RESUMO
BACKGROUND: Enhanced implant longevity through biological fixation is achievable using cementless total knee arthroplasty but concerns about patellar component failure have lingered because of prior experiences with older component designs. A new metal-backed patella (MBP) design was released which features a 3-dimensional printed porous titanium metal backing to improve biologic fixation potential and a unique compression molding technique to create a stronger interlock layer between the polyethylene and metal backing. Our study purpose was to determine the clinical and radiographic outcomes and survivorship of this novel cementless MBP. METHODS: Our institutional registry identified 388 cementless MBP with minimum 2-year and 80 with minimum 5-year follow-up. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and 12-item Veterans RAND/Short Form Health Survey (VR/SF-12) scores were used to evaluate clinical outcomes. Aseptic loosening noted on radiographs as well as revision for any reason were the end points used to determine survivorship. RESULTS: Improvement in the preoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, VR/SF-12 physical health and mental health scores were all statistically significant at 2-year follow-up and the VR/SF-12 mental health score at 5-year follow-up. By radiologic criteria, biologic fixation of the patellar component was present in all except 1 case at 2 years (99.6%) and at 5 years (97.7%). Radiolucent lines were present in 15 cases (6.2%) at 2 years and in 6 cases (14%) at 5 years, but progressive increase in radiolucent lines was seen in only 4 cases. No component was revised for loosening; aseptic survivorship was 100%. CONCLUSION: This 3-dimensional printed cementless patellar component shows excellent survivorship at 2-year and 5-year follow-up. We are hopeful about the long-term durability of this implant.
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Seguimentos , Humanos , Patela/diagnóstico por imagem , Patela/cirurgia , Desenho de Prótese , Falha de Prótese , Reoperação , Sobrevivência , Resultado do TratamentoRESUMO
BACKGROUND: There are limited data on the utility of a standard primary total knee arthroplasty (TKA) femoral component with an all polyethylene tibia as a functional prosthetic spacer in place of a conventional all cement spacer for the management of periprosthetic joint infection (PJI). The aim of this multicenter study was to retrospectively review (1) ultimate treatment success; (2) reimplantation rates; (3) reoperation rates; and (4) change in knee range of motion in patients managed with functional prosthetic spacers following TKA PJI. METHODS: A retrospective review was performed for patients at 2 tertiary care centers who underwent a functional prosthetic spacer implantation as part of a functional single-stage (n = 57) or all cement spacer conventional two-stage (n = 137) revision arthroplasty protocol over a 5-year period. Outcomes including reinfection, reimplantation, and reoperation rates, success rate as defined by the Delphi criteria, and final range of motion were compared between the 2 cohorts at a minimum of 2-year follow-up. RESULTS: There was no significant difference in reinfection (14.0 vs 24.1%), reoperation (19.3 vs 27.7%), or success rates (78.9 vs 70.8%; P > .05 for all) between the one-stage and two-stage revision TKA cohorts. Mean final total arc of motion was also similar between the 2 groups (105.8 vs 101.8 degrees, respectively). CONCLUSION: Functional prosthetic spacers offer the advantage of a single procedure with decreased overall hospitalization and improved cost-effectiveness with analogous success rates (78.9%) compared with two-stage exchange (70.8%) at mid-term follow-up. Although long-term data are required to determine its longevity and efficacy, the outcomes in this study are encouraging. LEVEL OF EVIDENCE: 3.
Assuntos
Artrite Infecciosa/cirurgia , Artroplastia do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Reoperação/instrumentação , Idoso , Antibacterianos/administração & dosagem , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/etiologia , Artroplastia do Joelho/instrumentação , Cimentos Ósseos , Feminino , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/etiologia , Amplitude de Movimento Articular , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Since its Food and Drug Administration approval in 2011 as a local anesthetic for postsurgical analgesia, liposomal bupivacaine (LB) has been incorporated into the periarticular injection (PAI) of many knee surgeons. The slow release of this medication from vesicles should significantly extend the duration of its analgesic effect, but current evidence has not clearly demonstrated this benefit. METHODS: We systematically searched electronic databases including PubMed, MEDLINE, Cochrane Library, EMBASE, ScienceDirect, and Scopus, as well as the Journal of Arthroplasty web page for relevant articles. All calculations were made using Review Manager 5.3. RESULTS: We identified 42 studies that compared LB to an alternate analgesic modality. Seventeen of these studies were controlled trials that were included in meta-analysis. Significant differences were seen in pain scores with LB over a peripheral nerve block (mean difference = 0.45, P = .02) and LB over a traditional PAI (standard mean difference = -0.08, P = .004). CONCLUSION: While LB may offer a statistically significant benefit over a traditional PAI, the increase in pain control may not be clinically significant and it does not appear to offer a benefit in reducing opioid consumption. However, there is no standardization among current studies, as they vary greatly in design, infiltration technique, and outcome measurement, which precludes any reliable summarization of their results. Future independent studies using a standardized protocol are needed to provide clear unbiased evidence.