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Sibarani, Tangkas
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Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Education Health Professions Neuroscience

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Treatment of Chronic Prosthetic Joint Infection after Total Knee Arthroplasty with Two-stage Revision Rizaldy, Muhammad Bayu; Santoso, Asep; Mariyanto, Ismail; Sibarani, Tangkas; Anwar, Iwan Budi
The Hip and Knee Journal Vol 5, No 1 (2024): February
Publisher : Indonesian Hip and Knee Society (IHKS)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.46355/hipknee.v5i1.135

Abstract

Periprosthetic joint infection (PJI) is common among complications of knee arthroplasty. Treatment is based on many factors in each patient individually, especially the time onset of infection whether it is acute or chronic. Two stage revision is the best method in chronic PJI case under certain circumstances. There are few patients in three years period whom diagnosed with chronic PJI after Total Knee Arthroplasty (TKA). All patients diagnosed more than three months postoperatively, confirmed by clinically sinuses on the knee, and some patients have blood test and radiological sign of infection. All treated with two stage revision which is debridement, removal all implant put articulating knee spacer in the first operation, continue with arthroplasty with constrain implant in the second operation after infection confirmly eradicated and treated by one consultant surgeon in the same hospital. All patients treated with the same method have good results which are no pain, stable knee and satisfying knee Range of motion (ROM) following different recovery time. Two-stage revision have a good success rate in chronic PJI treatment as long as the patient fulfill the treatment criteria.
Total knee arthroplasty in severe valgus deformity of knee osteoarthritis with non-constrained implant: A Case Report Limbong, Suyenci; Santoso, Asep; Anwar, Iwan Budiwan; Sibarani, Tangkas; Mariyanto, Ismail
The Hip and Knee Journal Vol 4, No 2 (2023): August
Publisher : Indonesian Hip and Knee Society (IHKS)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.46355/hipknee.v4i2.134

Abstract

Osteoarthritis (OA) is main cause of musculoskeletal disability all over the world. The incidence and prevalence of OA increase with aging . The treatment for grade four of knee osteoarthritis (OA) as classified by Kellgren and Lawrence classification is knee replacement, approximately 10% of patient need TKA have valgus deformity and 15% of it is severe deformity. type-III deformity (severe osseous deformity) with an incompetent medial soft-tissue sleeve, which is best managed with a constrained or hinged total-knee design, but it is not always available due to insurance limitation. In this case we choosed to manage the type III deformity using non constrained or hinged total knee design and achieve knee balancing by a soft tissue procedure (MCL tightening). Presetasion of case with Reporting female patient Mrs. S, a 61-year-old with painful and valgus deformity on the right  knee. Her range of motion preoperatively was 5-10° with 30° fixed valgus deformity on the right knee. We performed total knee arthroplasty used non-constraint implant with additional soft tissue procedure to gain ligament balance by shifted MCL origin with its bone (epicondyle ) superior and anteriorly. Intra operative we were able to correct valgus deformity and achieved 5-90 range of motion. Discussion in this study with total knee arthroplasty is a procedure that contains two main steps, bone cut and soft tissue balancing. In valgus knee tightness found at lateral site with loosening at medial site. In its severe condition medial collateral ligament may be found disfunctioned . Selective soft tissue release was effective to achieve good ROM and aligment without prosthetic constraint needed which was helped to manage patient when the constraint implant was not accessible. The conclusion after 3 month post operative we found patient was able to stand and walk without pain and device with 0-80° range of motion, stable and corrected valgus deformity.
Co-Authors Anwar, Iwan Budi Iwan Budiwan Anwar Limbong, Suyenci Mariyanto, Ismail Rizaldy, Muhammad Bayu Santoso, Asep