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PubMedDate not supplied

Surgical treatment of developmental dysplasia of the hip in adults: II. Arthroplasty options.

Total hip arthroplasty is the procedure of choice for most patients with symptomatic end-stage coxarthrosis secondary to hip dysplasia. The anatomic abnormalities associated with the dysplastic hip increase the complexity of hip arthroplasty. When pelvic bone stock allows, it is desirable to reconstruct the socket at or near the normal anatomic acetabular location. To obtain sufficient bony coverage of the acetabular component, the socket can be medialized or elevated, or a lateral bone graft can be applied. Uncemented acetabular components allow biologic fixation with potentially improved results compared with cemented cups, especially in young patients. The location of the acetabular reconstruction and the desired leg length influence the type of femoral reconstruction. Cemented and uncemented implants can be used in femoral reconstruction, depending on the clinical situation. Femoral shortening is required in some cases and can be performed by metaphyseal resection with a greater trochanteric osteotomy and advancement or by a shortening subtrochanteric osteotomy. The results of total hip arthroplasty demonstrate a high rate of pain relief and functional improvement. The long-term durability of cemented total hip arthroplasty reconstruction in these patients is inferior to that in the general population. The results of uncemented implants are promising, but only limited early and midterm data are available.

Acetabulum↗
PubMedDate not supplied

Use of antibiotic-impregnated cement in total joint arthroplasty.

The use of antibiotic-impregnated cement in revision of total hip arthroplasty procedures is widespread, and a substantial body of evidence demonstrates its efficacy in infection prevention and treatment. However, it is not clear that it is necessary or desirable as a routine means of prophylaxis in primary total joint arthroplasty. In the management of infected implant sites, antibiotic-impregnated cement used in one-stage exchange arthroplasties has lowered reinfection rates. In two-stage procedures, use of beads and either articulating or nonarticulating antibiotic-impregnated cement spacers also has lowered reinfection rates. In addition, spacers reduce "dead space," help stabilize the limb, and facilitate reimplantation. Problems associated with antibiotic-impregnated cement in total joint arthroplasty include weakening of the cement and the generation of antibiotic-resistant bacteria in infected implant sites.

Animals↗
PubMedDate not supplied

Stiffness after total knee arthroplasty.

Postoperative stiffness is a debilitating complication of total knee arthroplasty. Preoperative risk factors include limited range of motion, underlying diagnosis, and history of prior surgery. Intraoperative factors include improper flexion-extension gap balancing, oversizing or malpositioning of components, inadequate femoral or tibial resection, excessive joint line elevation, creation of an anterior tibial slope, and inadequate resection of posterior osteophytes. Postoperative factors include poor patient motivation, arthrofibrosis, infection, complex regional pain syndrome, and heterotopic ossification. The first steps in treating stiffness are mobilizing the patient and instituting physical therapy. If these interventions fail, options include manipulation, lysis of adhesions, and revision arthroplasty. Closed manipulation is most successful within the first 3 months after total knee arthroplasty. Arthroscopic or modified open lysis of adhesions can be considered after 3 months. Revision arthroplasty is preferred for stiffness from malpositioned or oversized components. Patients who initially achieve adequate range of motion (>90 degrees of flexion) but subsequently develop stiffness more than 3 months after surgery should be assessed for intrinsic as well as extrinsic causes.

Algorithms↗
PubMed1991

Basal joint arthroplasty using the Roosevelt Hospital techniques.

Many reconstructive procedures have been developed to treat osteoarthritis of the basal joint of the thumb. The current article describes techniques used at the Hand Surgery Center at Roosevelt Hospital in New York City. A tonometry applanation radiographic staging system is outlined; it serves as a rationale for selecting which form of arthroplasty is appropriate for a particular patient and is predicated on the extent of involvement of the trapezial articulations. Stage 1 disease implies symptomatic laxity of the trapeziometacarpal joint with normal articular surfaces and is most appropriately treated with volar ligament reconstruction. Stage 2 is an intermediate category and amenable to either volar ligament reconstruction or interpositional arthroplasty of the trapeziometacarpal joint, based on the condition of the articular cartilage at surgery. In stage 3 disease there are significant degenerative changes of the trapeziometacarpal joint with preservation of the articular surfaces of the scaphotrapezial joint. Two variations on ligament reconstruction with interpositional arthroplasty of the trapeziometacarpal joint are described; they have consistently good results. Finally, stage 4 is characterized by pantrapezial degenerative disease and necessitates trapezial resection. Reconstruction may be by silicone rubber implant arthroplasty using a stemmed trapezial implant stabilized by an abductor pollicis longus tenodesis. The alternative is a procedure in which the thumb metacarpal is tethered to the index metacarpal by a ligament reconstruction.

