BACKGROUND Periprosthetic joint infection(PJI) and periprosthetic fracture(PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications w...BACKGROUND Periprosthetic joint infection(PJI) and periprosthetic fracture(PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications with details on the characteristics, treatment strategy, and outcome.CASE SUMMARY A 69-year-old female patient who suffered from PJI and PPF following total knee arthroplasty was treated by a two-stage revision surgery. After thorough foreign material removal and debridement, we used a plate that was covered with antibiotic-loaded bone cement to link with a hand-made cement spacer to occupy the joint space and fix the fracture. Although the infection was cured, the fracture did not heal and caused bone defect due to the long interval between debridement and revision. In the revision surgery, a cemented stem and cortical allogenic splints were used to reconstruct the fracture and bone defect. At the final followup 27 mo after revision, the patient was satisfied with postoperative knee functions with satisfactory range of motion(104°) and Hospital for Special Surgery knee score(82 points). The radiographs showed no loosening of the prosthesis and that the bone grafts healed well with the femur.CONCLUSION Our two-stage revision surgery has proved to be successful and may be considered in other patients with PJI and PPF.展开更多
BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial.Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for ear...BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial.Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for early walking and rapid restoration of function and also pose significant obstacles to achievement of satisfactory results with standard fixation techniques.Recently,several authors have suggested that primary arthroplasty could be a viable alternative option to standard fixation techniques in selected patients with complex distal femur fractures.AIM To present our experience with 11 cases of distal femur fractures treated with knee arthroplasty and large femoral resection in a population of patients over the age of 85.METHODS Data from 11 consecutive patients(10 females,1 male)presenting with acute intra-articular supracondylar or intercondylar distal femur fractures and with pre-existent primary osteoarthritis who were treated with primary knee arthroplasty were recorded.We collected standard demographic data,comorbidities and patient reported outcomes including Visual Analogical Scale(VAS),Oxford Knee Score(OKS)and Barthel’s Index.Post-operative joint range of motion(ROM)and standard radiographic data were also collected.RESULTS At a mean follow-up of 23.2 mo,all of the implants were well-positioned and osteointegrated.Furthermore,all the patients were alive and walking either independently or with walking aids.There was a marked improvement in pain(VAS 4.5 postop vs 1.9 at the last follow-up),OKS score(29.5 postop vs 36.81 at the last follow-up),ROM(96.2°postop vs 102°at the last follow-up)and restoration of pre-injury ambulatory status(average Barthel Index 77.3).The radiographic evaluations showed good restoration of the articular geometry.No deaths and no complications were recorded.CONCLUSION In conclusion,we believe that knee megaprosthesis in the case of complex fractures of the distal femur is a valid surgical choice.This is particularly true in elderly patients with severe osteoporosis and pre-existing osteoarthritis.It is important to note that this surgery should be performed by surgeons with proven experience in prosthetic hip and knee surgery and that a scrupulous selection of the cases is completed.展开更多
We report a rare case of periprosthetic posttraumatic fracture of subtrochanteric region of femur alter a megaprosthesis of the knee, done for resistant non- union of distal femur with secondary osteoarthrosis in a 51...We report a rare case of periprosthetic posttraumatic fracture of subtrochanteric region of femur alter a megaprosthesis of the knee, done for resistant non- union of distal femur with secondary osteoarthrosis in a 51 years old man. Treatment with a locking femoral plate was able to achieve primary union with a good result.展开更多
基金Supported by the General Cultivation Project of Xi'an Health Commission,No.2021ms08.
文摘BACKGROUND Periprosthetic joint infection(PJI) and periprosthetic fracture(PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications with details on the characteristics, treatment strategy, and outcome.CASE SUMMARY A 69-year-old female patient who suffered from PJI and PPF following total knee arthroplasty was treated by a two-stage revision surgery. After thorough foreign material removal and debridement, we used a plate that was covered with antibiotic-loaded bone cement to link with a hand-made cement spacer to occupy the joint space and fix the fracture. Although the infection was cured, the fracture did not heal and caused bone defect due to the long interval between debridement and revision. In the revision surgery, a cemented stem and cortical allogenic splints were used to reconstruct the fracture and bone defect. At the final followup 27 mo after revision, the patient was satisfied with postoperative knee functions with satisfactory range of motion(104°) and Hospital for Special Surgery knee score(82 points). The radiographs showed no loosening of the prosthesis and that the bone grafts healed well with the femur.CONCLUSION Our two-stage revision surgery has proved to be successful and may be considered in other patients with PJI and PPF.
文摘BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial.Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for early walking and rapid restoration of function and also pose significant obstacles to achievement of satisfactory results with standard fixation techniques.Recently,several authors have suggested that primary arthroplasty could be a viable alternative option to standard fixation techniques in selected patients with complex distal femur fractures.AIM To present our experience with 11 cases of distal femur fractures treated with knee arthroplasty and large femoral resection in a population of patients over the age of 85.METHODS Data from 11 consecutive patients(10 females,1 male)presenting with acute intra-articular supracondylar or intercondylar distal femur fractures and with pre-existent primary osteoarthritis who were treated with primary knee arthroplasty were recorded.We collected standard demographic data,comorbidities and patient reported outcomes including Visual Analogical Scale(VAS),Oxford Knee Score(OKS)and Barthel’s Index.Post-operative joint range of motion(ROM)and standard radiographic data were also collected.RESULTS At a mean follow-up of 23.2 mo,all of the implants were well-positioned and osteointegrated.Furthermore,all the patients were alive and walking either independently or with walking aids.There was a marked improvement in pain(VAS 4.5 postop vs 1.9 at the last follow-up),OKS score(29.5 postop vs 36.81 at the last follow-up),ROM(96.2°postop vs 102°at the last follow-up)and restoration of pre-injury ambulatory status(average Barthel Index 77.3).The radiographic evaluations showed good restoration of the articular geometry.No deaths and no complications were recorded.CONCLUSION In conclusion,we believe that knee megaprosthesis in the case of complex fractures of the distal femur is a valid surgical choice.This is particularly true in elderly patients with severe osteoporosis and pre-existing osteoarthritis.It is important to note that this surgery should be performed by surgeons with proven experience in prosthetic hip and knee surgery and that a scrupulous selection of the cases is completed.
文摘We report a rare case of periprosthetic posttraumatic fracture of subtrochanteric region of femur alter a megaprosthesis of the knee, done for resistant non- union of distal femur with secondary osteoarthrosis in a 51 years old man. Treatment with a locking femoral plate was able to achieve primary union with a good result.
