of the femur, the superior tibial epiphysis and the center of the patella. Anatomic landmarks on the femur, the tibia, and the patella were identified to determine the plane of movement of each bone in the three rotation axes and the three translation directions. Three infrared cameras recorded movements of the reflectors fixed on the bony segments and, by mathematical transformation, the movement of the corresponding bony segment, displayed in time-course curves. RESULTS: The precision of the measurements, evaluated in a previous study, was +/- 1.5 degrees for rotation and +/- 0.5 mm for translation movements. Three acquisitions were made for each experiment and produced results differing less than one degree. A qualitative analysis of femorotibial and femoropatellar kinematics was achieved for the normal knee. The automatic internal rotation of the femur during flexion was observed and the patellar kinematics were defined with six degrees of freedom. DISCUSSION: This experimental setup enables a comparison of the kinetics of a normal knee with the kinetics observed after implantation of a prosthesis on the same knee. The kinetic analysis does not involve a succession of static states but rather a continuous movement generated by the action of the quadriceps that can be loaded, simulating partial weight bearing. Using the markers fixed directly on the bones, this in vitro study allowed remarkably precise and reproducible measurements. The movements simulated regularly encountered clinical situations. The quality of the movement recorded for a given prosthesis thus provides an accurate approach to the quality of the prosthesis. The goal is not to define the exact kinematics of the normal knee but rather to compare the kinematics of the normal knee with that of the same knee after prosthesis implantation allowing an accurate method for assessing prosthesis design and studying the influence of different parameters, particularly the ligaments. Concomitant study of femorotibial and femoropatellar kinematics provides further information rarely found in the literature.

Aged↗
PubMedDate not supplied

[Urinary concentration of collagen metabolites in endoprosthesis loosening].

Aseptic loosening is the most common long-term complication in arthroplasty. Loosening is in every case associated with bone resorption at the interface that leads to bone defects and complicates the revision. The diagnosis of aseptic loosening is based on clinical and radiological evaluation. Especially in clinically asymptomatic cases an early diagnosis with these methods is difficult. In our study we wanted to evaluate the diagnostic value of biochemical markers of the bone resorption in aseptic loosening. We compared 58 patients with proven implant loosening during surgery with 67 patients without clinical or radiological signs of loosening. We measured the crosslinks pyridinoline and hydroxypyridinoline in urine samples. In contrast to Schneider et al. [increased urinary crosslink levels in aseptic loosening of total hip arthroplasty, J. Arthroplasty 1995; 13 (6): 687-692] we found no significant differences between loose and asymptomatic hip or knee prosthesis. Also no correlation between the size of the acetabular defects of loose hip implants and the urinary crosslink excretion was measurable. Our results show no or only little diagnostic value of the urinary crosslinks pyridinoline and deoxypyridinoline in aseptic loosening of total hip and knee arthroplasty.

Aged↗
PubMed2002

Investigation of wear of knee prostheses in a new displacement/force-controlled simulator.

The performance of two knee simulators designed by ProSim (Manchester, UK) was evaluated by comparison of the wear seen in the press-fit condylar (PFC) Sigma (DePuy) knee prosthesis. Twelve specimens of the same design and manufacturing specification, were subjected to a wear test of 2 x 10(6) cycles duration using bovine serum as a lubricant. The anterior/posterior displacement and internal/external rotation inputs were based on the kinematics of the natural knee. International Standards Organization (ISO) standards were used for the flexion and axial load. The wear rates and wear scar areas were compared across all stations. The mean wear rates found were 17.6+/-5 mm3/10(6) cycles for stations 1 to 6 and 19.6+/-4 mm3/10(6) cycles for stations 7 to 12, resulting in an overall mean wear rate of 18.1+/-3 mm3/10(6) cycles. The differences between the two simulators were not significant. The average wear scar area seen on inserts from stations I to 6 was calculated at 32.4+/-1 per cent of the intended articulating surface. Similarly on stations 7 to 12 the average wear scar area was 30.7+/-3 per cent. The wear scars seen were a good physiological representation of those found from clinical explant data. This study has shown good repeatability from the simulator, both within and between the simulators.