Arthroplasty↗
PubMed1999

Risk factors for postoperative femoral fracture in cementless hip arthroplasty.

The objective of this study was to evaluate the incidence of and risk factors for femoral fracture in patients who underwent cementless hip arthroplasty during a 3-year period. Several predisposing factors have been reported; we tried to find another predictive indicator that could be recognized preoperatively. The records of all patients who underwent cementless hip arthroplasty from December 1993 to December 1996 were reviewed. The characteristics and clinical features (including age, gender, diagnosis, geometry of the proximal femur, and quality of bone) of the patients who had fractures were compared with those of patients who did not have fractures. During the 3-year study, 425 patients underwent a total of 454 cementless hip arthroplasties. There were 16 postoperative fractures (3.5%, 16 patients). Patients who suffered femoral fracture were significantly older than patients without fracture (65.6 +/- 10.9 yr vs 52.6 +/- 16.2 yr, p < 0.001). The fracture group had poorer preoperative bone quality compared with the nonfracture group (3.3 +/- 0.6 vs 3.8 +/- 0.7, Singh's Index of Osteoporosis, p < 0.01). The canal flare index of the proximal femur was significantly lower in the fracture group than in the nonfracture group (3.3 +/- 0.40 vs 3.8 +/- 0.7, p < 0.01). Our results indicate that old age and osteoporosis affect the likelihood of periprosthetic femoral fractures, and that a low flare index is a predictive indicator of femoral fracture. These factors should be taken into account during preoperative planning, and cemented arthroplasty should be considered for patients with these risk factors.

Aged↗
PubMed1999

Joint line restoration after revision total knee arthroplasty.

In 99 patients, 107 knee replacements were revised in two centers by two surgeons using a single revision total knee arthroplasty system. A retrospective radiographic review of joint line position before and after revision total knee arthroplasty was made, and compared with the joint line position before primary knee arthroplasty. Prospectively collected Knee Society Clinical Rating Scores were correlated with radiographic findings. The joint line position in unreplaced knee replacements averaged 16 mm, and the joint line position in knee replacements before revision surgery averaged 17 mm. The joint line was elevated by the revision total knee arthroplasty in 85 of 107 knees (79%). After the revision total knee replacement, the joint line elevation averaged 24 mm. The Knee Society Clinical Rating Score after revision surgery averaged 131 points. If the joint line position was elevated more than 8 mm, the Knee Society Clinical Rating Score averaged 125 points, if the joint line was elevated less than 8 mm, the score averaged 141 points. Joint line elevation after revision total knee replacement is a problem. Excessive elevation may result in worse clinical outcomes. Distal femoral augments should be used more often and with greater thicknesses. Standard implants used for revision surgery should have increased distal dimensions.

Aged↗
PubMed1999

Kneeling ability after total knee arthroplasty. Perception and reality.

Kneeling as one of the knee's capabilities required for many activities of daily living has not been examined in detail after total knee replacement. The purpose of the present study was to question the patients' ability to kneel and their perception of factors affecting this ability after total knee arthroplasty, and to objectively assess their kneeling ability. Seventy patients with 100 total knee arthroplasties were asked to comment on their ability to kneel. Thirty-one patients with 44 knees said they could kneel easily, 29 patients with 41 knees said they were able to kneel but avoided doing so, and 10 patients with 15 knees said they were unable to kneel. Regarding observed kneeling ability, all patients were able to kneel under supervision: 56 patients with 82 knees knelt easily and got up easily from this position, 11 patients with 14 knees showed slight difficulties in kneeling or in getting up, and three patients with four knees had marked difficulties with kneeling. The patients' perceived ability to kneel after total knee arthroplasty was less than their observed ability. Fear of harming the prosthesis and lack of information prevented kneeling in 49% of the patients (27 of 56 knees) with perceived inability to kneel. Of those patients with observed difficulty in kneeling, scar pain and back related problems seemed to be major factors in limiting the kneeling ability. Kneeling, as an important function of the knee, should be given additional consideration in relation to the functional results of total knee arthroplasty. Patients should be counseled regarding factors affecting future ability to kneel.

Adolescent↗
PubMed1999

Blood management in two-stage revision knee arthroplasty for deep prosthetic infection.

