International Knee Society Score Research Articles

Prior medial meniscus arthroscopy is not associated with worst functional outcomes in patients undergoing primary total knee arthroplasty: A retrospective single-center study with a minimum follow-up of 5 years.

There have been controversial studies on the impact of prior knee arthroscopy (KA) on outcomes of total knee arthroplasty (TKA). The purpose of this comparative study is to investigate the impact of prior KA of medial meniscus on patients undergoing TKA by evaluating the International Knee Society Score (IKS), the complications, and revisions. This retrospective study reviewed 84 patients with TKA who had undergone prior KA of the medial meniscus and compared them to 84 cases, without a history of prior KA as a control group. Outcomes were assessed with the original IKS scores and complications. The mean follow-up was 8years. There was no significant difference between groups with respect to demographics, or pre-operative IKS. The mean pre and postoperative IKS was not different between groups. The all-cause reoperation, revision, and complication rates of the KA group were not significantly higher than those of the control group. The present study seems to reveal that previous KA of the medial meniscus does not negatively affect a subsequent TKA. Nevertheless, larger studies may be necessary to confirm this observation.

Metal ion release after hip resurfacing arthroplasty and knee arthroplasty: a retrospective study of one hundred ninety-five cases.

Hip arthroplasty with metal-on-metal bearings like hip resurfacing results in the release of metallic ions. In parallel, like every metallic implant, knee arthroplasty implants undergo passive corrosion. We analyzed blood levels of cobalt and chromium ions in patients who have a hip resurfacing arthroplasty and compared them to patients who have undergone knee arthroplasty at a minimum follow-up of one year. The hypothesis was that there is no difference in the ion release between hip resurfacing and knee arthroplasty. Sixty-three patients who underwent knee arthroplasty were compared to a cohort of 132 patients who underwent hip resurfacing. The blood levels of cobalt and chromium ions were determined preoperatively and at six and 12 months postoperatively and then compared between groups. We analyzed the relationship between ion release and the change in clinical outcome scores (Harris Hip score, Oxford Hip score, Merle D'Aubigné Postel score, Oxford Knee score, International Knee Society score), the BMI, sex, physical activity, implant size and inclination of the acetabular implant (hip resurfacing patients only). Mixed linear models were used to assess the changes in ion blood levels over time. The cobalt blood levels were higher in the first 6 months in the resurfacing group (0.87 ug/L vs 0.67 ug/L; p = 0.011), while it was higher in the knee arthroplasty group at 12 months (1.20 ug/L vs 1.41 ug/L; p = 0.0008). There were no significant differences in chromium levels during the follow-up period. The increase in metal ion release after knee arthroplasty is as high as after hip resurfacing at the oneyear follow-up. The monitoring of this parameter probably should not be recommended in case of good clinicals outcomes.

Preoperative flexion contracture does not affect outcome in total knee arthroplasty: A case-control study of 2,634 TKAs

BackgroundOne issue in total knee arthroplasty (TKA) is management of preoperative flexion contracture, which may be associated with poor functional outcome. AimThe aim of this study was to compare functional results in TKA with or without preoperative flexion contracture, treated according to a standardized algorithm of tissue release and bone cut. Patients and methodA single-center retrospective case-control study was performed on prospectively collected data for the period 1987–2016. Patients with >10̊ flexion contracture were assigned to the “contracture” group and associated to a selected control group at a ratio of 1:4. Clinical analysis used pre and post-operative International Knee Society (IKS) scores. The significance threshold was set at p<0.05. ResultsEight hundred and forty-nine cases and 3,304 controls were included, comprising a total of 2,838 male and 1,315 female participants. Mean preoperative extension deficit was 13̊±6̊ in the contracture group and 1̊±2̊ in controls. Preoperative IKS total and functional scores were significantly poorer in the contracture group (38±18 and 54±20) than in controls (52±16 and 59±19) (p<0.001). Postoperatively, the two groups did not significantly differ in IKS functional score (77±22 vs. 79±21, p=0.143). There were differences in IKS knee score (87±12 vs. 88±13, p=0.006) and maximal flexion (114̊±14̊ vs. 119̊±13̊, p<0.0001) that were statistically, but not clinically, significant. DiscussionA systematic standardized algorithm for surgical treatment of flexion contracture during primary total knee arthroplasty provided clinical outcomes similar to those of patients without preoperative flexion contracture. Level of evidenceIII; case-control study.

