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Cecil H Rorabeck - One of the best experts on this subject based on the ideXlab platform.
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tibial tubercle osteotomy in Total Knee Arthroplasty surgery
Journal of Arthroplasty, 2008Co-Authors: Claire F Young, Robert B Bourne, Cecil H RorabeckAbstract:Tibial tubercle osteotomy (TTO) is a recognized technique for improving exposure when performing Total Knee Arthroplasty surgery. Forty-two patients were reviewed at a mean of 8 years after TTO. Preoperatively, mean extension was 8 degrees +/- 14 degrees , mean flexion 74 degrees +/- 30 degrees , and Knee Society score 73 +/- 37. At latest follow-up, mean extension was 4 degrees +/- 15 degrees , mean flexion 91 degrees +/- 22 degrees , and Knee Society score 124 +/- 42.6 (P < or = .0001). Seventy-three percent of patients had an excellent/good score at latest follow-up. Twenty-five percent of patients experienced no extensor lag, and 66% of extensor lags had resolved within 6 months. Mean time for osteotomy union was 14 weeks. In this series, TTO performed to enhance surgical exposure did not adversely affect the outcome after Total Knee Arthroplasty but resulted in serious complications in 5% of patients.
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wear and osteolysis around Total Knee Arthroplasty
Journal of The American Academy of Orthopaedic Surgeons, 2007Co-Authors: Douglas D R Naudie, Deborah J Ammeen, Gerard A Engh, Cecil H RorabeckAbstract:Osteolysis induced by wear debris of ultra-high-molecular-weight polyethylene has emerged as a significant problem after Total Knee Arthroplasty. The generation of polyethylene wear and the development of osteolysis around Total Knee Arthroplasty are caused by a combination of patient, implant, and surgical factors. Activity level over time may be the most important patient factor affecting the loads placed on a Total Knee replacement, but it is the most difficult to manage. Multiple factors related to the manufacturing of the polyethylene implant influence the extent of wear, and surgeons should be cautious in considering enhanced polyethylenes pending results of further investigations. The optimal design of the articular bearing surface remains controversial but needs to be considered with respect to the stresses imparted on component-bone and modular tibial backside interfaces. Surgical factors, including restoration of alignment and ligament balance, are important for long-term durability of the implant. Methods of measuring the wear of Total Knee implants are still evolving. Thus, when confronted with a worn Total Knee implant and developing osteolysis, the surgeon should consider each of these factors in selecting the best management option to eliminate the source of debris and minimize the potential for wear and osteolysis following revision.
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joint line restoration after revision Total Knee Arthroplasty
Clinical Orthopaedics and Related Research, 1999Co-Authors: Paul F Partington, Jaswin Sawhney, Cecil H Rorabeck, Robert L Barrack, Joel MooreAbstract: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.
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management of recurrent dislocation of the patella following Total Knee Arthroplasty
Journal of Arthroplasty, 1992Co-Authors: Patrick Kirk, Cecil H Rorabeck, Robert B Bourne, B Burkart, L NottAbstract:Fifteen Knees with patellar dislocation after Total Knee Arthroplasty had realignment of the extensor mechanism using a modification of the Trillat procedure. The onset of dislocation occurred on average 4.7 months from the time of surgery. After Total Knee Arthroplasty the patients had an average range of motion of 109 degrees. All patients had medialization of the tibial tubercle and lateral release. No patient had a recurrent dislocation after a minimum 2-year follow-up period. The average Knee score was 82 and the average flexion arc was 112 degrees. All but one of the osteotomies healed uneventfully.
Michael A Mont - One of the best experts on this subject based on the ideXlab platform.
