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Thomas S Thornhill - One of the best experts on this subject based on the ideXlab platform.
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Revision total knee Arthroplasty after failed unicompartmental knee Arthroplasty or high tibial osteotomy.
Clinical Orthopaedics and Related Research, 1995Co-Authors: Thomas J Gill, Gregory W. Brick, Emil H Schemitsch, Thomas S ThornhillAbstract:A retrospective matched-pair comparative analysis was done between 30 total knee arthroplasties following failed high tibial osteotomies and 30 total knee arthroplasties following failed unicompartmental knee arthroplasties. The groups were matched according to age, gender, type of prosthesis, primary disease, and length of followup. A minimum followup of 2 years was required for inclusion in the study, and the average followup was 3.8 years (range, 2-9 years). The Knee Society Knee Score for the high tibial osteotomy group was significantly higher than that for the unicompartmental Arthroplasty group. More osseous reconstructions were required in the unicompartmental revisions. Difficulty with exposure was not significantly greater in the osteotomy group. Rates of component loosening were not significantly different between the groups. A failed unicompartmental knee Arthroplasty and a failed high tibial osteotomy can be revised successfully to a total knee Arthroplasty. The results confirm that revisions after unicondylar Arthroplasty and high tibial osteotomy are technically demanding. In this series, the results of total knee Arthroplasty following unicompartmental knee Arthroplasty approached but did not equal those obtained after high tibial osteotomy.
Javad Parvizi - One of the best experts on this subject based on the ideXlab platform.
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Essentials in Total Knee Arthroplasty
2011Co-Authors: Javad Parvizi, Brian A. KlattAbstract:In today's world of orthopedic surgery, the adult knee is the area most frequently operated on, with total knee replacements being the second most commonly performed procedure, directly behind knee arthroscopy. "Essentials in Total Knee Arthroplasty" is a brand new text with the most concise information describing the basics of this common surgery.Dr. Parvizi has created a colorful text that contains a unique look into the world of total knee Arthroplasty, including an in-depth history of the procedure and provides strategies to treat, as well as prevent complications.Features include: colorful, visual, and descriptive text; in-depth material covering total knee Arthroplasty; user-friendly and 'easy to read'; charts and tables; and, bulleted text format.Inside you will find information on: History of Total Knee Arthroplasty (TKA); Surgical Approaches to Total Knee Arthroplasty; Implant Selection and Fixation; Controversies in Total Knee Arthroplasty; and, Surgical and Non-Surgical Alternatives." Essentials in Total Knee Arthroplasty" is the essential 'go-to' book for residents, fellows, physical therapists, students and junior attending involved with all matters related to total knee Arthroplasty.
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Distal Femoral Arthroplasty for the Treatment of Periprosthetic Fractures After Total Knee Arthroplasty
The Journal of arthroplasty, 2010Co-Authors: Sm Javad Mortazavi, Javad Parvizi, Mark F. Kurd, Benjamin Bender, Zachary D. Post, James J. PurtillAbstract:Periprosthetic fractures after total knee Arthroplasty present substantial challenge if associated with poor bone stock, fracture comminution, and loose or damaged components. Revision total knee Arthroplasty with distal femoral Arthroplasty is often necessary in these injuries. We reviewed 20 patients (22 knees) with a mean age of 69.5 years who underwent revision with distal femoral Arthroplasty fracture. Patients were followed for an average of 58.6 months. At the latest follow-up, the mean Knee Society knee and functional score were 82.8 and 40, and the Short Form 36 mean physical functioning and mental functioning scores were 55.8 and 65.6, respectively. There were 10 postoperative complications with 5 patients requiring additional surgery. Distal femoral Arthroplasty seems to be a viable option for complex periprosthetic femoral fractures after total knee Arthroplasty. However, considering the relatively high rate of complications, this procedure should be reserved for patients where alternative treatments are not possible.
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Periprosthetic infection does not preclude good outcome for revision Arthroplasty.
