Average Hospital For Special Surgery Score Research Articles

KNEE DEFORMITIES AND KNEE REPLACEMENTS IN SAUDI POPULATION: OUR EXPERIENCE AND LITERATURE REVIEW

It takes precise alignment, adequate balance, and deformity correction to accomplish a successful total knee arthroplasty (TKA). In main TKA, this can be successfully achieved with a posterior stabilized (PS) design, either with or without sub-periosteal release. However, severe abnormalities with a major bone defect, stiffness, and instability are often associated with these disorders in some circumstances, such as knee osteoarthritis. Additional restrictive prostheses are required since it is extremely difficult to balance these anomalies with soft tissue release alone, even after main TKA. In this situation, the constrained condylar knee (CCK) design is the optimum choice. This studys primary objectives were to characterize the clinical outcomes, function recovery, and complications of patients who underwent primary CCK-TKA for severe knee osteoarthritis related knee deformity. The secondary aim was to find out the mid-term prostheses survival. Methods: Between March 2021 and March 2022, 36 consecutive patients with knee osteoarthritis had cemented primary CCK-TKA. Twenty-Eight women and eight men, totaling 36 patients, had at least a 6 month follow-up for this retrospective analysis. We used the Knee Society Score (KSS), the Hospital for Special Surgery (HSS) score, and the roentgenographic evaluation form to assess the patients. The survival of prosthesis was assessed using Kaplan-Meiers survival analysis. The patients follow-up periods averaged 12 month. The KSS knee score rose from 44 points (23–68) to 91 points (76–100) following surgery [P < 0.001]. Following the procedure, the mean KSS functional score rose from 20–75 points to 91 points (65–100) [P < 0.001]. The average HSS score rose from 51 points (27–83) to 91 points (75–100) following surgery [P < 0.001]. The average range of motion (ROM) also increased after surgery, going from 68.09° ± 35.99° (0°–120°) to 113.68° ± 8.90° (100°–130°) [P < 0.001]. The average hip-knee-ankle (HKA) angle was 180.24° ± 1.77° (175°–184°) following surgery, compared to 176.88° ± 14.48° (135°–199°) before to surgery. Radiolucencies were seen in thirteen knees, mostly on the tibial side. After an average follow-up of 12 month, 94.7% of prosthesis were still in use. Despite severe deformity, instability, and stiffness at a relatively young age, the mid-term follow-up of primary CCK-TKA in knee osteoarthritis gives satisfactory clinical and functional outcomes with 94.7% prosthesis survival. However, there are a few issues.

A minimally invasive bipolar surgical approach for the treatment of patellar fracture using the tension-band wiring technique

Minimally invasive surgical techniques are becoming increasingly popular for the treatment of traumatic injuries. Although some minimally invasive techniques in the management of patellar fractures have been reported, the limited exposure in such methods may cause technical difficulties during surgery and restrict their wide application. In this context, this study aims to introduce a bipolar incision and assess the clinical outcomes of patellar fractures treated via this type of incision. Patients who suffered patellar fractures and who received surgical treatment via bipolar incision between 2018 and 2020 in our hospital were retrospectively reviewed and included in this study. The clinical and radiological records of all patients were reviewed. A classification of the fractures was done and intraoperative parameters, Visual Analog Scale (VAS) score, knee range of motion, and the Hospital for Special Surgery (HSS) knee score of the patients were evaluated and summarized. The study included 19 patients who met the inclusion criteria. All patellar fractures were operated through the minimally invasive bipolar surgical approach. The mean time of operation was 69.0 ± 8.5 min. The mean time to union was 12.8 ± 2.1 weeks. The average total knee range of motion was 131.8 ± 4.4°, and the average HSS score was 97.1 ± 2.6 at 1-year post-operation. No surgical-related complications were observed. The knee functional outcomes were favorable when patellar fractures were treated through the minimally invasive bipolar incision method. This bipolar surgical approach was found to be a feasible method for treating patellar fractures.