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chronic opioid use prior to Total Knee Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: Michael G Zywiel, Peter M. Bonutti, Alex D Stroh, Seung Yong Lee, Michael A MontAbstract:Background: Chronic use of opioid medications may lead to dependence or hyperalgesia, both of which might adversely affect perioperative and postoperative pain management, rehabilitation, and clinical outcomes after Total Knee Arthroplasty. The purpose of this study was to evaluate patients who underwent Total Knee Arthroplasty following six or more weeks of chronic opioid use for pain control and to compare them with a matched group who did not use opioids preoperatively. Methods: Forty-nine Knees in patients who had a mean age of fifty-six years (range, thirty-seven to seventy-eight years) and who had regularly used opioid medications for pain control prior to Total Knee Arthroplasty were compared with a group of patients who had not used them. Length of hospitalization, aseptic complications requiring reoperation, requirement for specialized pain management, and clinical outcomes were assessed for both groups. Results: Knee Society scores were significantly lower in the patients who regularly used opioid medications at the time of final follow-up (mean, three years; range, two to seven years); the opioid group had a mean of 79 points (range, 45 to 100 points) as compared with a mean of 92 points (range, 59 to 100 points) in the non-opioid group. A significantly higher prevalence of complications was seen in the opioid group, with five arthroscopic evaluations and eight revisions for persistent stiffness and/or pain, compared with none in the matched group. Ten patients in the opioid group were referred for outpatient pain management, compared with one patient in the non-opioid group. Conclusions: Patients who chronically use opioid medications prior to Total Knee Arthroplasty may be at a substantially greater risk for complications and painful prolonged recoveries. Alternative non-opioid pain medications and/or earlier referral to an orthopaedic surgeon prior to habitual opioid use should be considered for patients with painful degenerative disease of the Knee. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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chronic opioid use prior to Total Knee Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: Michael G Zywiel, Peter M. Bonutti, Alex D Stroh, Michael A MontAbstract:Background: Chronic use of opioid medications may lead to dependence or hyperalgesia, both of which might adversely affect perioperative and postoperative pain management, rehabilitation, and clinical outcomes after Total Knee Arthroplasty. The purpose of this study was to evaluate patients who underwent Total Knee Arthroplasty following six or more weeks of chronic opioid use for pain control and to compare them with a matched group who did not use opioids preoperatively. Methods: Forty-nine Knees in patients who had a mean age of fifty-six years (range, thirty-seven to seventy-eight years) and who had regularly used opioid medications for pain control prior to Total Knee Arthroplasty were compared with a group of patients who had not used them. Length of hospitalization, aseptic complications requiring reoperation, requirement for specialized pain management, and clinical outcomes were assessed for both groups. Results: Knee Society scores were significantly lower in the patients who regularly used opioid medications at the time of final follow-up (mean, three years; range, two to seven years); the opioid group had a mean of 79 points (range, 45 to 100 points) as compared with a mean of 92 points (range, 59 to 100 points) in the non-opioid group. A significantly higher prevalence of complications was seen in the opioid group, with five arthroscopic evaluations and eight revisions for persistent stiffness and/or pain, compared with none in the matched group. Ten patients in the opioid group were referred for outpatient pain management, compared with one patient in the non-opioid group. Conclusions: Patients who chronically use opioid medications prior to Total Knee Arthroplasty may be at a substantially greater risk for complications and painful prolonged recoveries. Alternative non-opioid pain medications and/or earlier referral to an orthopaedic surgeon prior to habitual opioid use should be considered for patients with painful degenerative disease of the Knee. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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static progressive stretch improves range of motion in arthrofibrosis following Total Knee Arthroplasty
Knee Surgery Sports Traumatology Arthroscopy, 2010Co-Authors: Peter M. Bonutti, German A. Marulanda, Michael A Mont, Michael S Mcgrath, Michael G ZywielAbstract:Arthrofibrosis is a relatively common complication after Total Knee Arthroplasty that negatively affects function and quality of life. Static progressive stretching is a technique that has shown promising results in the treatment of contractures of the elbow, ankle, wrist and Knee. This study evaluated a static progressive stretching device as a treatment method for patients who had refractory Knee stiffness after Total Knee Arthroplasty. Twenty-five patients who had Knee stiffness and no improvement with conventional physical therapy modalities were treated with the device. After a median of 7 weeks (range, 3–16 weeks), the median increase in range of motion was 25° (range, 8–82°). The median gain in Knee active flexion was 19° (range, 5–80°). Ninety-two percent of patients were satisfied with the results. The authors believe static progressive stretching devices may be an effective method for increasing the ranges of motion and satisfaction levels of patients who develop arthrofibrosis after Total Knee Arthroplasty.
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scientific evidence supporting computer assisted surgery and minimally invasive surgery for Total Knee Arthroplasty
Expert Review of Medical Devices, 2007Co-Authors: Slif D Ulrich, Peter M. Bonutti, David R Marker, Thorsten M Seyler, Michael A Mont, Lynne C JonesAbstract:This review provides an overview of the field of minimally invasive surgery and computer-assisted surgery for Total Knee Arthroplasty. The authors have examined the complete body of literature for scientific evidence supporting the use of these new technologies and how the literature specifically supports commonly asked questions. There is controversy concerning the benefits of minimally invasive surgery and computer-assisted surgery for Total Knee Arthroplasty. However, in most studies the results are similar for minimally invasive surgery compared to standard approaches. Computer-assisted navigation has been found in some studies to improve radiographic alignment of Total Knee Arthroplasty. The authors believe that there is evidence for both technologies to be at least equivalent in terms of results, as well as expectations of increased success with the techniques. Both technologies have led manufacturers to invest more effort into newer prosthetic instrumentations and designs to facilitate these techni...
