症例報告
人工膝関節置換術の関節縫合にbarbed sutureを施行し, 術後膝伸展機構の破綻をきたした2例
キーワード:
total knee arthroplasty,
barbed suture,
extensor mechanism failure,
hamstrings augmentation,
pull out
2019 年 38 巻 4 号 p. 493-497
詳細
2019 年 38 巻 4 号 p. 493-497
Cases of extensor mechanism failure after total knee arthroplasty (TKA) have often been reported. However, they used standard sutures and did not describe about the articular capsular suturing method. Our aim is to report two cases of extensor mechanism failure with barbed suture in patients undergoing TKA.
The patients did not have a history of diabetes mellitus, autoimmune diseases or use of corticosteroids. TKAs were performed on the right knees of both patients for osteoarthritis and STRATAFIX® was used for suturing of the articular capsules. No intraoperative adverse events occurred.
Case 1: An obese 77-year-old woman with a body mass index (BMI) of 33.5kg/m2. A medial parapatellar approach was undertaken in the primary TKA and a FINE® PS type prosthesis was used. However, the patient fell on the floor the next day, and the medial retinaculum and quadriceps tendon of her right knee ruptured, so a repair of the extensor mechanism was performed.
Case 2: A 73-year-old woman with a BMI of 25.1kg/m2. A subvastus approach was undertaken for the primary TKA and a FINE® PS type prosthesis was used. Similarly, the patient fell on to the floor when ambulating, and the medial retinaculum and patella tendon of her right knee ruptured, so a reconstruction of the extensor mechanism was performed. There were no recurrences and additional surgery was unnecessary.
Previous reports have indicated that barbed suture is stronger than standard suture. However, barbed suture had been associated with rupture and infection compared to standard suture. As a result, it is imperative to understand the risks of barbed suture in total joint surgery.