Treatment of posterolateral tibial plateau fractures with a rotational support plate and special pressurizer: technical note and retrospective case series

BackgroundIn tibial plateau fractures, the posterolateral segment of the tibia plateau is frequently affected and challenging to treat. Although there are many surgical approaches and fixation methods for the treatment of these fractures, all of these methods have limitations. We designed a new rotational support plate (RSP) and a special pressurizer that can fix the fracture directly via the anterolateral approach. This method is advantageous because it leads to little trauma, involves a simple operation, and has a reliable fixation effect. This study details the technique of treating these fractures with the RSP and special pressurizer and provides the outcomes.MethodsFrom May 2016 to January 2019, the data of 12 patients with posterolateral tibial plateau fractures treated with the RSP and special pressurizer in our hospital were retrospectively analyzed. Postoperative rehabilitation was advised, knee X-rays were taken at follow-ups, and fracture healing, complications, and knee range of motion were assessed. The Hospital for Special Surgery (HSS) knee score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to evaluate knee function at the last follow-up.ResultsThe average follow-up time of all patients was 16.5 months (range, 12–25 months). The average bony union time was 3.2 months (range, 3–4.5 months). At the last follow-up, the average knee range of motion was 138° (range, 107–145°). The average HSS score was 91 (range, 64–98). The average KOOS Symptoms score was 90 (range, 75–96). The average KOOS Pain score was 91 (range, 72–97). The average KOOS ADL score was 91 (range, 74–97). The average KOOS sport/recreation score was 83 (range, 70–90). The average KOOS QOL score was 88 (range, 69–93). Skin necrosis, incision infections, and fixation failure did not occur during the follow-up period.ConclusionsWith our newly designed RSP and special pressurizer, posterolateral tibial plateau fractures can be easily and effectively reduced and fixed through the anterolateral approach, which serves as a novel treatment for posterolateral tibial plateau fractures.

Clinical and Radiological Results of Oxford Phase-3 Medial Unicompartmental Knee Arthroplasty.

PurposeThe aim of this retrospective study was to investigate the effectiveness of medial unicompartmental knee arthroplasty (UKA) by showing the results of the radiological and clinical outcomes of the patients.Materials and methodsSeventy-two knees of 54 patients who underwent UKA between September 2005 and March 2011 for medial knee arthritis with a minimum follow-up of six months were evaluated. Range of motion (ROM), Hospital for Special Surgery (HSS) knee score, Knee Society Score (KSS), and Oxford Knee Score (OKS) were investigated both preoperatively and postoperatively. On the other hand, Oxford radiographic evaluation criteria were used to evaluate prostheses radiologically at the final follow-up.ResultsThe average age was 53.4 years (47 to 79 years). The average follow-up time was 39.8 months (8 to 72 months). There was a significant difference between preoperative and postoperative ROM, HSS, and OKS (p<0.05). Radiologically, there was no sign of arthritis on the unoperated side of the knee or failure of prosthesis detected. Before the operation, the average clinical KSS was 63.2 and improved to 91.4 after the operation. In addition, the average functional KSS was 54.9 before the operation and improved to 86.5 after the operation. The average knee flexion degree was 109.1 before the operation and there was an improvement to 123.6 degrees after the operation. Before the operation, the average HSS score was 67.5 (range, 52 to 75) and improved to 89.9 (range, 85 to 100) at the final control examination.ConclusionThis study supports the use of Oxford Phase 3 UKA, which has excellent clinical and radiological results in patients with medial knee arthritis.

A Modified Direct Posterior Midline Approach for the Treatment of Posterior Column Tibial Plateau Fractures.

The purpose of this study was to introduce a modified surgical approach for the treatment of posterior column tibial plateau fractures. Fifteen patients with posterior column fractures with or without other column fractures were included and treated with this approach between July 2015 and June 2016. The patients were followed up for 18 to 24 months (20.9 ± 1.8 months). Outcomes included neural or vascular injuries, wound complications, nonunion, plate loosening or breakage, and Hospital for Special Surgery (HSS) scores. Bone union was observed in all cases, and the average time for bone union was 13.5 ± 1.4 weeks (11-16 weeks). No neurovascular injuries, malunion, nonunions, or plate loosening or breakages were observed. The average HSS score was 94.7 ± 4.1 (range: 84-100). The modified direct posterior midline approach can provide excellent exposure and facilitate reduction and internal fixation of posterior column fractures of the tibial plateau, including split and depressed fractures. We expect that this approach can be used as a new effective method for managing complex posterior tibial fractures.