Beneficial effect of a zirconium-nitride-coated implant in total knee arthroplasty revision for suspected metal hypersensitivity

IntroductionRevision of total knee arthroplasty (rTKA) for suspicion of metal hypersensitivity (MHS) may require hypoallergenic implants. Results for coated implants have not been reported. The aim of the present study was to assess short-term results and survival of rTKA for MHS using a multilayer implant coating. HypothesisMultilayer implant coating improves functional results in rTKA, with survival comparable to primary coated implants. Material and methodsA single-center retrospective observational study included 28 patients (30 knees) undergoing rTKA for MHS using a coated implant between May 2011 and November 2016. Exclusion criteria comprised implant malpositioning and history of infection in the affected knee. Clinical and radiological results were assessed on the International Knee Society (IKS) and SF-36 functional scores and Ewald radiological score. Survival was calculated on Kaplan-Meier estimation. ResultsMean follow-up was 3.8 years. Mean IKS score increased by 40.2 points (40%) [range, 28.1–52.3] (p<0.05). Mean range of motion increased by 17° [range, 9.5–24.5°] (p<0.05). Mean physical and mental SF-36 components were respectively 44.7 and 46.1. Survivorship was 93%. DiscussionThere was significant functional improvement after rTKA for MHS. There were no short-term complications related to the zirconium nitrate coating. However, studies with longer follow-up will be needed for confirmation. Level of evidenceIV; retrospective study.

CORIN KneeTec DeepDishTM: Functional outcomes after a follow-up of 12 months and comparison with the STRYKER Triathlon PS.

Several competing concepts of anteroposterior stabilization have been developed for total knee arthroplasty (TKA), with an overall great success despite some differences in terms of clinical or radiological outcomes. The CORIN KneeTec DeepDish TM is a novel mobile-bearing implant, stabilized with an ultra-congruent deep-dish poly- ethylene insert. The aim of the present study was to report clinical and radiological outcomes of a series of patients who received the KneeTec DeepDish TM after a follow-up of 12 months, and to compare them to those of a comparable series of patients who received the STRYKER Triathlon ® posterior- stabilized. This was a retrospective comparative cohort study (level of evidence III). Demographic data, radiographic data and range of motion (ROM), as well the International Knee Society score and Oxford Knee Score were collected pre-operatively, and after a follow-up of 12 months. 106 KneeTec DeepDish TM and 80 Triathlon ® PS were evaluated at follow-up. Patients who received the KneeTec DeepDish TM had significant improvement in ROM, radiographic and clinical outcomes. There were no significant differences between the cohorts in terms of ROM, radiographic and clinical outcomes, as well as antero-posterior stability. This study is the first to report the 12-month outcomes of the CORIN KneeTec DeepDish TM. The novel KneeTec DeepDish TM achieved comparable ROM, radiographic and clinical outcomes to the Triathlon ® PS after 12 months. Further studies will be necessary to evaluate the mid- to long-term outcomes of the KneeTec DeepDish TM .

Similar outcomes including maximum knee flexion between mobile bearing condylar-stabilised and fixed bearing posterior-stabilised prosthesis: a case control study

PurposeProsthesis design influences stability in total knee arthroplasty and may affect maximum knee flexion. Posterior-stabilised (PS) and condylar-stabilised (CS) designed prosthesis do not require a posterior-cruciate ligament to provide stability. The aim of the current study was to compare the range of motion (ROM) and clinical outcomes of patients undergoing cemented total knee arthroplasty (TKA) using either a PS or CS design prosthesis.MethodsA total of 167 consecutive primary TKAs with a CS bearing (mobile deep-dish polyethylene) were retrospectively identified and compared to 332 primary TKA with a PS constraint, with similar design components from the same manufacturer. Passive ROM was assessed at last follow-up with use of a handheld goniometer. Clinical scores were assessed using Patient-Reported Outcome Measures (PROMs); International Knee Society (IKS) knee and function scores and satisfaction score. Radiographic assessment was performed pre and post operatively consisting of mechanical femorotibial angle (mFTA), femoral and tibial mechanical angles measured medially (FMA and TMA, respectively) on long leg radiographs, tibial slope and patella height as measured by the Blackburne-Peel index (BPI).ResultsBoth groups had a mean follow-up of 3 years (range 2–3.7 years). Mean post-operative maximum knee flexion was 117° ± 4.9° in the PS group and 119° ± 5.2° in the CS group (p = 0.29). Postoperative IKS scores were significantly improved in both groups compared to preoperative scores (p < 0.01). The mean IKS score in the PS group was 170.9 ± 24.1 compared to 170.3 ± 22.5 in the CS group (p = 0.3). Both groups had similar radiographic outcomes as determined by coronal and sagittal alignment, tibial slope and posterior condylar offset ratio measurements. When considering the size of tibial slope change and posterior-condylar offset ratio, there was no differences between groups (p = 0.4 and 0.59 respectively). The PS group had more interventions for post-operative stiffness (arthrolysis or manipulation under anaesthesia) 8 (2.7%) compared to 1 (0.6%) in the CS group (p = 0.17).ConclusionCondylar-stabilised TKA have similar patient outcomes and ROM at a mean follow-up of 3 years compared to PS TKA. Highly congruent inserts could be used without compromising results in TKA at short term.Level of evidenceLevel IV, retrospective case control study.

