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Inferior results at long-term follow-up after extensor mechanism allograft reconstruction in septic compared to aseptic revision total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Extensor mechanism lesion after total knee arthroplasty (TKA) is a catastrophic complication. Reconstruction with extensor mechanism allograft (EMA) has been described as a sound salvage procedure. Its effectiveness at long term and in septic cases is still under scrutiny. The long-term results of EMA reconstruction for chronic extensor mechanism failures following aseptic and septic revision TKA have been analysed.

Methods

From the institutional database, 35 patients with a revision TKA (RevTKA) undergoing EMA reconstruction from 2005 to 2015 have been retrospectively identified. A history of periprosthetic joint infection (PJI) was found in 13 (37%) patients. The mean follow-up was 81.2 months (± 34.7, range 3–120). EMA failures were considered for lag more than 20°, Knee Society Score (KSS) less than 60 points, and/or in the case of revision of the allograft.

Results

The mean KSS improved from 35.9 (± 16.9, range 0–54) to 86.6 (± 10.4, range 54–99) points in the aseptic group (p < 0.001) and from 27.5 (± 11.6, range 10–44) to 79.4 (± 16.3, range 48–94) points in the septic group (p < 0.001). The extensor lag changed from 48.4° (± 14.5, range 30–90) to 4.6° (± 10.8, range 0–50) in the aseptic group (p < 0.001) and from 56.5° (± 20.8, range 30–90) to 6.1° (± 6.8, range 0–20) in the septic group (p < 0.001). The mean postoperative flexion was 105.2° (± 13.2, range 75–130) in the aseptic group and 102.7° (± 12.5, range 80–120) in the septic group (p = 0.32). Three failures (14% of the cases) occurred in the aseptic group and five in the septic group (38% of the cases). The overall survivorship at 10 years was 83.3% (22 cases, CI95 94.2–121.7) vs 58% (13 cases, CI95 67.2–111.7) in the aseptic and septic group, respectively (p = 0.01).

Conclusions

EMA reconstruction after extensor mechanism disruptions in TKA is a reliable salvage procedure. The septic nature of the revision decreased the functionality of the knee joint after EMA, but it did not represent a risk factor for re-ruptures or recurrence of infection.

Level of evidence

Level III.

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Data availability

All the data of the present study are available on file under the archives of the corresponding author.

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Funding

The authors received no financial support for the research, authorship, and publication of this article.

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Authors and Affiliations

  1. Istituto Fiorentino di Cura e Assistenza (IFCA), Via del Pergolino 4/6, 50139, Florence, Italy

    Andrea Baldini, Alfredo Lamberti & Pierpaolo Summa

  2. Department of Public Health, School of Medicine, Federico II University, Via S. Pansini, 80131, Naples, Italy

    Giovanni Balato

  3. Department of Health Science, University of Florence, Viale GB Morgagni 48, 50134, Florence, Italy

    Giuseppe Cavallo

Authors
  1. Andrea Baldini
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  2. Alfredo Lamberti
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  3. Giovanni Balato
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Correspondence to Andrea Baldini.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the local Ethics committee of the Azienda Ospedaliera Universitaria di Careggi, Florence Italy with ID 15366 of 13 October 2019.

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Baldini, A., Lamberti, A., Balato, G. et al. Inferior results at long-term follow-up after extensor mechanism allograft reconstruction in septic compared to aseptic revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 31, 1477–1482 (2023). https://doi.org/10.1007/s00167-022-07280-0

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