Knee Function Score Research Articles

Surgical versus non-surgical interventions for treating patellar dislocation.

Surgical versus non-surgical interventions for treating patellar dislocation.

Comparison of patellar anchor fixation graft and graft through patellar tunnel reconstruction of medial patellofemoral ligament in the treatment of recurrent patellar dislocation: A protocol for a meta-analysis of comparative studies.

Recurrent patellar dislocation (RPD) occurs in people who have their own patellofemoral dysplasia and who have not been properly treated after their first patellar dislocation. For RPD where conservative treatment is ineffective, medial patellofemoral ligament (MPFL) reconstruction is the first choice for surgical treatment, but there are various and controversial ways of MPFL reconstruction and fixation. Initially, more scholars adopted the patellar lateral tunneling (PT) approach to contain and stabilize the graft, but with the newer materials and techniques, some experts adopted the lateral patellar anchor fixation (AF) of the graft, which can avoid the collateral damage caused by the patellar lateral tunneling and can obtain the same definite efficacy. Therefore, a meta-analysis must be performed to provide evidence whether there is a difference between AF and PT reconstruction of the MPFL in the treatment of RPD. We will search, with no time restriction, without any restriction of language and status, the time from the establishment of the database to October 2022, on the following databases: PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), Chinese Scientific Journals Database (VIP), and Chinese databases SinoMed (CBM) electronic databases. The electronic database search will be supplemented by a manual search of the reference lists of included articles. We will apply the risk-of-bias tool of the Cochrane Collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software. This systematic review and meta-analysis will evaluate the functional outcomes of the two fixation modalities, AF and PT, in reconstructing MPFL for RPD. The findings of this study will provide a basis for clinical judgment of whether there is a difference between the two forms of AF and PT reconstructed MPFL for RPD.

Diffuse pigmented villonodular synovitis treated with arthroscopic total synovial peel

BackgroundDiffuse pigmented villonodular synovitis (PVNS) is prone to recurrence after surgery, and it is difficult to achieve a long-term complete cure.ObjectiveTo reduce the recurrence rate of PVNS, the author pioneered the arthroscopic total synovial peel (ATSP).MethodsFrom March 2014 to July 2020, a total of 19 patients (6 males and 13 females) with diffuse PVNS of the knee were treated in our department and underwent ATSP. It’s ‘peel’ rather than simple excision. This method is similar to peeling bark. Relapse rates and functional scores were determined, with follow-ups ranging from 12 to 72 months, on average 36 months.ResultsTreatment efficacy was assessed by imaging and functional scores. Imaging results indicated a recurrence rate of 10.5%. In patients without recurrence, the visual analog score (VAS) decreased from 4.76 ± 2.02 preoperatively to 1.56 ± 1.15 postoperatively. The Tegner-Lysholm knee function score (TLS) score increased from 67.76 ± 15.64 preoperatively to 90.32 ± 8.32 postoperatively. Compared with the literature, ATSP significantly reduces the postoperative recurrence rate of diffuse PVNS. The preliminarily findings suggest that this approach could greatly reduce the recurrence rate of postoperative PVNS in follow-up studies.ConclusionThis approach may be a viable option for treating diffuse PVNS via arthroscopy and is worthy of clinical consideration.

Application of SolidWorks software in preoperative planning of high tibial osteotomy.

Open-wedge high tibial osteotomy (HTO) is a common surgical treatment for medial osteoarthritis in young and active patients. The accuracy of osteotomy is closely associated with postoperative efficacy. The accuracy of digital preoperative planning is higher than that of the preoperative manual measurement and several computer software with varying accuracy and convenience are used for digital preoperative planning. This study aimed to use the SolidWorks software for HTO preoperative planning and to determine its accuracy and reliability in HTO preoperative planning. We reviewed the data of 28 patients with 54 with medial compartment knee arthritis who underwent open-wedge HTO preoperative planning using SolidWorks between June 2019 and March 2021. The standard anteroposterior standing whole-leg radiographs were assessed before and 6 weeks after the surgery. The correction angle, weight-bearing line (WBL) ratio, mechanical femorotibial angle (mFTA), and medial proximal tibial angle (MPTA) before and after the surgery were compared. The clinical results were evaluated using the Knee Society score. At 6 weeks after the surgery, the WBL ratio was corrected from 16.8% to 50.5%, mFTA was corrected from 6.4° varus to 1.2° valgus, and MPTA was corrected from 83.4° to 89.3°. No significant difference was observed between the predicted correction angle before the surgery and the correction angle measured 6 weeks after the surgery (t = -1.745, p = 0.087). The knee score and function score of Knee Society increased from 76.4 and 80.7 before surgery to 95.0 and 95.7, respectively. The SolidWorks software showed high accuracy and reliability in preoperative planning of open-wedge HTO in patients with medial compartment knee arthritis.

