Average Postoperative Flexion Research Articles

Percutaneous Threaded Pin Fixation of Distal Radius Fracture in the Athlete.

The purpose of this study was to examine the outcomes and return to play with early rehabilitation in athletes who sustained unstable extra-articular distal radius fractures treated with a purpose-designed threaded pin technique. This prospective study examined athletes with displaced and unstable distal radius fractures treated surgically with purpose-designed threaded pins. Patients were enrolled in an early rehabilitation protocol, with formal therapy initiated on postoperative days 1 to 3. Range of motion and strength measurements were documented throughout the postoperative period, noting the time until return to athletic competition. These results were compared with historical values using other forms of fixation. Nineteen athletes, average age of 35 years, were treated with threaded pin technique with early rehabilitation; all had complete healing and maintained alignment based on radiographic evaluation. The average time span between surgery and release to competition was 8 weeks, with all but 1 patient returning to sport within 12 weeks of injury. Average postoperative flexion measured 58°, extension was 57°, pronation was 81°, and supination was 74°. JAMAR grip strength in position 3 measured 25.22 kg, which equated to 73% of the uninjured side's grip strength at the time of release to play. Surgical fixation using a purpose-designed threaded pin is a useful alternative to volar plating for isolated radial styloid and extra-articular distal radius fractures in athletes. The purpose-designed threaded pin may afford athletes rapid recovery during the early postoperative period, preserving strength and dexterity and minimizing time lost before return to play.

Pre-operative fixed flexion deformity a curse to the knee arthroplasty surgeon?

<p class="abstract"><strong>Background:</strong> The aim of the study was to study the effect of preoperative flexion deformity on the postoperative knee range of motion following total knee arthroplasty.</p><p class="abstract"><strong>Methods:</strong> A total of 28 knees were studied out of which twenty were osteoarthritis and eight were rheumatoid arthritis. Cruciate substituting and cruciate retaining implants were used. Patients above the age of 45 years with a minimum follow up period of two years from April 2010 were studied.<strong></strong></p><p class="abstract"><strong>Results:</strong> 28 knees had an average preoperative range of motion of 87.678. Patients with preoperative flexion deformity had postoperative range of motion of 97.5 degrees. The average postoperative flexion in 8 rheumatoid patients was 96.25 and 20 osteoarthritis patients was 107.462.</p><p class="abstract"><strong>Conclusions:</strong> The average postoperative range of motion was 105.538. Patients with a higher pre-operative range of motion had higher postoperative range of motion. Rheumatoid patients had a significantly low range of motion when compared to osteoarthritis patients. Patients with increased fixed flexion deformity had a significantly low postoperative range of motion.</p>

Long term outcome analysis of fixed bearing total knee arthroplasty

Introduction: Survivorship of TKA is directly related to appropriate alignment and balance. Surgeons should evaluate the biomechanics of knee alignment and determine the proper position of the implant. Malalignment of total knee prostheses has been implicated in few difficulties, including tibiofemoral instability, patellofemoral instability, patellar fracture, stiffness, accelerated polyethylene wear, and implant loosening. The aim of this study is to analyse the long term follow up of functional and radiological results of twenty cases of fixed bearing Total Knee Arthroplasty prospectively done in our institute during the period April 2008 to September 2009. Materials & Methods: This is a prospective study done in our department form 2008- 2009 which included total knee arthroplasty done for bicompartmental osteoarthritis without gross deformity. 20 cases were included in the study. The age range was 32 to 65 years. There were 5 male patients and 15 female patients. The accuracy of component position was assessed by mechanical axis restoration, coronal tibio femoral angle, sagittal femoral angle, posterior tibial slope by X-ray and the transepicondylar line-posterior condyle component angle by CT. We used Depuy PFC fixed bearing knee in 17 patients, Stryker knee in 2 patients and Indus knee in 1 patient. Knee society score was used to measure the functional outcome of the surgery. Results: The average postoperative flexion in the rheumatoid group was 105.4 degrees and in the osteoarthritis group was 115.8 degrees. There was no incidence of periprosthetic fractures. No patients had neurological deficit or dislocations. One case had valgus instability postoperatively. In our study all our patients showed an improvement in knee score with mean preop score of 50.4 (range: 46-57) improved to 75.6 (range: 65-88). 2 patients had excellent score (80-100).16 patients had good score (70-79) and 2 patients had fair results (60-69). No patients had maltracking of patella clinically.one patient with anterior knee pain and two patients with limited flexion post operatively were evaluated with axial view of knee. There were no evidence of patellar tilt or subluxation. No patients had loosening and osteolysis noted around the femoral and tibial components. No implant needed to be revised during the period of study. There was no incidence of superficial or deep infection. Of the 20 patients 18 cases returned to their premorbid condition. Two patients who were rheumatoid has persistent pain. The average follow up was 9.2 years (range 8.4 to 10.7 years). Conclusion: In patients with ideal placement of the components i.e. with mechanical axis and the rotational alignment accurate better knee flexion and knee score was obtained provided other factors are normal. We conclude that the correct positioning of the components both axially and rotationally improves the functional outcome of fixed bearing knee in low demand patients with an excellent long term clinical outcome.

