Posted: Mar 28 2020 #(C101411)

TKA extensor mechanism failure in 74M

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HPI

A 74-year-old male presents with progressive right knee pain and inability to straight leg raise after TKA revision in the distant past. Denies any recent history of trauma or any drainage from his incision.

PMH

No major medical comorbidities Right TKA (distant past) Right TKA revision in 2004 (not for infection)

Focused physical examination of the right lower extremity reveals a well-healed incision without erythema or warmth. Patient unable to perform a straight leg raise with a palpable defect inferior to the patella. He is neurovascularly intact. Labs: ESR: 4, CRP: 0.3 mg/dL, WBC: 4.5K

Poll

1 of 11

Would you obtain an aspiration?

1 No, labs are essentially normal

2 Yes, need to rule out infection given the clinical picture

3 Outside my area of expertise - best if I don't vote

Other

Submit

P: 125814

The patient has no evidence of an infection. How would you manage the patient?

1 Nonoperative

2 Operative

3 Outside my area of expertise - best if I don't vote

Other

Submit

P: 125815

If you choose Nonoperative management, what would you do?

1 I would not choose Nonoperative management

2 Observation

3 Physical therapy

4 Knee immobilizer

5 Drop-lock brace

6 Outside my area of expertise - best if I don't vote

Other

Submit

P: 127296

If you choose Operative management, what would you do?

1 I would not choose Operative management

2 Knee arthrodesis

3 Patella open reduction and internal fixation (ORIF)

4 Extensor mechanism reconstruction only

5 Revision TKA only

6 Revision TKA with extensor mechanism reconstruction

7 Above-knee amputation

8 Outside my area of expertise - best if I don't vote

Other

Submit

P: 125816

If you choose Knee arthrodesis, what method of arthrodesis would you choose?

1 I would not choose Knee arthrodesis

2 Plate and screws

3 Intramedullary nail

4 External fixator

5 Combination of above

6 Outside my area of expertise - best if I don't vote

Other

Submit

P: 127297

If you choose Extensor mechanism reconstruction only, what technique would you use?

1 I would not choose Extensor mechanism reconstruction

2 Direct repair

3 Mesh implant reconstruction

4 Allograft reconstruction

5 Extended gastrocnemius flap

6 Other

7 Outside my area of expertise - best if I don't vote

Other

Submit

P: 125817

If you choose Revision TKA with extensor mechanism reconstruction, what components would you revise?

1 I would not choose Revision TKA with extensor mechanism reconstruction

2 Patella only

3 Femur only

4 Tibia only

5 Femur + tibia

6 All components

7 Outside my area of expertise - best if I don't vote

Other

Submit

P: 125818

If you choose Revision TKA with extensor mechanism reconstruction, how would you obtain implant fixation?

1 I would not choose Revision TKA with extensor mechanism reconstruction

2 Long porous-coated cementless stems

3 Long cemented stems

4 Cemented stems with cones

5 Cementless stems with sleeves

6 Other

7 Outside my area of expertise - best if I don't vote

Other

Submit

P: 125819

If you choose Revision TKA with extensor mechanism reconstruction and obtained the construct below, what would be your initial postoperative range of motion (ROM)?

1 I would not choose construct below