Midterm Outcomes of Posterior Cruciate Ligament Substituting Total Knee Arthroplasty

Objective: In the present study, it is aimed to retrospectively investigate and present the midterm results of the cases with posterior cruciate ligament (PCL) substituting total knee arthroplasty. Materials and Methods: In this study, we included a total of 61 patients with 80 knees who underwent PCL-substituting total knee arthroplasty between July 2006 and June 2012. Results: 52 patients were female and 9 were male. The mean age of patients was 65.4 (42-85) years and the mean follow up period was 32.6 (12-72) months. Patients were evaluated according to the American Knee Society Score for knee score and knee functional score. Radiological evaluation was performed according to Total Knee Arthroplasty Radiological Evaluation criteria. Knee score was 38-71 (mean 43.7) prior to the surgery and 78-100 (mean 95) subsequently. 69 knee (86,25%) had perfect knee scores and 11 knee (13.75%) had good scores. Functional score was 10-60 (mean 35.08) prior to the surgery and 60-100 (mean 82.2) subsequently. In the evaluation according to the functional knee score, we obtained perfect results in 45 knee (56.25%) and good results in 29 knees (36.25%) and moderate results in 6 knees (7.5%). Patients had a mean 9.7o varus (8o valgus – 20o varus) prior to the surgery and mean 4.75o valgus (2o varus – 10o valgus) alignment was obtained subsequently to surgery. In 1 case revision arthroplasty was performed due to late deep infection. In 1 case insert replacement was performed due to insert fracture due to trauma. As a result of our PCL substituting total knee arthroplasty applications, we obtained 86.25%perfect knee score and 56.25%perfect functional score. Conclusion: PCL substituting total knee arthroplasty is a favorable orthopedic surgical intervention when preformed with adequate preoperative preparations and cautious surgical techniques with appropriate patient choice.

Long-Term clinical results of patellofemoral arthroplasty for isolated patellofemoral osteoarthritis.

The aim of this study was to explore the clinical outcomes and long-term survival of patellofemoral arthroplasty in treatment of isolated patellofemoral osteoarthritis. We retrospectively studied a total of 46 type Y-L-Q PFAs that were designed at our institution in 38 patients. Implant survivorship was analyzed with a follow-up of 18.9-29.6years. Knee Society Score (KSS), Oxford Knee Score (OKS), and University of California Los Angeles activity scale (UCLA) were used to assess functional outcomes. The implant survivorship was 83.6% at 15years, 76.8% at 20 years, and 59.4% at 25years 14 PFAs in 12 patients were revised into total knee arthroplasty at 16.0 ± 6.7years; 13 for progression of tibiofemoral osteoarthritis and one for polyethylene wear. The mean Knee Society Score objective scores and functional scores were 73.0 ± 17.5 (range, 49-95) and 56.4 ± 28.9 (range, 5-90), respectively. The mean Oxford Knee Score was 25.8 ± 11.5 (range, 8-44). Type Y-L-Q patellofemoral arthroplasty can be an effective method for treating isolated patellofemoral osteoarthritis with satisfactory survival.

Midterm Outcomes of Unicompartmental Knee Arthroplasty for the Treatment of Knee Medial Compartment Osteoarthritis: A Retrospective Study.

