Periprosthetic total knee fracture after remote reconstruction of the anterior cruciate ligament: a case report

Abstract Background Distal femoral fracture is a rare, but significant, postoperative complication of anterior cruciate ligament reconstruction. However, there has not been a reported case of periprosthetic total knee arthroplasty fracture associated with a previous anterior cruciate ligament repair. Case presentation We report the case of a 51-year-old white man with a history of total knee arthroplasty and remote anterior cruciate ligament reconstruction, who presented with a distal femoral periprosthetic fracture at the site of a previous anterior cruciate ligament augmentation staple. Conclusions Based on these findings, it may be important to consider removal of previous anterior cruciate ligament hardware prior to total knee arthroplasty to reduce risk of periprosthetic fracture, which should be determined on a patient-specific basis

Bicompartmental knee arthroplasty vs total knee arthroplasty for the treatment of medial compartment and patellofemoral osteoarthritis

Background: Interest in bicompartmental knee arthroplasty (BKA) for the treatment of medial patellofemoral osteoarthritis (MPFOA) has grown in recent years because BKA offers a bone and ligament-preserving alternative to total knee arthroplasty (TKA). BKA only resurfaces the diseased compartments, while preserving proprioception and native knee kinematics. Therefore, the objective of this study is to assess knee function, perioperative morbidity, and implant survivability in patients undergoing BKA vs TKA for MPFOA. Methods: The databases MEDLINE, PUBMED, and EMBASE were systematically searched. Randomized controlled trials and nonrandomized comparative studies comparing BKA with TKA for the treatment of MPFOA were included for further analysis. The primary outcome of interest was knee function. Secondary outcomes included range of movement, operation length, intraoperative blood loss, hospital length of stay, postoperative complications, and rate of revision length. The quality of evidence was evaluated using the GRADE approach. Meta-analysis was performed by pooling the results of the selected studies when possible. Results: Six studies were selected for inclusion (4 prospective studies and 2 retrospective cohort studies). In total, 274 patients and 277 knees were included for analysis. There were no significant differences between the 2 groups at any time points in terms of knee function, length of stay, complication rate, or revision rate, when monolithic BKA designs were controlled for. BKA did result in significantly decreased intraoperative blood loss, at the expense of increased operative length compared with TKA. Conclusions: The use of modular BKA for MPFOA is comparable with TKA in terms of short-term function, complication rate, and revision rate. BKA reduces intraoperative blood losses, but it is also more technically demanding, resulting in increased operation length. The use of modular BKA has acceptable short-term outcomes, but more long-term data are needed before it can be recommended for routine use in the treatment of MPFOA. The selection of modular BKA should be determined on a patient-specific basis. Currently, there is no evidence to suggest the use of monolithic BKA designs because of their high revision and failure rate. Keywords: Total knee arthroplasty, Bicompartmental knee arthroplasty, Medial patellofemoral arthritis, Meta-analysi

A scoping review on the surgical management of metastatic bone disease of the extremities

Abstract Background Management of metastatic bone disease of the extremities (MBD-E) is challenging, and surgical directions pose significant implications for overall patient morbidity and mortality. Recent literature reviews on the surgical management of MBD-E present a paucity of high-level evidence and global inconsistencies in study design. In order to steer productive research, a scoping review was performed to map and assess critical knowledge gaps. Methods The Arksey and O’Malley framework for scoping studies was followed. A comprehensive literature search identified a large body of literature pertaining to the surgical management of MBD-E. Study data and meta-data was extracted and presented using descriptive analytics and a thematic framework. Literature gaps were identified and analyzed. Results Three hundred eighty five studies from 1969 to 2017 were included. Studies were categorized into 11 separate themes, with the majority (63%) falling into the “surgical fixation strategies” theme, followed by “complications” at 7% and “prognosis and survival” at 6.2%. Less than 3% of studies were categorized in “patient related outcomes” or “epidemiology” themes. 89% of studies were retrospective and only 6 studies were of level 1 or 2 evidence. We identified a temporal increase in publication by decade, and all studies published on interventional radiology techniques or economic analyses were published after 2007 or 2009, respectively. 64.9% of studies were published in Europe and 20.3% were published in North America. Average patient age was 62 (± 5.2 years), and breast was the most common primary tumour (28%), followed by lung (17%) and kidney (15%). In terms of surgical location, 75% of operations involved the femur, followed by the humerus at 22% and tibia at 3%. Conclusions We present a descriptive overview of the current published literature on the surgical management of MBD-E. Critical knowledge gaps have been identified through the development of a thematic framework. Consolidation of literary gaps must involve bolstered efforts towards patient and family-engaged research initiatives and assessment of patient-related surgical outcomes. Multi-disciplinary engagement in developing prospective research will also help guide evidence-based personalized practice for these patients. By building on existing comprehensive patient databases and registries, knowledge on survival and prognostic parameters can be greatly improved

Additional file 1: of A scoping review on the surgical management of metastatic bone disease of the extremities

Appendix 1. Detailed Search Strategies. (DOCX 13 kb