The Use of a Transolecranon Pin in the Treatment of Pediatric Flexion-type Supracondylar Humerus Fractures.

Flexion-type supracondylar humerus fractures are much more uncommon than their extension-type counterparts. Instability in elbow flexion renders traditional closed techniques inadequate and often results in the need for open reduction. We present a simple technique for closed reduction using a transolecranon pin for temporary stability. A retrospective review of 9 patients treated with a transolecranon pin technique for a flexion-type supracondylar humerus fracture was performed. Operative time, need for open reduction, postoperative range of motion, final radiographic alignment using Baumann angle, and the intersection of the anterior humeral line with the capitellum was evaluated. All 9 patients were treated with closed reduction using a temporary transolecranon pin technique. Total surgical time averaged 38±15 minutes and was longer for type III than type II flexion-type fractures. All fractures healed by first follow-up at 1 month. There was 1 preoperative ulnar nerve deficit that resolved by the first postoperative visit. Average Baumann angle at radiographic healing was 71.2±3.3 degrees and all cases showed restoration of the normal anterior humeral line:capitellar relationship. Average postoperative flexion at final follow-up was 125 degrees and extension was 5 degrees. One patient had a flexion contracture of 10 degrees. Use of a temporary transolecranon pin allowed for closed reduction of all flexion-type fractures with no radiographic malunion. This technique is technically simple and avoids the need for open reduction or multiple fluoroscopy views. Level IV-case series.

The role of wound closure in total knee arthroplasty: a systematic review on knee position.

Post-operative range of motion (ROM) is one of the most important parameters to assess, following total knee arthroplasty (TKA). The aims of the present systematic review were to analyse the available literature and determine if closing the knee in flexion or extension influences post-operative ROM, clinical outcomes, and complications following TKA. A systematic review was performed using the keywords "total knee arthroplasty", "total knee replacement", and "wound closure" or "joint closure" or "extension" or "flexion" with no limit regarding the year of publication. The review was limited to the English-language articles, and each article was evaluated with a modified Coleman Methodology Score (mCMS). Six articles met inclusion criteria. The initial cohort included 202 TKAs in the flexion group and 201 in the extension group. Three hundred and ninety-seven TKAs were evaluated with an average follow-up of 8months. There was no statistical difference (n.s.) between the two groups in terms of the average post-operative flexion. There were no statistical differences between the two groups regarding post-operative functional scores and VAS scores (n.s.). The average mCMS was 70.9, indicating good methodological quality in the included studies. The findings of the present review did not show any statistically significant differences in terms of post-operative flexion ROM, functional scores, or complications related to the position of the knee at the time of joint and wound closure during TKA. There is no clear advantage to either closure method based on the currently available evidence, and therefore, this choice should be based on surgeon preference.

Intérêt d’un spacer articulé dans la reprise en deux temps d’une prothèse totale de genou infectée

Deep periprosthetic infection is one of the most serious complications after total knee replacement. The two-stage procedure with implantation of a temporary cement spacer and later re-implantation of revision total knee prosthesis is an accepted procedural standard. The use of articulating spacers has been proposed to enhance ease of revision and functional results. Patients and methodsTwenty-three patients treated with an articulating spacer were retrospectively studied. All patients had undergone a two-stage surgery. The infected prosthesis was explanted and the femoral component was sterilized and re-implanted. On the tibial side, a block of gentamicin-loaded bone cement was produced intraoperatively using specially manufactured templates. Eighteen total knee arthroplasty revisions and 5 arthrodesis were finally performed. ResultsA total of three (13%) re-infections occurred 5–20 months after revision of total knee arthroplasty in a mean follow-up period of 47 months. Prior to re-implantation, flexion with the articulating spacer ranged between 15° and 100° (mean 68°±28°). The average postoperative flexion after re-implantation of TKR was 105°±11°. ConclusionThe articulating spacer used in this study appears to be as effective as the standard procedures in terms of re-infection risk rate and postoperative range of motion recovery. Level of evidenceLevel IV