Clinical Orthopaedics and Related Research, 2007Co-Authors: Elie Ghanem, Camilo Restrepo, Peter F. Sharkey, William J. Hozack, Ashish Joshi, Javad ParviziAbstract:Periprosthetic infection of a total knee Arthroplasty (TKA) can be successfully eradicated by two-stage resection Arthroplasty. However, the outcome of surgical intervention for infection is believed inferior to revision surgery for aseptic failures. We hypothesized patients having revision Arthroplasty for infected TKA have worse functional outcome compared to patients having revisions Arthroplasty for aseptic reasons. We prospectively studied 93 patients who underwent revision TKA, 22 of whom underwent two-stage resection Arthroplasty and compared outcomes to 71 patients who had revision for aseptic reasons. Infected patients had worse baseline SF-36 physical scores (32 versus 39) and WOMAC functional scores (41 versus 31) than the noninfected group, but at 2-year followup both cohorts had similar functional outcomes. The two groups had similar baseline and postoperative WOMAC pain scores. Although infected patients had lower baseline SF-36 mental scores (50 versus 58), they achieved similar mental health at 2-year followup (66 versus 65). This data suggest infected patients benefit from revision Arthroplasty and achieve functional, pain, and mental health status at 2-year followup similar to those of noninfected patients.
Sang Yeop Shin - One of the best experts on this subject based on the ideXlab platform.
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A COMPARISON OF RESULTS AFTER TOTAL KNEE Arthroplasty AND UNICOMPARTMENTAL KNEE Arthroplasty IN SAME PERSON
Journal of Bone and Joint Surgery-british Volume, 2016Co-Authors: In Soo Song, Sang Yeop ShinAbstract:Purpose We may consider total knee Arthroplasty on one knee and unicompartmental knee Arthroplasty on another knee when the patient has different grade osteoarthritis on one knee and opposite knee. Both total knee and unicompartmental knee Arthroplasty had been reported as excellent clinical results, but there can be different results and different preference if the same patient undergo operation of simulataneous total knee and unicompartmental knee. We performed total and unicompartmental knee Arthroplasty and pretend to report results of the clinical and radiological results and rationale of the operation. Materials and Methods From Marth 2007 to February 2014, 23 patients, 46 knees that underwent total knee Arthroplasty and unicompartmental knee Arthroplasty on knees with different osteoarthritis grade in same person enrolled in this study(Fig. 1). The mean age was 64.4 years old(range:55–75) and mean follow-up period was 25.1 months(range:13–72). Results The tibiofemoral angle changed from 4.0 of varus to 5.4 of valgus in the total knee Arthroplasty, and from 0.5 of valgus to 3.8 of valgus in the unicompartmental knee Arthroplasty. The mechanical axis deviation changed from varus 28.35mm to varus 3.68mm in the total knee Arthroplasty, and from 16.42 to 8.81 in the unicompartmental knee Arthroplasty. The average Hospital for Special Surgery Knee-Rating Scale(HSS) improved from 55.1 preoperatively to 93.4 at last follow-up in the total knee Arthroplasty, and from 65.2 to 95.2 in the unicompartmental knee Arthroplasty. The average WOMAC Score improved from 61.6 preoperatively to 18.0 at last follow-up in the total knee Arthroplasty, and from 55.4 to 16.2 in the unicompartmental knee Arthroplasty. For patient preference, 5 patients(22%) preferred the unicompartmental knee Arthroplasty, and 6 patients(26%) preferred the total knee Arthroplasty, and 12 patients felt no difference between two knees. 20 patients(87%) reported being ‘very satisfied’ or ‘satisfied’ in the total knee Arthroplasty, and 18 patients(79%) reported in the unicompartmental knee Arthroplasty. We underwent 1 case complication of tibial implant loosening and varus malalignment. So, we converted total knee Arthroplasty about 3 months later(Fig. 2). Conclusions Total knee Arthroplasty and unicompartmental knee Arthroplasty in same person showed satisfactory clinical and radiological results. There was no difference in preference site and postoperative range of motion showed more regainment on unicompartmental knee Arthroplasty. More complications were demonstrated in unicompartmental knee Arthroplasty. Total and unicompartmental knee Arthroplasty in same person seems to be a good option when the both knee have different osteoarthritis grade.
Thomas J Gill - One of the best experts on this subject based on the ideXlab platform.
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Revision total knee Arthroplasty after failed unicompartmental knee Arthroplasty or high tibial osteotomy.