Treatment of infected total knee arthroplasty requires aggressive management to treat the infection and restore joint function. For patients with infected knee arthroplasties, a two-stage procedure is used that involves resection of the joint and placement of an antibiotic impregnated cement spacer followed by implantation of a new prosthetic 6 weeks later. Patients undergoing the two-stage procedure typically endure high allogeneic blood transfusion rates (82% to 88%) and progressive anemia because the two surgeries are spaced closely and because the infection precludes the use of alternatives to allogeneic blood. Records were reviewed of 75 patients who underwent two-stage total knee arthroplasty to characterize perioperative hemoglobin levels and blood transfusion needs in this patient group. Although transfusions were administered only when warranted by clinical symptoms and were not based on predetermined hematologic values, 62 (82%) patients received a mean of 2.3 units of blood at first-stage surgery, and 60 (80%) patients received a mean of 2.1 units of blood at the second stage. Overall, only 12% of patients did not have allogeneic blood transfusion. At the first stage before resection, mean hemoglobin concentration was 11.6 g/dL and reached a mean nadir of 8.6 g/dL 3 days after surgery. At the second stage before reimplantation, hemoglobin concentration averaged 11.1 g/dL and reached a mean nadir of 8.2 g/dL 3 days after surgery. After the first stage, allogeneic blood transfusion failed to improve postoperative hemoglobin levels enough to prevent transfusions associated with the second-stage. Patients undergoing two-stage total knee arthroplasty have anemia, and a substantial proportion of these patients require allogeneic blood transfusion at both stages. Thus, novel blood management practices are required to improve hemoglobin levels and reduce allogeneic transfusion rates in this patient population.

Aged↗
PubMed2000

Revision hip arthroplasty activity in a single UK health region: an audit of 1265 cases.

Revision hip arthroplasty is an operation which is steadily increasing in number and can often be technically challenging. We have utilised a regional hip register (the Trent Regional Arthroplasty Study) to analyse the epidemiology of revision hip arthroplasties in a single UK health region. The study shows that of the large number (1265) of procedures performed over a 7-year period (1991-1997), the majority were performed by general orthopaedic surgeons, with 91 different surgeons performing the operation and only two surgeons performing more than 20 procedures per year. Of more than 100 prosthetic combinations used for the procedure, the Charnley prosthesis was the most common (38.3% of acetabular revisions and 37.5% of femoral revisions). The same component was also the most commonly explanted (43%). There was an even geographical spread across the region with revision hip arthroplasty being performed in all hospitals with an orthopaedic in-patient facility. Prospective audit of this large and varied cohort is necessary to determine differences in outcome (if any) between 'specialist' hip surgeons and general orthopaedic surgeons.

Adolescent↗
PubMed2001

[Surgical treatment of arthritis of the carpometacarpal joint of the thumb--personal experience with soft-tissue arthroplasty].

PURPOSE OF THE STUDY: The authors deal with surgical treatment of osteoarthritis of carpometacarpal joint of the thumb. They present results of three different techniques of interposition arthroplasty. MATERIAL: Thirteen operations were carried out in the period of 1997-1999 in 12 patients (9 women and 3 men). In seven cases the dominant right hand was affected, in 4 cases the left hand was involved. The average age was 56 years (range, 48-91 years). In none of the patients any extreme activity of the operated on hand is expected in future. METHODS: The surgical treatment consists in resection of damaged articular surface and interposition of soft tissue. In Nalebuff-Millender operation the graft is taken from the tendon of m. palmaris longus (PL). In the operation after Burton and Pellegrini the graft is formed by the longitudinal half of the tendon of m. flexor carpi radialis (FCR). The tendon is fixed to the Ist metacarpal by its pulling through a channel drilled in the base of the metacarpal. In Wulle operation the interposition tissue is harvested from the longitudinal half of tendon of m. abductor pollicis longus (APL) wound around FCR tendon. During the operation after Nalebuff-Millender we performed in the first 3 patients partial resection of trapezium, in all other cases total resection of trapezium. The thumb was fixed for three weeks with a subsequent physiotherapy. The results were evaluated according to a three-grade classification--excellent, good, poor (fully functional, partially functional and non-functional hand) according to tenderness, strength of grip and abduction range of the thumb. RESULTS: In 7 patients after Nalebuff-Millender operation the result was twice excellent and five times good. Among 5 good results were three patients with partial resection of trapezium. The condition was stabilized after 4-9 months. In patients after Burton and Pellegrini operation we achieved an excellent result in 4 cases and in 2 cases a good result. Recovery lasted for 3-6 months. In the female patient after Wulle operation the result is good, stabilized after 4 months. DISCUSSION: The authors make a mutual comparison of the results of individual applied procedures. Burton and Pellegrini procedure provides good results which are certainly enhanced by stabilization of base I by MT tendon pulled through the channel. Better results were achieved by using total resection of trapezium. The authors compare the interposition arthroplasty with other surgical procedures which they present in a short overview (arthrodesis, arthroplasty, osteotomy). CONCLUSION: Interposition arthroplasty is a suitable solution of osteoarthritis of carpometacarpal joint after the failure of conservative treatment in patients in whom no extreme activity of the affected hand is expected. Burton-Pellegrini procedure is technically more demanding, however, it provides the best results and the fastest recovery. Total resection of trapezium proved efficient as it contributes to a better orientation during operation and to good results.