Primary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post-traumatic arthritis

BackgroundKey to a successful outcome of total knee arthroplasty (TKA) is to attain optimum alignment, adequate balance, and deformity correction. In primary TKA, this can be achieved efficiently by posterior stabilized (PS) design with or without the sub-periosteal release. However, certain circumstances such as post-traumatic arthritis are often associated with severe deformities with a significant bone defect, stiffness, and instability. Such deformities are extremely difficult to balance with soft tissue release only and require additionally constrained prostheses even in primary TKA. In such situation, constrained condylar knee (CCK) design is the ultimate choice. This study primarily aimed to report on clinical outcome, regain of function, and complication of patients who underwent primary CCK-TKA for severe deformity of the knee secondary to post-traumatic arthritis. The secondary aim was to find out the mid-term prostheses survival.MethodsBetween February 2007 and November 2013, 38 consecutive patients with post-traumatic arthritis of the knee received cemented primary CCK-TKA. Thirty-four patients (21 men and 13 women) who had a minimum of 3 years follow-up were included in this retrospective study. We used Knee Society Score (KSS), Hospital for Special Surgery (HSS) score, and roentgenographic evaluation form to assess the patients. Prostheses survival was assessed using Kaplan-Meier’s survival analysis.ResultsPatients were followed up for an average duration of 6.47 years. KSS knee score improved from 44 points (23–68) pre-operatively to 91 points (76–100) post-operatively [P < 0.001]. The average KSS functional score improved from 49 points (20–75) pre-operatively to 91 points (65–100) post-operatively [P < 0.001]. The average HSS score improved from 51 points (27–83) pre-operatively to 91 points (75–100) post-operatively [P < 0.001]. Similarly, the average ROM improved from 68.09° ± 35.99° (0°–120°) to 113.68° ± 8.90° (100°–130°) post-operatively [P < 0.001]. The average hip-knee-ankle (HKA) angle was 176.88° ± 14.48° (135°–199°) pre-operatively and 180.24° ± 1.77° (175°–184°) post-operatively. Radiolucencies were evident in 13 knees, mostly on the tibial side. Prostheses survival was 94.7% at a mean follow-up of 6.47 years.ConclusionDespite severe deformity, instability, and stiffness at a relatively young age, mid-term follow-up of primary CCK-TKA in post-traumatic arthritis provides satisfactory clinical and functional outcomes with 94.7% prostheses survival. However, it is not without complication.

Clinical and radiological results of cruciate-retaining total knee arthroplasty with the NexGen\xae-CR system: comparison of patellar resurfacing versus retention with more than 14\xa0years of follow-up

