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Synthetic Graft Compared With Allograft Reconstruction for Extensor Mechanism Disruption in Total Knee Arthroplasty

A Multicenter Cohort Study

Wood, Thomas J., MD, FRCSC; Leighton, Jennifer, MD, FRCSC; Backstein, David J., MD, FRCSC; Marsh, Jacquelyn D., PhD; Howard, James L., MD, FRCSC; McCalden, Richard W., MD, FRCSC; MacDonald, Steven J., MD, FRCSC; Lanting, Brent A., MD, MSc, FRCSC

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: June 15, 2019 - Volume 27 - Issue 12 - p 451–457
doi: 10.5435/JAAOS-D-18-00393
Research Article

Background: Extensor mechanism disruption after total knee arthroplasty is a serious complication leading to notable patient morbidity. The purpose of this study is to compare the outcomes of extensor mechanism allograft with synthetic graft reconstruction.

Methods: We retrospectively identified all patients who underwent extensor mechanism reconstruction using either allograft or synthetic graft from two high-volume academic arthroplasty institutions between 2006 and 2017. We collected extensor lag, need for ambulatory aids, and patient-reported outcome measures, as well as the incidence of postoperative complications and revision surgeries. We evaluated cost differences, considering both material cost and the need for revision surgery.

Results: We identified 27 cases. A significantly greater postoperative extensor lag was found in the allograft group (P = 0.05). Graft failure after synthetic reconstruction was zero, with an overall revision surgery rate of 15%. Graft failure was 21%, and the revision surgery rate was 43% after allograft reconstruction. The allograft cost was significantly higher compared with the synthetic graft cost (P = 0.001). The mean total cost was 4,733.08 CAD for the synthetic group and 24,050.40 CAD for the allograft group (P = 0.17).

Discussion: Synthetic reconstruction for extensor mechanism disruption shows benefit in postoperative extensor lag, graft failure, revision surgery, and cost when compared with allograft.

Level of Evidence: Level III

From the Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada (Dr. Wood, Dr. Howard, Dr. McCalden, Dr. MacDonald, and Dr. Lanting), the Granovsky Gluskin Division of Orthopedic Surgery, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada (Dr. Leighton and Dr. Backstein), the School of Physical Therapy, Faculty of Health Sciences (Dr. Marsh), Western University, the Bone and Joint Institute (Dr. Marsh, Dr. Howard, Dr. McCalden, Dr. MacDonald, and Dr. Lanting), Western University, London, Ontario, Canada, and the Department of Surgery, Division of Orthopaedic Surgery, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (Dr. Wood).

Correspondence to Dr. Wood: Thomas.wood@medportal.ca

Dr. Backstein or an immediate family member has received IP royalties from MicroPort Orthopedics; is a member of a speakers' bureau or has made paid presentations on behalf of or has stock or stock options held in MicroPort Orthopedics and Zimmer Biomet; serves as a paid consultant to MicroPort Orthopedics; has stock or stock options held in Intellijoint Orthopaedics; and has received research or institutional support from Surgical Services. Dr. Howard or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of DePuy and Stryker; serves as a paid consultant to DePuy, Intellijoint, and Stryker; has stock or stock options held in PersaFix Revision Technologies; has received research or institutional support from DePuy; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from DePuy, Microport, Smith & Nephew, Stryker, and Zimmer Biomet. Dr. McCalden or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of and serves as a paid consultant to Smith & Nephew; and has received research or institutional support from Smith & Nephew, DePuy, and Stryker. Dr. MacDonald or an immediate family member has received IP royalties from and serves as a paid consultant to DePuy; has stock or stock options held in Hip Innovations Technology and JointVue; and has received research or institutional support from DePuy, Smith & Nephew, and Stryker. Dr. Lanting or an immediate family member serves as a paid consultant to DePuy, Integra, Intellijoint, Smith & Nephew, and Stryker; has stock or stock options held in IdealFit Spacer Solutions and PersaFix Revision Solutions; has received research or institutional support from DePuy, Smith & Nephew, and Stryker; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from DePuy, Smith & Nephew, Stryker, and Zimmer Biomet. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Wood, Dr. Leighton, and Dr. Marsh.

© 2019 by American Academy of Orthopaedic Surgeons
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