Aged↗
PubMed1998

[The reason and management of intraoperative femur fracture during hip arthroplasty].

OBJECTIVE: To study the pathogenesis, treatment and prevention of intraoperative femur fracture. METHODS: Intraoperative femur fracture occurred in 25(2.6%) of 945 hip arthroplasties performed from 1972 to 1996. 142(5.6%) occurred in revision arthroplasties, 12 (2.4%) 493 primary arthroplasties (2.4%), and 5(1.3%) in 310 semi-arthroplasties. RESULTS: The causes of these fractures included osteoporosis, iatrogenic, congenital alteration of bony anatomy, and inadequate soft tissue release prior to hip dislocation during revision of hip surgery. Femoral fractures can be prevented by preoperative templating of rontgenograms containing markers to measure magnification; routine overdrawing of the femoral canal when implanting long-stemmed prostheses; and a more extensive release of the external rotators and other scar tissue performed prior to dislocation. Any structures preventing free rotation of the femur should also be considered for the release. CONCLUSIONS: We recommend that intraoperative roentgenograms be made whenever preparation of the femoral canal or impacting of the prosthesis is more difficult or when resistance is suddenly lost during implication of implant. When diagnosed intraoperatively, it should be fixed with cerclage wiring. When an incomplete fracture near the hip of the stem was discovered postoperatively and the posterior part of the femoral cortex was intact, a spica cast was applied. For a complete fracture at the tip of stem, we recommend open reduction and internal fixation.

Adult↗
PubMed2001

The relationship between postoperative ligament balance and preoperative varus deformity in total knee arthroplasty.

We hypothesize that in knees with severe varus deformities, varus-valgus ligament imbalance tends to remain postoperatively after total knee arthroplasty. The purpose of this study was to evaluate the correlation between preoperative varus deformity and postoperative ligament balance quantitatively measured by stress radiograph using Telos SE in total knee arthroplasty. In this study, 44 knee arthroplasties in 32 patients were evaluated. We defined the angle in varus and valgus stress as "varus angle" and "valgus angle," and the sum of varus angle and valgus angle as "sum of varus-valgus angle." There was a significant correlation between preoperative lateral femoral angle and varus angle (p < 0.0001, r = 0.56), which means that postoperative ligament imbalance tends to remain in knees with preoperative varus deformities. There was a significant correlation between the postoperative period and the sum of varus-valgus angle, which suggests that knees with total knee arthroplasty have potential to increase laxity postoperatively.

Aged↗
PubMed2002

Alumina-on-alumina total hip arthroplasty: a minimum 18.5-year follow-up study.

BACKGROUND: The purpose of this retrospective study was to report the results, after a minimum of 18.5 years of follow-up, in a consecutive series of total hip arthroplasties performed with an alumina-on-alumina combination. METHODS: One hundred and eighteen consecutive total hip arthroplasties were performed in 106 patients between 1979 and 1980. The prostheses combined a 32-mm alumina head and an all-alumina socket. Both components were cemented in eighty-five hips, both components were implanted without cement in twenty-nine, and only the stem was cemented in four. The mean age of the patients at the time of the index arthroplasty was 62.2 years (range, thirty-two to eighty-nine years). RESULTS: At the 18.5 to 20.5-year follow-up evaluation, forty-five patients (fifty-one hips) were alive and had not had a revision, twenty-five patients (twenty-five hips) had undergone revision of one or both components, twenty-seven patients (thirty hips) had died, and nine patients (twelve hips) had been lost to follow-up. The mean Merle d'Aubigné hip score (and standard deviation) was 16.2 +/- 1.8 points at the latest follow-up evaluation. The rate of survival at twenty years, with revision for any reason as the end-point, was 85.6% for the cementless cups compared with 61.2% for the cemented cups and 84.9% for the cementless stems compared with 87.3% for the cemented stems. Wear of the prosthetic components was undetectable on plain radiographs. Periprosthetic cystic or scalloped lesions requiring the use of allograft bone during revision were present in three of the twenty-five revised hips. In addition, seven hips had moderate acetabular osteolysis treated with a 4-mm-larger cup. No fracture of the alumina socket or head was recorded. The mean acetabular wear rate in this series was <0.025 mm/yr. CONCLUSION: With the alumina-on-alumina total hip arthroplasty, minimal wear rates and limited osteolysis can be expected up to twenty years after the operation, provided that sound acetabular component fixation is obtained.

