Posttraumatic Gonarthrosis Research Articles

Primary total knee arthroplasty in patients under 55 years of age: is the mid-term revision rate worrying?

The indications for total knee arthroplasty (TKA) are expanding to include younger and more active patients. Several recent studies have warned of a higher revision rate and lower patient satisfaction in younger patients. The aim of this study was to assess the survival of TKAs in patients under the age of 55 and to determine the risk factors for revision and complications. The hypothesis was that TKA survival in patients under 55 years of age is greater than 90% at 10 years. This work was a single-center retrospective study. All patients under 55 years of age with first-line TKA between 2006 and 2016 were included. The survival rate was calculated with TKA failure as the primary outcome, which was defined as revision surgery regardless of cause. The Kaplan‒Meier method was used to meet the primary objective. A total of 168 patients (median age 52 years) with 193 TKAs were included. The mean follow-up was 7.9 years, and 24 cases of failure were identified. The 10-year survival rate was 86.6% (95% CI [81.1-92.2]). The mean time to failure was 4.1 years. Mechanical loosening and infection were the main causes of failure. Body mass index (BMI) appeared to increase the risk of revision (p < 0.01). TKAs with a third condyle were less strongly associated with the risk of revision and complications (p < 0.05), as was the presence of a tibial keel (p < 0.05). TKAs with posttraumatic gonarthrosis (p = 0.066), osteonecrosis (p < 0.05) and sequelae of septic arthritis (p < 0.05) appeared to be the most at risk of revision. This hypothesis has not been verified, and TKA in patients under 55 years of age appears to have a higher revision rate than in the general population. The indication for TKA in these patients remains a reliable option, but certain risk factors must be considered. IV; retrospective study.

Role of Imbalance of Lipid Peroxidation and Articular Cartilage Remodeling in the Pathogenesis of Early Primary and Post-Traumatic Gonarthrosis in Rats.

We studied serum indicators of LPO and antioxidant system mechanisms in nonlinear male white rats at the early stages of simulated primary knee osteoarthrosis (n=60) and posttraumatic knee osteoarthrosis (n=60) as well as in intact animals (n=20). An imbalance in the peroxidation-antioxidant system with accumulation of lipoperoxides and malondialdehyde along with a decrease in catalase and superoxide dismutase activities was revealed. Early stages of osteoarthrosis were characterized by increased production of primary and intermediate LPO products and exhaustion of the antioxidant system enzymes.

Применение препарата группы SYSADOA, содержащего биоактивный концентрат из мелкой морской рыбы, у пациентов с посттравматическим гонартрозом первой и второй стадий

Применение препарата группы SYSADOA, содержащего биоактивный концентрат из мелкой морской рыбы, у пациентов с посттравматическим гонартрозом первой и второй стадий

Primary Total Knee Arthroplasty (TKA) with revision Total Stabilizer Prosthesis in a 66-year-old patient with secondary knee osteoarthritis and valgus deformity. Case Report

Abstract Knee osteoarthritis (gonarthrosis) is the most prevalent knee pathology encountered nowadays in the third age population, leading to severe disability and reduced life quality. Secondary gonarthrosis may be caused by a traumatic event, which subjects the knee joint to a transitory highly increased mechanical stress, initiating a rapidly progressive degrading process of the articular cartilage and subjacent bone tissue. TKA is intended to replace all the intra-articular components with artificial parts, in order to relieve pain, compensate for ligament instability, correct deformities, and restore proper joint functionality. Semi-constrained, non-hinged implants are usually used for revision TKA, in knees that already had a primary TKA but sustained complications. Nevertheless, here we reported the case of a 66-year-old female patient diagnosed with posttraumatic gonarthrosis who underwent TKA with a revision total stabilizer implant as primary treatment due to severe joint instability and high grade valgus deviation. The outcome of the surgical procedure was positive, with significant pain relief and increased knee stability. The valgus angle was reduced from 37° to 4° and the KSS score increased from 3 to 87 points. Therefore, revision semi-constrained prosthesis may be used as a primary implant with promising result in severe cases.