Peter M. Bonutti - One of the best experts on this subject based on the ideXlab platform.
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chronic opioid use prior to Total Knee Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: Michael G Zywiel, Peter M. Bonutti, Alex D Stroh, Michael A MontAbstract:Background: Chronic use of opioid medications may lead to dependence or hyperalgesia, both of which might adversely affect perioperative and postoperative pain management, rehabilitation, and clinical outcomes after Total Knee Arthroplasty. The purpose of this study was to evaluate patients who underwent Total Knee Arthroplasty following six or more weeks of chronic opioid use for pain control and to compare them with a matched group who did not use opioids preoperatively. Methods: Forty-nine Knees in patients who had a mean age of fifty-six years (range, thirty-seven to seventy-eight years) and who had regularly used opioid medications for pain control prior to Total Knee Arthroplasty were compared with a group of patients who had not used them. Length of hospitalization, aseptic complications requiring reoperation, requirement for specialized pain management, and clinical outcomes were assessed for both groups. Results: Knee Society scores were significantly lower in the patients who regularly used opioid medications at the time of final follow-up (mean, three years; range, two to seven years); the opioid group had a mean of 79 points (range, 45 to 100 points) as compared with a mean of 92 points (range, 59 to 100 points) in the non-opioid group. A significantly higher prevalence of complications was seen in the opioid group, with five arthroscopic evaluations and eight revisions for persistent stiffness and/or pain, compared with none in the matched group. Ten patients in the opioid group were referred for outpatient pain management, compared with one patient in the non-opioid group. Conclusions: Patients who chronically use opioid medications prior to Total Knee Arthroplasty may be at a substantially greater risk for complications and painful prolonged recoveries. Alternative non-opioid pain medications and/or earlier referral to an orthopaedic surgeon prior to habitual opioid use should be considered for patients with painful degenerative disease of the Knee. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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chronic opioid use prior to Total Knee Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: Michael G Zywiel, Peter M. Bonutti, Alex D Stroh, Seung Yong Lee, Michael A MontAbstract:Background: Chronic use of opioid medications may lead to dependence or hyperalgesia, both of which might adversely affect perioperative and postoperative pain management, rehabilitation, and clinical outcomes after Total Knee Arthroplasty. The purpose of this study was to evaluate patients who underwent Total Knee Arthroplasty following six or more weeks of chronic opioid use for pain control and to compare them with a matched group who did not use opioids preoperatively. Methods: Forty-nine Knees in patients who had a mean age of fifty-six years (range, thirty-seven to seventy-eight years) and who had regularly used opioid medications for pain control prior to Total Knee Arthroplasty were compared with a group of patients who had not used them. Length of hospitalization, aseptic complications requiring reoperation, requirement for specialized pain management, and clinical outcomes were assessed for both groups. Results: Knee Society scores were significantly lower in the patients who regularly used opioid medications at the time of final follow-up (mean, three years; range, two to seven years); the opioid group had a mean of 79 points (range, 45 to 100 points) as compared with a mean of 92 points (range, 59 to 100 points) in the non-opioid group. A significantly higher prevalence of complications was seen in the opioid group, with five arthroscopic evaluations and eight revisions for persistent stiffness and/or pain, compared with none in the matched group. Ten patients in the opioid group were referred for outpatient pain management, compared with one patient in the non-opioid group. Conclusions: Patients who chronically use opioid medications prior to Total Knee Arthroplasty may be at a substantially greater risk for complications and painful prolonged recoveries. Alternative non-opioid pain medications and/or earlier referral to an orthopaedic surgeon prior to habitual opioid use should be considered for patients with painful degenerative disease of the Knee. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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static progressive stretch improves range of motion in arthrofibrosis following Total Knee Arthroplasty
Knee Surgery Sports Traumatology Arthroscopy, 2010Co-Authors: Peter M. Bonutti, German A. Marulanda, Michael A Mont, Michael S Mcgrath, Michael G ZywielAbstract:Arthrofibrosis is a relatively common complication after Total Knee Arthroplasty that negatively affects function and quality of life. Static progressive stretching is a technique that has shown promising results in the treatment of contractures of the elbow, ankle, wrist and Knee. This study evaluated a static progressive stretching device as a treatment method for patients who had refractory Knee stiffness after Total Knee Arthroplasty. Twenty-five patients who had Knee stiffness and no improvement with conventional physical therapy modalities were treated with the device. After a median of 7 weeks (range, 3–16 weeks), the median increase in range of motion was 25° (range, 8–82°). The median gain in Knee active flexion was 19° (range, 5–80°). Ninety-two percent of patients were satisfied with the results. The authors believe static progressive stretching devices may be an effective method for increasing the ranges of motion and satisfaction levels of patients who develop arthrofibrosis after Total Knee Arthroplasty.