Arthroplasty, Replacement, Knee↗
PubMed1986

Survival of knee arthroplasties. A nation-wide multicentre investigation of 8000 cases.

A prospective nation-wide study of knee arthroplasty has been under way in Sweden since October 1975. By the end of 1983, 4505 arthroplasties for osteoarthritis and 3495 for rheumatoid arthritis had been recorded and reviewed one, three and six years after the operation. Using actuarial methods, the probability of the prosthesis remaining in situ after six years was calculated. In osteoarthritis this probability ranged from 65% for hinged prostheses to 90% for medial compartment prostheses. Two-and three-compartment prostheses produced intermediate results with 87% survival. In rheumatoid arthritis the probability varied from 72% for medial compartment prostheses to 90% for two- and three-compartment prostheses. The main reason for failure was loosening of the components, the second most common was infection. The probability of revision for infection by six years was 2% in osteoarthritis and 3% in rheumatoid arthritis. Most revisions were to a three-compartment prosthesis. Knee fusion at primary revision was required in 2% of the cases at six years.

Arthritis, Rheumatoid↗
PubMed1995

A late sternal wound infection caused by hematogenous spread of bacteria.

A 56-year-old man presented with a sternotomy wound infection 6 months after coronary artery bypass grafting. The organism responsible was group B beta-hemolytic Streptococcus. This organism was simultaneously cultured from an infected diabetic ulcer on the patient's foot as well as from a total knee prosthesis. The Streptococcus apparently spread hematogenously to the sternum, an extremely rare cause of sternotomy wound infection.

Bacteremia↗
PubMed1991

Meniscal bearing dislocation in the Oxford knee.

The Oxford knee is a unicompartmental knee prosthesis with a polyethylene meniscal bearing. Anterior dislocation or medial subluxation has been described in lateral compartment arthroplasties. The authors present the case of a medial dislocation of the lateral meniscal bearing and a review of the literature concerning meniscal bearing instability in the Oxford Knee.

Female↗
PubMed1990

Infection as a complication of total knee-replacement arthroplasty. Risk factors and treatment in sixty-seven cases.

Of 4171 total knee arthroplasties that were performed at our institution from 1973 to 1987, sixty-seven were followed by infection. The risk of infection was significantly increased in patients, particularly men, who had rheumatoid arthritis; in patients who had ulcers of the skin; and in patients who had had a previous operation on the knee. Infection was also associated with obesity, recurrent urinary-tract infection, and oral use of steroids, although the correlation was not statistically significant. Of the various treatment options that were studied, removal and delayed replacement of the knee prosthesis resulted in the best functional results.

Aged↗
PubMed1990

Experience with a new technique for managing severely overcorrected valgus high tibial osteotomy at total knee arthroplasty.

Total knee arthroplasty (TKA) after valgus proximal tibial osteotomy poses no major difficulties in most cases. There is, however, a small subgroup of severely overcorrected patients in whom TKA is particularly difficult. These patients require special considerations. A complex ligament reconstruction has been developed to allow simultaneous implantation of a minimally constrained total knee prosthesis for patients with failed, severely overcorrected valgus high tibial osteotomies. The technique is described in five patients. The mean age of the group was 57 years and the average follow-up period was 34 months (range, 12-72 months). A 100-point knee-evaluation scale was used to rate the knees before and after TKA. The average pre- and postoperative scores were 50 and 94, respectively. None of the patients was noted to have any more than mild instability in any direction postoperatively. Despite this extensive reconstruction, the group functioned as well as most recipients of more standard primary TKAs and demonstrated it is possible to avoid highly constrained implants, custom prostheses, or major bone grafts.

Female↗
PubMed2002

Dual Articular Knee in demanding primary and revision replacements in patients with rheumatic diseases.

We report the results of 25 total knee replacements in 24 patients with rheumatoid arthritis (RA) using the Dual Articular Knee prosthesis. There were four primary and 21 revision procedures. The main indication was severe joint instability. In four infected arthroplasties a two-stage revision procedure was used. Four patellar tendon avulsions and one deep infection were encountered. Results were excellent in 18 patients. Dual Articular Knee proved to be favourable in both demanding primary as well as revision arthroplasties in patients with RA.