Many surgeons avoid performing unicompartmental knee arthroplasty (UKA) due to various concerns. Cohort studies showing the satisfactory outcomes of UKA can convince surgeons to use this technique. In this study, we report the mid-term outcomes of UKA in a series of patients with medial compartment knee osteoarthritis. Seventeen patients with unicompartmental degenerative joint disease of the knee that underwent UKA and were available for final evaluation were included. The mean age of the patients was 63 ± 5.1 years. The mean follow-up of the patients was 37.2 ± 18.3 months. The outcome measures were the Oxford Knee Score (OKS), Knee Society Score (KSS) for knee score and knee function, Knee injury and Osteoarthritis Outcome Score (KOOS), knee range of motion (ROM), and satisfaction rate on a 5-point Likert scale. In the last follow-up visit, the mean of OKS and knee score section of the KSS were 44.6 ± 3.2 and 83.8 ± 2.1, respectively. The mean knee function section of the KSS was measured at 98.2 ± 7.2. The mean KOOS score and the mean knee ROM were 84 ± 9.4 and 134.4 ± 7º, respectively. The mean VAS for pain was 8.9 ± 1.1 (range 8-10) before the operation and 1.2 ± 0.8 (range 0-2) at the last follow-up. All the patients were very satisfied (n=14) or satisfied (n=3) with the results. No postoperative complication or reoperation was recorded during the follow-up. Unicompartmental knee arthroplasty provides satisfactory outcomes and a high survival rate, at least in mid-term follow-up. These findings suggest increased use of UKA in future workups.

Associations between postural orientation errors in patients undergoing rehabilitation for ACL reconstruction and future patient-reported outcomes: An explorative study

ObjectiveTo investigate associations between postural orientation errors (POEs) in patients undergoing rehabilitation for anterior cruciate ligament reconstruction (ACLR) and patient-reported outcomes (PROMs) at 2-year follow-up. DesignProspective cohort study. MethodsFifty-three participants (mean (SD) 27 (6.5) years, 24 women), (mean (range) 7 (4–10) months post ACLR) were included. At baseline, all participants were visually assessed for POEs using a validated test battery. The POE subscales Activities of Daily Living and Sport were used in the analysis. At 2-years, the following PROMs were collected: Global knee function, Knee injury and Osteoarthritis Outcome Score, ACL Quality of Life (QoL), Knee Self-Efficacy Scale (K-SES), and ACL Return-to-Sport after Injury scale. ResultsTwenty-one participants answered the questionnaires at 2 years (7 women and 14 men). Worse baseline POE Sport was associated with worse scores on K-SES (rs ​= ​–0.435, p ​≤ ​0.049) and ACL-QoL (rs ​= ​−0.467 to −0.576, p ​≤ ​0.038) at follow-up. No statistically significant associations were observed between POEs and the other PROMs. ConclusionPostural orientation during the rehabilitation phase may be important for future knee self-efficacy and knee-related QoL after ACLR. Given the small population and low response rate, this result needs to be confirmed in future research.

