Average Postoperative Range Of Motion Research Articles

Three-dimensional-printed porous prosthesis for the joint-sparing reconstruction of the proximal humeral tumorous defect.

Background: Tumorous bone defect reconstructions of the proximal humerus with joint sparing is a challenge. Numerous reconstruction methods have been proposed but the proximal residual humerus is commonly sacrificed because of its extremely short length. To preserve the proximal humerus and improve clinical outcomes, we designed a three-dimensional (3D) printed uncemented prosthesis with a porous structure to treat tumorous bone defects of the proximal humerus. Methods: Our analysis included seven patients treated between March 2018 and July 2019. A 3D model was established, and related data were obtained, including the diameter of the humeral head, the resection length, and the residual length. A prosthesis was designed and fabricated based on these data. Functional and oncologic outcomes were recorded, and complications and osseointegration were evaluated. Results: The mean age of the patients was 20.3years, and the median follow-up period was 26months. The lengths of the residual proximal humerus were 17.9mm on average. All the patients had preserved humeral heads and most of the rotator cuff was intact. The average postoperative range of motion (ROM) of the affected shoulder was 83.8°; flexion was 82.5°, extension was 43.8°, and adduction was 16.3°. The average Musculoskeletal Tumor Society score (MSTS) was 94.3%. Good osseointegration was observed on the interface between the bone and prosthesis. Conclusion: A 3D printed porous prosthesis with cone-like structures successfully achieved joint-sparing reconstruction of proximal humeral tumorous defects with satisfying functional outcomes. The preservation of the rotator cuff and humeral head plays an essential role in the function of the shoulder joint.

Effect of Distal Tibial Cortical Bone Coverage in Rates of Total Ankle Arthroplasty Implant Subsidence, Loosening, Heterotopic Bone Formation and Clinical Outcomes

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has continued to increase in popularity as a treatment modality for ankle arthritis. Despite this increased popularity, continual updates to implant designs strive for improved outcomes. This has led to different implant design changes including an extended length tibial tray to offer more distal tibia cortical coverage. This study compares the rates of tibial component subsidence, tibial component loosening, heterotopic ossification (HO) formation, average post-operative range of motion (ROM), and patient reported outcome measures (PROMs) between two matched groups of patients who underwent TAA with Salto Talaris extended tibial tray components with full distal tibia cortical coverage and a group who underwent TAA with Salto Talaris traditional tibial tray components without full tibia cortical coverage. Methods: Patients who underwent TAA between January 2019 and February 2021 with Salto Talaris implants (Smith & Nephew, Memphis, TN) were included for review. Patients were matched into two groups for age, gender, and Body Mass Index (BMI). Group 1 consisted of patients who received TAA with the extended tibial tray implant and full distal tibia cortical coverage and Group 2 consisted of patients who received the standard tibial tray implant without full distal tibia cortical coverage. Preoperative and postoperative radiographs were analyzed for the presence of subsidence, loosening, HO formation. ROM was measured utilizing plantarflexion and dorsiflexion weight-bearing lateral radiographs. PROMs were also analyzed including the Veterans- RAND 12 (VR-12) Item Health Survey, Ankle Osteoarthritis Scale (AOS), Foot and Ankle Ability Measure (FAAM), Visual Analog Score (VAS), and Patient Satisfaction. Results: Sixty-one patients (36 males; 25 females) were matched between the two groups. The mean age was 66.9 years in Group 1 and 67.1 years in Group 2, with a mean follow-up of 15.6 months and 22.1 months, respectively. Mean BMI was 30.6 in Group 1 and 30.5 in Group 2. The post-operative VR-12 Physical score was significantly higher in Group 1 (49.2 vs 45.1, P=0.025). Group 1 also had a significantly lower post-operative VAS pain score (11.1 vs 21.2, P=0.012) as well as patient satisfaction (93.8 vs 85.2, P=0.018). Radiographically, the rate of subsidence was significantly lower in Group 1 (0% vs 16.4%, P=0.001) as well as the rate of HO formation (26.2% vs 67.2%, P<0.001). Group 1 had significantly greater post-operative plantarflexion (17.7 degrees vs 14.0 degrees, P=0.018). Conclusion: Early short-term results appear to indicate that utilizing TAA implants with an extended length tibial tray with full distal tibia cortical coverage is associated with less subsidence, less heterotopic ossification formation, greater post-operative plantarflexion, less pain and higher patient satisfaction. Future analysis with longer-term follow up as well as a larger patient cohort may help shed even more light into the efficacy of this new implant design.

