RESUMEN
Introduction: Non-classical Celiac disease is a previously undescribed cause of debilitating post-operative cutaneous complications following an orthopedic procedure. Non-specific symptoms and rarity of the disease pose a diagnostic challenge; however, given underdiagnosis and significant morbidity, after ruling out of acute pathology, Celiac disease should be included in differential diagnosis for refractory cutaneous complications following an operative procedure. Case Report: A 34-year-old woman who underwent patellofemoral arthroplasty and medial patellofemoral ligament reconstruction experienced over 5 months of post-operative knee swelling, erythema, and pain unresponsive to antihistamines and negative infectious, vascular, and implant allergy testing workups. After careful dietary monitoring by an allergy specialist, she was tested and confirmed to have Celiac disease. Following cessation of her oral contraceptive pill and dietary gluten, her knee swelling, erythema, and debilitating pain resolved. Conclusion: Skin erythema, swelling, and pain are known complications after any operative treatment, but after ruling out of acute infectious and thromboembolic processes, diagnosis and management of refractory complications pose a challenging scenario. In this rare phenomenon, previously undescribed, a patient presented with months of post-operative knee erythema, swelling, stiffness, and extreme pain on activity along with non-specific symptoms of headache and fatigue before diagnosis with Celiac disease. On cessation of her birth control and dietary gluten, her symptoms and knee function improved dramatically.
RESUMEN
PURPOSE: The aim of this study was to assess whether preoperative valgus or varus deformity affected survivorship after total knee arthroplasty (TKA) and to quantify the risk factors for implant failure in a registry-based population. METHODS: The Emilia-Romagna Registry of Prosthetic Orthopedic Implants was examined regarding TKAs performed on patients with a preoperative diagnosis of valgus or varus deformity. Demographics, implant characteristic and survivorships were investigated and compared. A total of 2327 TKA procedures performed from 2000 to 2016 were included in the study. Six hundred and forty primary TKAs with a diagnosis of valgus deformity were evaluated with a median follow-up of 3.3 years; 1687 primary TKAs with a diagnosis of varus deformity were evaluated with a median follow-up of 2.5 years. RESULTS: Bi-compartmental, cemented posterior stabilised fixed-bearing implants were preferred. For both diagnoses, the implant survivorship rate was greater than 98% in the first year. However, the survival curve of the TKAs implanted for valgus deformity showed a greater slope in the first 3 years as compared to the survival curve of those implanted for varus deformity. Valgus deformity had a 2.1-fold higher risk for revision as compared with varus deformity. Infection was a major cause of implant failure in TKAs for varus deformity, 9/24 (37.5%), while its incidence was lower for valgus deformity, 1/21 (4.8%). CONCLUSIONS: Preoperative valgus alignment showed a twofold risk of failure as compared to varus alignment after TKA. This should be considered in daily practice, and surgeons are called on to pay more attention when performing TKAs on such patients. Prospective randomised controlled trials are, therefore, necessary to better understand the role of preoperative coronal knee deformity in implant failure. LEVEL OF EVIDENCE: Prognostic study, level III.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/métodos , Coxa Vara/fisiopatología , Genu Valgum/fisiopatología , Articulación de la Rodilla/anomalías , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla , Sistema de Registros , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Ortopedia/métodos , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Reoperación , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: Prior studies comparing unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) in the elderly are limited by heterogeneity in arthritic disease patterns and patient selection. We report the results of UKA and TKA in patients 75 years and older with isolated medial compartmental arthritis, with special emphasis on immediate postoperative recovery, complications, reoperation rates, and implant survivorship at midterm follow-up. METHODS: A retrospective review was performed of all patients 75 years and older who underwent UKA or TKA at our institution between 2002 and 2012. All TKA preoperative X-rays were reviewed by a blind observer to identify knees with isolated medial compartmental arthritis considered acceptable candidates for UKA. Patients with less than 2 years of follow-up, flexion contracture greater than 10°, and rheumatoid arthritis were excluded. The final sample included 120 UKA (106 patients) and 188 TKA (170 patients) procedures. Patient records were reviewed to determine early postoperative recovery, complications, reoperations for any reason, and implant survivorship. RESULTS: UKA patients experienced significantly shorter operative time, shorter hospital stay, lower intraoperative estimated blood loss, lower postoperative transfusions, greater postoperative range of motion, and higher level of activity at time of discharge. Two UKA and 2 TKA patients required revision surgery. There was no statistically significant difference in postoperative Knee Society Scores. There were no differences in 5-year survivorship estimates. CONCLUSION: Due to its less invasive nature, patients older than 75 undergoing UKA demonstrated faster initial recovery when compared to TKA, while maintaining comparable complications and midterm survivorship. UKA should be offered as an option in the elderly patient who fits the selection criteria for UKA.