BackgroundThe purpose of this study is to analyze clinical and radiological outcomes of patients (with a minimum of 14 years of follow-up) who underwent cruciate-retaining (CR) total knee arthroplasty (TKA) using a NexGen®-CR, comparing a patellar resurfacing group with a patellar retention group.MethodsFrom June 1996 to April 2002, 116 cases of TKA using a NexGen®-CR who had at least 14 years of follow-up were enrolled in this study. Among them, 68 cases had patellar resurfacing and 48 had patellar retention. The average follow-up period was 14.8 years (14.1–18.7). Clinical scores and range of motion (ROM) were evaluated preoperatively and at the last follow-up in all patients. The Hospital for Special Surgery (HSS) score, Knee Society Score (KSS), Western Ontario and MacMaster Universities Osteoarthritis (WOMAC) score, and a new patellar score were assessed. Radiological evaluations are done by analyzing the tibiofemoral angle, loosening, and a radiolucent line on the radiograph by American Knee Society Roentgen Graphic Evaluation.ResultsThe average HSS score of both the patellar resurfacing group and retention group increased from 42.3 and 41.2 preoperatively to 90.2 and 90.8 at the last follow-up, respectively. The KSS, WOMAC score, patellar score, and knee joint ROM also improved significantly in both groups. However, there were no significant differences in clinical results between the two groups. On the radiological evaluation, the tibiofemoral angle in both groups had improved from varus 7.8° and 7.2° preoperative to valgus 4.9° and 4.8°, respectively. The average angles of α, β, γ, and δ were 94.1°, 90.4°, 3.2°, and 87.8° in the patellar resurfacing group and 94.4°, 89.8°, 3.3°, and 88.1° in the patellar retention group, respectively. A radiolucent line shown on radiograph was noted in a total of seven cases, three in the patellar resurfacing group and four in the patellar retention group. In the patellar resurfacing group, among the seven zones on the tibia radiograph, all cases were located at the medial side of tibia and two cases were in zone 1 and one case in zone 2, and in the patellar retention group, three cases were in zone 1 and 1 case was in zone 2, also located on the same side.ConclusionsWe achieved satisfactory clinical and radiological outcomes on long-term follow-up when performing TKAs with a NexGen®-CR. There was no significant difference in clinical or radiological results between the patellar resurfacing and retention groups in our study.

A combined approach for the treatment of lateral and posterolateral tibial plateau fractures

IntroductionThe treatment of tibial plateau fractures involving the lateral and posterolateral column is a demanding and fine surgical challenge. The purpose of this study was to evaluate the safety and clinical efficacy of combined approach for the treatment of lateral and posterolateral tibial plateau fractures. MethodsA prospective study was performed in 17 patients with lateral and posterolateral tibial plateau fractures between January 2009 and December 2012. There were 12 males and 5 females with a mean age of 40 years. All of them received dual-plate fixation through the combined approach, with the patients in a floating position. The combined approaches included a conventional anterolateral approach and an inverted L-shaped posterolateral approach. Operation time, intraoperative blood loss, fracture healing time, Hospital for Special Surgery (HSS) knee score, knee flexion and extension range of motion, and complications were recorded to evaluate treatment effects. ResultsThere were no intraoperative complications related to this technology. Mean operation time was 144min with a mean intraoperative blood loss volume of 233mL. The mean follow-up was 23 months. All 17 patients had good postoperative fracture healing. Mean union time was 12 weeks. At the final follow-up, the average HSS score was 92.5, with the average knee flexion of 125° and an average knee extension of 2°. Two patients had complications in postoperative incisions with aseptic fat liquefaction. After thorough debridement, second-stage wounds healing were achieved. No neurovascular injury occurred. No collapse of reduced articular surface was detected. ConclusionsThe combined approach with dual-plate offers direct and complete surgical exposure and provide an effective method for the treatment of lateral and posterolateral tibial plateau fractures.

Application of 3D printing in treatment of traumatic knee varus deformity: a pilot study

Objective To explore the clinical effect of using 3D printing in the treatment of genua varus deformity. Methods From September 2010 to April 2013, 27 cases of genua varus were admitted. They were 15 men and 12 women, with an average age of 37.8 years. The deformity affected the left side in 10 cases and the right in 17, with an average angle of 20.1°. All patients were examined by lamellar CT scan to harvest the original data of lower limbs. Three dimensional reconstruction of bone models was performed by software Materialise Mimics 10.01. 3D models were imported into software 3-matic 6.1 to measure the angles of varus, femorotibial angle, and the medial interspace of knee joint. The position and angle of osteotomy were precisely determined according to the results of computer-aided measurement. The cloud data of surface points were collected to design individual osteotomy-assisting templates by software Geomagic Studio 11.0, and the virtual procedures of the osteotomy and reconstruction of genua varus were simulated in software Magics 9.55. Physical templates were manufactured using 3D printing technology. In the actual operation, the best location of tibial osteotomy was determined according to the template. After osteotomy, internal fixation was performed using a steel plate and screws. X-ray examinations of bilateral lower limbs were conducted preoperation, 3 and 12 months postoperation. The femorotibial angles and the medial interspaces of knee joint were measured on postoperative X-ray films of lower limbs. The Hospital for Special Surgery (HSS) knee score was used to evaluate the preoperative and postoperative functions of the knee joint. Results All 27 patients were followed up from 7 to 36 months (average, 23.4 months). The bony union time was 3 to 5 months (average, 3.3 months). The femorotibial angles and the medial interspaces of knee joint at 3 and 12 months postoperation were significantly greater than those at preoperation, the average HSS score at 12 months postoperation was significantly higher than that at preoperation and 3 months postoperation, and the average HSS score at 3 months postoperation was significantly higher than that at preoperation (P < 0.05). According to the HSS scores at the last follow-up, 21 cases were excellent, 4 cases good, and 2 cases fair, giving an excellent to good rate of 92.6%. Conclusion 3D printing technology can be used along with computer-aided design to manufacture an individualized osteotomy-assisting template which greatly improves the accuracy of bone cutting and ensures better lines of force at the lower limb in the treatment of traumatic knee varus deformity. Key words: Surgery, computer-assisted; Knee joint; Abnormalities; Osteotomy; 3D printing technology