Adult↗
PubMed2002

Computerized management of oral anticoagulant therapy: experience in major joint arthroplasty.

OBJECTIVE: Evaluation of the safety and potential cost savings of a computerized, laboratory-based program to manage inpatient warfarin thromboprophylaxis after major joint arthroplasty. DESIGN: A consecutive-case study of adults. SETTING: A tertiary care orthopedic institution. PATIENTS: Patients requiring joint arthroplasty who had no recent episodes of thromboembolic disease, no mechanical heart valve, atrial fibrillation, severe liver disease or baseline international normalized ratio [INR] greater than 1.3 admitted over a 54-month period (July 1994-December 1998). All patients received a standard regimen of warfarin beginning on the evening after the operation. Four hundred and thirty randomly selected patients managed by the program were followed up by telephone survey 3 months after discharge. Patients exhibiting erratic responses to warfarin were withdrawn from the program and managed individually thereafter. INTERVENTION: Major joint arthroplasty with warfarin therapy administered through the computerized program. MAIN OUTCOME MEASURES: Test results maintained within the desired therapeutic range (INR 2.0-3.0), clinically severe bleeding episodes, readmission rates, clinically symptomatic and venographically proven episodes of venous thrombosis or pulmonary embolism. RESULTS: Over the study period 5629 patients underwent joint arthroplasty; 5,372 patients were considered for the program; 332 patients were ineligible and were managed individually; 311 entered patients did not complete the program. This left 4,729 patients who completed the program. In 2932 (62%) patients test results were maintained in the desired therapeutic range. The major bleeding rate was less than 0.5%, the readmission rate was 3.8%, the deep venous thrombosis rate was 3.7% and the pulmonary embolism rate was 0.2% with no thromboembolic related deaths in the small sample cohort. CONCLUSIONS: The majority of patients requiring warfarin thromboprophylaxis can be safely and effectively managed by this laboratory-based computerized program while in hospital. Significant potential cost savings in nursing time could be achieved.

Anticoagulants↗
PubMed2002

Displaced intracapsular hip fractures: hemiarthroplasty or total arthroplasty?

The role of total hip arthroplasty for the treatment of displaced intracapsular fractures of the proximal femur in active patients is controversial. Some authors have shown that such patients, when treated with a bipolar or unipolar hemiarthroplasty, are at increased risk of having acetabular erosion develop that might require later revision to a total hip replacement. In fact, the results of some authors were not substantially different from those reported for elective total hip arthroplasty and were better than results reported for hemiarthroplasty. However, other authors have strongly recommended avoiding total hip replacement in active elderly patients without preexisting acetabular disease (osteoarthritis, rheumatoid arthritis, Paget's disease). Although the current belief is that there is a place for primary total hip arthroplasty after intracapsular hip fracture, and that this procedure should be reserved for patients with preexisting symptomatic acetabular disease, in a preliminary prospective comparative study of 46 active patients without preexisting acetabular disease, the current author found better results with cemented Charnley's total hip arthroplasty than with cemented Thompson's hemiarthroplasty. Long-term outcome and more detailed indications for total hip replacement as the primary treatment for intracapsular displaced fractures of the proximal femur are topics for additional study.

Aged↗
PubMed2002

Alternative bearing surfaces in total hip arthroplasty: zirconia-alumina pairing. Contribution or caveat?

