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Polyethylene Exchange Only for Prosthetic Knee Instability : Clinical Orthopaedics and Related Research®
Prosthetic knee instability is a common cause of patient dissatisfaction and early failure after total knee arthroplasty (TKA). Strategies to manage such instability are dependent on the recognition of the presenting instability pattern because some require full revision, whereas others can be managed by polyethylene exchange (PE) only. This retrospective chart review classifies and reports on a series of patients where PE only was used to manage an unstable TKA.
- Each participant drew questions and shared their insights, knowledge and some personal fun facts that left us inspired about the future of health and wellness.
- Outside of the developments in the Middle East it was a quiet weekend from a macro perspective and there is no major economic data scheduled to be released until later in the week.
- This study classifies a series of patients where PE only was used to manage an unstable TKA and reports on the results of this treatment alternative.
- Then a pointed blunt impactor is inserted through the metaphyseal tibial bone lateral to the patellar tendon to hammer the component (Fig. 2).
- It is advanced below the component’s surface as much as possible until the pegs or the box area is reached.
Plastics in Total Knee Replacement: Processing to Performance
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Spacer blocks placed in full extension must match a spacer block placed at 90° of flexion to stabilize the knee. Two options exist to manage flexion instability; however, both involve removal of the femoral implant. A larger femoral implant can be used with posterior augments to tighten the flexion gap relative to the extension gap.
When Polyethylene Exchange Is Appropriate for Prosthetic Knee Instability : JAAOS Global Research & Reviews
A type 2 instability pattern is probably the most common type of periprosthetic knee instability, that is, flexion-extension mismatch. This can lead to flexion instability where the knee is stable in extension and loose at 90° of flexion. Alternatively, the flexion-extension mismatch can lead to a flexion contracture where the extension gap is smaller than the flexion gap. In each of these presentations, the flexion gap is greater than the extension gap. This is caused by reluctance to either remove more distal femoral bone or strip the posterior capsule off the posterior femur at the time of primary surgery. Both these maneuvers can increase the extension gap to “catch up” with the flexion gap.
Alkaline stability of pendant C2-protected poly(imidazolium)s
Different techniques have been described in the literature for implant removal.14 An optimized tool set composed of a reciprocating saw, a bone impactor, a small osteotome and a pointed impactor make this phase fast and effective. Implant extraction should be performed cautiously how to buy polymath and in a systematic manner to avoid major bone loss and periprosthetic fractures. The first step is the modular polyethylene liner removal that can be easily performed with the use of a lever (i.e. the tip of a standard Hohmannretractor) or cutting the pivot in rotating implants.
Planning the revision with proper X-rays
Peripheral defects can be filled up with cement augmented with screws or metal augments if the thickness is superior to 10 millimeters.21 After completing the trial tibial reconstruction, the knee is maintained in flexion and a trial femoral component is chosen. The resulting antero-posterior size should be the size https://www.tokenexus.com/ which better fills the flexion gap. The femoral component must be correctly rotated using the tibial platform as a main guide to recreate a symmetric flexion gap with collateral ligament equally tensioned. To avoid patellar maltracking problems, the epicondylar axis should be considered as a complementary guide.
- By definition, the instability patterns are subjective by surgeon and patient alike.
- We provided a surgical step-by-step procedure to overcome the majority of the challenges you might encounter in a revision setting.
- Further increasing the radiation dose (5 to 10 Mrd), results in radical species that react with chain imperfections leading to polymer chain cross-linking with stable C-C chemical bonds.
- Thus, the resin type, conversion method, and machining to the final product have individual effects on the physical properties and wear characteristics of the final plastic product.
- Data from one hospital suggests that HXLPE inserts cost approximately 150 USD more than CPE, while others estimate this difference to be even higher [43].
- Wear resistance is improved by crosslinking the PE, which is accomplished by higher doses of radiation (Gamma or E-beam).
Component removal
However, one long-term study (Australian joint registry) showed significantly lower revision rates at a 10-year follow-up with XLPE than CPE (3.5% versus 5.8%) [35]. Of these 71 patients, 3 died without 2-year follow-up, 9 declined participation, 1 was unable to answer the questions, and 17 were lost to follow-up. The final data set included 41 patients at an average follow-up of 43 months (range, 24 to 134 months). The chosen resin powder is consolidated into rods/sheets from which final implants are made. Table Table44 summarizes joint replacement registry studies and the revision rates with CPE and HXLPE [35,40-42].
- Open arthrolysis had been reported with sub-optimal success in gaining arc of motion.
- Reconstruction is started at the tibia as it affects both flexion and extension gaps.
- The degree of instability was not specifically documented in this retrospective study.
- Patients may be asymptomatic early in the disease, but most will present with pain, swelling or acute synovitis.
- However, it led to a reduction in fatigue crack propagation (FCP) resistance, ultimate tensile strength, elongation at break values, and impact toughness [10].
Open Debridement and Polyethylene Exchange (ODPE) in the Infected Total Knee Arthroplasty
Revision of painful prostheses, performed in pre-arthritic knees, is doomed to fail if a major cause of failure is not identified and corrected. Walking gait, knee range of motion and ligamentous stability have to be closely evaluated during clinical examination. Results should follow the validated criteria of the International Consensus Meeting.6 Do not hesitate to retry intraarticular aspiration in ‘dry tap’ knees.