Average Hospital For Special Surgery Research Articles

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.

An alternative patellar resurfacing technique in knee replacement: patellofemoral fascial interposition arthroplasty

The present study reports the early clinical results of 38 osteoarthritic patients (38 knees) who were treated by total knee replacement in conjunction with patellofemoral fascial interposition arthroplasty (PFIA). After the femoral and tibial components were inserted, a fasciotendinous graft was harvested from the anterior surface of the quadriceps tendon and sutured around the articular surface of the patella. The patients were followed-up for a minimum of 24 months. The durability of the fascial graft was assessed radiographically by addition of a wire suture marker placed into the fascia in the first five patients. Patients were evaluated using the Hospital for Special Surgery (HSS) knee-rating system, and anterior knee pain was assessed using specific patellofemoral-related questions. The average HSS knee score improved from 61 points preoperatively to 92 points at 24 months' follow-up (P<0.001). Twenty-five patients (65.7%) had anterior knee pain preoperatively, and seven patients (18.4%) revealed anterior knee pain at their last visits (P<0.001). The position of the markers in the fascial grafts did not show any change during radiological follow-ups. Our data suggest that, PFIA provides good pain relief and it may be an alternative resurfacing technique avoiding the complications of patellar components.

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.

Arthroscopic synovectomy in haemophilic arthropathy of the knee

From January 1996 to January 2001, arthroscopic synovectomies were performed in 28 knees with haemophilic arthropathy. The mean follow-up period was 5 years and 11 months. Six portals (two anterior, two suprapatellar, two posterior) and a posterior trans-septal portal were used in all cases. The average Hospital for Special Surgery (HSS) knee score increased from 56.4 to 71.5 points at the last follow-up. The average frequency of haemarthrosis reduced from five times per month before operation to once per month. The amount of factor replacement decreased from a mean of 4,633 U to 1,505 U. Progression of arthritis was observed radiographically in three cases at the last follow-up. An arthroscopic synovectomy of the knee using appropriate arthroscopic portals is a useful method in treating haemophilic patients as it decreases bleeding episodes, amount of factor replacement and knee pain.

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.

Two-stage reimplantation without cement spacer for septic total knee replacement.

The management of an infected total knee implant is a major challenge to the orthopedic surgeon. We report the outcome using two-stage reimplantation without cement spacers between stages. Seven infected total knee replacements (TKR) were treated with the two-stage reimplantation technique from September 1994 through January 2001. Treatment of these patients consisted of thorough debridement and removal of the implants. No antibiotic-impregnated cement blocks or beads were inserted and only a long leg cylinder cast was applied for immobilization between stages. Intravenous antibiotics were used and C-reactive protein (CRP) values were monitored. All of the patients were free of infection and revision TKR was performed without using antibiotic-impregnated cement for fixation at an average interval of 6.3 weeks (range 6-10 weeks). The average length of follow-up was 3.5 years (range 1-7 years) and the average HSS (Hospital for Special Surgery) knee score was 86 points (range 78-94). A good result was obtained in one patient and excellent results in six patients. Average range of motion was 91 degrees (range 80 degrees -100 degrees ). No recurrence of infection was noted. Two-stage reimplantation without using a cement spacer between stages for septic total knee replacement is tolerable for patients, simpler for surgeons and can achieve good results without recurrence of infection.

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.

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.

Arthroscopic debridement for the treatment of osteoarthritis of the knee: 2- and 5-year results

Purpose: The purpose of this study was to evaluate the effect that arthroscopic debridement in osteoarthritic knees has on patient satisfaction and function. Type of Study: Cohort observational study. Methods: Thirty-six patients (mean age, 64.8 years) were available for 2- and 5-year follow-up after undergoing knee arthroscopy to treat arthritic symptoms refractory to conservative treatment. Surgical treatment included debridement of meniscal lesions, stabilization of chondral defects, removal of impinging osteophytes, and notchplasty. Age, symptoms, preoperative and postoperative Hospital for Special Surgery (HSS) scores, compartments involved, motion, impinging lesions, and level of satisfaction were evaluated. Results: At 2 years, 32 of 36 patients were satisfied. Mean HSS scores improved from 29.2 to 48.0. All 4 early failures had tricompartment disease (mean preoperative HSS scores, 21.5; preoperative flexion contractures, 15.6°). At 5 years, 25 of the 36 patients were satisfied with good to excellent results. Mean HSS scores decreased slightly to 43.2. Three patients had some deterioration and were rated fair, and 8 were considered failures requiring further surgery. The 25 of 36 with satisfactory results had a mean preoperative flexion contracture of 7.3° and average HSS scores of 33.2, whereas the other 11 of 36 had mean contractures of 15.0° and average HSS scores of 20.1. Poor results were associated with contractures greater than 10° (P =.05) and lower preoperative HSS scores (P =.05). Conclusions: Arthroscopic debridement of osteoarthritic knees has a favorable outcome in selected patients. Those patients with preoperative flexion contractures less than 10° and preoperative HSS scores greater than 22 beneficially responded to this method of treatment.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 8 (October), 2002: pp 829–834

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.

A comparison of isokinetic strength testing and gait analysis in patients with posterior cruciate-retaining and substituting knee arthroplasties

Fourteen patients with a posterior-stabilized prosthesis in one knee and a posterior cruciate-retaining prosthesis in the contralateral knee and both scoring good or excellent on the Hospital for Special Surgery (HSS) knee scale were evaluated by isokinetic muscle testing and comprehensive gait analysis at a mean follow-up of 98 months after arthroplasty. The average HSS knee score (93 points) and the average Knee Society score (94 points) were the same for the cruciate-retaining and posterior-stabilized knees. No differences were noted between the cruciate-retaining and the posterior stabilized knees with respect to isokinetic muscle testing parameters (peak torque, endurance, angle of peak torque, and torque acceleration energy) for both quadriceps and hamstrings. No significant differences were found between the cruciate-retaining and the posterior-stabilized knees with regard to gait parameters, knee range of motion, and electromyographic waveforms during level walking and stair climbing. Cruciate-retaining and posterior-stabilized total knee prostheses perform equally well during level gait and stair climbing.