The influence of posterior tibial slope on the mid-term clinical effect of medial-pivot knee prosthesis

ObjectiveTo evaluate the effect of posterior tibial slope (PTS) on the mid-term clinical outcome following a medial-pivot (MP) prosthesis.MethodTwo hundred thirty-three patients from The Affiliated Hospital of Qingdao University, who had undergone a total knee arthroplasty (TKA) with MP prosthesis between January 2015 and December 2015, were retrospectively included in this study. They were divided into 3 groups according to postoperative PTS: A ≤ 5°; B 5-7°; and C ≥ 7°. Multiple assessments were made on the patient postoperatively and recorded in the three groups, the measurements of this study included: the range of motion (ROM), knee scoring system (KSS), Western Ontario and McMaster universities osteoarthritis index (WOMAC), posterior condylar offset (PCO), joint line height, and postoperative complications.ResultsThe average post-operative ROM for groups B and C were 108° and 110° respectively; this was significantly higher than that of group A (98°, P < 0.001). The WOMAC scores of patients in group C were significantly lower than those in groups A and B (P < 0.05). However, there were no significant differences in KSS, PCO, and joint line height among the 3 groups (P > 0.05). Only 2 cases of postoperative complications occurred in group C, these were ameliorated after operation.ConclusionWith an increase to PTS, the postoperative ROM can be significantly increased for the patient. However, the knee joint function will not be significantly improved, and the stability of knee joint will not be affected when within the limits of appropriate PTS.

Increased posterior translation but similar clinical outcomes using ultracongruent instead of posterior stabilized total knee arthroplasties in a prospective randomized trial.

The aim of this study was to compare the posterior tibial translation after ultracongruent (UC) and posterior-stabilized (PS) total knee arthroplasty (TKA) with two different UC with different heights in the anterior lip, and two different PS designs. This study also aimed to compare the range of motion (ROM) and outcomes scores after the use of these TKA models. It was hypothesised less posterior tibial translation after PS than after UC TKA, and less posterior tibial translation with a higher anterior lip in the UC insert than with a lower one. It was designed as a prospective randomized study of a group of 120 patients operated with a cemented TKA. To clarify the main purpose of the study, four groups were analysed using different polyethylene designs: Triathlon PS insert in group one, Triathlon UC insert in group two, U2 PS insert in group three and U2 UC insert in group four. One year after surgery, a forced posterior drawer with a Telos Stress applying 15kg of force posteriorly on the proximal tibia at 90° of knee flexion was analysed in the lateral radiograph. Limb alignment, tibial posterior slope and posterior condylar offset were also studied. 30 patients were included in each group. The average age was 73years. There were 72.2% female and 27.8% male patients. There were no significant differences in any demographic or radiographic studied variables, preoperative range of motion (ROM) or preoperative Knee Society Scores (KSS) among the different groups. One year after surgery, the average postoperative ROM and the postoperative KSS Knee and KSS Function scores improved in respect of the preoperative values in all the groups. There were no significant differences in the postoperative outcome scores among the different groups (p = n.s.). Postoperative alignment of the limb, tibial posterior slope and posterior condylar offset were similar in the 4 study groups (p = n.s.). The postoperative posterior tibial translation was different between groups: the PS groups (groups 1 and 3) showed significant inferior values (p < 0.001) in respect of the UC groups (groups 2 and 4). There were no differences between both groups of PS models, but there was a significant increase in the posterior tibial translation of the Triathlon UC insert (11.2mm SD 3.2) in respect of the U2 UC insert (6.1mm SD 4.5) (p = 0.004). UC inserts restrict the posterior tibial translation after TKA less than PS inserts, but a design with a high anterior lip in the polyethylene UC insert can better control the posterior tibial translation than an insert with a small anterior lip. Level I. Randomised controlled trial.