Predicting and preventing the development of post-traumatic gonarthrosis with intra-articular bone fractures of the knee joint

To develop a program for the prediction and prevention of post-traumatic osteoarthritis of the knee joints. For the period 2012-2017. 155 patients were examined in the traumatology departments of the Municipal Hospital No.4. This group of patients was hospitalized with various intraarticular lesions of the knee joints. Patients with injuries to the condyles of the femur were 54, with fractures of the proximal metaepiphysis of the tibia of different severity, 101 patients were examined. All the patients in the study group underwent a special questionnaire with a view to a detailed study of the risk factors for post-traumatic gonarthrosis, as well as studies of the possible effect of genetic components (ribosomal gene activity) in the pathogenesis of the disease. All patients in the study group were divided into three groups, posttraumatic gonarthrosis, based on prognostically valuable factors: the first group (low risk), the second group (probable development of the disease), the third group (in soky risk). A follow-up examination of patients, to assess the development of a disease, was performed 1 and 3 years after the operation. No patients were diagnosed with osteoarthritis in the first group of clinical and new X-ray signs after a year of examination. In the second and third groups there was an appearance of initial radiographic signs in 9.6 and 16% of patients, respectively, in the absence of a significant clinical picture of osteoarthritis. Two years later, the development and progression of osteoarthritis in the groups was observed in 14.7, 36.8 and 68% cases, respectively, with clinical manifestations of the disease. Three years later, the number of patients with post-traumatic arthrosis in the first group practically did not change (17.9%), and in the second and third groups the development of gonarthrosis occurred almost in all cases. Intra-articular fractures of the condyles of the femoral and tibia bones, with the most 'favorable' prognosis, lead to the development of post-traumatic osteoarthritis of the knee joint in 14.7%, with a probable prognosis, osteoarthritis developed in 47.6% of cases, and with unfavorable prognosis.

3D PRINTING TECHNIQUE FOR PATIENT-SPECIFIC INSTRUMENTATION IN TOTAL KNEE ARTHROPLASTY

The aim of the study was to evaluate clinical and radiological outcomes of knee arthroplasty using patient specific guides produced using physical prototypes and 3D printing that are applied for positioning of resection blocks. Materials and methods. The authors analyzed the treatment outcomes of 4 patients during the period from 2015 to 2016 who underwent total knee arthroplasty for posttraumatic gonarthrosis of III-IV stage with the use of patient specific guides for resection blocks positioning. The mean age of patients was 59±12 years. Initially, all patients reported marked limitation of movement in the knee joint. The average flexion prior to surgery was 53.3±35.1°. According to FLFS roentgenography all patients had a varus deformity of the lower limb with an average value of 15.0±12.3°.Results. In all cases the axis of the lower limb was normalized postoperatively. The average KOOS score for “pain” was 85.2±14.0, for “daily physical activity” — 74.5±14.8, for “symptoms and stiffness” — 69.0±11.0, for “quality of life” — 62.5±12.5 points. Average knee ROM after arthroplasty: flexion 113.3±5.787° and full extension. Such outcomes can be considered as excellent considering preoperative marked knee movement limitations in all patients.Conclusion. Preoperative planning using the technology of producing patient specific guides and prototyping on physical tibia and femur models allowed to restore normal axis of the lower limb. The authors observed a significant improvement in joint function and a pain syndrome reduction in all patients. In authors’ opinion patient specific precision guides can be used in the following cases: inflammatory process or deformation of the femur in patient’s history; when the use of intramedullary guides is difficult and does not allow positioning of the prosthesis components with sufficient accuracy or is associated with an increased risk of a purulent-inflammatory process; ipsilateral hip joint prosthesis when it is desirable to avoid opening the medullary canal; substantial bone defects or massive osteophytes of the posterior portion of femoral condyles that impede correct rotation of the femoral component; severe movement limitations in the knee joint, when it is technically impossible to perform TKA using computer navigation and the use of a standard set of instruments poses significant technical difficulties.

Subchondroplasty for the Treatment of Post-Traumatic Bone Marrow Lesions of the Medial Femoral Condyle in a Pre-Clinical Canine Model

