In an unselected, prospective case control study, the incidence of risk factors and perioperative complications was investigated in 237 knees (203 patients) undergoing implantation of cementless total knee endoprostheses. Intraoperative complications and postoperative complications occurred in 84 patients (99 knees), with 61 specific orthopaedic complications in 50 patients (57 knees) and 74 nonsurgical complications in 55 patients (65 knees). The presence of cardiac, neurologic, or psychiatric concomitant diseases, advanced age, male gender, high-risk anesthesia scores, number and extent of intraoperative blood pressure fluctuations, and surgery under intubation anesthesia are associated significantly with the incidence of nonsurgical perioperative complications. In contrast, body weight, concomitant metabolic and circulatory diseases, previous surgery on the joint, origin of the articular disease, and the duration of surgery and tourniquet time do not correlate with the probability of a nonsurgical perioperative complication. A significant correlation with the parameters investigated could not be found for the occurrence of specific orthopaedic complications. The current report identifies specific risk factors that define patients with risk of having perioperative complications according to objective criteria. These parameters must be given individual consideration when establishing the indication and planning of surgery.
Kerboull, Marcel MD; Hamadouche, Moussa MD; Kerboull, Luc MDHip
Sixty consecutive revision total hip arthroplasties were performed with bulk allograft bone supported by the Kerboull reinforcement acetabular device in 53 patients from 1980 to 1987. The average age of the patients at the time of hip revision was 57.7 years. Acetabular bone loss according to the American Academy of Orthopaedic Surgeons grading system was Type III for 48 hips in 41 patients and Type IV for 12 hips in 12 patients. Three failures, defined as radiologic loosening of the socket, revised or not, were reported in this series at a mean 8-year followup. Eight patients died of unrelated causes at a mean of 5 years. No patient was lost to followup. The mean followup of the series was 10 years ± 3 years. The mean preoperative Merle d’Aubigné hip functional score was 11.7 ± 2.4 versus 17.4 ± 0.6 at the latest followup. Consolidation of the graft was considered completed in all 60 hips and occurred by 12 months. Remodeling of the graft proceeded for 3 to 4 years. The survival rate at 13 years was 92.1% ± 5% using loosening of the acetabular component as the end point. This study indicated that acetabular allograft reconstructions reinforced by the Kerboull acetabular device were able to provide satisfactory long-term clinical and radiologic results.
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