Dorsal Capsule Interpositional Arthroplasty of the Metacarpophalangeal Joint.

Background: Current recommendations for osteoarthritis of the metacarpophalangeal joint (MCPJ) are confined to implant arthroplasty to preserve joint motion and provide pain relief. This study documents the median 2-year results of a novel soft tissue arthroplasty technique that interposes the dorsal capsule. Methods: A retrospective review of 10 MCPJ dorsal capsule interposition arthroplasties in 8 patients was conducted. Physical evaluation assessed MCPJ range of motion (ROM), grip strength, and pain. Outcome tests used were the Michigan Hand Outcome Score, Visual Analog Scale (VAS), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH). Kellgren and Lawrence Classification assessed severity of MCPJ osteoarthritis on preoperative radiographs. Results: The mean follow-up was 29 months from surgery. Average VAS was 2/10 postoperatively and average postoperative ROM improved 7 degrees. Average postoperative grip strength of the surgical hand was 30 kg. The QuickDASH average score was 24. Average Michigan Hand Questionnaire final score was 70. Patients with Kellgren Grades 2 or 3 osteoarthritis had the best QuickDASH and Michigan Hand Outcome scores. All patients working before surgery returned to work. No patient required a second surgery. Conclusion: This technique of dorsal capsule interposition arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ at an average follow-up of 2 years. Pain relief was most reliably provided in patients with less severe radiograph findings. The advantages of this procedure include preservation of bony anatomy, collateral ligaments, and volar plate to not preclude later implant arthroplasty.

Revision total knee arthroplasty (TKA): mid-term outcomes and bone loss/quality evaluation and treatment

BackgroundRevision total knee arthroplasty (rTKA) is a demanding procedure, with a high complication and failure rate and a high rate of bone losses and poor bone quality. Different classifications for bone losses have been proposed, but they do not consider bone quality, which may affect implant fixation. The aim of this study is to describe the outcomes of a consecutive series of rTKA. Furthermore, a modified bone loss classification will be proposed based also on bone quality. Finally, the association between radiolucent line (RLL) development and different risk factors will be evaluated.MethodsAll the patients who underwent rTKA between 2008 and 2016 in the same institution were included. rTKAs were performed by the same surgeon according to the three-step technique. Bone losses were classified according to the proposed classification, including bone quality evaluation. The Knee Scoring System (KSS), the Hospital for Special Surgery Knee Score (HSS), and the SF-12 were used for the clinical evaluation. Radiological evaluation was performed according to the Knee Society Roentgenographic Evaluation System. Different possible risk factors (i.e., gender, age, amount of bone losses) associated to RLL development were identified, and this association was evaluated using logistic regression.ResultsFifty-one patients (53 knees) were included (60.8% female, average age 71.5 years). The average follow-up was 56.6 months (range 24–182). The most frequent cause of failure was aseptic loosening (41.5%). 18.9% of the cases demonstrated poor bone quality. Bone losses were treated according to the proposed algorithm. In all the cases, there was a significant improvement in all the scores (P < 0.05). The average post-operative range of motion was 110.5° (SD 10.7). At the radiological evaluation, all the implants resulted well aligned, with 15.1% of non-progressive RLL. There were 2 failures, with a cumulative survivorship of 92.1% at the last follow-up (SD 5.3%). At the logistic regression, none of the evaluated variables resulted associated to RLL development.ConclusionrTKA is a demanding procedure, and adequate treatment of bone losses is mandatory to achieve good results. However, also bone quality should be taken into consideration when approaching bone losses, and the proposed classification may need surgeons after an adequate validation.Level of evidenceLevel IV

