دورية أكاديمية
Total Knee Arthroplasty Periprosthetic Joint Infection With Concomitant Extensor Mechanism Disruption and Soft-Tissue Defect: The Knee Arthroplasty Terrible Triad.
| العنوان: | Total Knee Arthroplasty Periprosthetic Joint Infection With Concomitant Extensor Mechanism Disruption and Soft-Tissue Defect: The Knee Arthroplasty Terrible Triad. |
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| المؤلفون: | Entezari B; Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada; School of Medicine, Queen's University, Kingston, Ontario, Canada., Lex JR; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Litowski ML; Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Almaslmani S; Department of Surgery, Faculty of Medicine, Al-Qunfudhah, Umm Al-Qura University, Makkah, Saudi Arabia., Backstein DJ; Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Wolfstadt JI; Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. |
| المصدر: | The Journal of arthroplasty [J Arthroplasty] 2024 Jun 01. Date of Electronic Publication: 2024 Jun 01. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Taylor and Francis Country of Publication: United States NLM ID: 8703515 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8406 (Electronic) Linking ISSN: 08835403 NLM ISO Abbreviation: J Arthroplasty Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: New Brunswick, NJ : Taylor and Francis Original Publication: [New York, NY : Churchill Livingstone, c1986- |
| مستخلص: | Background: Periprosthetic infection (PJI) with concomitant extensor mechanism disruption (EMD) and soft-tissue defect-hereinafter termed the "Terrible Triad"-is a devastating complication following total knee arthroplasty. The purpose of this study was to define the surgical and clinical outcomes following management of a cohort of patients who have the Terrible Triad. Methods: From 2000 to 2022, 127 patients underwent operative management for PJI alone, 25 for PJI with soft-tissue defects (defined as defects requiring flap reconstruction or being a factor contributing to the decision of performing above-knee amputation or arthrodesis), 14 for PJI with EMD, and 22 for the Terrible Triad. A composite outcome of infection status, range of motion, extensor lag, and ambulatory status at final follow-up was used to compare the proportion of patients in each group with a favorable overall knee outcome. Differences between groups were determined using one-way analyses of variance with post hoc Tukey's tests and Pearson's Chi-square tests or Fisher's exact tests with post hoc Bonferroni adjustments, where applicable. Odds ratios (OR) were calculated for comparison of the overall knee outcome between groups. A Kaplan-Meier survival analysis for patient mortality was performed. Results: The mean follow-up was 8.4 years and similar between groups (P = .064). Patients who had the Terrible Triad had a 45.5% incidence of above-knee amputation, or arthrodesis, and an 86.4% incidence of an unfavorable outcome. Compared to patients in the PJI group, patients in the PJI who had a soft-tissue defect (OR = 5.8, 95% CI [confidence interval] 2.2 to 15.7), PJI with EMD (OR = 3.7, 95%CI 1.0 to 12.9), and Terrible Triad groups (OR = 11.6, 95% CI 3.3 to 41.5) showed higher odds of an unfavorable knee outcome. Conclusions: This study demonstrates that the total knee arthroplasty Terrible Triad is a dreaded diagnosis with poor outcomes. Clinicians and patients might consider early treatment with amputation or arthrodesis. Level of Evidence: III. (Copyright © 2024 Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: TKA Terrible Triad; extensor mechanism disruption; flap reconstruction; periprosthetic joint infection; revision arthroplasty; total knee arthroplasty |
| تواريخ الأحداث: | Date Created: 20240603 Latest Revision: 20240626 |
| رمز التحديث: | 20240627 |
| DOI: | 10.1016/j.arth.2024.05.084 |
| PMID: | 38830429 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1532-8406 |
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| DOI: | 10.1016/j.arth.2024.05.084 |