Lower function, quality of life, and survival rate after total knee arthroplasty for posttraumatic arthritis than for primary arthritis

International audienceBackground and purpose - Total knee arthroplasty (TKA) for treatment of end-stage posttraumatic arthritis (PTA) has specific technical difficulties and complications. We compared clinical outcome, postoperative quality of life (QOL), and survivorship after TKA done for PTA with those after TKA performed for primary arthritis (PA). Patients and methods - We retrospectively reviewed patients who were operated on at our institution for PTA between 1998 and 2005 (33 knees), and compared them to a matched group of patients who were operated on for PA during the same period (407 knees). Clinical outcomes and postoperative QOL were compared in the 2 groups using Knee Society score (KSS), range of motion (ROM) of the knee, and the knee osteoarthritis outcomes score (KOOS). Implant survival rate was calculated using Kaplan-Meier analysis. Results - At a mean follow-up of 11 (5-15) years, KSS knee increased from mean 39 (SD 18) to 87 (SD 16) in the PA group (p = 0.003), and from 31 (SD 11) to 77 (SD 15) in the PTA group (p = 0.003). KSS function increased from 55 (12) to 89 (25) in the PA group (p = 0.008) and from 44 (SD 14) to 81 (SD 10) in the PTA group (p = 0.008). Postoperative ROM also improved in both groups, from 83 degrees to 108 degrees in the PTA group (p < 0.001) as opposed to 116 degrees to 127 degrees in the PA group (p = 0.001), with lower results in the PTA group (p < 0.001). KOOS was lower in the PTA group (p < 0.001). The survival rate of TKA at 10 years with an endpoint defined as "any surgery on the operated knee" showed better results in the PA group (99%, CI: 98-100 vs. 79%, CI: 69-89; p < 0.001). Interpretation - Patients and surgeons should be aware that clinical outcome and implant survival after TKA for PTA are lower than after TKA done for P

Clinical, ultrasonographic and CT markers for botulinum toxin injections into the piriformis muscle

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Analysis of 8years activity of the mobile rehabilitation team in the Besançon University Hospital

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Необъяснимая боль после тотального эндопротезирования коленного сустава

Although total knee arthroplasty (TKA) improves function and reduces pain for the large majority of the patients, a few continue to have pain and require investigation. The causes of dysfunction and pain after total knee arthroplasty can be described as intrinsic (intra-articular) or extrinsic (extra-articular) sources of pain. For the majority of the cases, following a complete evaluation protocol, the cause of pain can be identified and a specific treatment can be applied, however occasionally there remains a group of patients with unexplained pain whose management is difficult. It was our hypothesis that revising a TKA without pre-operative diagnosis of the failure is not worth. Therefore, the aimed of this review was to: 1) analyse the results of revision TKA for unexplained pain, and 2) described the potential solutions for an alternative conservative management of the painful TKA.Несмотря на то, что тотальная артропластика коленного сустава приводит к улучшению функции и уменьшению болевого синдрома у подавляющего большинства пациентов, ряд больных после операции продолжают испытывать болевые ощущения. Причины боли и нарушения функции после эндопротезирования могут быть обусловлены как внутрисуставными, так внесуставными факторами. Системный подход к обследованию таких пациентов чаще всего позволяет установить источник боли и провести соответствующее лечение. Тем не менее, существует небольшая группа пациентов с необъяснимой болью, лечение которых является крайне сложной клинической задачей. Нами выдвинута гипотеза, что без четкого понимания причины неудачи первичного вмешательства проведение ревизионного эндопротезирования таким пациентам не показано. В данном обзоре литературы проведён анализ результатов реэндопротезированя коленного сустава, выполненных пациентам с необъяснимой болью и описаны возможные варианты консервативных подходов к лечению этой категории больных

Unexplained pain after total knee arthroplasty

Although total knee arthroplasty (TKA) improves function and reduces pain for the large majority of the patients, a few continue to have pain and require investigation. The causes of dysfunction and pain after total knee arthroplasty can be described as intrinsic (intra-articular) or extrinsic (extra-articular) sources of pain. For the majority of the cases, following a complete evaluation protocol, the cause of pain can be identified and a specific treatment can be applied, however occasionally there remains a group of patients with unexplained pain whose management is difficult. It was our hypothesis that revising a TKA without pre-operative diagnosis of the failure is not worth. Therefore, the aimed of this review was to: 1) analyse the results of revision TKA for unexplained pain, and 2) described the potential solutions for an alternative conservative management of the painful TKA

