Evidence map›Paper›PMID 32693822›Full record

ArticleKnee surgery & related research2020

Total knee arthroplasty following intramedullary tibial nailing.

Evan J Smith, Marilyn Heng, Hany S Bedair, Christopher M Melnic

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Knee surgery & related research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.0field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 14 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

Evan J SmithDepartment of Orthopaedic Surgery, Massachusetts General Hospital/Newton Wellesley Hospital, Harvard Medical School, 55 Fruit Street, YAW 3700 - Suite 3B, Boston, MA, 02114, USA. ejs5086@gmail.com.ORCID http://orcid.org/0000-0003-4937-5594
Marilyn HengDepartment of Orthopaedic Surgery, Massachusetts General Hospital/Newton Wellesley Hospital, Harvard Medical School, 55 Fruit Street, YAW 3700 - Suite 3B, Boston, MA, 02114, USA.
Hany S BedairDepartment of Orthopaedic Surgery, Massachusetts General Hospital/Newton Wellesley Hospital, Harvard Medical School, 55 Fruit Street, YAW 3700 - Suite 3B, Boston, MA, 02114, USA.
Christopher M MelnicDepartment of Orthopaedic Surgery, Massachusetts General Hospital/Newton Wellesley Hospital, Harvard Medical School, 55 Fruit Street, YAW 3700 - Suite 3B, Boston, MA, 02114, USA.
Harvard University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introduction/purposeTotal knee arthroplasty (TKA) in the setting of previous periarticular hardware increases resource utilization, readmissions, complications, and revision rates. Despite the frequency of intramedullary nail (IMN) fixation for tibial fractures, little guidance exists on the management of these patients and no series have reported on outcomes of patients undergoing TKA in the setting of a retained or removed IMN.

methodsThis is a retrospective case series of patients who underwent TKA after IMN fixation of tibial fractures. Patient and case data, including need for hardware removal, staged vs non-staged procedures, operative time, and need for revision implants, were recorded. Postoperative data, including complications and revision, were recorded. Oxford Knee Score (OKS) was performed at follow-up.

resultsNine patients were identified consisting of eight women and one man. Follow-up ranged from 0.8-13 years. Non-staged removal of the intramedullary hardware occurred in three cases that had increased operative lengths recorded. There were no complications related to wound healing or infection. No patients required revision. Two of the three patients who underwent non-staged TKA developed arthrofibrosis requiring manipulation. OKS scores in patients who underwent non-staged surgery were consistently low.

conclusionsConversion TKA after tibial IMN fixation can result in satisfying outcomes in many patients. However, intramedullary hardware presents challenges to TKA similar to more extensively studied conversion TKA scenarios. Removing hardware in either a staged or non-staged fashion results in increased resource utilization and imparts perioperative challenges with only theoretical benefits of one approach compared to the other. Increased stiffness may be associated with a non-staged approach to hardware removal and TKA. Several technical factors may permit component positioning without removal of hardware. Despite limitations, this is the first series to discuss this challenging clinical scenario and provides surgeons with technical guidance and data on operative outcomes.

Indexed as

ArthroplastyFractureIntramedullary nailKneeTibial nail

Identifiers

PMID32693822
PMCPMC7374830
OpenAlexW3044849324

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.