Outcome of Total Knee Replacement in Morbid Obese Patients

Aim: The purpose of our study was to determine the outcomes of total knee replacement in morbidly obese patients. Methodology: This prospective analysis was carried out on 128 morbidly obese patients (BMI> 40 kg/m2) in the Department of Orthopedic Surgery, Federal Govt. Polyclinic Hospital (FGPC) Islamabad, Mardan Medical Complex, Mardan and Bacha Khan Medical Complex, Swabi for the duration from January, 2021 to June, 2022. Demographic details, anthropometric parameters, and radiological assessment were recorded. Pre and post-operative radiological assessments included alignment, implant position, and radiolucent lines presence around the implant were compared. Outcome of TKR such as pre and post-operative functional score, knee society score, age, diagnosis, gender, laterality, and type of prosthesis were assessed and compared. SPSS version 25 was used for data analysis. Results: Of the total 128 TKR in morbid obese patients, the incidence of unilateral and bilateral TKR was 10 (7.8%) and 118 (92.2%) respectively. The overall mean age of the patients was 62.00 ± 8.12 years. Out of 126 TKR patients, there were 11 (8.6%) males and 117 (91.4%) females. Out of 10 unilateral TKR groups, males and females were 4 (40%) and 6 (60%) respectively. In the bilateral TKR group, there were 7 (5.9%) males and 111 (94.1%) were females. The mean BMI was 42.84 ± 3.46 kg/m2 with a range of 40-60 kg/m2. Based on Knee Society Scores and Functional Scores, Pre-operative mean knee score and functional score was 26.4 and 48.8, p=0.01 compared to post-operative 83.7 and 74.2, p=0.07 respectively. A higher prevalence for post-operative radiolucent lines was 28% against pre-operative 9%, p=0.01 were observed. During follow-up, the complications rate was 17.2% (n=22). Post-TKR complications such as superficial wound infection, deep joint infection, and deep vein thrombosis was found in 12.5% (n=16), 1.6% (n=2), and 3.1% (n=4) respectively. Conclusion: Our study found that prior to total knee replacement, patients with BMI>40 kg/m2 should lose weight to maintain weight reduction criteria. Knee arthroplasty's growth rate and epidemiological changes in morbid obese patients were the particular issues regarding total knee replacement highlighted in the present study. Based on our study, morbidly obese patients could be suitable candidates for total knee replacement. Morbid obese patients should be counseled. Keywords: Total Knee Replacement, Unilateral, Bilateral, Morbid Obese Patients

Distal tibial tubercle-high tibial osteotomy with assistance of modifiable spreader in the treatment of varus knee osteoarthritis: A retrospective observational study

As one of the knee preservation surgical approaches, good clinical outcomes of high tibial osteotomy were reported. Aims of this study were to analyze the clinical outcome and pre- and postoperative radiographical parameter and knee functional score between distal tibial tubercle high tibial osteotomy (DTTHTO) and open wedge- high tibial osteotomy (OWHTO) in patients with varus knee osteoarthritis after more than 1 year following-up. A total of 194 consecutive patients in our joint center from March 2016 to October 2021 were enrolled, according to the surgical method, patients were divided into DDTHTO and OWHTO groups. Radiographic parameters of Kellgren-Lawrence grading, hip-knee-ankle angle, weight bearing line ratio and medial tibial plateau angle, knee functional score of American knee society (AKS) score, western Ontario and McMaster universities arthritis index (WOMAC) score, visual analogue score (VAS) were introduced to evaluate clinical outcome for patients who received DDTHTO and OWHTO. There were 103 knees and 89 knees in the OWHTO and DTTHTO group, respectively. Mean weight bearing line ratio for OWHTO and DTTHTO were 25.1 ± 11.7 and 25.2 ± 12.0% respectively, medial tibial plateau angle and hip-knee-ankle angle angle demonstrated that all patients in the present study inherited a varus angle ranges from 3.4° to 9.5°. Preoperative AKS, WOMAC and VAS were 68.4 ± 5.7 versus 69.0 ± 5.9, 109.3 ± 15.0 versus 107.7 ± 14.0 and 6.8 ± 1.0 versus 6.9 ± 0.8, and there was no significant difference between 2 groups (P > .05). Mean postoperative AKS and WOMAC score for patients in both OWHTO and DTTHTO group were significantly improved, moreover, postoperative VAS of DTTHTO patients was lower than that in OWHTO group (P < .05). When comparing the operation time, intraoperative blood loss and bone union time, DHHTO group shows a superiority in these variables over patients in OWHTO (121 ± 29.6 vs 145.7 ± 35.2 minutes, 115.0 ± 20.8 vs 103.3 ± 17.3 mL, 13.7 ± 4.1 vs 12.0 ± 2.8 weeks; P < .005) and incidence of complication was lower for DTTHTO group. DTTHTO in patients with varus knee osteoarthritis has good clinical outcomes, and it can achieve a better postoperative alignment. Operation time and surgical trauma were also less in patients who underwent DTTHTO.

Effects of anterior cruciate ligament rupture and reconstruction on sexual activity of male patients.