Total knee arthroplasty for severe valgus knee deformity

Objective To investigate the surgical methods and clinical effects of total knee arthroplasty (TKA) in patients with severe valgus knee deformity.Methods From January 2007 to December 2012,22 patients with 23 severe valgus knee deformity underwent TKA by means of medial parapatellar approach,standard osteotomy and only lateral soft tissue release with posterior stabilized implants were retrospectively analyzed.They were 7 males and 15 females,aged from 41 to 78 years,with an average age of 65 years.Tibiofemoral angle (angle between the femur and tibia anatomic axis) was 22°-50°,with an average of 34.6±2.4°.Among them,17 cases were osteoarthritis,5 cases were rheumatoid arthritis,3 cases complicated with patella dislocations,1 case complicated with medial instability,3 cases of 4 knees complicated with flexion contracture.Posterior stabilized prosthesis were used in 21 cases of 22 knees,constrained prosthesis were used in 1 case of 1 knee,5 cases accepted intraoperative patellar replacement.Clinical and radiographic evaluations including range of motion (ROM),the Hospital for Special Surgery (HSS)knee score and the tibial and femur angle (T-F angle) were performed at follow-up.Results The duration of follow-up averaged 30.5 months.The average HSS score improved from 19.6±4.7 points preoperatively to 89.7±3.6 points at the time of the last follow up.The average ROM improved from 43.7°-±5.8° preoperatively to 110.6°±7.5°.The average T-F angle was 8.6°±0.8°.We had 5 patella replacements,2 medial instability cured by using articular branches,2 palsies of nervus peroneus communis recovering after 3 months.No complications such as infection,DVT,or component loosening.Conclusion The techniques of medial parapatellar approach,standard osteotomy and only lateral soft tissue release with posterior stabilized implants can deal with a severe valgus knee deformity very successfully in patients undergoing primary total knee arthroplasty,and provide excellent results. Key words: Arthroplasty, replacement, knee; Genu valgum; Osteoarthritis; Arthritis, rheumatoid

FRI0141 The effect of patellar non-resurfacing during total knee arthroplasty in patients with rheumatoid arthritis

BackgroundAnterior knee pain is the most common complication after total knee replacement and patellofemoral problems were recognized as a major cause. The question whether to resurface the patella or not...

Total knee arthroplasty in the treatment of knees with bony ankylosis in extension

