Laptop Battery 252 Faculty of Medicine Siriraj Hospital AVOIDNESS AND TREATMENT OF COMPLICATION IN PRIMARY TOTAL KNEE ARTHROPLASTY V. Rojvanit Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University Bangkok, Thailand.
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Thinkpad Key words : Knee, Arthroplasty, Complication
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Microsoft Purpose: Although total joint arthroplasty in osteoarthritic and rheumatoid arthritis patients is a common procedure. There were failures in the knee that leading to revision total knee replacements up ten or more percents in some centers. This study evaluated the outcomes of our first 210 primary total knee arthroplasty. 85% of the cases were observed through a period that extended beyond 5 years.
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Laptop Computers Material and Methods: Beginning in Sept. 1990, data from 210 patients were reviewed and analysed. There were 195 females and 25 males. The age ranged from 46-81 (Av. 64.6). The most often used prosthesis in this small series were mostly IB-II-PS type. About 15% of the cases were replaced with the newer model NEXGEN-LPS. The approach were anterior midline and paramedial patellar approach.
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Laptop Computer Results : There were 9 wound complications 3 superficial and 6 deep wound infections. Three deep wound infection were salvaged after multiple joint debridement. Three cases required knee arthrodesis. There were 5 patellar complications mostly aseptic loosening, 2 were re-resurfaced, 3 were left without putting in a new prosthesis. Periprosthetic fracture were encountered in 3, open reduction and internal fixation were attempted. Three patellar clunk syndrome were seen exclusively in the group that using IB-II prosthesis. Arthroscopic removal of the fibrotic tissue helped relieving the symptom. Three deep vein thrombosis and one suspected pulmonary embolism were also encountered.
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Desktop Computer Discussion : Primary wound healing is critical for the success of any total knee arthroplasty (TKA). Proper selection of skin incision and an understanding of vascular anatomy are mandatory. Infection remain the nightmare that every one try to avoid. Although multiple debridement may sometimes salvage the prosthesis, majority of cases still had to undergo revision or arthrodesis. Patello-femoral resurfacing resulted a high rate of complications in the past (5-55%). We tried to use smaller diameter "button" like ÆÆ 29 and avoid metal-backed. Patellar clunk syndrome can be avoided by intraoperative removal of synovium and plicae at the posterior aspect of quadriceps closed to the proximal pole of the patella. Supracondylar fracture is a challenging problem , although lateral plating had been widely practiced, however a locked intramedullary rod is also worthy of consideration.
Notebooks Conclusion : One of the most fundamental consideration for the prevention of TKA complications in general is the selection of an implant and instrumentation system that yield the best flexibility and minimize the chances for technical error. Alignment and stability are the two most important points when durability issue is concerned. We felt that the PCL-substituting designs offer a wider margin of safety. Cemented designs possess more inherent stability and will better tolerate the aggressive ligament release required to correct severe deformities.
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