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.
Francesco BenazzoSezione di Chirurgia Protesica ad Indirizzo Robotico – Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Lombardy, Italy Università degli Studi di Pavia, Pavia, Lombardy, Italy
Patellar resurfacing during total knee arthroplasty remains a controversial topic.
Some surgeons routinely resurface the patella to avoid the increased rates of postoperative anterior knee pain and reoperation for secondary resurfacing, whilst others selectively resurface based on the presence of preoperative anterior knee pain, damaged articular cartilage, inflammatory arthritis, isolated patellofemoral arthritis, and patellar subluxation and/or maltracking. A third group of surgeons never resurface the patella.
The anatomy and biomechanics of the patellofemoral joint as well as the advances in surgical techniques and prosthetic design must be taken into account when making a decision about whether to resurface the patella. Accurate component implantation if the patella is resurfaced becomes crucial to avoid complications.
In our institution before 2008 we were performing a selective resurfacing of the patella, but in the last decade we have decided to always resurface it, with good outcomes and low complication rate. A reproducible surgical technique may be helpful in reducing the risk of postoperative anterior knee pain and complications related to implants.
In this article we analyse the current trend and controversial topics in dealing with the patella in total knee arthroplasty, and discuss the available literature in order to sustain our choice.
Cite this article: EFORT Open Rev 2020;5:785-792. DOI: 10.1302/2058-5241.5.190075
Giuseppe SolarinoDepartment of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, School of Medicine, University of Bari Aldo Moro, AOU Consorziale ‘Policlinico’, Bari, Italy
Hip, spine, and pelvis move in coordination with one another during activity, forming the lumbopelvic complex (LPC).
These movements are characterized by the spinopelvic parameters sacral slope, pelvic tilt, and pelvic incidence, which define a patient’s morphotype.
LPC kinematics may be classified by various systems, the most comprehensive of which is the Bordeaux Classification.
Hip–spine relationships in total hip arthroplasty (THA) may influence impingement, dislocation, and edge loading.
Historical ‘safe zones’ may not apply to patients with impaired spinopelvic mobility; adjustment of cup inclination and version and stem version may be necessary to achieve functional orientation and avert complications.
Stem design, bearing surface (including dual mobility), and head size are part of the armamentarium to treat abnormal hip–spine relationships.
Special attention should be directed to patients with adult spine deformity or fused spine because they are at increased risk of complications after THA.
Søren OvergaardDepartment of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Copenhagen, Denmark Department of Clinical Medicine, Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Thomas M GruppAesculap AG Research & Development & Medical Scientific Affairs, Tuttlingen, Germany Department of Orthopaedic and Trauma Surgery, Ludwig Maximilians University Munich, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Munich, Germany
Anne LübbekeDivision of Surgery and Traumatology, Geneva University Hospitals and University of Geneva, Switzerland Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
With the implementation of the new MDR 2017/745 by the European Parliament, more robust clinical and pre-clinical data will be required due to a more stringent approval process.
The EFORT Implant and Patient Safety Initiative WG1 ‘Introduction of Innovation’, combined knowledge of orthopaedic surgeons, research institutes, orthopaedic device manufacturers, patient representatives and regulatory authorities to develop a comprehensive set of recommendations for the introduction of innovations in joint arthroplasty within the boundaries of MDR 2017/745.
Recommendations have been developed to address key questions about pre-clinical and clinical requirements for the introduction of new implants and implant-related instrumentation with the participation of a steering group, invited by the EFORT Board in dialogue with representatives from European National Societies and Speciality Societies.
Different degrees of novelty and innovation were described and agreed on in relation to when surgeons can start, using implants and implant-related instrumentation routinely.
Before any clinical phase of a new implant, following the pre-market clinical investigation or the equivalent device PMCF pathway, it is a common understanding that all appropriate pre-clinical testing (regulatory mandatory and evident state of the art) – which has to be considered for a specific device – has been successfully completed.
Once manufacturers receive the CE mark for a medical device, it can be used in patients routinely when a clinical investigation has been conducted to demonstrate the conformity of devices according to MDR Article 62 or full equivalence for the technical, biological and clinical characteristics has been demonstrated (MDR, Annex XIV, Part A, 3.) and a PMCF study has been initiated.