Objective To explore the clinical results of total knee arthroplasty (TKA) in the treatment of knees with bony ankylosis in extension.Methods From June 2000 to June 2007,10 patients had knees with bony ankylosis in extension were treated with TKA,including 4 males and 6 females,with an average age of 49 years (range,29 to 63 years).The primary diseases were as follows:ankylosing spondylitis in 3 cases,rheumatoid arthritis in 2 cases,hemophilic arthritis in 1 care,traumatic arthritis in 3 cases and pyogenic arthritis in 1 case.The range of motion (ROM) was 0° in all knees,and the average HSS (the Hospital for Special Surgery) score before operation was 32.5±10.26.Two patients underwent bilateral TKA,and 8 underwent unilateral TKA.Results All patients were followed up for 3 to 10 years (average,5.3 years).The average HSS score was improved to 87.75±6.45 at the last follow-up,and there was significant difference compared with that before operation (t=18.668,P=0.000).The average ROM was improved to 97.08°±11.57°at the last follow-up,and there was remarkable difference compared with that before operation (t=29.063,P=0.000).The postoperative complications included cutaneous necrosis in 2 cases,deep venous thrombosis of lower limb in 1 case,periprosthetic fracture in 1 case,and deep prosthetic infection in 1 case who underwent revised TKA later.The postopertative X-ray showed no looseness of the prostheses.Conclusion TKA through medial parapatellar approach,with dissection of the rectus femoris,secondary osteotomy and soft tissue balance intraoperatively is effective in the treatment of knees with bony ankylosis in extension,which can correct the ankylosed knee deformitis successfully.Combining with the correct rehabilitation exercise,it is possible to improve significantly the function of knee and life quality in these patients. Key words: Arthrop lasty, replacement, knee; Spondylitis, ankylosing; Treatment outcome

Cemented fixed-bearing PFC total knee arthroplasty: survival and failure analysis at 12–17 years

BackgroundTotal knee arthroplasty (TKA) is the appropriate treatment for degenerative pathology of the knee. Implant surveillance is mandatory to improve clinical results. We present the long-term results of a series of consecutive TKA Press Fit Condylar (J&J), cemented fixed bearing with selective patellar resurfacing in nonselected patients.Materials and methodsIn this prospective case series, 223 TKA were clinically and radiographically evaluated using the Hospital for Special Surgery (HSS) knee score and the Knee Society Roentgenographic Evaluation and Scoring System.ResultsThere were 197 patients, with an average age of 68.4 years [95% confidence interval (CI) 52.7–84.1 years]; 49 arthroplasties were implanted in men (21.1%) and 184 (78.9%) in women. The average follow-up was approximately 13.5 years (162.1 months; 95% CI 132.3–191.9), and it was possible to evaluate 179 implants (76.8% of the implanted prosthesis) in 176 patients. The average HSS score increased from 61.5 (95% CI 60.4–62.7) to 89.4 (95% CI 87.7–.93.5) points. The cumulative average survival rate at 15 years (the endpoint being failure with revision) was 90.6% ± 2% standard deviation. Resurfacing the patella did not make a difference in terms of implant survival. Progressive radiolucent lines were observed around 20 implants (14.3%); all were revised.ConclusionsThe PFC system is an excellent prosthetic solution. Early clinical complications, mechanical axis and patellar resurfacing do not correlate with implant failure, whereas progressive radiolucent lines do.

Complications following treatment of peri-knee fracture or nonunion by locking plates

ObjectiveTo analyze complications following the treatment of peri-knee fracture or nonunion by locking plates.Methods From January 2005 to May 2009, we used internal fixation with a locking plate to treat 106 closed peri-knee fractures in 97 patients (46 distal femoral fractures and 60 proximal tibia fractures). There were 85 cases of fresh fracture and 21 cases of nonunion. They were 62 males and 35 females, with an average of 34.8 years (from 18 to 54 years). The patients were followed up monthly for The Hospital for Special Surgery (HSS) scores and complications. Analyses were done to find associations between complications and gender, injury cause, injury type, facture type and operation time. ResultsThe follow-ups averaged 23.8 months (from 10 to 32 months ). The 46 distal femoral fractures obtained an average HSS score of 83.4 points one year after operation and had a complication rate of 32.6 ％ ( 15 cases); the 60 proximal tibia fractures obtained an average HSS score of 86. 4 points one year after operation and had a complication rate of 16.7 ％ (10 cases). There were no significant associations between complication rate and gender, injury cause, injury type and fracture type ( P ＞ 0. 05). There was a significant association between complication rate and operation time(x2 = 5.440, P = 0. 015).Conclusions Although locking plates are a new and effective treatment for peri-knee fracture or nonunion, they still have drawbacks. Indications should be strictly followed and care should be taken to avoid postoperative complications as much as possible. Key words: Knee joint; Femoral fractures; Tibial fractures; Fracture fixation, internal; Bone plates

