Nils Meißner, Andreas M. Halder, Oscar Torney, Alexander Preis, Jonas P. Sina, Daniel Schrednitzki
{"title":"No shortening of the patellar tendon during two-stage total knee arthroplasty revision using articulating spacers","authors":"Nils Meißner, Andreas M. Halder, Oscar Torney, Alexander Preis, Jonas P. Sina, Daniel Schrednitzki","doi":"10.1007/s00402-024-05545-6","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Surgical techniques in two-stage revision total knee arthroplasty (rTKA) include the use of articulating spacers and static spacers. Shortening of the patellar tendon could be a reason for inferior functional outcomes in two-stage septic rTKA . The aim of this study was to determine if articulating spacers also have negative effects on the extensor mechanism in rTKA.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This retrospective study includes 65 consecutive patients (23 women, 42 men, age 71.3 ± 1.2; range, 51.2–88.6 years) undergoing septic two-stage rTKA using an articulating spacer between 2014 and 2021 in a single orthopedic center. For all patients, calibrated true lateral radiographs before total knee arthroplasty (TKA) explantation (T0), directly after TKA explantation (T1), shortly before TKA reimplantation (T2) and 6–8 days after TKA reimplantation (T3) were used to calculate the modified Insall Salvati ratio (mISR).</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Overall, the mISR decreased significantly immediately after explantation (T0 vs. T1, <i>p</i> = 0.002) from 1.43 ± 0.03 to 1.36 ± 0.03 and remained stable until T2 (1.37 ± 0.02, p = 0.74). Following TKA reimplantation, the mISR increased again to 1.43 ± 0.03 (T3). There were no significant differences between T0 and T3 (<i>p</i> = 0.88). Six out of 65 patients (9%) experienced patellar tendon shortening > 10% at T3.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Septic two-stage revision TKA using an articulating spacer does not lead to patellar tendon shortening in the majority of cases. This study suggests that one reason for the improved range of motion after reimplantation may be the use of articulating spacers compared to static spacers. <i>Keywords: revision total knee arthroplasty</i>,<i> articulating spacer</i>,<i> infection</i>,<i> PJI</i>,<i> two-stage revision</i>,<i> revision arthroplasty</i>,<i> patellar tendon</i>,</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"37 1","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Orthopaedic and Trauma Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00402-024-05545-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Surgical techniques in two-stage revision total knee arthroplasty (rTKA) include the use of articulating spacers and static spacers. Shortening of the patellar tendon could be a reason for inferior functional outcomes in two-stage septic rTKA . The aim of this study was to determine if articulating spacers also have negative effects on the extensor mechanism in rTKA.
Methods
This retrospective study includes 65 consecutive patients (23 women, 42 men, age 71.3 ± 1.2; range, 51.2–88.6 years) undergoing septic two-stage rTKA using an articulating spacer between 2014 and 2021 in a single orthopedic center. For all patients, calibrated true lateral radiographs before total knee arthroplasty (TKA) explantation (T0), directly after TKA explantation (T1), shortly before TKA reimplantation (T2) and 6–8 days after TKA reimplantation (T3) were used to calculate the modified Insall Salvati ratio (mISR).
Results
Overall, the mISR decreased significantly immediately after explantation (T0 vs. T1, p = 0.002) from 1.43 ± 0.03 to 1.36 ± 0.03 and remained stable until T2 (1.37 ± 0.02, p = 0.74). Following TKA reimplantation, the mISR increased again to 1.43 ± 0.03 (T3). There were no significant differences between T0 and T3 (p = 0.88). Six out of 65 patients (9%) experienced patellar tendon shortening > 10% at T3.
Conclusions
Septic two-stage revision TKA using an articulating spacer does not lead to patellar tendon shortening in the majority of cases. This study suggests that one reason for the improved range of motion after reimplantation may be the use of articulating spacers compared to static spacers. Keywords: revision total knee arthroplasty, articulating spacer, infection, PJI, two-stage revision, revision arthroplasty, patellar tendon,
期刊介绍:
"Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance.
"Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).