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

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 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.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; 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.&lt;/p&gt;

Lateral Femoral Epicondylar Osteotomy for Correction of Fixed Valgus Deformity in Total Knee Arthroplasty: A Technical Note

BackgroundMultiple surgical techniques exist to restore limb alignment and to balance soft tissues in valgus knees during total knee arthroplasty (TKA). One technique is to perform a lateral femoral epicondylar osteotomy. MethodsA retrospective analysis was performed on all patients with a fixed valgus deformity that was corrected with a lateral femoral epicondylar osteotomy during TKA. Preoperative and postoperative Knee Society Knee Scores, knee stability, range of motion, and radiographic alignment were recorded. ResultsTen patients (3 male and 7 female) underwent 12 TKAs by a single surgeon using a lateral femoral epicondylar osteotomy to correct a fixed valgus deformity. Implants used included 7 posterior stabilized, 3 constrained posterior stabilized, and 2 constrained condylar knees. Average age was 68 years (range 48-89) and average follow-up was 34.7 months (4-109). Average postoperative range of motion was 125° of flexion (range 95°-145°). The mean radiographic preoperative and postoperative anatomic tibiofemoral angles were 16.4° of valgus (range 12°-26°) and 5.5° of valgus (range 4°-7°), respectively. The mean preoperative knee society objective, satisfaction, expectation, and functional activity scores were 71, 20, 11, and 30, respectively. The mean postoperative knee society objective, satisfaction, expectation, and functional activity scores were 88, 34, 13, and 64, respectively. There was 1 postoperative deep vein thrombosis and 1 temporary peroneal nerve palsy. ConclusionLateral femoral epicondylar osteotomy is a useful technique to restore mechanical alignment in fixed valgus deformities in TKA.

All-Polyethylene Tibial Component Use for Elderly, Low-Demand Total Knee Arthroplasty Patients

BackgroundPotential advantages combined with lower cost have prompted a renewed interest in modern all-polyethylene tibial designs. MethodsA total of 317 Natural Knee total knee arthroplasties with an all-polyethylene tibial component that was performed since 1993 were retrospectively reviewed to confirm that cost savings were not associated with inferior clinical results. They were primarily used in elderly, low-demand patients. The average age at the time of surgery was 80.8 years. Results227 knees with a minimum of 2-year follow-up were identified. The average follow-up was 5.6 years (range, 2-20 years). Clinical and radiographic outcomes were evaluated. At the latest follow-up, the average Knee Society and functional score was 94.2 and 57.2. The average postoperative range of motion was 1.6°-115.4°. No patient required a revision for aseptic or septic loosening, wear, or instability. Only 5 knees had a partial nonprogressive cement/bone radiolucency. There was an approximate 33% cost savings for the implants when the all-polyethylene component was used. ConclusionAn all-polyethylene tibial component of this design provides excellent results in the elderly population along with a significant cost savings.

Early clinical and radiological results of total knee arthroplasty using patient-specific guides in obese patients.

Total knee arthroplasty (TKA) is a challenging procedure in patients with a high body mass index (BMI). The aim of our study was to assess the outcome and accuracy of restoration of mechanical alignment in TKA using patient-specific guides (PSG) involving patients with high BMI. Patients with BMI of 30 or above were enrolled in the study. The mean age of the patients was 65.15 years. The study comprised of 46 males and 54 females. Total knee arthroplasty was planned after a pre-operative MRI and long leg x-ray films using customized PSG. Of the 105 knees (100 patients) in the study, average BMI was 35.42 kg/m(2) (30-56). Twenty patients (20 %) had class III obesity (≥40 kg/m(2)). The average blood loss and operative time were 236.1 ml (range 50-700 ml) and 92.2 min (65-130 min), respectively. The average post-operative mechanical axis was noted to be 1.85° varus (range 4° valgus to 6° varus). Eighty-eight patients (86.27 %) had mechanical alignment within 3° of neutral. There were no adverse intraoperative events. One patient had deep infection that required a two-stage revision. The average post-operative range of motion at 1-year follow-up was 105.8° (range 80°-130°). Patient-specific guides technology restores the coronal mechanical axis reliably in obese patients without adversely affecting outcomes. Our short-term follow-up has shown favorable outcomes. Surgeons should use these customized jigs as a guide and adjust the size of components, alignment and rotation according to normal surgical principles.