Total knee arthroplasty following closed wedge high tibial osteotomy

The purpose of this study was to evaluate the results of total knee arthroplasty (TKA) following a closed wedge high tibial osteotomy (HTO). A total of 16 TKAs were performed in 13 patients who had previously undergone a closed wedge HTO. The clinical results were reviewed using the Hospital for Special Surgery (HSS) score. The radiographic results were evaluated with respect to the femorotibial angle (FTA), joint line height (JLH) and tibial bone resection. The average HSS score before TKA was 63.6, which improved to 92.8 at the last follow-up. The FTA averaged varus 0.9 preoperatively and valgus 5.7 at the last follow-up. The JLH averaged 13.9 mm preoperatively and 15.6 mm at the last follow-up. The amount of tibial bone resection averaged 4.8 mm. A meticulous surgical technique can produce satisfactory results in TKA after HTO, considering the correction of the deformity, JLH and the amount of the tibial bone resection.

Comparison of Posterior Cruciate Ligament Retentionversus Substitution in PFCSigma Rotating-Platform Total Knee Arthroplasty

Purpose : The purpose of this study was to assess the results of posterior cruciate ligamentretaining and posterior cruciate ligament-sacrificing total knee arthroplasty using PFC Sigma rotating-platform (RP). Materials and Methods : The subjects for this study were 43 patients who had undergone total knee arthroplasties by means of PFC Sigma RPs from February 2002 to July 2002 and, thereafter, had been observed for a period of at least 36 months. Twenty-two of the patients were categorized to group I, which retained the posterior cruciate ligament and 21 to group II, which substituted for the ligament. All the patients were evaluated for pre- and post-operative ranges of motion, the Hospital for Special Surgery (HSS) knee rating system, and radiographic analysis. Results : The average flexion contracture was 6.5˚ (±1.0˚) in group I and 6.7˚ (±0.8˚) in group II pre-operatively, and 1.1˚ (±0.3˚) in group I and 0.9˚ (±0.2˚) in group II at the last follow-up. The average active range of knee motion improved from 87.6˚ (±6.5˚) in group I and 86.6˚ (±6.1˚) in group II pre-operatively, to 123.0˚ (±7.8˚) and 125.1˚ (±7.3˚), respectively, at the last follow-up. The average HSS score improved from 41.1˚ (±7.1˚) in group I and 40.3˚ (±5.3˚) in group II preoperatively, to 87.3˚ (±6.0˚) and 88.9˚ (±4.9˚), respectively, at the last follow-up. There was also improvement in the average tibio-femoral angle from 8.0˚ in varus to 5.7˚ in valgus in group I and from 10.9 in varus to 5.4˚ in valgus in group II. Radiolucent lines were observed in 4 cases from group I and in 1 case from the group II. No significant progressive periprosthetic osteolysis was observed in the follow-up radiographs of both groups. Conclusion : There were no clinical and radiographic differences between the posterior cruciate ligament-retention and ligament-substitution groups, which indicates the necessity for long-term observation.

Management of periprosthetic femoral fractures after total knee arthroplasty using a distal femoral allograft

This study is a review and discussion of 12 consecutive patients who were revised with a distal femoral allograft for periprosthetic supracondylar fractures of the femur associated with poor bone quality by the same surgeon between 1990 and 2001. Two were lost to follow-up. The average age was 65 years, and the mean follow up was 6 years. Charts were reviewed to identify complications and graft survivorship. Functional assessment consisted of the modified Hospital for Special Surgery (HSS) knee score and the MOS 36-ITEM Short Form Health Survey. Radiographs were evaluated by 3 independent observers to determine graft union, resorption, and component loosening. The average postoperative HSS score and SF-36 were 75 and 88, respectively. Mean flexion was 100°. Nine patients achieved union and were able to fully bear weight. Three patients required more surgery as a result of postoperative complications. Radiographs showed no migration, no loosening, and good interface union in 9 of the 10 patients available for follow-up. We concluded that this is a viable salvage procedure for this type of injury.

