The aim of this study was to investigate the distribution of phenotypes in Asian patients with end-stage osteoarthritis (OA) and assess whether the phenotype affected the clinical outcome and survival of mechanically aligned total knee arthroplasty (TKA). We also compared the survival of the group in which the phenotype unintentionally remained unchanged with those in which it was corrected to neutral. The study involved 945 TKAs, which were performed in 641 patients with primary OA, between January 2000 and January 2009. These were classified into 12 phenotypes based on the combined assessment of four categories of the arithmetic hip-knee-ankle angle and three categories of actual joint line obliquity. The rates of survival were analyzed using Kaplan-Meier methods and the log-rank test. The Hospital for Special Surgery score and survival of each phenotype were compared with those of the reference phenotype with neutral alignment and a parallel joint line. We also compared long-term survival between the unchanged phenotype group and the corrected to neutral alignment-parallel joint line group in patients with Type IV-b (mild to moderate varus alignment-parallel joint line) phenotype.Aims
Methods
Chauffeur fractures or isolated radial styloid fractures (IRSF) are known to be associated with scapholunate ligament (SL) injuries. Diagnosis without arthroscopic confirmation is difficult in acute fractures. Acute management of this injury with early repair may prevent the need for more complex reconstructive procedures for chronic injuries. We investigated if all IRSF should be assessed arthroscopically for concomitant SL injuries. We performed a prospective cohort study on patients above the age of 16, presenting to the Gold Coast University Hospital with an IRSF, over 2 years. Plain radiographs and computerized tomography (CT) scans were performed. All patients had a diagnostic wrist arthroscopy performed in addition to an internal fixation of the IRSF. Patients were followed up for at least 3 months post operatively. SL repair was performed for all Geissler Grade 3/4 injuries. 10 consecutive patients were included in the study. There was no radiographic evidence of SL injuries in all patients. SL injuries were identified arthroscopically in 60% of patients and one third of these required surgical stabilisation. There were no post operative complications associated with wrist arthroscopy. We found that SL injuries occurred in 60% of IRSF and 20% of patients require surgical stabilisation. This finding is in line with the literature where SL injuries are reported in up to 40-80% of patients. Radiographic investigations were not reliable in predicting possible SL injuries in IRSF. However, no SL injuries were identified in undisplaced IRSF. In addition to identifying SL injuries, arthroscopy also aids in assisting and confirming the reduction of these intra-articular fractures. In conclusion, we should have a high index of suspicion of SL injury in IRSF. Arthroscopic assisted fixation should be considered in all displaced IRSF. This is a safe additional procedure which may prevent missed SL injuries and their potential sequelae.
Well-balanced soft tissue is essential for achieving a good result when performing total knee arthroplasty. The preoperative planning is critical for ensuring a good operation. This study evaluated the preoperative distractive stress radiographs in order to quantify and predict the extent of medial release according to the degree of varus deformity in primary total knee arthroplasty. We evaluated 120 varus, osteoarthritic knee joints (75 patients). The association of the angle on the distractive stress radiograph with extent of medial release was analyzed. The extent of medial release was classified into the following 4 groups according to the stage: release of the deep medial collateral ligament (group 1), release of the posterior oblique ligament and/or semimembranous tendon (group 2), release of the posterior capsule (group 3) and release of the superficial medial collateral ligament (group 4).Introduction
Methods
The acquisition of proper soft tissue balance is one of the crucial factors for preventing long-term failure and obtaining successful treatment outcomes of total knee arthroplasty (TKA). Medial collateral ligament (MCL) release is essential for encountering severe varus deformity. However, conventional subperiosteal MCL release for severe varus deformity can cause the complete detachment of MCL. This study compared retrospectively the results of complete distal release of the MCL with those of medial epicondylar osteotomy during ligament balancing in varus knee TKA This study retrospectively reviewed 9 cases of complete distal release of the MCL (group 1) and 11 cases of medial epicondylar osteotomy (group 2) which were used to correct severe medial contracture. The clinical assessment was based on the American Knee Society knee score (KS), function score (FS), and the ROM preoperatively and at the final follow-up. For the radiological assessment, the femorotibial angle was measured based on the whole lower extremity radiograph preoperatively and at the final follow-up. Three months after surgery and at the final follow-up, medial instability was assessed using the valgus stress radiographs, in which the contralateral side was compared using Telos (Telos, Weterstadt, Germany).Introduction