This study aims to investigate the impact of anterior cruciate ligament (ACL) injury and its reconstruction on men's sexual functions. Between February 2016 and November 2019, a total of 27 sexually active male patients (mean age: 33.7±4.3 years; range, 26 to 40 years) who were operated for ACL injury at least six months after trauma were retrospectively analyzed. Erectile function was assessed using the International Index of Erectile Function questionnaire (IIEF) and knee function was evaluated by using the International Knee Documentation Committee (IKDC) Scoring System, Lysholm Knee Scoring Scale, and Tegner Activity Score. Sexual and functional questionnaires were applied to evaluate three different periods retrospectively. These periods were as follows: the period before an ACL injury (Period I); the period in which the patient suffered from an ACL injury, but not operated (Period II), and the period after the ACL reconstruction (Period III). There was a statistically significant difference in the comparison of knee function scores according to three different periods. Sexual function scores were significantly different between Periods I and II, and between Periods I and III. However, although the IIEF value was higher in Period III than in Period II, no statistically significant difference was observed. A moderate correlation was found between the sexual functional scores of IIEF and IKDC scores. Our study results suggest that ACL injury affects sexual functions adversely. The change in sexual functions after ACL surgery depends on the success of surgery. While deciding on the treatment of ACL injury, the patient's sexual life should be questioned along with his expectations.

Impacts of Circular Frame Fixator (Ilizarov) on Management of Compound fractures of proximal tibia

Aim: To determine the outcome of patients diagnosed with complex fractures of tibial plateau with associated soft tissue compromise treated by using Ilizarov fixator. Study design: Prospective observational study. Place and period of study: Orthopaedic unit, Chandka Medical College SMBBMU Larkana from January 2021 to December 2021 Methods: Patients diagnosed with complex tibial plateau fracture with associated soft tissue compromise fulfilling inclusion criteria were enrolled in study. All participants were managed with Ilizarov fixator and it was removed when fracture was united clinically and radiologically. Outcome of patients was evaluated on the basis aggregate score of knee society score and knee functional score at 6month follow up. Results: Twenty seven consecutive patients met the inclusion criteria, of which 19(70.37%) were male and 8(29.7%) were female. Average age of patients was 32.37 years. All fractures healed by the end of the 4th month. Ring fixator was removed routinely at 16th weeks after initial surgery in all patients. Transient peroneal nerve injury was found in 2 patients; no patients developed deep vein thrombosis, whereas pin site infection was most common complication and occurred in 5 patients (18.5%). According to knee society score results were excellent in 15(55.55%) patients, good in 08(29.62%) patients, fair in 03(11.11%) in patients and poor in 01(3.70%) patient. Practical implication most of proximal tibial plateau fractures with soft tissue compromise are kept under observation till the soft tissue status become favorable for open reduction and internal fixation, while fixing these type of fracture with Ilizarov fixator one can provide early relief to patients and results of this study will be help for operating surgeons while managing complex proximal tibia fractures. Conclusion: complex tibial plateau fracture can be effectively treated with Ilizarov fixation method without any complication, when exposed reduction and interior fixation with plate is contraindicated due to compromised soft tissue. Keywords: Tibial plateau, fractures, Ilizarov, fixation method, outcome, soft tissue compromise,

Quality of life of patients with ACL reconstruction is interrelated with sporting activity and significantly improved when their concomitant meniscal rupture has been repaired. A long-term follow-up study

