Post-traumatic Knee Arthritis Research Articles

Asymmetric Post-Traumatic Knee Arthritis Is Closely Correlated With Both Severity and Time for Lower Limb Coronal Plane Malalignment.

Mechanical alignment of the lower limbs has been suggested to cause abnormal uneven loading across the compartments at the knee, but its contribution to the initiation and progression of arthritis remains controversial. This study aimed to establish whether malalignment of the lower limb after trauma is associated with worsened arthritis scores in the theoretically overloaded compartment, and if arthritis scores continuously correlate with the degree of malalignment and time with deformity. After screening 1160 X-rays, 60 patients were identified with long-leg radiographs > 2 years after fracture. Measurement of mechanical axis deviation (MAD) divided into groups of varus malalignment (n = 16, >16 mm), valgus (n = 25, <0 mm), and normal alignment (n = 19). Alignment and bilateral knee compartmental arthritis scores were recorded by three clinicians, compared via analysis of variance and assessed with linear regression against time since injury using MAD as a covariate. In varus and valgus malalignment, there was a greater mean arthritis score in the "overloaded" compartment compared to the contralateral side, with varus medial Osteoarthritis Research Society International (OARSI) scores 5.17 ± 2.91 vs 3.50 ± 2.72 (P = 0.006) and Kellegren-Lawrence scores 2.65 ± 1.19 vs 1.79 ± 1.24 (P ≤ 0.001). In a linear regression model, OARSI arthritis score was significantly associated with absolute MAD (0.6/10 mm MAD, P < 0.001) and time (0.7/decade, P ≤ 0.001). Malalignment consistently results in more advanced arthritis scores in the overloaded compartment, most likely related to abnormal loading across the knee. Severity of arthritis using OARSI grading continuously correlates with degree of malalignment and time with deformity after post-traumatic malunion.

Short- and mid-term effectiveness of unicompartmental knee arthroplasty for post-traumatic arthritis of knee

To investigate the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA) for post-traumatic arthritis (PTA) of knee. The clinical data of 30 patients with PTA of unilateral knee between March 2014 and September 2021 was retrospectively analyzed. There were 14 males and 16 females with an average of 64.5 years (range, 33-81 years). The average body mass index was 26.7 kg/m 2 (range, 19.8-35.6 kg/m 2). The types of injuries that caused PTA included intra-articular fracture in 16 cases, extra-articular fracture in 8 cases, and soft tissue injury in 6 cases. The initial injuries were treated by conservative therapy in 12 cases and by surgical therapy in 18 cases. Ten cases were medial compartment osteoarthritis and 20 cases were lateral compartment osteoarthritis. According to Kellgren-Lawrence staging, there were 19 cases of grade Ⅲ and 11 cases of grade Ⅳ. The operative time, the length of hospital stay, complications, and subjective satisfaction were recorded. The Oxford Knee Function Score (OKS), Hospital for Special Surgery (HSS) score, and knee range of motion (ROM) were used to evaluate knee function. Weight-bearing X-ray films were taken to measure the femoro-tibial angle (FTA) and to assess alignment correction of the lower limb. The operative time ranged from 50 to 95 minutes (mean, 63.7 minutes), the length of hospital stay ranged from 3 to 8 days (mean, 6.9 days). Superficial infection occurred in 2 patients, while the remaining incisions healed by first intention. There was no deep vein thrombosis or neurovascular injury. All patients were followed up 17-109 months (median, 70 months). At last follow-up, OKS score, HSS score, and ROM in 30 cases significantly improved when compared with those before operation (P<0.05). Lower limb alignment was significantly corrected and there was significant difference in FTA of the varus and valgus knees between pre- and post-operation ( P<0.05). The patient satisfaction rate was 86.7% (26/30). Two cases developed contralateral osteoarthritis progression during follow-up. No bearing dislocation, prosthesis loosening or sinking occurred and none required further revision. For patients with PTA of knee, UKA can obtain definite short- and mid-term effectiveness with high patient satisfaction.

Application of Cortical Bone Plate Allografts Combined with Less Invasive Stabilization System (LISS) Plates in Fixation of Comminuted Distal Femur Fractures.

