Document Detail


Tibial tubercle osteotomy or quadriceps snip in two-stage revision for prosthetic knee infection? A randomized prospective study.
MedLine Citation:
PMID:  23283675     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although 7% to 38% of revision total knee arthroplasties (RTKAs) are attributable to prosthetic knee infections, controversy exists regarding the best surgical approach while reducing the risk of extensor mechanism complications and the reinfection rate.
QUESTIONS/PURPOSES: We compared The Knee Society Score(©) (KSS), incidences of complications, maximum knee flexion, residual extension lag, and reinfection rate in patients with prosthetic knee infections treated with two-stage RTKAs using either the tibial tubercle osteotomy (TTO) or the quadriceps snip (QS) for exposure at the time of reimplantation.
METHODS: We prospectively followed 81 patients with chronic prosthetic knee infections treated between 1997 and 2004. Patients were randomized to receive a TTO or QS for exposure at the time of reimplantation. All patients had the same rehabilitation protocol. The minimum followup was 8 years (mean, 12 years; range, 8-15 years).
RESULTS: Patients in the TTO group had a higher mean KSS than the QS group (88 versus 70, respectively). Mean maximum knee flexion was greater in the TTO group (113° versus 94°); with a lower incidence of extension lag (45% versus 13%). We observed no differences in reinfection rate between groups.
CONCLUSIONS: We found the TTO combined with an early rehabilitation protocol associated with superior KSS did not impair extensor mechanism function or increase the reinfection rate. We believe a two-stage RTKA with TTO is a reasonable approach for treating prosthetic knee infections.
LEVEL OF EVIDENCE: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Authors:
Danilo Bruni; Francesco Iacono; Bharat Sharma; Stefano Zaffagnini; Maurilio Marcacci
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2013-01-03
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  471     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-04     Completed Date:  2013-05-16     Revised Date:  2014-04-01    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1305-18     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee*
Chronic Disease
Female
Humans
Male
Middle Aged
Osteotomy / methods*
Prospective Studies
Quadriceps Muscle / surgery*
Surgical Wound Infection / surgery*
Tibia / surgery*
Treatment Outcome
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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