The goal of the present study is to report patient-reported outcomes after anatomic ACL reconstruction with a hamstrings autograft, to investigate how a concomitant meniscal injury and its management could affect these outcomes and to identify a possible correlation between quality of life and activity levels at a minimum of 10-years follow-up. Patients from a single center, treated with a unilateral anatomic ACL reconstruction with or without a concomitant meniscal injury, between 2003 and 2011 were investigated. Patients were asked to provide the following validated patient-reported outcome measures (PROMs): the International Knee Documentation Committee Subjective Knee Function (IKDC-SKF) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Lysholm knee score, the Tegner Activity Scale, the EQ-5D-5L questionnaire and a patient acceptable symptom state (PASS). Sex, age, BMI, and meniscal status were examined as patient-specific risk factors regarding long-term activity and quality of life. Mean follow-up was 13.2 years. In a total sample of 131 patients, response rate was 81% and finally, 106 patients, 90 men (85%) and 16 women (15%) were enrolled in the study. Re-tear rate was 2.8%. The majority (90.5%) of patients considered their knee state, satisfactory during follow-up. Mean IKDC score was 80 ± 16, mean KOOS score was 87 ± 15, mean Lysholm score was 90 ± 11, mean Tegner score was 5.6 ± 1.9 and mean EQ-5D-5L score was 91 ± 14. Patients who had been treated with meniscectomy had statistically significantly lower scores in all PROMs except for the Tegner score and the EQ-5D-5L score, when compared to patients treated with meniscal repair. Patient sex, age, and BMI did not affect patient-reported outcomes. There was a statistically significant, strong positive correlation between quality of life and activity levels. Patients have few or no symptoms and consider their knee state satisfactory, 13.2 years after surgery. Patients having undergone meniscal repair have improved PROMs compared to those treated with meniscectomy. Participation in sporting activities is interrelated with quality-of-life and does not seem to be affected by sex, BMI and age.

The influence of early virtual reality intervention on pain, anxiety, and function following primary total knee arthroplasty

BackgroundTotal knee arthroplasty (TKA) is one of the most popular surgeries in the orthopedic field. One of the reasons for a failed TKA is pain and difficulty to return to normal function. A pain control method that is becoming more and more popular is the use of virtual reality (VR). We aimed to examine VR intervention in the immediate post-operative physiotherapy following TKA. MethodsThis prospective randomized-controlled study recruited a total of 55 patients undergoing primary TKA in a single institute, operated by three surgeons. They were assigned either study group or control group. Both groups were treated with conventional physiotherapy and CPM equipment (Continuous passive motion device), the study group received additional VR modality. Both groups completed a series of questionnaires prior and after the intervention: State-Trait Anxiety Inventory (STAI) questionnaire (used to diagnose anxiety), Visual analog scale (VAS) for pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) (knee function score). ResultsThe average age was 70 years-old with equal distribution of male and female. Both groups showed a decrease in pain and anxiety following the intervention (p value < 0.05) but there was no difference between the groups (p value > 0.05 for all parameters). The was no difference in the WOMAC scores in the six-month post-operative examination between groups (p-value = 0.653). ConclusionsVirtual reality intervention in the immediate post-operative period following total knee arthroplasty decrease pain and anxiety but did not influence the pain, anxiety, and long-term function results more than conventional physiotherapy.

Return to Sport After Revision ACL Reconstruction: A Comparative Cohort Study of Outcomes After Single- Versus Multiple-Revision Surgeries.

The return-to-sport rate at 2 years after multiple-revision anterior cruciate ligament (ACL) reconstructions has not been evaluated. It was hypothesized that patients who undergo multiple-revision ACL reconstructions would have a lower return-to-sport rate at 2 years after surgery than those who undergo a single-revision reconstruction. Furthermore, it was hypothesized that the multiple-revision group would have lower functional scores. Cohort study; Level of evidence, 3. A single-center cohort study in patients who underwent revision ACL reconstruction was begun in 2012. This study included 2 groups: Patients who underwent a single revision, and those who underwent multiple revisions. The main evaluation criterion was the return to sport at the 2-year follow-up. The secondary criteria were the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and ACL-Return to Sport after Injury (ACL-RSI) functional knee scores at the 1- and 2-year follow-ups. A total of 322 patients (single-revision group: n = 302; multiple-revision group: n = 20) were included. A significant difference in the percentage of patients who stopped all sports activity was found between the 2 groups at 2 years (single-revision group: 19.4%; multiple-revision group: 50%). The return-to-sport rate at the same or lower level of performance was higher in the single-revision group as well (17% vs 14.3% for return at the same level; 45.6% vs 14.3% for return at a lower level; P = .03). At the 2-year follow-up, the functional scores of the single-revision group were significantly higher those than in the multiple-revision group: IKDC (77.7 ± 13.82 vs 64.79 ± 15.22; P < .001), KOOS (72.66 ± 17.63 vs 52.5 ± 15.64; P < .001), Lysholm (84.05 ± 11.88 vs 72.5 ± 13.49; P < .001), and ACL-RSI (52.34 ± 21.83 vs 46.43 ± 14.8; P = .0036). Only a small percentage of patients returned to the same level of sport after single- revision and multiple-revision ACL reconstruction, yet significantly more in the former. More patients who underwent multiple revisions gave up their sport. Functional scores were higher for single-revision than multiple-revision surgeries.