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Functional problems and arthrofibrosis following Total Knee Arthroplasty.
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Thorsten M Seyler, German A. Marulanda, Peter M. Bonutti, David R Marker, Johannes F Plate, Anil Bhave, Ronald E DelanoisAbstract:Improved surgical techniques and multidisciplinary rehabilitation protocols that involve coordination among surgeons, physical therapists, anesthesiologists, and social services personnel have led to excellent Knee function and range of motion in a large percentage of patients following Total Knee Arthroplasty. Nevertheless, there remains a small number of patients with persistent dysfunction that is difficult to treat1-4. Functional problems following Total Knee Arthroplasty may be incapacitating as a result of persistent pain5, instability6, and a limited range of motion7. It has been shown recently that there is a direct correlation between a decreased range of motion following surgery and a lower perceived quality of life as evaluated with use of the Short Form-36 health survey questionnaire8. Continued dysfunction for any reason ultimately leads to decreased patient satisfaction. There is controversy about treatment methods for patients for whom initial rehabilitation efforts are unsuccessful following Total Knee Arthroplasty. The reported efficacy of both noninvasive and invasive treatment modalities has been variable, with the percentage of patients obtaining improvement ranging from 0% to 90%3,9-12. Patients who have continued dysfunction despite initial rehabilitation efforts may require revision surgery. However, patients who have well-aligned, well-fixed prosthetic components will likely not benefit from a complete revision. Treatment of arthrofibrosis, scarring, soft-tissue contractures, and/or other soft-tissue dysfunction should involve less invasive treatment protocols before surgical options are considered. Nonoperative treatment modalities for restoring the range of motion include intensive rehabilitation protocols, static or dynamic splinting, injections, and application of serial casts13. Manipulation with the patient under anesthesia and invasive procedures, including arthroscopic debridement, open debridement with or without polyethylene exchange, and complete component revision, have been utilized when initial nonoperative rehabilitation efforts have failed. As a result of the …
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scientific evidence supporting computer assisted surgery and minimally invasive surgery for Total Knee Arthroplasty
Expert Review of Medical Devices, 2007Co-Authors: Slif D Ulrich, Peter M. Bonutti, David R Marker, Thorsten M Seyler, Michael A Mont, Lynne C JonesAbstract:This review provides an overview of the field of minimally invasive surgery and computer-assisted surgery for Total Knee Arthroplasty. The authors have examined the complete body of literature for scientific evidence supporting the use of these new technologies and how the literature specifically supports commonly asked questions. There is controversy concerning the benefits of minimally invasive surgery and computer-assisted surgery for Total Knee Arthroplasty. However, in most studies the results are similar for minimally invasive surgery compared to standard approaches. Computer-assisted navigation has been found in some studies to improve radiographic alignment of Total Knee Arthroplasty. The authors believe that there is evidence for both technologies to be at least equivalent in terms of results, as well as expectations of increased success with the techniques. Both technologies have led manufacturers to invest more effort into newer prosthetic instrumentations and designs to facilitate these techni...
Michael G Zywiel - One of the best experts on this subject based on the ideXlab platform.
