OKOJ, Volume 7, No. 6

The Infected Total Knee Arthroplasty

Deep infection is one of the most devastating complications of total knee arthroplasty (TKA). The incidence of infection after TKA ranges from 1.1% to 12.4%. Multiple risk factors for infection in total joint arthroplasty have been identified, including diabetes mellitus, rheumatoid arthritis, use of immunosuppressive medications, renal failure, cardiopulmonary insufficiency, and the presence of skin ulcerations. Effective diagnosis requires a high index of suspicion and the concomitant use of multiple diagnostic modalities. Treatment goals for an infected TKA include eradication of infection, pain relief, and maintenance of a functional lower extremity. Currently, two-stage reimplantation is the gold standard in the treatment of late chronic periprosthetic knee infections. The protocol consists of removal of the prosthesis and cement, thorough débridement of soft tissue and bone, 6 weeks of intravenous antibiotics, and then reimplantation of a new prosthesis. This technique gives the most predictable result for eradication of infection and has the advantage of improved functional outcome compared with arthrodesis, definitive resection arthroplasty, or amputation.

    • Keywords:
    • deep knee infection

    • infected knee arthroplasty

    • infected total knee

    • infected knee replacement

    • prosthetic joint infection

    • acute hematogenous knee infection

    • late chronic knee infection

    • early postoperative knee infection

    • arthroplasty component failure

    • revision total knee arthroplasty

    • Subspecialty:
    • Adult Reconstruction

Evaluation and Surgical Treatment of the Cavus Foot Deformity

A cavus foot deformity has an abnormally high longitudinal arch. There are two main types of cavus deformity: cavovarus foot, which is characterized by plantar flexion of the forefoot and hindfoot varus, and calcaneocavus foot, which has dorsiflexion of the calcaneus. Most cavus foot deformities are the result of muscle imbalances with an underlying neurologic cause. Moderate-to-severe or progressive deformities usually require surgical treatment with three main goals: 1) correction of the existing deformity; 2) preservation of foot mobility; and 3) rebalancing the deforming muscle forces. Every cavus foot is unique; therefore, a through examination and development of an individualized surgical plan are required.

    • Keywords:
    • pes cavus

    • cavus foot

    • cavovarus foot

    • calcaneocavus foot

    • Charcot-Marie-Tooth disease

    • hereditary sensory motor neuropathy

    • Subspecialty:
    • Foot and Ankle

    • Pediatric Orthopaedics

Late-Presenting Developmental Dysplasia of the Hip

Developmental dysplasia of the hip (DDH) refers to abnormal acetabular morphology with lateralization of the femoral head. This can range in overall spectrum from decreased acetabular coverage of the femoral head (dysplasia) to actual dislocation of the hip joint. Abnormal alignment of the hip joint can lead to abnormal forces resulting in pain and early degenerative changes. Many different treatment options can be considered for patients with DDH, depending on the age of the child and the progression of deformity. This article focuses on the late presentation of DDH and treatment modalities to prevent early degenerative changes of the hip joint. Because children and adolescents have different presentations, different assessments, and different treatment options, walking age dysplasia/dislocation and adolescent dysplasia are discussed separately.

    • Keywords:
    • DDH

    • walking age dysplasia

    • adolescent dysplasia

    • late-onset dysplasia

    • open reduction

    • femoral osteotomy

    • Salter osteotomy

    • Dega osteotomy

    • Steel osteotomy

    • Tonnis osteotomy

    • Ganz periacetabular osteotomy

    • Subspecialty:
    • Pediatric Orthopaedics