Medium Term Results of a Mobile Bearing Total Knee Replacement

Purpose: The LCS (low contact stress) mobile bearing knee replacement has been used extensively. The purpose of this study was to report at least five-year clinical results of a primary total knee replacement performed with LCS mobile bearing design. Materials and Methods: From January 1992 to October 1997, author performed 80 total knee arthroplasties in 59 patients with LCS mobile bearing knee replacement. At the final follow-up, one patient had died, and ten patients had been lost to follow-up. The patients were evaluated with HSS (Hospital for Special Surgery) knee rating system and radiographic analysis. Results: The fifty-six knees in the forty-two patients were examined for final clinical and radiographic analysis at five to ten years. The average active range of knee flexion was from 5 degrees to 112 degrees preoperatively and 0 degrees to 123 degrees at the final follow-up evaluation. The average HSS score was 60.7 points preoperatively and 88.9 points at the final follow-up evaluation. Of the 56 knees, none had a dislocation of the mobile bearing prosthesis, one case had a traumatic periprosthetic fracture and four cases required reoperation, one for infection, one patellar revision for patellar polyethylene breakage, one rotating platform change to thicker one for posterior instability during flexion and one meniscal bearing change for medial meniscal bearing wear. There was no significant progressive periprosthetic osteolysis on follow-up radiographs. Conclusion: After five to ten years of follow-up, the LCS knee replacement was found to be performing well, with durable clinical and radiographic results.

Results of PCL Substituting Total Knee Replacement Arthroplasty

Purpose : To report the clinical and roentgenographic results of patients who had received PCL substituting total knee replacement arthroplasty. Materials and Methods : Forty-eight knees in thirty-two patients who received the PCL sustituting total knee system insertion from October 1994 to May 1997 were evaluated. There were ten men (31.3%) and twenty-two women (68.7%), and the average duration of follow up was 73 months (range, 60 months to 91 months). Clinical evaluation was performed according to Hospital for Special Surgery (HSS) scale and the radiologic evaluation was performed according to The Knee Society Roentgenographic Evaluation and Scoring System. Results :The average HSS score improved from 46.4 preoperatively to 92.4 postoperatively, and the average range of motion improved from preoperatively to postoperatively. The tibio-femoral angle improved from varus preoperatively to valgus at final follow-up. Forty four knees (91.7%) showed excellent or good clinical results. Radiolucent lines around the prosthesis were found in 20 cases (41.7%), but none showed any clinical symptom. One case had a revision operation due to aseptic loosening. Conclusion : PCL substituting total knee replacement arthroplasty is a good treatment method for osteoarthritis of the knee joint.

Duracon Total Knee Replacement in Kuwait: A Clinical and Radiographic Analysis of52 Knees Followed for 2–5 Years

Objective: In this prospective clinical and radiological study results of 52 consecutive Duracon bicompartmental total knee arthroplasties in 37 patients with femorotibial arthrosis and rheumatoid arthritis with the average observation time of 3 (2–5) years were analyzed. Methods: The study includes 32 women (44 knees) and 5 men (8 knees) with a mean age of 60 years. Details of implant design and surgical technique were given. Two surgeons performed all the operations. The patients were evaluated by an unbiased observer. The Hospital for Special Surgery (HSS) score for both pre- and postoperative assessment was used. Results: The average initial HSS score of 44 (20–65) improved to 85 (60–99) after operation. By subjective assessment, 41 knees were excellent, 10 good and 1 knee had a fair result. There were no revisions. The mean postoperative flexion was 101° (80–120). The mean anteroposterior angle of the tibial component was 4° of the varus and the mean lateral angle was 3° of the posterior slope. The mean postoperative hip-knee-ankle deviation was 4° of the varus. Conclusion: In Kuwait, the cemented Duracon total knee arthroplasty without patellar resurfacing gave satisfactory clinical results after an intermediate follow-up period of 3 years.