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chronic opioid use prior to Total Knee Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: Michael G Zywiel, Peter M. Bonutti, Alex D Stroh, Michael A MontAbstract:Background: Chronic use of opioid medications may lead to dependence or hyperalgesia, both of which might adversely affect perioperative and postoperative pain management, rehabilitation, and clinical outcomes after Total Knee Arthroplasty. The purpose of this study was to evaluate patients who underwent Total Knee Arthroplasty following six or more weeks of chronic opioid use for pain control and to compare them with a matched group who did not use opioids preoperatively. Methods: Forty-nine Knees in patients who had a mean age of fifty-six years (range, thirty-seven to seventy-eight years) and who had regularly used opioid medications for pain control prior to Total Knee Arthroplasty were compared with a group of patients who had not used them. Length of hospitalization, aseptic complications requiring reoperation, requirement for specialized pain management, and clinical outcomes were assessed for both groups. Results: Knee Society scores were significantly lower in the patients who regularly used opioid medications at the time of final follow-up (mean, three years; range, two to seven years); the opioid group had a mean of 79 points (range, 45 to 100 points) as compared with a mean of 92 points (range, 59 to 100 points) in the non-opioid group. A significantly higher prevalence of complications was seen in the opioid group, with five arthroscopic evaluations and eight revisions for persistent stiffness and/or pain, compared with none in the matched group. Ten patients in the opioid group were referred for outpatient pain management, compared with one patient in the non-opioid group. Conclusions: Patients who chronically use opioid medications prior to Total Knee Arthroplasty may be at a substantially greater risk for complications and painful prolonged recoveries. Alternative non-opioid pain medications and/or earlier referral to an orthopaedic surgeon prior to habitual opioid use should be considered for patients with painful degenerative disease of the Knee. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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chronic opioid use prior to Total Knee Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: Michael G Zywiel, Peter M. Bonutti, Alex D Stroh, Seung Yong Lee, Michael A MontAbstract:Background: Chronic use of opioid medications may lead to dependence or hyperalgesia, both of which might adversely affect perioperative and postoperative pain management, rehabilitation, and clinical outcomes after Total Knee Arthroplasty. The purpose of this study was to evaluate patients who underwent Total Knee Arthroplasty following six or more weeks of chronic opioid use for pain control and to compare them with a matched group who did not use opioids preoperatively. Methods: Forty-nine Knees in patients who had a mean age of fifty-six years (range, thirty-seven to seventy-eight years) and who had regularly used opioid medications for pain control prior to Total Knee Arthroplasty were compared with a group of patients who had not used them. Length of hospitalization, aseptic complications requiring reoperation, requirement for specialized pain management, and clinical outcomes were assessed for both groups. Results: Knee Society scores were significantly lower in the patients who regularly used opioid medications at the time of final follow-up (mean, three years; range, two to seven years); the opioid group had a mean of 79 points (range, 45 to 100 points) as compared with a mean of 92 points (range, 59 to 100 points) in the non-opioid group. A significantly higher prevalence of complications was seen in the opioid group, with five arthroscopic evaluations and eight revisions for persistent stiffness and/or pain, compared with none in the matched group. Ten patients in the opioid group were referred for outpatient pain management, compared with one patient in the non-opioid group. Conclusions: Patients who chronically use opioid medications prior to Total Knee Arthroplasty may be at a substantially greater risk for complications and painful prolonged recoveries. Alternative non-opioid pain medications and/or earlier referral to an orthopaedic surgeon prior to habitual opioid use should be considered for patients with painful degenerative disease of the Knee. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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static progressive stretch improves range of motion in arthrofibrosis following Total Knee Arthroplasty
Knee Surgery Sports Traumatology Arthroscopy, 2010Co-Authors: Peter M. Bonutti, German A. Marulanda, Michael A Mont, Michael S Mcgrath, Michael G ZywielAbstract:Arthrofibrosis is a relatively common complication after Total Knee Arthroplasty that negatively affects function and quality of life. Static progressive stretching is a technique that has shown promising results in the treatment of contractures of the elbow, ankle, wrist and Knee. This study evaluated a static progressive stretching device as a treatment method for patients who had refractory Knee stiffness after Total Knee Arthroplasty. Twenty-five patients who had Knee stiffness and no improvement with conventional physical therapy modalities were treated with the device. After a median of 7 weeks (range, 3–16 weeks), the median increase in range of motion was 25° (range, 8–82°). The median gain in Knee active flexion was 19° (range, 5–80°). Ninety-two percent of patients were satisfied with the results. The authors believe static progressive stretching devices may be an effective method for increasing the ranges of motion and satisfaction levels of patients who develop arthrofibrosis after Total Knee Arthroplasty.
William A Jiranek - One of the best experts on this subject based on the ideXlab platform.
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the results of tibial tubercle osteotomy for revision Total Knee Arthroplasty
Journal of Arthroplasty, 2004Co-Authors: Michael W Mendes, Paul Caldwell, William A JiranekAbstract:Tibial tubercle osteotomy was used in the surgical exposure of 67 Knees in 64 patients undergoing revision Total Knee Arthroplasty. The clinical and radiographic results were reviewed retrospectively. The mean follow-up time was 30 months (range, 5-60 months). Knee Society scores (KSS) confirmed good or excellent results in 87% of the Knees, and the mean KSS was 86. The procedure was particularly effective in 2-stage exchanges for infected Total Knee Arthroplasty, in which infection was eradicated in 9 of 10 cases, with a mean KSS of 82. In this series, no patellofemoral complications, no component malalignments, and no avulsions of the patellar tendon occurred. Serious complications directly related to the tibial tubercle osteotomy occurred in 5 patients (7%).