Total knee arthroplasty after opening– versus closing-wedge high tibial osteotomy. A 135-case series with minimum 5-year follow-up

INTRODUCTION: High tibial osteotomy (HTO) is effective in treating isolated medial osteoarthritis of the knee, but subsequent deterioration is inevitable, and total knee arthroplasty (TKA) is then an option. The present study sought to compare TKA following medial opening-wedge HTO (OW-HTO) versus lateral closing-wedge HTO (CW-HTO) in terms of intraoperative data and clinical results. The study hypothesis was that there is no significant difference in clinical results or complications in TKA following OW-HTO or CW-HTO. MATERIAL AND METHOD: A retrospective multicenter (9 centers) study was conducted for the French Society of Orthopedic Surgery and Traumatology (SoFCOT), including 135 TKAs following HTO (58 OW and 77 CW) at a minimum 5 years' follow-up. Mean interval between HTO and TKA was 134 months and was longer in case of CW-HTO (P<0.0001). Mean age at TKA was 65.4 years and older in case of CW-HTO (P=0.021). Tibial slope was greater in case of OW-HTO (P=0.024). Prior to TKA, 55.7% of patients could walk without canes, 98.4% found stairs difficult or impossible and only 19.1% could manage a walking distance greater than 1000m. Mean flexion was 110°; 54.2% of patients showed frontal knee stability and 87.8% sagittal stability; 60.1% had a mechanical axis in varus, without difference according to OW- or CW-HTO. RESULTS: Hardware was almost systematically removed (in 98.5% of cases): in the same step for OW-HTO (P=0.018) or often in 2 steps for CW-HTO. The primary approach was generally re-used (54.2%), but less frequently in the CW-HTO group (P=0.0004). Lateral or medial ligament release was not associated in respectively 78.2% and 79.7% of cases. The TKA implant was usually without stem (87.2%) and was fitted using a conventional technique (74.4%). At a mean 87 months' follow-up, 78.5% of patients could walk without canes, stairs were still difficult or impossible for 67%, and 74.1% could now walk further than 1000m; mean flexion was 110.5°. Overall, 91.5% of patients showed frontal knee stability and 98.2% sagittal stability, without difference according to OW- or CW-HTO. There were 15 complications within 3 months, more often in the OW-HTO group (12.3%) although not significantly, and with no difference in severity. Late complications comprised loosening (5.5%) and infection (3.6%) and were more frequent in the CW-HTO group (12%) (P<0.05). DISCUSSION: The study hypothesis was partially confirmed. The only technical differences concerned hardware removal, often performed in two steps in case of CW-HTO, and TKA approach, which differed from the primary approach in case of CW-HTO. Clinical results were comparable between OW- and CW-HTO, but late complications were more frequent in the CW-HTO group

Ten-year survival and complications of total knee arthroplasty for osteoarthritis secondary to trauma or surgery: A French multicentre study of 263 patients

BACKGROUND: Previous surgical procedures raise technical challenges in performing total knee arthroplasty (TKA) and may affect TKA outcomes. Survival rates of TKA done after trauma or surgery to the knee have not been accurately determined in large populations. The objectives of this retrospective study in 263 patients with TKA after knee trauma or surgery and a follow-up of 10 years were to assess survival, functional outcomes, and the nature and frequency of complications. HYPOTHESIS: Knee trauma or surgery before TKA increases the risk of complications and decreases implant survival. MATERIAL AND METHODS: Two hundred and sixty-three patients (122 [47%] females and 141 [53%] males) underwent TKA between 2005 and 2009 at nine centres in France. Mean age at surgery was 61 years. The patients had knee osteoarthritis secondary to a fracture (n=66), osteotomy (n=131), or ligament injury (n=66). Mean time from trauma or surgery to TKA was 145 months (range, 72-219 months). RESULTS: Major complications were infection (n=12, 4.5%), skin problems (n=8, 3%), and stiffness (n=8, 3%). Ten-year survival to implant exchange for any reason was 89%±2.8%. Flexion range increased by 2.5°±17° (p=0.02) to a mean of 110° (range, 30° to 140°); extension range increased by 4°±7° (p<0.001) to a mean of -1.19 (range, -20° to 0°). Of the 263 patients, 157 (60%) reported little or no pain at last follow-up. Mean postoperative hip-knee-ankle angle was 179°±3.2° (range, 171°-188°). CONCLUSION: TKA performed after knee injury or surgery carries a risk of specific complications (infection, skin problems, and stiffness) and may have a lower survival rate compared to primary TKA