Louis Rouquette1, Roger Erivan1,2,3, Bruno Pereira4, Stéphane Boisgard1,2,3, Stéphane Descamps1,2,3, Guillaume Villatte5,6,7. 1. Service d'Orthopédie-Traumatologie, Hôpital Gabriel Montpied, CHU de Clermont Ferrand BP 69, 63003, Clermont Ferrand Cedex 01, France. 2. Université Clermont Auvergne, SIGMA Clermont, Institut de Chimie de Clermont-Ferrand, BP 10448, 63000, Clermont-Ferrand, France. 3. CNRS, UMR 6296, ICCF, 63178, Aubière, France. 4. DRCI, CHU de Clermont Ferrand BP 69, 63003, Clermont Ferrand Cedex 01, France. 5. Service d'Orthopédie-Traumatologie, Hôpital Gabriel Montpied, CHU de Clermont Ferrand BP 69, 63003, Clermont Ferrand Cedex 01, France. guillaumevillatte@hotmail.fr. 6. Université Clermont Auvergne, SIGMA Clermont, Institut de Chimie de Clermont-Ferrand, BP 10448, 63000, Clermont-Ferrand, France. guillaumevillatte@hotmail.fr. 7. CNRS, UMR 6296, ICCF, 63178, Aubière, France. guillaumevillatte@hotmail.fr.
Abstract
INTRODUCTION: Tibiofemoral dislocation is the most serious form of instability following total knee arthroplasty (TKA). It is little reported in the literature, despite severity comparable to that in the native knee. The present systematic review and meta-analysis aimed to identify risk factors and treatment strategies. METHODS: The Cochrane, Medline (via PubMed), Google, and PROSPERO data-bases were searched in January 2018 following the PRISMA meta-analysis guidelines. All articles referring to tibiofemoral dislocation following primary TKA were included for analysis and extraction of individual data. Study data comprised age, gender, comorbidities, primary and revision implant design, aetiology, and treatment strategy. RESULTS: Individual data for 57 patients (23 studies) were analyzed. A total of 62.0% of primary implants were posterior-stabilized (49 patients) and 30.4% posterior-cruciate-retaining (24 patients). Obesity was the most frequent comorbidity (39.2%; 31 patients), followed by severe pre-operative deformity (31.6%; 25 patients). Aetiologies of dislocation were mainly related to comorbidity (15 studies; 65.2%) or intra-operative iatrogenic destabilization (14 studies; 60.9%). Non-operative treatment (splint) after dislocation was associated with high rates of recurrence (39.1%) but significantly fewer complications (p = 0.033). Implant revision surgery (45 patients; 80.4%) usually involved higher-constraint models (31 patients; 70.8%). CONCLUSIONS: Improved implant design has reduced the rate of tibiofemoral dislocation, although this complication remains serious in both the short and the long term. The present review identified patient- and surgeon-related risk factors. Awareness of the former, which are identifiable pre-operatively, and of the most frequent technical errors is critical.
INTRODUCTION:Tibiofemoral dislocation is the most serious form of instability following total knee arthroplasty (TKA). It is little reported in the literature, despite severity comparable to that in the native knee. The present systematic review and meta-analysis aimed to identify risk factors and treatment strategies. METHODS: The Cochrane, Medline (via PubMed), Google, and PROSPERO data-bases were searched in January 2018 following the PRISMA meta-analysis guidelines. All articles referring to tibiofemoral dislocation following primary TKA were included for analysis and extraction of individual data. Study data comprised age, gender, comorbidities, primary and revision implant design, aetiology, and treatment strategy. RESULTS: Individual data for 57 patients (23 studies) were analyzed. A total of 62.0% of primary implants were posterior-stabilized (49 patients) and 30.4% posterior-cruciate-retaining (24 patients). Obesity was the most frequent comorbidity (39.2%; 31 patients), followed by severe pre-operative deformity (31.6%; 25 patients). Aetiologies of dislocation were mainly related to comorbidity (15 studies; 65.2%) or intra-operative iatrogenic destabilization (14 studies; 60.9%). Non-operative treatment (splint) after dislocation was associated with high rates of recurrence (39.1%) but significantly fewer complications (p = 0.033). Implant revision surgery (45 patients; 80.4%) usually involved higher-constraint models (31 patients; 70.8%). CONCLUSIONS: Improved implant design has reduced the rate of tibiofemoral dislocation, although this complication remains serious in both the short and the long term. The present review identified patient- and surgeon-related risk factors. Awareness of the former, which are identifiable pre-operatively, and of the most frequent technical errors is critical.
Entities:
Keywords:
Complication; Knee dislocation; Meta-analysis; Tibiofemoral; Total knee arthroplasty
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