Functional interest of an articulating spacer in two-stage infected total knee arthroplasty revision

IntroductionDeep periprosthetic infection is one of the most serious complications after total knee replacement. The two-stage procedure with implantation of a temporary cement spacer and later re-implantation of a revision total knee prosthesis is an accepted procedural standard. The use of articulating spacers has been proposed to enhance ease of revision and functional results. Patients and methodsTwenty-three patients treated with an articulating spacer were retrospectively studied. All patients had undergone a two-stage surgery. The infected prosthesis was explanted and the femoral component was sterilized and re-implanted. On the tibial side a block of gentamicin-loaded bone cement was produced intraoperatively using specially manufactured templates. Eighteen total knee arthroplasty revisions and 5 arthrodesis were finally performed. ResultsA total of three (13%) re-infections occurred 5–20 months after revision total knee arthroplasty in a mean follow-up period of 47 months. Prior to re-implantation, flexion with the articulating spacer ranged between 15 and 100° (mean 68±28°). The average postoperative flexion after re-implantation of total knee replacement was 105±11°. ConclusionThe articulating spacer used in this study appears to be as effective as the standard procedures in terms of re-infection risk rate and postoperative range of motion recovery. Level of evidenceLevel IV.

Comparison of range of motion after standard and high-flexion posterior stabilised total knee replacement

The purpose of this study was to compare the range of motion after standard version posterior stabilised TKR and high-flexion version TKR in patients receiving bilateral total knee replacement. Thirty-five patients were recruited. The range of motion of the knees was measured clinically with a goniometer in both the pre-operative period and the most recent follow-up. It was found that the pre-operative range of motion was comparable in the two groups. The average post-operative flexion was 105 degrees +/- 13 degrees in the standard version group and 106 degrees +/- 14 degrees in the high-flexion design group (p = 0.201, paired t-test; beta error = 0.073). A slight loss in flexion was observed in the standard version group (0.5 degrees ) as opposed to a slight gain in the high-flexion design group (2 degrees ). However, this was not statistically significant (p = 0.251, paired t-test; beta error = 0.105).

Knee Disarticulation and Hip Release for Severe Lower Extremity Contractures

Severe lower extremity contractures cause many problems for patients and their caregivers. Hygiene, skin and perineal care, positioning, and dressing are severely compromised. Surgical management of such deformities is challenging and results have not been published. We treated eight nonambulatory adults with severe and rigid lower extremity contractures with hip release and knee disarticulation of 14 extremities. The patients had neurologic disorders with spasticity. The indications for surgery were fixed contractures of at least 90 degrees at the knee and hip that interfered with passive function and quality of life. All patients were bed-bound secondary to their contractures. The average age at surgery was 57 years; the minimum followup was 6 months (mean, 34 months; range, 6-102 months). The average preoperative flexion contractures were 106 degrees at the hips and 139 degrees at the knees. The average postoperative hip flexion contracture was 6 degrees , and there were no serious complications or recurrent contractures. Positioning and hygiene problems were universally improved, enabling all of the patients to become wheel-chair users, and all patients or their caretakers reported resolution of pain.

Meniscal bearing uncemented total knee arthroplastyEarly clinical results at a minimum 2-year review

A prospective study of early clinical and radiologic outcome of the Motus (Osteo, Selzach, Switzerland) meniscal bearing total knee arthroplasty was performed. We reviewed the first 75 consecutive prostheses in 62 patients, implanted over a 4-year period. The mean follow-up was 2.5 years. Average preoperative knee score was 97 out of 200 (Knee Society score, 43; functional score, 54) and at 2-year review was 179 out of 200 (Knee Society score, 87; functional score, 92). Average postoperative flexion at 2 years was 113°. No meniscal bearing subluxation, dislocation, or breakages occurred. Radiologically, there was no evidence of subsidence or osteolysis. Our results support the continued use of this meniscal bearing knee prosthesis. It is important to confirm, however, an equal flexion and extension gap without proximal joint line migration. Copyright 2003, Elsevier Science (USA). All rights reserved.

Total knee arthroplasty in patients 40 years of age and younger with osteoarthritis.