The aim of the present study was to evaluate the zirconia and alumina articulation in total hip arthroplasty in regard to clinical and radiological outcome. This is the first report concerning the clinical application of a hybrid ceramic articulation. Owing to ethical reasons, a limited number of patients was enrolled in the study. Ten consecutive patients with degenerative arthritis were randomly allocated after informed consent to hybrid total hip arthroplasty treatment using an alumina femoral head and an alumina acetabular liner (5 hips), or using a zirconia femoral head and an alumina acetabular liner (5 hips). The median age of patients at index operation was 57.8 years. Current criteria were used for clinical and radiological assessment. The mean follow-up was 5.1 years (5 to 5.3 years). No hip required revision, and no clinical and radiological differences were observed between the two groups of hips. The median preoperative Harris hip score was rated 55.3 points in the control group of hips with alumina head, and 55.6 in the group of hips with zirconia head. The median Harris hip score increased to 94.9 points at the time of follow-up in the control group, and 96 points in the zirconia group. No radiological signs of cup loosening or focal acetabular osteolysis were detected at follow-up. All stems showed stable fixation without radiolucent lines or focal osteolysis. Zirconia femoral heads and alumina acetabular liners have been successfully used in the present series of 5 total hip arthroplasties with a mean follow-up of 5.1 years. Nevertheless, the use of femoral heads made of zirconia in total hip arthroplasties remains an important clinical concern due to the potential genesis of wear microparticles which can lead to progressive osteolysis. Further in-vitro and in-vivo investigations are required to define the value of this alternative bearing surface.

Aged↗
PubMed2002

[Total hip arthroplasty without cement in children and adolescents: 17 cases].

PURPOSE OF THE STUDY: Hip disease can produce major pain and functional disorders in children who should benefit from total hip arthroplasty. We report our experience with total hip prostheses implanted without cement in children. MATERIAL AND METHODS: We performed 17 total hip arthroplasties in 13 children who had various conditions, mainly chronic juvenile osteoarthritis and aseptic osteonecrosis secondary to sickle cell anemia. The acetabular inserts were not cemented. All the femoral stems were custom-made using computer-assisted preoperative planning based on standard x-rays and computed tomography findings. Outcome was assessed on the basis of patient satisfaction, pain, and function. Radiographically, we assessed stem implantation, stability and integration. Results were classed with the Harris score and also with the Steinbrocker classification in order to take into account the child's overall functional handicap. RESULTS: Mean follow-up was 36.4 months. There were three cases of superficial hematoma, one case of superficial sepsis and one acetabular loosening. All patients were satisfied. Unsatisfactory function, observed in 80% of the children preoperatively, was found in only 17% postoperatively. The Harris score improved from 23.8 preoperatively to 87.7 at last follow-up. There were no cases of stem loosening and integration was achieved in 85.3% of the cases proximally in the area with hydroxyapatite surfacing. DISCUSSION: The problem with these children is to determine when total hip arthroplasty should be proposed. We retain three important indications: uncontrollable chronic pain, normal school attendance impossible, no other possibility for conservative surgery. Several studies have reported only mediocre results with cemented stems. We opted for custom-made stems without cement for three reasons: preservation of bone stock, better adaptation to bone whose quality and morphology had been remodeled by the underlying condition and repeated osteotomies which also affect the gluteus medius, and finally, better chance of success for future revisions in these active young patients. CONCLUSION: The question on whether or not total hip arthroplasty should be performed early in these children to avoid osteotomies which could alter the longevity of a future prosthesis remains open. Custom-made stems inserted without cement have provided satisfactory results in our experience. To date, follow-up is too short to compare our results with those obtained by others using cemented stems.

Activities of Daily Living↗
PubMed2002

[Arthroscopic treatment of hematogenous infected total knee arthroplasty: 5 cases].

PURPOSE OF THE STUDY: The purpose of this retrospective study was to assess the contribution of arthroscopic treatment on hematogenous infected total knee arthroplasty. MATERIAL AND METHODS: Five patients were treated for hematogenous infected total knee arthroplasty. All patients had a posterior stabilized prosthesis that had been implanted without any element suggesting primary infection. Delay to infection after arthroplasty was 25 months on the average. Arthroscopic treatment included joint wash-out and synovectomy in combination with prolonged antibiotic therapy. RESULTS: One female patient, treated within 24 hours of the onset of infection, achieved cure without recurrence at 6 months follow-up. One other female patient died. Three patients required revision surgery after failure (two reimplantations in two procedures and one reimplantation in one procedure). DISCUSSION: The gravity of hematogenous infections of total knee arthroplasty is well known. Cure requires insertion of a new implant in three-quarters of the cases. Local arthroscopic treatment is not effective unless performed very early. Beyond this delay, it can at best limit local symptoms.

Aged↗