Methods
The aim of the study was to develop a quantitative scoring system
to predict whether a large-to-massive rotator cuff tear was arthroscopically
reparable prior to surgery. We conducted a retrospective review of the pre-operative MR imaging
and surgical records of 87 patients (87 shoulders) who underwent
arthroscopic repair of a large-to-massive rotator cuff tear. Patients
were divided into two groups, based on the surgical outcome of the
repair. Of the 87 patients, 53 underwent complete repair (Group
I) and 34 an incomplete repair (Group II). Pre-operative MR images
were reviewed to quantify several variables. Between-group differences
were evaluated and multiple logistic regression analysis was used
to calculate the predictive value of significant variables. The
reparability index (RI) was constructed using the odds ratios of
significant variables and a receiver operating characteristic curve
analysis performed to identify the optimal RI cutoff to differentiate
between the two groups.Aims
Patients and Methods
Severely varus deformed knees are common in Asian countries due to lifestyles such as sitting on the floor. MCL release is essential for encountering severe varus deformity. However, conventional subperiosteal MCL release for severe varus deformity can cause the complete detachment of MCL and it can induce mid-flexion instability. We performed medial epicondylar osteotomy when conventional subperiosteal MCL release couldn't resolve tight medial gap of severely varus deformity. The epicondyle is reattached with #5 nonabsorbable sutures or screws (figure 1). This study evaluated the clinical and radiologic results of medial epicondylar osteotomy for severe varus TKA. From 2004 to 2012, 63 cases (of total 909 cases of primary TKA, 6.9%) with a minimum follow-up of 2 years (24 to 116 months) were included in this study. Two cases of 63 cases were excluded due to the loss of follow up. Intraoperative medial and lateral gap difference in flexion and extension was accepted at less than 2 mm. Average follow up was 50.6±29.8 months (24–116 months). Average clinical knee score was 35.5±17.1 preoperatively and 89.1±8.4 postoperatively. Average function score improved from 48.7±16.0 preoperatively to 88.6±8.0 postoperatively. Average flexion contracture was reduced from 8.5±9.8° preoperatively to 1.0±2.3° postoperatively and range of motion improved from 112.0±21.8° preoperatively to 118.9±13.3° postoperatively. Preoperative femorotibial angle was average varus 10.4±5.7° and mechanical axis was average varus 16.7±5.6°. Postoperative femorotibial angle was average valgus 5.5±3.4° and mechanical axis was average varus 1.0±4.1° (figure 2). Valgus stress radiographs showed average 1.6±0.7 mm gap (femoral implant to liner) and varus stress radiographs revealed average 2.7±1.5 mm gap. The difference with medial and lateral gaps was average 1.2±1.1 mm (figure 2). Unions of bony wafer were 39 bony and 22 fibrotic unions (figure 3). According to the difference with medial and lateral gaps, bony union was average 1.2±1.2 mm and fibrotic union was average 1.2±0.9 mm. There were no significant differences between bony and fibrotic union groups. The clinical and radiological results of medial epicondylar osteotomy are satisfactory in severe varus TKA. The stability with bony and fibrotic unions is not different.
Medial open wedge high tibial osteotomy (HTO) is a generally accepted surgical method for medial unicompartmental osteoarthritis with varus malalignment of the lower extremity. However, several authors have suggested the possibility of unintentional secondary changes during open wedge HTO, which include posterior tibial slope angle (PTS) change, tibial rotation change and medial–lateral slope change of the knee joint line, may influence knee kinematics and produce poor clinical outcomes. We sought to analyze postoperative changes in three-dimensional planes using a virtual wedge osteotomy 3D model. Pre- and post-operative changes in the medial proximal tibial angle (MPTA) in the coronal plane, posterior tibial slope (PTS) in the sagittal plane, and axial tibial rotation were measured as dependent variables. And this study was attempted to determine their mutual relationships and to clarify which independent variables, including hinge axis angle and gap ratio, affect tibial rotation change and PTS change by applying the identified hinge position. A total of 17 patients with 19 knees underwent HTO and were evaluated with 3D-CT before and after surgery. A 3D model was constructed by applying reverse engineering software.Introduction
Method
C-reactive protein(CRP) Used as screening test for acute periprosthetic joint infection has high sensitivity and low specificity. So there are many reasons except acute infection after total knee arthroplasty to elevate CRP level but it is unclear what reasons exactly were concerned. We therefore performed this study to determine the Causes of elevated CRP level in the early-postoperative period after primary total knee arthroplasty. Between 2005 and 2013, 502 patients undergone primary total knee arthroplasty were included. We excluded patients performed total knee arthroplasty with inflammatory arthritis and revision total knee arthroplasty, We measured the serial CRP levels in the all cases and then found cases with CRP level show elevation-depression-elevation pattern(bimodal graph) or >23.5mg/dl. We analyzed causes of elevated CRP level of thatObjectives