Patients with Kashin-Beck Disease Obtained Lower Functional Activities but Better Satisfaction Than Patients with Osteoarthritis After Total Knee Arthroplasty: A Retrospective Study.

Increasingly, patient satisfaction after total knee arthroplasty (TKA) is being recognized as an important measure of health-care quality in osteoarthritis (OA) patients. But satisfaction after TKA has not yet been reported in Kashin-Beck disease (KBD). We aim to examine satisfaction and clinical efficacy of TKA in the treatment of OA and KBD. Retrospectively review of 37 KBD patients (45 knees) and 52 OA patients (58 knees) who underwent TKA from January 2015 to January 2017. Data of outcome measures such as Knee Society knee score (KSKS) and function score (KSFS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and radiographic evaluation were collected preoperatively and during the last follow-up. Satisfaction was compared using the 2011 Knee Society Scoring System. There were no differences in age, gender, BMI and Follow-up time. KBD patients had significantly worse preoperative range of motion, KSKS, and mechanical lateral distal femoral angle (mLDFA) compared with OA patients (P < 0.05). At the last follow-up, the KSKS, KSFS, WOMAC score, and radiographic parameters of all patients significantly improved (P < 0.05), but the satisfaction was higher in KBD patients than in OA (P < 0.05). Further analysis showed that KSFS, WOMAC total, pain, stiffness, and function scores were significantly worse for KBD (P < 0.05). Patient satisfaction was greater but clinical outcomes were inferior in KBD than in OA. This study also demonstrated that TKA is an effective surgical procedure for KBD, but how to improve functional outcomes needs to be further studied.

Functional Outcome of Hybrid Illizarov Technique in patients with Complex Tibial Plateau Fractures

Background:Tibial fractures are the most common long bone fracture, with approximately 25% being open. The majority of open tibial fractures result from a high velocity trauma, such as a motorcycle accident, or a low energy, torsional type injury, such as skiing. They are complex fractures to treat because of the lack of soft tissue coverage and blood supply of the tibial shaft. Aim: To determine the functional outcome of hybridillizarov technique in patients with complex tibial plateau fractures Study Design: Descriptive case series. Place of Study: Orthopedics Surgery Department, Jinnah Hospital, Lahore. Duration of Study: Study was carried out over a period of six months from 28-07-2021 to 28-01-2022 Methods: All the 73 patients fulfilling the selection with complex tibial plateau fractures of Schatzker's type V and VI were enrolled. Informed consent and demographic information were recorded. All the patients were evaluated for injuries, haemodynamically stabilized. Bone grafting and minimal internal fixation with cc screws was done in severely comminuted fractures. The functional results were measured by Rasmussen’s knee functional score (as per operational definition). Results: Distribution of the functional outcome of the patients was done, it showed that out of 73 patients 20(27.4%) were in excellent outcome, 41(56.2%) were in good outcome, 7(9.6%) were in fair outcome, 5(6.8%) were in poor. Conclusion: Based on our results, the use of hybrid illizarov fixation for the treatment of complex tibial plateau fractures is safe and effective in terms of low rates of complication and good functional results. Keywords: Functional outcome, Tibia plateau fracture, Hybrid ilizarov.

