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Late-Onset De Novo Genu Recurvatum after Primary Total Knee Arthroplasty: A Potential Indication for Isolated Polyethylene Exchange.

ABSTRACT: Knee instability is the second most common cause of revision after total knee arthroplasty (TKA). Genu recurvatum (GR) is the rarest form of instability usually occurring in patients with underlying conditions such as neuromuscular disorders and fixed valgus deformities. The literature regarding de novo post-TKA GR and its treatment is scarce. In this case series and review of literature, we aimed to review the treatment strategies of post-TKA GR and to present our experience in the treatment of late-onset de novo GR after TKA by isolated polyethylene exchange. To our knowledge, isolated polyethylene exchange has not been so far described for GR correction after TKA. We found a unique wear pattern at the base of the liner post in all 3 patients. They showed a satisfactory outcome with no recurrence on a mean follow-up of 26.67 months.

SUBMITTER: Mortazavi SMJ

PROVIDER: S-EPMC7358988 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Late-Onset De Novo Genu Recurvatum after Primary Total Knee Arthroplasty: A Potential Indication for Isolated Polyethylene Exchange.

Mortazavi Seyed Mohammad Javad SMJ Razzaghof Mohammadreza M Noori Abbas A Okati Ali A

Arthroplasty today 20200713 3

Knee instability is the second most common cause of revision after total knee arthroplasty (TKA). Genu recurvatum (GR) is the rarest form of instability usually occurring in patients with underlying conditions such as neuromuscular disorders and fixed valgus deformities. The literature regarding de novo post-TKA GR and its treatment is scarce. In this case series and review of literature, we aimed to review the treatment strategies of post-TKA GR and to present our experience in the treatment of ...[more]

PMID: 32685642

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Project description:A decreased posterior tibial slope has been associated with an increased risk of posterior cruciate ligament failure, anterior knee pain, and premature knee osteoarthritis. Trauma is a common cause of osseous genu recurvatum. Surgical management is recommended to correct the tibial slope and prevent knee pain and osteoarthritis progression. This article discusses our preferred treatment using a proximal tibial opening-wedge osteotomy for surgical management of genu recurvatum secondary to significant anterior tibial slope. Technique Video Video 1 Once the arthroscopic evaluation of the knee has been done using the standard medial and lateral portals, a 15-cm longitudinal anteromedial skin incision is made in line with the medial border of the patellar tendon, raising full-thickness subcutaneous flaps. Medial dissection is performed, and the periosteum under the medial collateral ligament is elevated to the posteromedial corner of the tibia. Lateral dissection is accomplished carefully with the detachment of the tibialis anterior. Then, the patellar tendon is isolated, and the tibial tuberosity is exposed. An osteotomy of the tibial tubercle is performed (with a bone block of 6-8 cm long and should reach into the metaphyseal bone). Two guide pins are introduced anteriorly approximately 4 to 5 cm below the joint line directed posteriorly and aimed at the level of the insertion of the posterior cruciate ligament. These pins are used as guides for performing the osteotomy. After correct placement is confirmed by fluoroscopy, an osteotome is advanced. Great care is taken not to violate the posterior cortex while using the osteotome (up to 1 cm of the posterior cortex must be preserved to obtain a solid posterior hinge). Opening of the osteotomy is achieved by the sequential introduction of several osteotomes. The osteotomy is then widened using a spreader device until the desired tibial slope is achieved. The spreader device is left in place for a few minutes to allow for stress relaxation of the posterior cortex. The appropriate medial locking plate is fixed just medial to the tibial tuberosity osteotomy. The osteotomy is then packed with iliac crest autograft bone graft. The tibial tuberosity is proximally advanced by the same amount as the opening wedge osteotomy, to avoid a patella infera and to act as a biologic plate. Final fluoroscopic images are obtained to confirm osteotomy position, hardware position, and adequate bone grafting.

Project description:Background and purpose - Backside wear of the polyethylene insert in total knee arthroplasty (TKA) can produce clinically significant levels of polyethylene debris, which can lead to loosening of the tibial component. Loosening due to polyethylene debris could theoretically be reduced in tibial components of monoblock polyethylene design, as there is no backside wear. We investigated the effect of 2 different tibial component designs, monoblock and modular polyethylene, on migration of the tibial component in uncemented TKA. Patients and methods - In this randomized study, 53 patients (mean age 61 years), 32 in the monoblock group and 33 in the modular group, were followed for 2 years. Radiostereometric analysis (RSA) was done postoperatively after weight bearing and after 3, 6, 12, and 24 months. The primary endpoint of the study was comparison of the tibial component migration (expressed as maximum total point motion (MTPM)) of the 2 different implant designs. Results - We did not find any statistically significant difference in MTPM between the groups at 3 months (p = 0.2) or at 6 months (p = 0.1), but at 12 and 24 months of follow-up there was a significant difference in MTPM of 0.36 mm (p = 0.02) and 0.42 mm (p = 0.02) between groups, with the highest amount of migration (1.0 mm) in the modular group. The difference in continuous migration (MTPM from 12 and 24 months) between the groups was 0.096 mm (p = 0.5), and when comparing MTPM from 3-24 months, the difference between the groups was 0.23 mm (p = 0.07). Interpretation - In both study groups, we found the early migration pattern expected, with a relatively high initial amount of migration from operation to 3 months of follow-up, followed by stabilization of the implant with little migration thereafter. However, the modular implants had a statistically significantly higher degree of migration compared to the monoblock. We believe that the greater stiffness of the modular implants was the main reason for the difference in migration, but an initial creep in the polyethylene metal-back locking mechanism of the modular group could also be a possible explanation for the observed difference in migration between the 2 study groups.

Dataset Information

Late-Onset De Novo Genu Recurvatum after Primary Total Knee Arthroplasty: A Potential Indication for Isolated Polyethylene Exchange.

Publications

Late-Onset De Novo Genu Recurvatum after Primary Total Knee Arthroplasty: A Potential Indication for Isolated Polyethylene Exchange.

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