Background and Objectives: At present, the management of comminuted distal femur fractures remains challenging for orthopedic surgeons. The aim of this study is to report a surgical treatment for comminuted distal femur fractures using supplementary medial cortical bone plate allografts in conjunction with the lateral less invasive stabilization system (LISS) plates. Materials and Methods: From January 2009 to January 2014, the records of thirty-three patients who underwent supplementary medial cortical bone plate allografts combined with lateral LISS plates fixation were reviewed. Clinical and radiographic data were collected during regular postoperative follow-up visits. Functional outcomes were determined according to the special surgery knee rating scale (HSS) used at the hospital. Results: Thirty patients were followed for 13 to 73 months after surgery, with an average follow-up time of 31.3 months. The mean time to bone union was 5.4 months (range of 3-12 months) and the mean range of knee flexion was 105.6° (range of 80-130°). Of the remaining patients, 10 had a score of "Excellent", while 10 had a score of "Good". Three patients had superficial or deep infections, one patient had nonunion that required bone grafting, and one patient had post-traumatic knee arthritis. Conclusions: Based on these promising results, we propose that supplementary medial cortical bone plate allografts combined with lateral LISS plate fixation may be a good treatment option for comminuted distal femur fractures. This treatment choice not only resulted in markedly improved stability on the medial side of the femur, but also satisfactory outcomes for distal femoral fractures.

Chronic Irreducible Knee Dislocations: Outcomes following Open Reduction and Reconstructive Surgery.

The management of unreduced knee dislocations who present late is challenging. The aim of this study was to determine the clinical, radiological, and functional outcomes following open reduction and reconstructive surgery for chronic irreducible knee dislocations. This retrospective study analyzed prospectively collected data of patients with an unreduced fixed anterior or posterior knee dislocation of 1 to 6 months' duration, treated with open reduction, hinged external fixator application, and ligament reconstruction who had a minimum 2-year follow-up. Patients were classified based on presence of prior periarticular surgery and direction of dislocation. Data on pre- and posttreatment clinical, radiological, and functional scores were analyzed. A total of 21 patients (age range: 19-43 years) fulfilled all inclusion criteria. These included 13 missed dislocations and 8 neglected postoperative dislocations. There were 18 posterior and 3 anterior dislocations. The mean follow-up was 6.9 years (range: 2.7-16.2 years). On final follow-up, all 21 patients were independently ambulatory with mean knee range of motion 127 degrees. No patient had symptomatic knee instability at final follow-up, despite four having isolated grade-III posterior cruciate ligament (PCL) laxity. Anatomical reduction was achieved in 19 patients, whereas 2 patients had incomplete joint reduction with a persistent grade-II fixed posterior subluxation. Scanograms revealed coronal alignment within 5 degrees of the opposite unaffected limb in 17 patients. Mean functional scores improved from preoperative 9.4 ± 4.7 (range: 2-19) to postoperative 75.9 ± 8.0 (range: 64-95) for Lysholm's and preoperative 10.7 ± 1.8 (range: 8.3-13.7) to postoperative 73.5 ± 6.7 (range: 66.7-88.7) for knee injury and osteoarthritis outcome score (KOOS) scores. Prior periarticular surgery was associated with significantly inferior Lysholm's scores (p < 0.04). Although 23.8% knees developed posttraumatic knee arthritis, no patient had undergone conversion to knee arthroplasty or arthrodesis. The study concludes that open reduction and reconstructive surgery is an effective surgical treatment for chronic irreducible knee dislocations of up to 6 months duration. An individualized, often staged approach that prioritizes joint reduction, early knee mobilization, and knee stability, ensures satisfactory clinical, radiological, and functional outcomes in the medium term. This is a clinical case series and reflects level of evidence IV.

Managing of post-traumatic knee arthritis by total knee arthroplasty: case series of 15 patients and literature review

PurposePost-traumatic arthritis is one of the leading causes of joint disability. This study aims at outlining outcomes of total knee arthroplasty in post-traumatic arthritis and technical difficulty and reviewing literature regarding this issuePatients and methodsWe analyzed the outcome of total knee arthroplasty following post-traumatic arthritis in 15 patients with unilateral involvement. Ten had stable arthritic knees treated with posterior stabilized (PS) prosthesis, while five with unstable arthritic knees treated as follows: three with ligamentous instability managed by constrained condylar prosthesis and two with osseous deficiency, metal augmentation used together with stemmed constrained condylar prosthesis (CCK). Average follow-up 6 years, mean age 49.8 years at time of arthroplasty. Patient outcomes were evaluated on the basis of Knee Society score.ResultsMean clinical knee society scores (CKSS) at latest follow-up improved from 43.6 ± 11.66 points to 77.3± points postoperatively while mean functional knee society score (FKSS) improved from 40. ± 6.3 to 76.6 ± 84 postoperatively. Patients with stable knees had a higher mean values, both clinical and functional KSS, while unstable knees were poorer. Complications occurred in three cases, one with wound dehiscence with prolonged drainage treated by antibiotics and daily dressings until the wound closed completely, one was complicated by infection and improved by serial debridement, and the third case had aseptic loosening which required revision surgery.ConclusionTotal knee arthroplasty for post-traumatic arthritis decreases pain and improves knee function. However; the procedure is not as simple as primary arthroplasty as it is technically demanding and requires adequate planning.