The results of 32 total knee arthroplasties performed for osteoarthritis in 32 patients who were 40 years of age or younger are reviewed. At a mean followup of 7.9 years (minimum, 5 years), the Knee Society knee scores increased from an average of 47 to 88 points, and the function scores increased from 45 to 70 points. Overall, Knee Society knee scores were considered good or excellent in 82% of patients (26 knees) and fair or poor in 18% (six knees). Postoperative function scores were good or excellent in only 40% (13 knees). The average postoperative flexion arc was 110 degrees. If patients involved in worker's compensation cases are excluded from analysis, the results improved substantially, with range of motion averaging 113 degrees, and Knee Society knee scores and function scores averaging 92 points and 77 points, respectively. Excluding the five patients involved in workmen's compensation cases, knee scores were good or excellent in 91% of patients (25 knees) and function scores were good or excellent in 50% of patients (14 knees). Three revisions were performed for aseptic failure; one additional patient has radiographic evidence of tibial loosening, representing an aseptic failure rate of 12.5% at 8 years. Although slightly higher than observed in older patients, this failure rate still may be considered acceptable for this population of patients with severely affected knees who are not considered candidates for nonarthroplasty surgery. Despite a slightly higher tendency for aseptic failures in this group of patients, cemented total knee arthroplasty may provide some patients younger than 40 years of age with severe debilitating and recalcitrant osteoarthrosis, an important option with reasonable mid- and long-term results.

Total knee arthroplasty with or without patellar resurfacing - a comparative study: 3–8 year results

Sixty-one total knee arthroplasties (39 implanted with patellar resurfacing, 22 without) were reviewed more than 3 years after implantation. The decision of whether or not to resurface the patella was taken according to the pre-operative radiographic aspect on the skyline view and the anatomical configuration during the operation. The clinical results, the radiographic outcomes and the patellar complications were evaluated comparatively. Among the 39 resurfaced patellae there were five knees with patellofemoral pain. The average postoperative flexion was 110°. A loss of active extension > 5° was found in 10 knees. There were four lateral patellar subluxations, two fractures of the patella and one patellar loosening. Two revisions were necessary. The Hospital for Special Surgery (HSS) score showed 82% good and excellent results with a score of 80 or higher. Among the 22 unresurfaced patellae there were four knees with patellofemoral pain. The average postoperative flexion was 108°. A loss of active extension > 5° was found in five knees. There were three lateral patellar subluxations and one patellar fracture. No revision was necessary. The HSS score showed 78% good and excellent results with a score of 80 or higher. After an average follow-up of 5 years and 9 months, no significant difference was found between the two groups. The author's conclusion is that when the posterior side of the patella is relatively pristine, there is no need for a patellar implant.

Posteriorly stabilised (Insall-Burstein) total condylar knee arthroplasty

We reviewed 157 knees in 118 patients who underwent posteriorly stabilised (Insall-Burstein) knee replacement arthroplasty. Their mean age at operation was 69 years (range 47 to 85 years) and the average follow-up was 3.5 years (range 2 to 7 years). The "BASK" knee function assessment chart was utilised to evaluate the functional and clinical results. One hundred and thirty-five knees (86%) had excellent or good results, 16 knees (10%) had fair results and six (4%) had poor results. The mean postoperative BASK score was 79 points and the average postoperative knee flexion was 95 degrees (range 65 degrees to 130 degrees). Two patients had a superficial infection, one deep sepsis requiring revision arthroplasty and two mechanical loosening. Patellar impingement symptoms were present in 8% of the knees, although they were troublesome in less than half. Varus alignment of the knee and a varus tilt of the tibial component of more than 2 degrees correlated with the incidence of radiolucent lines around the tibial prosthesis. 90% of the patients were pleased or satisfied with the functional result. The total condylar knee is a safe, reliable and versatile prosthesis.

Radiographic study of kinematic total knee arthroplasty

One thousand sixty-nine consecutive cemented Kinematic Condylar total knee arthroplasties performed by one group of orthopaedists were studied. The maximum follow-up period was 7 years. Most patients had rheumatoid arthritis or osteoarthritis, and the average patient age was 67 years (range, 12–90 years). Aseptic revisions for loosening were required for only one tibial component and six patella components. Average postoperative flexion was 2.5–107°. The preoperative to postoperative change in range of flexion was not affected by the tilt angle of the tibial component in the sagittal plane. With the use of external alignment guides, the average postoperative alignment was ideal but the standard deviation was high; the standard deviation and the extremes were lower when intramedullary guides were used. There was a 14% incidence of femoral radiolucency and a 30% incidence of tibial radiolucency, which increased only slightly with time. Most radiolucencies on the tibial side were small and restricted to the extreme edges; rarely did radiolucency occur around the central peg. More than one half of the thicker radiolucencies occurred adjacent to wedge-shaped bone defects that were filled with cement.