The objective of this study was to assess the safety and efficacy of subchondroplasty for the treatment of bone marrow lesions of the femoral condyle in a canine model of post-traumatic osteoarthritis. Impaction injury to the femoral condyles is often a pre-cursor to post-traumatic osteoarthritis (PTOA). Appropriate treatment of the pain and dysfunction associated with bone marrow lesions (BML) in this setting is unknown. Subchondroplasty (SCP) involves the percutaneous injection of calcium phosphate into the region of the BML. The objective of this study was to assess the safety and efficacy of SCP for the treatment of BMLs of the femoral condyle in a canine PTOA model. With ACUC approval, purpose-bred research hounds (n=12) underwent an arthroscopic-assisted impact injury (40N) to both medial femoral condyles (MFC) to result in focal articular cartilage damage with associated BML. Twelve weeks after impact injury, dogs were treated by injection (3 ml) of calcium phosphate SCP (AccuFill BSM, Zimmer) into one MFC and sham injection in the contralateral MFC using fluoroscopic and arthroscopic guidance. Dogs were evaluated over the following year for clinical function and kinetics, radiographic and MRI scoring and at 3, 6 and 12-month endpoints (n=4/time) by arthroscopic, gross, microCT, and histologic assessments. Data were compared for statistically significant (p<0.05) differences to pre-operative measures and between groups. Twelve weeks after impact and prior to treatment, all dogs had MFC BMLs and significantly (p<0.01) more lameness/less limb loading, greater pain and joint effusion, and decreased knee range of motion compared to pre-operative values, with no significant difference between limbs. Transient pain and lameness requiring extended oral analgesic treatment were noted for up to 3 months after SCP injection. At all time points after treatment, all dogs had radiographic evidence of mild osteoarthritis and MRI-evident BMLs of the MFC with associated clinical symptoms, with no significant differences between groups until 1 year after treatment. At the 1-year endpoint, SCP was associated with significantly (p<0.05) less pain, better knee range of motion, and better arthroscopic scores. BMLs were present in both groups based on one-year MRI, microCT, and histology with SCP-treated MFCs showing subjectively better trabecular bone architecture. SCP injectate was retained in all MFCs at one year and was well integrated with trabecular bone with no evidence of associated pathology. Both groups showed MRI, gross, and histologic evidence for medial compartment gonarthrosis at all time points with no significant differences noted between groups for these assessments. In this pre-clinical canine model of PTOA, the treatment of BMLs of the medial femoral condyle with SCP was associated with superior clinical results and better trabecular bone architecture at the one year time point when compared with sham controls. Despite improvements in clinical outcomes and bony histology, there were no difference detected in the progression of medial compartment post-traumatic gonarthrosis between groups. Clinical trials are warranted to further validate these results and to determine the efficacy of SCP in human subjects.

Оценка эффективности использования технологии субхондральной тунелизации бедренной кости в составе комплексной терапии I стадии посттравматического гонартроза подростков

Оценка эффективности использования технологии субхондральной тунелизации бедренной кости в составе комплексной терапии I стадии посттравматического гонартроза подростков

Analysis of the Relationship between Antioxidant Enzyme Gene Polymorphisms and Their Activity in Post-Traumatic Gonarthrosis.

Analysis of polymorphisms of genes encoding antioxidant enzymes SOD1 (G7958A), SOD2 (T58C), CAT (C-262T), and GSTP1 (Ile105Val) in 93 patients with post-traumatic gonarthrosis showed that GSTP1 Ile105Val polymorphism is often associated with heterozygous mutation in catalase gene CAT C-262T. In gonarthrosis, catalase activity in peripheral blood mononuclear cells in patients with CT genotype of the C-262T locus of CAT gene more than 2-fold surpassed that in CC genotype and more than 50% surpassed the normal. Changes in the balance of activity of antioxidant enzymes can affect viability of mononuclear cells.

Метод консервативного лечения тяжелого посттравматического гонартроза

Introduction. Joint replacement is currently a routine surgery and a radical method of osteoarthrosis treatment. However, the high cost of implants, the development of serious complications, and the presence of contraindications to surgical treatment make to continue searching efficient conservative techniques of osteoarthrosis treatment. Materials and Methods. The clinical experience of treating 35 patients, males and females, at the age of 31-75 years with posttraumatic gonarthrosis of Stage 3-4 according to Kellgren classification with the existing contraindications to joint replacement or those resisting surgical treatment for any reason. The treatment consisted in consecutive courses of intraarticular injections of Cel-T and Adgelon chondroprotectors. Results. By three (3) months after the end of treatment the pain syndrome released significantly, the number of overcome staircases without the need of rest increased, as well as the range of motion in the joint, both the crepitation in the involved joint and the need for analgetics decreased. Conclusion. In our opinion, the achievement of a positive result is associated with the pharmacological effect of potentiating the action of two different chondroprotectors, and gives the possibility to continue working in the desired direction.

Complicated Cases of Knee Arthroplasty

Experience in treatment of 190 patients (mean age 61 years) with marked (&gt; 15°) knee deformity due to various pathology (idiopathic gonarthrosis, rheumatoid arthritis, posttraumatic gonarthrosis) is presented. In 19 cases revision interventions for aseptic instability of implant were performed. In all cases «Smith &amp; Nephew» RT-PLUS system of either standard or modular modification was used. In 183 (96.3%) cases satisfactory results were noted: steady remission of chronic pain syndrome was achieved, limb axis, joint mobility and weight bearing ability were restored, conditions for early loading and mobilization were provided. All that promoted the improvement of patients’ life quality. Complications included 1 case of periprosthetic fracture, 5 cases of deep purulent inflammation 2 of which required implant removal with creation of arthrodesis in functionally favorable position, and 3 cases of arthrofibrosis. As a whole the achieved results enable to recommend the use of RT-PLUS system in complicated cases of arthroplasty.