Does pre-operative flexion factor influence the post operative range of motion in total knee arthroplasty

Background: Range of motion and flexion are important outcome measures following total knee arthroplasty. Many of the activities of daily living require knee flexion in the range of 45 to 105°. Several factors affect postoperative range of motion (ROM), including pre-operative and post operative factors, among which pre-operative ROM is the most important factor. Aim: To analyze the patient's pre-operative flexion factor responsible for the outcome of range of motion in post operative Total Knee Replacement (TKR). Materials and Methods: We studied 80 patients having Total Knee Replacement (TKR) by a single surgeon in SRMC, Chennai, between 2005 and 2010 with a minimum follow up of upto 1 year. Results: The mean pre-operative flexion was 85° and post operative mean flexion was 115°. Obesity is associated with poor flexion after TKR. Knees with Rheumatoid arthritis started with a lesser flexion (80°) than those with Osteoarthritis (90°) and the change in flexion score has shown a significant difference of 40 and 20°, respectively. Average post operative range of motion for patient with pre-operative ROM <90° was 110° flexion, whereas in patients with pre-operative ROM >90° flexion, the average post operative ROM was 120° flexion. This shows, the gain in flexion is more in patients with <90° than those with >90° pre-operative flexion. Conclusion: Yes, the pre-operative flexion significantly influenced the post operative flexion and it is a good parameter for predicting the post operative outcome.

New Surgical Approach to Advanced Kienböck Disease

Reconstructive procedures such as proximal row carpectomy or partial arthrodesis have been commonly proposed for advanced Kienböck disease (Lichtmann IIIB to IV). The purpose of this study is to evaluate an alternative surgical technique to advanced Kienböck disease: lunate excision and replacement with pedicled vascularized scaphoid graft and partial radioscaphoidal arthrodesis. The main advantage of the proposed intervention is to preserve mobility while not jeopardizing prime clinical outcomes such as pain. By replacing the devitalized lunate we aim at maintaining midcarpal range of motion, and preventing disease progression with carpal collapse and osteoarthritis of the wrist. Between 2002 and 2008, 13 patients of mean age 41 years (range, 25 to 57 y) were operated using this technique. The surgical act included 3 key steps. First, we excised the lunate, then, filled the generated gap with the rotated scaphoid, using it as a pedicled vascularized autograft. Finally, we performed a partial radioscaphoid arthrodesis. At the final follow-up, none of the intervened patients had pain at rest, and 6 patients could perform nonrestricted daily activities. The average postoperative range of motion in flexion/extension was 70 degrees (range, 55 to 90 degrees), 44% (range, 38% to 54%) of what could be achieved by the contralateral arm, and only 16% (range, 14% to 19%) or 25 degrees (range, 18 to 30 degrees) less than the preoperative range of motion of the same wrist. Grip strength improved by more than 30% (range, 24% to 36%). At an average follow-up of 4 years after surgery, 12 of 13 patients had no radiographic evidence of osteoarthritis or collapse of subchondral bone at the level of the new scaphocapitate joint. At follow-up evaluation, the average DASH score was 14 points (range, 6 to 20). The patients experienced a significant improvement in their functional abilities, achieving good results compared with the conventional techniques. The absence of carpal collapse and good functional results are encouraging.

