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The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study

BACKGROUND: To investigate the feasibility, safety and therapeutic efficacy of arthroscopy in managing the 3 most common soft tissue complications, peripatellar impingement (PI), arthrofibrosis (AF) and generalized synovitis (GS), after total knee arthroplasty (TKA). METHODS: A retrospective review...

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Autores principales: Hou, Yunfei, Gao, Jiaxiang, Chen, Jian, Lin, Jianhao, Ni, Lei, Sun, Tiezheng, Jiang, Jun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708148/
https://www.ncbi.nlm.nih.gov/pubmed/33256773
http://dx.doi.org/10.1186/s13018-020-02112-8
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author Hou, Yunfei
Gao, Jiaxiang
Chen, Jian
Lin, Jianhao
Ni, Lei
Sun, Tiezheng
Jiang, Jun
author_facet Hou, Yunfei
Gao, Jiaxiang
Chen, Jian
Lin, Jianhao
Ni, Lei
Sun, Tiezheng
Jiang, Jun
author_sort Hou, Yunfei
collection PubMed
description BACKGROUND: To investigate the feasibility, safety and therapeutic efficacy of arthroscopy in managing the 3 most common soft tissue complications, peripatellar impingement (PI), arthrofibrosis (AF) and generalized synovitis (GS), after total knee arthroplasty (TKA). METHODS: A retrospective review of patients undertaking arthroscopy for PI, AF and GS was conducted. Outcome measures included complications, postoperative range of motion (ROM), Knee Society Score (KSS) and rates of symptom recurrence, prosthesis revision. Intraoperative findings and surgical procedures were also recorded. Paired t test, Fisher’s exact test, Kruskal-Wallis test and post hoc analysis with Bonferroni correction were used for statistical evaluation. RESULTS: A total of 74 patients, including 35 patients with peripatellar impingement, 25 patients with arthrofibrosis and 14 patients with generalized synovitis, with a mean age of 66.1 ± 7.9 years, were analysed. The mean follow-up (FU) duration was 81.3 ± 40.6 months. All patients underwent arthroscopic surgery safely without intraoperative complications. However, there were 4 postoperative complications, including 1 acute myocardial infarction and 3 periprosthetic joint infections. Overall, patients acquired improvements in ROM from 81.7 ± 23.1° to 96.8 ± 20.5° (p < 0.05), in KSS knee score from 64.2 ± 9.6 to 78.7 ± 12.1 (p < 0.05) and in KSS function score from 61.1 ± 7.4 to 77.3 ± 12.2 (p < 0.05) postoperatively. Patients in all 3 groups had improvements in ROM (p < 0.05), KSS knee score (p < 0.05) and KSS function score (p < 0.05). The overall recurrence rate was 22.9% (95% confidence interval (CI) 15.1–34.9%), and the overall revision rate was 14.9% (95% CI 8.6–25.6%). There were significant differences in both the symptom recurrence and prosthesis revision rates among the groups (p < 0.05). The PI group had a significantly lower symptom recurrence rate (11.4%, 95% CI 4.5–28.7%) and revision rate (8.6%, 95% CI 2.9–25.3%) (p < 0.017), while the GS group had a significantly higher recurrence rate (42.9%, 95% CI 23.4–78.5%) and revision rate (35.7%, 95% CI 17.6–72.1%) (p < 0.017). CONCLUSIONS: In the setting of symptomatic TKA, although carrying certain risks for PJI and other complications, arthroscopic intervention could be feasible and provide clinical improvement in most cases at an average of 81.3 months follow-up. Patients with PI had the best outcomes, while patients with GS had the worst outcomes. LEVEL OF EVIDENCE: Level IV
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spelling pubmed-77081482020-12-02 The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study Hou, Yunfei Gao, Jiaxiang Chen, Jian Lin, Jianhao Ni, Lei Sun, Tiezheng Jiang, Jun J Orthop Surg Res Research Article BACKGROUND: To investigate the feasibility, safety and therapeutic efficacy of arthroscopy in managing the 3 most common soft tissue complications, peripatellar impingement (PI), arthrofibrosis (AF) and generalized synovitis (GS), after total knee arthroplasty (TKA). METHODS: A retrospective review of patients undertaking arthroscopy for PI, AF and GS was conducted. Outcome measures included complications, postoperative range of motion (ROM), Knee Society Score (KSS) and rates of symptom recurrence, prosthesis revision. Intraoperative findings and surgical procedures were also recorded. Paired t test, Fisher’s exact test, Kruskal-Wallis test and post hoc analysis with Bonferroni correction were used for statistical evaluation. RESULTS: A total of 74 patients, including 35 patients with peripatellar impingement, 25 patients with arthrofibrosis and 14 patients with generalized synovitis, with a mean age of 66.1 ± 7.9 years, were analysed. The mean follow-up (FU) duration was 81.3 ± 40.6 months. All patients underwent arthroscopic surgery safely without intraoperative complications. However, there were 4 postoperative complications, including 1 acute myocardial infarction and 3 periprosthetic joint infections. Overall, patients acquired improvements in ROM from 81.7 ± 23.1° to 96.8 ± 20.5° (p < 0.05), in KSS knee score from 64.2 ± 9.6 to 78.7 ± 12.1 (p < 0.05) and in KSS function score from 61.1 ± 7.4 to 77.3 ± 12.2 (p < 0.05) postoperatively. Patients in all 3 groups had improvements in ROM (p < 0.05), KSS knee score (p < 0.05) and KSS function score (p < 0.05). The overall recurrence rate was 22.9% (95% confidence interval (CI) 15.1–34.9%), and the overall revision rate was 14.9% (95% CI 8.6–25.6%). There were significant differences in both the symptom recurrence and prosthesis revision rates among the groups (p < 0.05). The PI group had a significantly lower symptom recurrence rate (11.4%, 95% CI 4.5–28.7%) and revision rate (8.6%, 95% CI 2.9–25.3%) (p < 0.017), while the GS group had a significantly higher recurrence rate (42.9%, 95% CI 23.4–78.5%) and revision rate (35.7%, 95% CI 17.6–72.1%) (p < 0.017). CONCLUSIONS: In the setting of symptomatic TKA, although carrying certain risks for PJI and other complications, arthroscopic intervention could be feasible and provide clinical improvement in most cases at an average of 81.3 months follow-up. Patients with PI had the best outcomes, while patients with GS had the worst outcomes. LEVEL OF EVIDENCE: Level IV BioMed Central 2020-12-01 /pmc/articles/PMC7708148/ /pubmed/33256773 http://dx.doi.org/10.1186/s13018-020-02112-8 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Hou, Yunfei
Gao, Jiaxiang
Chen, Jian
Lin, Jianhao
Ni, Lei
Sun, Tiezheng
Jiang, Jun
The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study
title The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study
title_full The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study
title_fullStr The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study
title_full_unstemmed The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study
title_short The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study
title_sort role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708148/
https://www.ncbi.nlm.nih.gov/pubmed/33256773
http://dx.doi.org/10.1186/s13018-020-02112-8
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