Complicated Cases of Knee Arthroplasty

Experience in treatment of 190 patients (mean age 61 years) with marked (&gt; 15°) knee deformity due to various pathology (idiopathic gonarthrosis, rheumatoid arthritis, posttraumatic gonarthrosis) is presented. In 19 cases revision interventions for aseptic instability of implant were performed. In all cases «Smith &amp; Nephew» RT-PLUS system of either standard or modular modification was used. In 183 (96.3%) cases satisfactory results were noted: steady remission of chronic pain syndrome was achieved, limb axis, joint mobility and weight bearing ability were restored, conditions for early loading and mobilization were provided. All that promoted the improvement of patients’ life quality. Complications included 1 case of periprosthetic fracture, 5 cases of deep purulent inflammation 2 of which required implant removal with creation of arthrodesis in functionally favorable position, and 3 cases of arthrofibrosis. As a whole the achieved results enable to recommend the use of RT-PLUS system in complicated cases of arthroplasty.

Lack of Information About Antibiotics on Device Identification Systems

After total joint replacement, most patients receive a personalized medical identification card, which usually provides data on the type of prosthesis that was implanted and its manufacturer. The card may also assist in passing through airport metal detectors and security de vices. A replica radiograph is sometimes included to help describe their previous orthopedic surgery. The surgeon who performed the surgery and the hospital where the procedure was performed may also be included on this card. Unfortunately, it seems uncommon to use this card as a reminder to patients to use antibiotic prophylaxis, especially before medical procedures that are likely to cause transient bacteremia. A 38-year-old patient underwent total knee replacement for posttraumatic gonarthrosis. Perioperative cefazolin prophylaxis was used. No signs or symptoms of infection were noticed initially after this surgical procedure. Three months later, the patient underwent multiple wisdom teeth extractions. No antimicrobial prophylaxis was administered during this dental treatment. Nine months later, the patient had a knee joint prosthesis group G streptococci infection, which are bacteria of the physiological oral flora. The infected prosthesis was removed and replaced. Cephalosporins were used for peri- and postoperat ive prophylaxis. Approximately 2 years later, again, an infection developed in this joint by group G streptococci, most likely due to several carious teeth following extraction. Removal and replacement of the infected prosthesis became necessary and was performed in 2 separate operations. Patients with a joint endoprosthesis should be thoroughly educated regarding their condition by their orthopedic surgeon. The patient and/or his or her relatives must understand the increased risk of joint infections due to the implantation of such a device. The importance of antibiotic prophylaxis during teeth extraction (which represents a high-risk procedure for the induction of bacteremia) was not effectively communicated in the case described above. Although interdisciplinary guidelines strictly recommend using antibiotics to protect the patient’s prosthetic device,

Stabilization of interligamentous valgus procedure in tibial head osteotomy using staples

In patients with painful post-traumatic or idiopathic varus gonarthrosis we perform interligamentous valgization osteotomy of the tibial head if arthroscopy shows the lateral joint surfaces to be in sufficiently good condition. Between 1989 and 1993, a total of 75 osteotomies were performed in symptomatic varus gonarthrosis, including 52 cases of idiopathic and 22 cases of post-traumatic gonarthrosis, and one case following infection of the knee joint. The corrections were stabilized exclusively with osteotomy staples (e.g. Richards). The stability thus achieved permits mobilization without plaster with partial loading up to 15 kg from the first postoperative day on. If the indication is adhered to, the operation correctly performed and the complication rate low, we regard the described procedure as appropriate for treating monocondylar varus gonarthrosis.

Tibiakopffraktur

Fractures of the tibial head are severe injuries, characterized by enormous variety. Fractures can be classified into fractures of the tibial plateau, luxation fractures, and comminuted fractures. Due to the mechanism of injury luxation fractures are frequently associated with lesions of the menisci and intra- and extra-articular ligaments. Multiple factors can be etiologic for post-traumatic gonarthrosis: nonanatomic reduction of the joint surface, malalignment, and unaddressed associated injuries. Therefore in addition to diagnostic steps such as X-ray, CT scan, and MRI a sophisticated therapeutic regime is necessary. In cases with severely damaged soft tissue or unstable patients, the fracture should initially be reduced and fixed with an external fixator and the definite fixation should be performed in a second setting. Arthroscopically assisted treatment is reserved for fractures of the tibial eminence, crack fractures, and impression fractures. Comminuted and bilateral fractures can be addressed via different incisions. New locking plates with angular stability allow avoidance of bilateral plating in most situations. In specific cases such as compound fractures and for patients with low compliance, a hybrid fixator may be a well-chosen alternative.