Treatment of chronic patellar ligament lesion with autograft and v-y quadricepsplasty

ObjectiveReview of the literature concerning the subject and to compare the results of the technique we have been using with the ones reported on the literature. MethodsThis is a retrospective, cross-sectional and observational study. We evaluated the records of patients treated surgically at the Hospital from Hospital Maria Amelia Lins January 1997 to January 2011.The following variables were considered: age, gender, side, degree of injury, mechanism of trauma, associated injuries, time elapsed between injury and surgical procedure, complications, range of motion and muscle strength. ResultsFive patients underwent surgical treatment with the use of autograft semitendinosus and gracilis tendons and V-Y quadricepsplasty. Regarding gender, there was a male predominance (80%). The average age was 35.2 years old. The right side was the most affected (60%). The predominant mechanism of injury was motorcycle accident (80%). All patients had a complete tendon lesion. Time between injury and surgery averaged 10.4 months. Four patients (80%) had had associated injuries. In all patients muscle strength was satisfactory (M4/M5). Wound dehiscence was observed in 01 patient. Average postoperative range of motion was 110°. ConclusionsThese are rare lesions. Stretching the quadriceps is essential to decrease the tension to the reconstructed patellar ligament and patellofemoral joint. Use of a quadriceps transtendon tunnel is an option to prevent fractures. Hypotrophy of the quadriceps is inevitable, however, the resulting force is sufficient for daily living activities.

Tratamento da lesão crônica do ligamento patelar com enxerto autólogo e quadricepsplastia em V-Y

ObjectiveReview of the literature concerning the subject and to compare the results of the technique we have been using with the ones reported on the literature. MethodsThis is a retrospective, cross-sectional and observational study. We evaluated the records of patients treated surgically at the Hospital from Hospital Maria Amelia Lins January 1997 to January 2011.The following variables were considered: age, gender, side, degree of injury, mechanism of trauma, associated injuries, time elapsed between injury and surgical procedure, complications, range of motion and muscle strength. ResultsFive patients underwent surgical treatment with the use of autograft semitendinosus and gracilis tendons and V-Y quadricepsplasty. Regarding gender, there was a male predominance (80%). The average age was 35.2 years old. The right side was the most affected (60%). The predominant mechanism of injury was motorcycle accident (80%). All patients had a complete tendon lesion. Time between injury and surgery averaged 10.4 months. Four patients (80%) had had associated injuries. In all patients muscle strength was satisfactory (M4/M5). Wound dehiscence was observed in 01 patient. Average postoperative range of motion was 110°. ConclusionsThese are rare lesions. Stretching the quadriceps is essential to decrease the tension to the reconstructed patellar ligament and patellofemoral joint. Use of a quadriceps transtendon tunnel is an option to prevent fractures. Hypotrophy of the quadriceps is inevitable, however, the resulting force is sufficient for daily living activities.

Corrective Dome Osteotomy Using the Paratricipital (Triceps-sparing) Approach for Cubitus Varus Deformity in Children

Dome osteotomy has been described extensively in literature to correct posttraumatic cubitus varus deformity in children. Most case series on dome osteotomy using the posterior triceps-splitting approach report a decreased postoperative range of motion (ROM). We prospectively analyzed the results of dome osteotomy using the soft-tissue preserving paratricipital, (triceps-sparing) approach with respect to correction of deformity and preservation of elbow ROM. During 2006 to 2009, 24 children with cubitus varus deformity after supracondylar humerus fracture were treated with a dome osteotomy using the triceps-sparing approach. The follow-up period varied between 22 and 36 months (average, 27.6 mo). The average interval between injury to surgery was 26.7 months. The average age of the patients was 9.2 years. The average preoperative carrying angle (humerus-elbow-wrist angle, HEW) was -17.1 degrees (range, -8 to -30 degrees), whereas the average postoperative carrying (humerus-elbow-wrist) angle was +11.7 degrees (range, -12 to +16 degrees) with a mean correction of 28.8 degrees. The average preoperative ROM in the flexion/extension arc was 126.8 degrees and the average postoperative ROM was 132.1 degrees (range, 110 to 140 degrees). The lateral condylar prominence index changed from an average of -9.5% preoperatively to an average of -15.2% postoperatively. Excellent results were seen in 14 patients, whereas 9 had a good outcome. Supracondylar humeral dome osteotomy using the paratricipital approach for cubitus varus deformity allows correction of deformity, prevents lateral condylar prominence and avoids loss of elbow motion. IV.