Metaphyseal sleeves as the primary implant for the management of bone defects in total knee arthroplasty after post-traumatic knee arthritis

BackgroundImplantation of a prosthesis after post-traumatic knee arthritis poses challenges derived from the bone defects and soft tissue damage. The objective of this study was to evaluate the clinical and radiological results of the use of metaphyseal sleeves in primary total knee arthroplasty surgery after post-traumatic arthritis. MethodsClinical and radiological results of 25 patients undergoing surgery for post-traumatic knee arthritis were prospectively evaluated. A semi-constrained, mobile platform prosthesis with metaphyseal sleeves was implanted. American Knee Society scales, Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Short Form 12 Health Survey were used. Patients were evaluated at the baseline and at postoperative months three, 12, and annually until final follow-up. ResultsThe mean follow-up was 79 months with a maximum of 10 years. Mean Knee Society Score (KSS) increased from 29 to 78, and functional KSS from 42 to 81.The average WOMAC pain index changed from 12 to three; average WOMAC stiffness improved from four to one, and WOMAC function score improved from 44 to 16.The mean physical SF12 varied from 30 to 46, while mental SF-12 varied from 45 to 55.Radiological osseointegration of the implants was considered optimal in all cases, with a survival of 100%. ConclusionsMetaphyseal sleeves in combination with varus–valgus constrained (VVC) components and a rotating platform, have shown good clinical and radiological results in patients with post-traumatic knee arthritis and constitute a reliable alternative for treatment of this disease when the epiphyseal zone is deteriorated and has bone defects.

Knee replacement in chronic post-traumatic cases.

Post-traumatic knee arthritis is a challenging condition. Prosthetic surgery is demanding and the risk of complications is relatively high.Planning is an essential element of this surgery; correct diagnosis (to exclude latent infection) and adequate considerations regarding approach, axis, bone loss, choice of implant and level of constraint are indispensable.There are two main categories of post-traumatic arthritis: extra-articular deformities and articular deformities.Use of an algorithms can support the surgeon’s choice of implant.Correct implant positioning and limb alignment restoration is associated with very good results, similar to those achieved with standard total knee arthroplasty.Cite this article: Benazzo F, Rossi SMP, Combi A, Meena S, Ghiara M. Knee replacement in chronic post-traumatic cases. EFORT Open Rev 2016:1:211-218. DOI: 10.1302/2058-5241.1.000025.

Computer-assisted Total Knee Arthroplasty After Prior Femoral Fracture Without Hardware Removal

This study presents a consecutive series of patients who underwent total knee arthroplasty (TKA) after prior distal femoral fracture without hardware removal. The purpose of this study was to determine the effectiveness of computer-assisted TKA in patients with posttraumatic arthritis, specifically those with retained hardware after prior distal femoral fracture. The study group included a consecutive series of 16 patients who had developed posttraumatic knee arthritis after a distal femoral fracture with retention of hardware (group A). Patients in the study group were matched with patients who had undergone a computer-assisted TKA using the same implant and software (group B). The indication for TKA in all group B patients was atraumatic arthritis, and surgery was performed during the same period as that in the study group. Patients were matched for age, sex, preoperative range of motion, preoperative severity of arthritis, type and grade of deformity, and implant features. No statistically significant differences existed between the 2 study groups in terms of operative time, duration of hospital stay, or intra- and postoperative complications. At last follow-up, no statistically significant differences existed in Knee Society Scores and Western Ontario and McMaster Universities Arthritis Index scores. Implant alignment and radiological parameters were similar in both groups. This study demonstrated that posttraumatic knee arthritis after prior distal femoral fracture can be safely managed using a computer-assisted TKA without hardware removal. Comparison between the study group and a matched group with atraumatic arthritis showed similar postoperative results and complication rates.