Outcomes of Distal Femur Fractures Treated with Retrograde Indigenous Intramedullary Supracondylar (IMSC) Nailing

Introduction Fractures of the distal femur are complex injuries that pose a challenge to orthopaedic surgeon. Significant advances have been made in treatment of these fractures. Out of various options for surgical treatment, retrograde intramedullary nailing has several benefits compared to other methods of fixation. Amongst the routinely available IMSC nails which have a specific design, we used an indigenous IMSC nail with unique design. Materials And Methodology We conducted a retrospective study among 40 patients with distal femur fractures treated with this indigenous IMSC nail in our institute from May 2019 to October 2021. The patients were followed up in outpatient department till June 2022. Data was retrieved from case record forms and hospital information computer software. The study was conducted after obtaining permission from institutional review board. Results All the patients in our study were assessed using knee society score and functional knee score. Average knee society score at final follow up was 88.75/100 and average functional knee score at final follow up was 86.50/100 which showed excellent results. The results were better for extra-articular fractures. Average operative time, blood loss, time for radiological union and rate of complications were considerably less. Discussion Retrograde intramedullary nailing has been developed in order to address previous problems associated with distal femur fracture fixation. It has several advantages over plate fixation. Indigenous IMSC nail used in our study has added benefits over the routine IMSC nail due to its structure, number of screw holes in the distal part of nail, alignment of screw holes inside nail and unique thread design of the screws. Thus, it provides multi-planar fixation of fracture rather than in only one plane as achieved by routine IMSC nail giving excellent rotational stability to bone-implant construct.

Optimized Tourniquet Use in Primary Total Knee Arthroplasty: A Comparative, Prospective, and Randomized Study

BackgroundThe results of recent studies investigating tourniquet (TNQ) use for knee arthroplasty are controversial. Therefore, this study aimed to compare patients undergoing total knee arthroplasty who did not have a TNQ to those in whom an optimized TNQ protocol was applied. MethodsWe prospectively evaluated 127 patients who had knee osteoarthritis who had undergone total knee arthroplasty and randomized them into two groups: “without TNQ” and “optimized TNQ” (TNQ inflation before skin incision, deflation after cementing, with pressure one hundred millimeters of mercury above the systolic blood pressure, and without articular suction drain usage). The means of surgery and TNQ duration, blood loss, number of blood transfusions, degree of pain, edema, range of motion (ROM), functional score over time, and postoperative complications were compared between the groups. Statistical significance was set at P < .05. ResultsNo significant differences were found in terms of surgical timing, blood loss, thigh and knee pain, edema, ROM, functional scores, and complications between the “without TNQ” and “optimized TNQ” groups. ConclusionThe use of an optimized TNQ in primary total knee arthroplasty presents similar clinical results to surgery without a TNQ and did not increase the incidence of postoperative complications. Its use allowed surgery to occur with the benefits of a clean and dry surgical field provided by TNQ without increasing procedure-related comorbidities.

Intra-Articular Leukocyte-Poor Platelet-Rich Plasma Injections for Japanese Patients With Osteoarthritis of the Knee: A Three-Year Observational Retrospective Study After Phase 1 and Phase 2a Trials.

We have previously confirmed the safety and feasibility of intra-articular (IA) platelet-rich plasma (PRP) injections in Japanese patients with osteoarthritis (OA) of the knee. This study aimed to investigate the clinical and radiological outcomes in patients who were followed up for three years. Nine patients were evaluated in this observational study. All the patients were women with a mean age of 60.6 years. PRP was prepared by single centrifugation and classified as leukocyte-poor (LP)-PRP, and was administered via three IA injections at weekly intervals. Patients were evaluated at baseline and final follow-up using the Kellgren-Lawrence (KL) grade and the Japanese Orthopedics Association (JOA) score. The need for additional treatment was also investigated at the final follow-up. At a mean follow-up of three years, the JOA score improved from 75 points (p) to 83.8 p. The sub-categorical scores changed as follows: gait, 23.1-26.9 p; stairs, 12.5-17.5 p; range of motion, 30-30 p; and swelling, 9.4-10 p. While the KL grade was maintained in six patients, it progressed in two patients from I to II and II to III, respectively. Two patients received additional treatment at the final follow-up. At the final follow-up, the functional knee score, especially gait and the ability to go up and down the stairs, improved in six out of eight patients without additional treatment. These results suggest that LP-PRP injections produced safe outcomes without OA-worsening in most patients at three-year follow-up.