Arthroscopic Ulnar Nerve Decompression (SS-54)

To report our results with an arthroscopic technique for ulnar nerve decopression. A retrospective review of a single surgeon series of arthroscopic ulnar nerve releases associated with other arthroscopic elbow procedures. From April of 2007 to January of 2011, fifty nine elbow arthroscopies were performed by the surgeon; sixteen patient hand an arthroscopic ulnar nerve decompression as part of the surgery; no isolated arthroscopic nerve decompressions were performed. All patients were available for clinical and radiographic follow-up at an average of 16 months (range 3-24). Average preoperative range of motion was 25.4o of extension to 112.3o of flexion. Average postoperative range of motion was 9.6o of extension to 130o of flexion, a gain of 15.8o and 17.7o respectively. Thirteen patients remain very satisfied with their elbow surgery. Three patients underwent a subsequent elbow surgery: one total elbow (in a rheumatoid), and two formal ulnar nerve transpositions. Arthroscopic ulnar nerve decompression can be performed successfully. The technique is demanding and revision demonstrates significant scaring around the nerve. One case had a significant neuroma as a result of the arthroscopic procedure. With the ease of an isolated decompression through a small incision, the arthroscopic approach may not be the procedure of choice.

Clinical Utility of Cruciate Retaining Total Knee Arthroplasty with Fourpegged Tibial Baseplate in the Valgus Knee: A Concise Minimum 4 Year Follow-up

Introduction: The four pegged tibial base plate in the cruciate retaining (CR) total knee is a modern design used in the treatment of gonarthritis. This design allows preservation of host bone, smaller incisions, and ease with removal of implant in the revision setting. In this study, we investigate the outcome of the four pegged tibial base plate in the treatment of valgus knee. Methods: We performed a retrospective review of 39 TKA who had a four pegged TKA in 38 consecutive patients with an average of 68 month follow-up (52-98 months). There were 29 females and 9 males, with mean age of 67 (range 27 to 89 years old). Radiographs, clinical notes, and functional scores were evaluated. Results: The average postoperative range of motion was 119 ± 9 degrees, which increased compared to the preoperative range of motion of 101 ± 14 degrees (p<0.0001). Postoperative knee function scores were 95 ± 5, (range 82 to 100). Additionally, the knee scores were 91 ± 14, (range 45 to 100). Survivorship for this cohort with endpoint of revision was 94.8% at a minimum of 4 years. All patients had good coronal and anterior posterior stability postoperatively. There were two complications; one patient was revised for patellar mal-tracking and the other for an incompetent posterior cruciate ligament. Conclusions: To our knowledge, this is the first study reviewing retrospectively the four pegged CR TKA in the treatment of valgus gonarthritis. Our results support the use of the four pegged tibial base plate in valgus knee.

Proximal interphalangeal joint arthroplasty with silicone implants (NeuFlex) by a lateral approach: a series of 51 cases

The aim of this study is to assess outcomes of a lateral surgical approach for proximal interphalangeal joint arthroplasty with NeuFlex(®) silicone implants for primary degenerative osteoarthritis. We reviewed 51 arthroplasties performed on 43 patients. The mean follow up period was 36 months (range 18-42). The average preoperative range of motion (ROM) was 38°. The average postoperative ROM was 63°. In 21/51 (41%) cases, there was an average axial deviation of 17° (range 10-30°). VAS and Quick DASH scores improved. In 5/51 (10%) cases, further surgery was required. Our lateral approach seems to be effective and minimally invasive, providing adequate exposure. Contralateral incision and contralateral ligament reinforcement should be performed, whenever necessary, to improve lateral stability.