Methods
The pathophysiology of osteonecrosis of femoral head (ONFH) is uncertain for most cases with speculation of vascular impairment and changes in cell biology due to multi-factorial etiologies including corticosteroid, alcohol, smoking, trauma, radiation or caisson disease and genetic. Extracorporeal shockwave therapy (ESWT) began with an incidental observation of osteoblastic response pattern during animal studies in the mid-1980 that generated an interest in the application of ESWT to musculoskeletal disorders. The mechanism of shockwave therapy is not fully understood but several reports showed better clinical outcomes and promoted bone remodelling and regeneration effect of the femoral head after ESWT in ONFH. Therefore, we compared the clinical results of the use of extracorporeal shock wave therapy (ESWT) on the patients with ONFH in radiographic staging. We evaluated 24 patients with 32 hip joints diagnosed ONFH treated with ESWT from 1993 to 2012. Average follow-up period was 27 months, and patients were average 47.8 aged. Association Research Circulation Osseous (ARCO) staging system was used to grade radiographic stage before treatment. All the patients were divided to two groups; group 1 (ARCO stage I,II), group 2 (ARCO stage III). Comparative analysis was done between two groups with visual analogue scale (VAS) score and Harris hip score (HHS) at pre-treatment, 3, 6, 12 and 24 months after treatments. The failure was defined when radiographic stage was progressed or arthroplasty surgery was needed due to clinical exacerbation.Introduction
Methods
A large proportion of patients with osteoarthritis of the knee, present with bilateral symptoms at the outpatient department. A simultaneous total knee arthroplasty (TKA) procedure is available for such patients. The first operation in a simultaneous surgery may provide information to the operator to determine component size, soft tissue balancing, and estimate gap size for the second operation, while the second team usually conducts an operation in a confined space on the contralateral side during closure for the first operation, which can disturb cooperation during the second operation and may lead to more intra-operative surgical errors. We hypothesized that the circumstances of the two consecutive operations of a simultaneous bilateral TKA are different, could lead to different outcomes of overlapping bilateral TKAs. We therefore addressed the following research questions to determine whether there would be differences in short-term clinical outcomes, radiographic results, and implanted component size between the two sides A retrospective review of 451 consecutive patients, who underwent simultaneous bilateral TKA between January 2011 and April 2012, was conducted. Bilateral TKAs were performed with the senior surgeon conducting the main procedure (from skin incision to implantation of first prosthesis until prior closure of the first knee) on the right side first and subsequently the left side with a second team. At 1 year after surgery, clinical outcome scores (the Knee Society Knee and Function scores, WOMAC score), radiologic findings were evaluated and clinical results as postoperative blood loss, operation time were compared between bilateral sides.Introduction
Methods
We compared the ceiling effects of two patient-rating
scores, the Disability of the Arm, Shoulder and Hand (DASH) and
Patient-Rated Wrist Evaluation (PRWE), and a physician-rating score,
the Modified Mayo Wrist Score (MMWS) in assessing the outcome of
surgical treatment of an unstable distal radial fracture. A total
of 77 women with a mean age of 64.2 years (50 to 88) who underwent
fixation using a volar locking plate for an unstable distal radial fracture
between 2011 and 2013 were enrolled in this study. All completed
the DASH and PRWE questionnaires one year post-operatively and were
assessed using the MMWS by the senior author. The ceiling effects
in the outcome data assessed for each score were estimated. The data assessed with both patient-rating scores, the DASH and
PRWE, showed substantial ceiling effects, whereas the data assessed
with MMWS showed no ceiling effect. Researchers should be aware of a possible ceiling effect in the
assessment of the outcome of the surgical treatment of distal radial
fractures using patient-rating scores. It could also increase the
likelihood of a type II error. Cite this article:
There were 27 male and 46 female patients (8 bilateral). The mean age was 42 (range 18 to 57). Secondary osteoarthritis was the most common presenting pathology. There were no exclusion criteria beyond those applicable to any replacement arthroplasty.
There was no evidence of stem subsidence. A sclerotic line was frequently observed around the non-coated distal stem. Buttressing of the coated area was almost universally seen in the metaphyseal region. There were no radiolucent lines in any of the zones around the textured area in the metaphyseal region.