Post traumatic knee arthritis: Navigated total knee replacement without hardware removal

BackgroundThe Authors present the results of a series of navigated total knee replacements (TKR) without hardware removal in patients with post-traumatic arthritis following femoral fractures. The purpose of the paper was to determine the effectiveness of computer-assisted TKR in these patients compared to routine primary implants. MethodsSixteen patients with post-traumatic knee arthritis following a distal femoral fracture and retained hardware were included in the study (group I). Patients in the study group were matched with patients who had undergone a computer navigated TKR using the same implant and software (group II). The indication for TKR in all group II patients was atraumatic arthritis and surgery was performed in the same period as the study group. Patients were matched for age, gender, pre-operative range of motion, severity of arthritis pre-operatively, type and grade of deformity and implant features. ResultsThere were no statistically significant differences in surgical time, hospital staying or intra-operative and post-operative complications between the two study groups. At the latest follow-up no statistically significant difference was seen for the Knee Society Score and WOMAC indices. Implant alignment and radiological parameters were similar in both groups. ConclusionsThis study demonstrated that post-traumatic knee arthritis following prior distal femoral fracture can be safely managed using a computer navigated TKR without hardware removal. Comparison between this patient group and a matched group with atraumatic arthritis showed similar post-operative results and complication rates.Level of evidence: III.

TKA After Clamshell Osteotomy for Femoral Diaphyseal Malunion

Proper component positioning is essential for successful total knee arthroplasty (TKA). Femoral component positioning presents a technical challenge when significant femoral deformity is present. Most commonly, an intramedullary guide is used to make an accurate distal femoral cut. However, in the presence of a significant femoral deformity, this is not a viable option.The use of clamshell osteotomy to restore anatomic alignment in patients with complex femoral diaphyseal deformity is described in the literature. This article describes a case of a patient who underwent staged TKA after clamshell osteotomy and retrograde femoral nailing to correct femoral diaphyseal malunion. The retrograde intramedullary nail was retained and used as an intramedullary guide, allowing for TKA in a routine manner. Using an intramedullary nail as an alignment guide may be more accurate than using extramedullary alignment and may avoid the increased surgical time and potential pin-site stress risers of navigation. It is a simple, effective way to treat complicated diaphyseal femoral deformities in the face of posttraumatic knee arthritis. Further study of this technique with longer follow-up and multiple surgeons is necessary to validate this treatment algorithm.

One-stage procedure for total knee arthroplasty in post-traumatic osteoarthritis of the knee with wound defect. Usefulness of navigation and flap surgery

Total knee arthroplasty in post-traumatic arthritis of the knee joint is a challenging situation. Difficulties are linked to malalignment, joint stiffness, or wound complications.The authors report on a case of post-traumatic intra-articular knee arthritis with tibial malalignment and a skin defect. Using computer-assisted surgery for implant positioning, and simultaneous pedicled flap surgery for wound coverage, IKS score at 2years follow-up was 85 and 75 for clinical and function respectively.The results of total knee replacement in post-traumatic knee arthritis are not as satisfactory as in degenerative situations. In severe malalignment due to bone landmark changes following malunions, computer-assisted surgery gives immediate correct references for final positioning of implants and restoration of limb alignment. Implant selection must allow use of normal and revision components to fit the local anatomy. Commonly-used pedicle flaps such as the gastrocnemius flap are valuable to cover wound defects after prosthesis implantation. All these procedures can be used successfully in a one-stage surgical procedure.

Total knee replacement in post-traumatic arthritic knees with limitation of flexion

The objective of this study is to investigate the results of total knee arthroplasty (TKA) in traumatic osteoarthritis cases with flexion restriction and to describe the technical details of their management. A multicentre series comprising 40 patients with limitation of flexion less than or equal to 90° was selected from 152 cases of post-traumatic knee arthritis with malunion. We hypothesized that the arthroplasty complication rate would be higher than in other etiologies of limitation of flexion and would require specific management strategies. In 23 cases, intra-articular malunion was present, in 15 cases extra-articular, and in two cases combined. The mean flexion was 72±23°, extension was 6±6°, and total range of motion (ROM) 66±23°. Eight cases of flexion restriction were severe (flexion<50°), six intermediate (flexion, 50-70°) and 26 moderate. In 14 cases, the anterior tibial tuberosity was osteotomized (43% intra-articular malunion and 6% extra-articular malunion). Five simultaneous realignment osteotomies were necessary. In severe cases of limitation of flexion, five extensive quadriceps releases were associated. Four mobilizations under general anesthesia were performed. In the cases of severe limitation of flexion, we noted three avulsions of the patellar tendon, two cases of cutaneous necrosis, one of which was associated with deep infection, and another case of deep infection. In the cases of moderate limitation of flexion, we noted one case of nonunion of the tibial tuberosity and two cases were revised for loosening, one aseptic and the other septic. With a mean follow-up of 5±4 years, the mean flexion was 99.4°±23 for a gain of 26.7±20°. The final flexion and the gain in flexion were correlated with preoperative flexion (r=0.62 and r=-0.47, respectively). The final amplitude was 99±27° for a gain of 33±21°. The flexion gains were comparable for both types of malunion, whether they were intra- or extra-articular. Arthroplasty provided a substantial gain in flexion. Osteotomy of the tibial tuberosity and the realignment osteotomies should be performed if necessary, with no risk of compromising the result. Superior gains can be sought in severe cases of limitation of flexion by releasing the extensor apparatus, in absence of cutaneous scar tissue retractions and recent infection. Level 4. Noncomparative retrospective study.