Outcome of total knee arthroplasty for end-stage type A hemophilic arthropathy.

Objective To evaluate the outcome of total knee arthroplasty (TKA) for end-stage hemophilic arthropathy, the effectiveness and safety of factor Ⅷ replacement treatment, and the selection of prothesis. Methods Nineteen patients (25 knees) with type A hemophilic arthropathy underwent TKA from June 2003 to April 2009. The average age at index operation was 33.4 years old (range, 18-54 years). The level of coagulation factor for replacement treatment was 100% on operation day, >80% within 3 days after operation, >60% from the third day to the seventh day after operation. Clinical assessment included hospital for special surgery knee score(HSS), pain symptom, range of motion(ROM) and complication. Results Eigh-teen patients(24 knees) were followed-up, and the average duration was 31 months(range, 7-54 months). The average preperative HSS score was 51±14 (31-64), whereas the average postoperative HSS score was 86±9.5 (62-110). The average preoperative ROM was 55°±26.3°(60°-100°), whereas the average postoperative ROM was 82°±18.6°(10°-100°). Flexion contracture had improved from 19°±13°(0°-45°) preoperatively to 2.7°± 3.2°(0°-10°) postoperatively. The average serum factor Ⅷ level was 74.07% between the first day and the fifth day after operation. As for postoperative complication, one had a hemarthrosis and one had a paralysis of common peroneal nerve. One patient underwent revision surgery because of infection of femoral compo-nent 17 months later. Conclusion TKA is an effective treatment for end-stage bemophilic arthropathy of knee joint, it can provide good outcome and improve the quality of life. Reasonable factor Ⅷ replacement is the basis of successful treatment program. Key words: Hemophilia A ; Knee joint; Factor Ⅷ; Arthroplasty,replacement,knee

Total knee arthroplasty for severe haemophilic arthropathy: long‐term experience in Taiwan

A number of articles have investigated the outcomes of total knee arthroplasty (TKA) and causes of prosthetic failure in patients with haemophilic arthropathy. The aims of this retrospective study were to evaluate the clinical and functional outcomes of TKA and causes of prosthetic failure in patients with haemophilic arthropathy. A consecutive series of 35 TKA in 26 patients with haemophilic arthropathy were performed between November 1985 and October 2006 by one experienced surgeon. The mean age at index operation was 34.2 years old (range: 23.4-47 years) and the mean follow-up duration was 82.2 months (range: 12-218 months). Clinical assessment included range of flexion, range of extension and total range of motion (ROM). Functional evaluation comprised pain score and functional score by Dr. Insall's Knee Society Clinical Rating System. The average preoperative ROM was 63.2 degrees with flexion contracture 15 degrees , whereas the average postoperative ROM was 79.8 degrees with flexion contracture 5.5 degrees . Improvement of range of flexion was 7.1 degrees (P = 0.16); improvement of range of extension was 9.5 degrees (P < 0.01). Average increase of total ROM was 16.6 degrees (P = 0.02). Pain score by Knee Society was 7.1 points preoperatively and 48 points postoperatively (P < 0.01); functional score by Knee Society was 42 points preoperatively and 77.1 points postoperatively (P < 0.01). Three patients received manipulations because of an inadequate ROM. Three infection episodes were treated with debridement and one of them received arthrodesis after removal of prosthesis. Two patients received revision TKA. One of them was because of loosening of femoral component. The other one received revision TKA because of insert wear. Though improvement in range of flexion is insignificant in haemophilic arthropathy of knee after TKA, it showed significant increase in total ROM after operation, especially in improvement of flexion contracture. It also showed great pain relief and significant functional gain. Under the circumstance of acceptable infection rate and complication, TKA is an effective method to achieve pain relief and gain better function in patients with haemophilic arthropathy of knee. The data of this study confirm those previously published by many authors.