Posttraumatic Monocondylar Gonarthrosis: Does Monocondylar Sleigh Arthroplasty Increase Joint Function and Quality of Life?

Background: The aim of this study was to evaluate if monocondylar knee arthroplasty increases the range of motion and life quality in patients with monocondylar posttraumatic gonarthrosis. Patients and Methods: 38 patients with monocondylar posttraumatic gonarthrosis were treated between January 1990 and December 1995. Gonarthrosis was predominantly caused by fractures of the lower leg (50.0%) following by fractures of the thigh (23.7%) and traumatic knee damages (26.3%). The average age of patients treated was 63.4 years and thus lower than in patients with nontraumatic monocondylar gonarthrosis. Results: Monocondylar knee arthroplasty did not increase the range of motion but the range of walking distance and qualitiy of life measured by pain character and pain intensity. Rated by the “Knee Society Score” the average number of points was 166.2 (max. 200 points). Rated by the “Hospital of Special Surgery Score” the average number of points was 75.7, corresponding with a good result (70–84 points). Conclusion: Monocondylar knee arthroplasty in patients with monocondylar posttraumatic gonarthrosis leads to increased life quality, decreased pain level, increased level of activity and preserves joint funtion.

Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis.

Knee ligament injuries are common in sport. A rupture of the anterior cruciate ligament (ACL) is the most serious of these injuries because it may cause long term disability. In this literature review, the frequency of post-traumatic gonarthrosis is examined. There are few long term prospective studies but a number of retrospective studies with follow-up times between 5 and 20 years have been published. These studies show that radiographic gonarthrosis is significantly increased after all knee injuries compared with the uninjured joint of the same patient. Isolated meniscus rupture and subsequent repair, or partial or total ruptures of the ACL without major concomitant injuries, seem to increase the risk 10-fold (15 to 20% incidence of gonarthrosis) compared with an age-matched, uninjured population (1 to 2%). Meniscectomy in a joint with intact ligaments further doubles the risk of gonarthrosis (30 to 40%), and 50 to 70% of patients with complete ACL rupture and associated injuries have radiographic changes after 15 to 20 years. Thus, an ACL rupture combined with meniscus rupture or other knee ligament injuries results in gonarthrosis in most patients. Ten to 20 years after ACL injury, gonarthrosis often presents as a slight joint space reduction or, occasionally, joint space obliteration (Ahlbäck grades I to II), but is usually not associated with major clinical symptoms. According to the few longitudinal studies, the progress of gonarthrosis is slow, and in some cases the condition seems to remain stable. Time is an important determinant for the degree of gonarthrosis and problems demanding treatment may be encountered only at > 30 years after the initial accident.

Glycosaminoglycans as markers of post-traumatic gonarthrosis?

Osteoarthritis (OA) influences the levels of free intraarticular glucosaminoglycans (GAG). Little is known about the direction--decrease/increase--of these changes, and information on the correlation between GAG levels and the degree of OA is sparse. Objectives of this study were to investigate the correlation between intraarticular levels of sulphated and unsulphated GAG and the degree of experimental OA, the time course of these changes and whether GAG might be useful as a marker for OA. Twenty-one sheep were randomly assigned to three groups: (1) transsection of the posterolateral bundle of the anterior cruciate ligament, ACL (TD), (2) medial meniscectomy (ME), and (3) meniscectomy and resection of the ACL (MV). During follow-up clinical and radiological examinations were done. After screening for intraarticular effusions, a joint tab was performed and the levels of hyaluronic acid and chondroitin sulphate were measured. The radiological scores differ significantly between group TD and groups ME and MV (P < 0.01). Hyaluronic acid levels in ME and MV are significantly higher than in the controls. Significantly increased levels (P < 0.01) of chondroitin sulphate are found 6 months after ME and 1 year following TD. Clinical consequences: Hyaluronic acid levels--at least in the experimental setting--correspond to a certain degree with osteoarthrotic changes: increasing levels were found along with increasing postoperative interval and increasing grade of OA. Chondroitin sulphate, on the other hand seems, to lend itself as a marker for chondromalacia, in other words for prearthrotic deformities and early stages of OA.