Combined Arthroscopic Treatment of Tibial Plateau and Intercondylar Eminence Avulsion Fractures

Fractures of the tibial plateau represent 1% of all fractures and 8% of fractures in the elderly population1. These fractures represent a surgical challenge because of the variety of fracture patterns and the associated soft-tissue injuries. If not adequately treated, these fractures often cause persistent knee pain, arthritis, and angular deformity. In one study, posttraumatic knee arthritis following a tibial plateau fracture was reported, after a seven-year follow-up, in 74% of patients with an associated meniscal tear and in 34% of patients with intact menisci2. Intercondylar eminence avulsion fractures are relatively uncommon. First described by Poncet in 1875, this injury usually has been considered to be the childhood equivalent of anterior cruciate ligament rupture in adults3. As an isolated injury, these fractures are most frequent in pediatric patients between the ages of eight and fourteen years4-9. These lesions also can occur in adults in association with another periarticular injury or a tibial plateau fracture3,5. In our experience, 19.4% of tibial plateau fractures have been associated with an intercondylar eminence fracture whereas 84.3% of tibial spine fractures in adults have been associated with a tibial plateau fracture (unpublished data). Associated tibial plateau and intercondylar eminence avulsion fractures are complex articular lesions that vary widely from one patient to another, and therefore treatment requires personalized solutions. When determining the best treatment, anatomic joint reconstruction with minimally invasive techniques should be considered. Arthroscopic reduction and internal fixation have demonstrated various advantages over open reduction and internal fixation in terms of surgical morbidity, time of hospital stay, recovery, and complications such as infection and loss of knee motion10-12. The high prevalence of associated intra-articular lesions justifies the use of arthroscopy to evaluate and treat all of …

Management of the Posttraumatic Arthritic Knee

Excellent long-term outcomes can be achieved with contemporary methods of ligament reconstruction and open reduction and internal fixation for injuries around the knee; nevertheless, posttraumatic arthritis frequently develops. Reconstruction options for symptomatic posttraumatic knee arthritis include osteotomy, arthrodesis, and arthroplasty. Surgical challenges include the presence of extensive (often broken) hardware, scarring, stiffness, bony defects, compromised soft tissues, and malalignment. Patient age and activity and the anatomic location and extent of damage to the articular surface must be taken into account when determining the surgical treatment plan. For younger patients, osteotomy, allograft transplantation, or arthrodesis of the knee is considered, whereas older, low-demand patients are usually treated with arthroplasty. Attention to specific technical details and careful surgical technique are necessary to achieve a successful result. Functional improvement is usually seen following arthroplasty and, sometimes, arthrodesis. However, complications are common, and outcomes following arthroplasty are generally inferior to those reported for other diagnoses.

Gene Expression Profile of Synovial Cells in Experimental Post-Traumatic Arthritis of Knee in Swine

Gene Expression Profile of Synovial Cells in Experimental Post-Traumatic Arthritis of Knee in Swine

Candidate Molecules Identified by Proteomic Study of Synovial Cells in Experimental Post-Traumatic Arthritis of Knee in Swine

Candidate Molecules Identified by Proteomic Study of Synovial Cells in Experimental Post-Traumatic Arthritis of Knee in Swine

Knee arthroplasty in post-traumatic arthritis

Post-traumatic arthritis of the knee can involve the tibiofemoral joint, patellofemoral joint, or both joints. In the tibiofemoral articulation, disabling injuries include articular crush, condylar split, shaft involvement, ligamentous injuries, or a combination. In the patella, similar injuries include articular crush, large or stellate displaced fractures, tendon disruption, or a combination. Cementless mobile-bearing knee arthroplasty principles and implants can provide satisfactory long-term results in patients with complex post-traumatic knee arthritis. Primary, resurfacing unicompartmental or total knee implants can be used for articular damage, whereas more complex modular or constrained implants and osteotomies are needed for angular or combined deformities. Bearing exchange revision may be needed for young, active patients within 20 years of their initial arthroplasty. Copyright 2002, Elsevier Science (USA). All rights reserved.