Clinical Orthopaedics and Related Research, 1995Co-Authors: Thomas J Gill, Gregory W. Brick, Emil H Schemitsch, Thomas S ThornhillAbstract:A retrospective matched-pair comparative analysis was done between 30 total knee arthroplasties following failed high tibial osteotomies and 30 total knee arthroplasties following failed unicompartmental knee arthroplasties. The groups were matched according to age, gender, type of prosthesis, primary disease, and length of followup. A minimum followup of 2 years was required for inclusion in the study, and the average followup was 3.8 years (range, 2-9 years). The Knee Society Knee Score for the high tibial osteotomy group was significantly higher than that for the unicompartmental Arthroplasty group. More osseous reconstructions were required in the unicompartmental revisions. Difficulty with exposure was not significantly greater in the osteotomy group. Rates of component loosening were not significantly different between the groups. A failed unicompartmental knee Arthroplasty and a failed high tibial osteotomy can be revised successfully to a total knee Arthroplasty. The results confirm that revisions after unicondylar Arthroplasty and high tibial osteotomy are technically demanding. In this series, the results of total knee Arthroplasty following unicompartmental knee Arthroplasty approached but did not equal those obtained after high tibial osteotomy.
Soko Setoguchi - One of the best experts on this subject based on the ideXlab platform.
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Unicompartmental knee Arthroplasty and total knee Arthroplasty among Medicare beneficiaries, 2000 to 2009.
Journal of Bone and Joint Surgery American Volume, 2013Co-Authors: Michael P Bolognesi, David E. Attarian, Melissa A Greiner, Lesley H Curtis, Samuel S Wellman, Keith R. Berend, Tyler Steven Watters, Soko SetoguchiAbstract:Background: Unicompartmental knee Arthroplasty is a less-invasive alternative to total knee Arthroplasty for patients with arthritis affecting only the medial or lateral compartment. However, little is known about recent trends in the use of these procedures and the associated outcomes among older patients. Methods: With use of a nationally representative 5% sample of Medicare beneficiaries who were sixty-five years of age or older and who had undergone either unilateral unicompartmental knee Arthroplasty or unilateral total knee Arthroplasty from 2000 to 2009, we assessed trends in the use of unicompartmental and total knee Arthroplasty, associated durations of hospital stay, and postoperative outcomes. The outcome measures were the rates of implant revision or removal within five years and the rates of periprosthetic infection, thromboembolic events, myocardial infarction, and all-cause mortality within one year. We conducted Kaplan-Meier analyses to assess the cumulative incidence of unadjusted outcomes and used Cox proportional-hazards regression to understand the relative risks of the outcomes for each procedure. Results: A total of 68,603 patients underwent unilateral total knee Arthroplasty (n = 65,505) or unilateral unicompartmental knee Arthroplasty (n = 3098) from 2000 to 2009. The mean age was seventy-five years; 34% of the patients were men, and 92% were white. The procedure rate was twenty-one times higher for total knee Arthroplasty (597 per 100,000 person-years) than unicompartmental knee Arthroplasty (twenty-nine per 100,000 person-years). The use of total knee Arthroplasty increased 1.7-fold, and the use of unicompartmental knee Arthroplasty increased 6.2-fold. The mean length of stay (and standard deviation [SD]) was 3.9 ± 2.1 days for total knee Arthroplasty and 2.4 ± 1.7 days for unicompartmental knee Arthroplasty. The five-year revision rate was 3.7% for total knee Arthroplasty and 8.0% for unicompartmental knee Arthroplasty. After multivariable adjustment, the risk of revision remained 2.4 times higher for unicompartmental knee Arthroplasty than for total knee Arthroplasty (95% confidence interval [CI] = 2.03 to 2.83). After multivariable adjustment, patients who underwent unicompartmental knee Arthroplasty had no significant differential one-year risk of infection (adjusted hazard ratio [HR] = 0.74; 95% CI = 0.55 to 1.01), thromboembolic events (adjusted HR =0.86; 95% CI = 0.57 to 1.29), or mortality (adjusted HR = 0.75; 95% CI = 0.50 to 1.11). Conclusions: Although unicompartmental knee Arthroplasty accounted for only 4.5% of the unilateral knee replacements among Medicare beneficiaries, the use of this procedure has increased dramatically. Compared with those who had total knee Arthroplasty, patients who underwent unicompartmental knee Arthroplasty had higher revision rates but shorter durations of stay and tended to have lower rates of perioperative complications. These findings need to be confirmed by studies that incorporate detailed clinical information. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