Adult↗
PubMed1982

Cementless fixation of the tibial component for the ICLH knee.

The use of polymethylmethacrylate bone cement in joint replacement surgery is not without drawbacks. Certain hazards have been appreciated and the bone cement interface may not be as stable in the long run as was once felt. This paper reports the results in 52 knees which were replaced using the uncemented ICLH (Imperial College/London Hospital) tibial component; the average follow up was two years (range six months to four years). The results were compiled with regard to pain as well as clinical examination and X-ray evaluation. The results were comparable to those achieved in knees replaced using bone cement. Roentgenographic evaluation revealed no evidence of loosening nor sinkage of any of these prostheses. Considerations in the development of a knee prosthesis to be utilized without bone cement and the operative technique employed to implant such a prosthesis are presented. The merits of such a system are discussed.

Adult↗
PubMed1996

[Knee joint endoprostheses].

The story of the total knee arthroplasty begins in the last century. But in 1971, Gunston shows the way of the modern knee arthroplasty and creates the concept of unconstrained arthroplasty. The indication of the total knee arthroplasty should be precise and rigorous. It's not possible to describe all the situations, where a total knee arthroplasty is indicated or not, but the clinical signs could be summarized in pain, stiffness, deformation with or without instability. We observed 10% of postoperative complications; most of them are secondary, but the infections and loosening remain the principal problem in 2% and in 5% of cases, respectively. If the results are now quite the same to those of total hip arthroscopy by survivorship analysis, the indication and the choice of the total knee prosthesis should be passed on a reflection, where the clinical and functional evaluation are the most important.

Aged↗
PubMed1991

Motion of the knee after condylar resurfacing--an in vivo study.

The purpose of this study was determine the amounts of rotation and displacement occurring in a relatively unconstrained condylar replacement knee, and to compare the motion with a matched group of normal knees. The motion was measured using an electromagnetic device, the 3-Space Tracker, for various common activities, for 25 normal volunteers and 25 total knee patients. The main variables studied were internal-external rotation of the tibia about its long axis and anterior-posterior displacement of the femoral origin with respect to the tibia, as a function of flexion angle or per cent of gait cycle. The motion of the total knees was very similar to that of the normals. For sitting, standing and free-swing, the knee rotated internally by 5-10 degrees and the femur displaced posteriorly by 9-14 mm, as the knee was flexed from 0 to 90 degrees. For walking and going upstairs and downstairs the absolute values of the rotations and displacements were similar to the above. However, the mean values of rotation were less due to greater variation in the rotation patterns, due probably to the increased laxity of the knee during the swing phases. From these data, taking the mean motions and one standard deviation (S.D.), it is suggested that a knee prosthesis should allow a rotation from minus to plus 12 degrees (a total range of 24 degrees) and an anterior-posterior displacement of 13 mm. It is suggested that these motions be subject to progressive restraint from the neutral position in the manner of the natural knee.

Activities of Daily Living↗
PubMed2005

[What is the influence of the approach to intraoperative measurement of the knee joint on total knee arthroplasty? A navigation-controlled study on a cadaver knee].

Correct postoperative leg alignment and stability of the total knee prosthesis over the full range of movement is one critical factor for successful TKA. The anatomic approach is still the subject of controversy. The aim of our study was to elucidate the influence of the surgical approach on the ligament balancing and the anterioposterior limb axis.On five cadaver knees we studied the influence of the subvastus, midvastus, medial parapatellar, rectus snip, and tuberosity osteotomy approaches on the anterioposterior leg axis in extension and the rotation of the femoral component in flexion. Measurements were performed and documented by CT-free Ci-Navigation-System. Ligament tension was measured with a tensor device. We found that the subvastus approach leads to less widening of the medial compartment than all other approaches in extension. In 90 degrees flexion we found a similar influence. The consecutive release from subvastus to midvastus to medial parapatellar approach leads to a further opening of 0.5-1 degrees valgus in extension as well as in flexion. An everted patella amplifies this influence. The surgeon has to be aware of the impact on the ligament situation in regard to the anatomic approach when ligament balancing and soft tissue releases are carried out. Patella eversion should be avoided when managing soft tissues.

Arthroplasty, Replacement, Knee↗