S'abonner

Intraoperative fractures and ligament tears during total knee arthroplasty. A 1795 posterostabilized TKA continuous series - 03/06/09

Doi : 10.1016/j.otsr.2008.04.002 
A. Pinaroli a, S.R. Piedade b, E. Servien a, P. Neyret a,
a Knee Surgery Department, Livet Hospital, Albert-Trillat Center, 8, rue de Margnolles, 69300 Caluire, France 
b Department of Orthopaedics and Traumatology, School of Medical Sciences, State University of Campinas, Sao Paulo, Brazil 

Corresponding author.

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

Summary

Introduction

Intraoperative fractures are a reported complication during the course of primary total knee replacement. Major ligament disruptions can also occur. Clinical data are lacking to tell how much these incidents affect implantation quality and outcome.

Hypothesis

A thorough knowledge of these occasional incidents helps proper decision making when confronted to such situations at surgery.

Materials and methods

This report is based on a series of primary, posterostabilized total knee arthroplasties (posterostabilized, mobile bearing TKA with a third median condyle from Tornier Laboratory). We studied all possible mechanical complications that developed during the course of arthroplasty and analyzed their cause. We compared the functional results of patients presenting these complications to those of the total series and to data from the literature. The entire operative reports for the 1795 TKA performed during this study were available and evaluated. A clinical and radiological review was performed for 1624 patients at an average follow-up time of 36.8±34 (2–193) months.

Results

At this last follow-up, the average International Knee Society (IKS) score was 91.2 (19–100) and the function score was 77.76 (0–100). One hundred and thirty-two patients were deceased (unrelated to TKA) at this last follow-up evaluation. A total of 69 mechanical complications were accounted for at the time of surgery (3.8%): 40 definite fractures or fissures around the knee (2.2%), 29 tendon or ligament disruptions or attenuations (1.6%). The risk of tibial cracks was statistically more significant, with the smaller sizes tibial trays (size 1) (p=0.019) or when an anterior tibial tuberosity elevation had been performed (p=0.02). Survival curve analysis (at an average seven and a half-years postoperative follow-up) showed that all prosthetic components were still present in 93.3% of cases in the series of patients with these peroperative complications, and in 93.8% of cases in the series of patients without these intraoperative complications; this survival rate amounted to 91.9% of cases at an average 16-years postoperative follow-up.

Conclusion

This large, homogeneous series of primary, posterostabilized TKA took on 3.8% of intraoperative bone or ligament complications. All these complications could be prevented by a rigorous surgical technique. The improvement of ancillary materials, the saws, and good knowledge of such complications by the surgeon are essential.

Level of evidence: Level IV. Therapeutic Study.

Le texte complet de cet article est disponible en PDF.

Keywords : Total knee arthroplasty, Intraoperative complications, Periprosthetic fracture, Ligament injuries


Plan


© 2009  Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Vol 95 - N° 3

P. 183-189 - mai 2009 Retour au numéro
Article précédent Article précédent
  • LCS mobile-bearing total knee replacement. A 10-year’s follow-up study
  • J.-C. Vogt, C. Saarbach
| Article suivant Article suivant
  • Child pectus excavatum: Correction by minimally invasive surgery
  • E. Felts, J.-L. Jouve, B. Blondel, F. Launay, F. Lacroix, G. Bollini

Bienvenue sur EM-consulte, la référence des professionnels de santé.

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.


Tout le contenu de ce site: Copyright © 2024 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.