Minimum 5-Year Outcomes of a Multicenter, Prospective, Randomized Control Trial Assessing Clinical and Radiological Outcomes of Patient-Specific Instrumentation in Total Knee Arthroplasty

BackgroundPatient-specific instrumentation (PSI) was developed to produce more accurate alignment of components and consequently improve clinical outcomes when used in total knee arthroplasty. We compare radiological accuracy and clinical outcomes at a minimum of 5-year follow-up between patients randomized to undergo total knee arthroplasty performed using PSI or traditional cutting block techniques. MethodsThis multicenter, randomized control trial included patients blinded to the technique 1used. Outcome measures were coronal alignment measured radiologically, Euroqol-5D, Oxford knee score, and International Knee Society Score measured at 1- and 5-year follow-up. ResultsAt a minimum 5-year follow-up, there were 38 knees in the PSI group and 39 in the conventional instrumentation group for analysis. Baseline demographics and clinical outcome scores were matched between groups. Overall, there was no significant difference in the coronal femoral angle (P = .59), coronal tibial angle (P = .37), tibiofemoral angle (P = .99), sagittal femoral angle (P = .34), or the posterior tibia slope (P = .12) between knees implanted using PSI and those implanted with traditional cutting blocks. On the measurement of coronal alignment, intraobserver reliability tests demonstrated substantial agreement (k = 0.64). Clinical outcomes at both 1-year and 5-year follow-up demonstrated statistically significant and clinically relevant improvement in scores from baseline in both groups, but no difference could be detected between the Euroqol-5D (P = .78), Oxford knee score (P = .24), or International Knee Society Score (P = .86) between the 2 groups. ConclusionThis study has shown no additional benefit to PSI in terms of improved alignment or functional outcomes at minimum 5-year follow-up over traditional techniques.

Rotating Hinge Knee Arthroplasty for Revision Prosthetic-Knee Infection: Good Functional Outcomes but a Crucial Need for Superinfection Prevention.

Introduction: Management of chronic infection following total knee arthroplasty (TKA) is challenging. Rotating hinged prostheses are often required in this setting due to severe bone loss, ligamentous insufficiency, or a combination of the two. The nature of the mechanical and septic complications occurring in this setting has not been well-described. The aim of this study was to evaluate patient outcomes using a hinge knee prosthesis for prosthetic knee infections and to investigate risk factors for implant removal.Methods: This was a retrospective cohort study that included all patients treated in our tertiary level referral center between January 2009 and December 2016 for prosthetic knee infection with a hinge knee prosthesis. Only patients with a minimum 2-year of follow-up were included. Functional evaluation was performed using international knee society (IKS) “Knee” and “Function” scores. Survival analysis comparing implant removal risks for mechanical and septic causes was performed using Cox univariate analysis and Kaplan-Meier curves. Risk factors for implant removal and septic failure were assessed.Results: Forty-six knees were eligible for inclusion. The majority of patients had satisfactory functional outcomes as determined by mean IKS scores (mean knee score: 70.53, mean function score: 46.53 points, and mean knee flexion: 88.75°). The 2-year implant survival rate was 89% but dropped to 65% at 7 years follow-up. The risk of failure (i.e., implant removal) was higher for septic etiology compared to mechanical causes. Patients with American society of anesthesiologists (ASA) score>1, immunosuppression, or with peripheral arterial diseases had a higher risk for septic failure. Patients with acute infection according to the Tsukayamaclassification had a higher risk of failure. Of the 46 patients included, 19 (41.3%) had atleast one infectious event on the surgical knee and most of these were superinfections (14/19) with new pathogens isolated. Among pathogens responsible for superinfections (i) cefazolin and gentamicin were both active in six of the cases but failed to prevent the superinfection; (ii) cefazolin and/or gentamicin were not active in eight patients, leading to alternative systemic and/or local antimicrobial prophylaxis consideration.Conclusions: Patients with chronic total knee arthroplasty (TKA) infection, requiring revision using rotating hinge implant, had good functional outcomes but experienced a high rate of septic failure, mostly due to bacterial superinfection. These patients may need optimal antimicrobial systemic prophylaxis and innovative approaches to reduce the rate of superinfection.

Similar outcomes to primary total knee arthroplasty achievable for aseptic revision using the same primary posterior-stabilised prosthesis at a mean follow-up of 49months.

The aim of the study was to compare clinical and radiological outcomes between primary and aseptic revision TKAs using the same posterior-stabilised (PS) prosthesis. The authors hypothesised similar outcomes between both groups for selected patients. This retrospective, case-control study assessed 36 patients who underwent aseptic revision TKA compared to a match group of 72 primary TKA. Both groups had the same PS design implant (ANATOMIC®, Amplitude, Valence, France). The International Knee Society (IKS) score, radiological outcomes (postoperative alignment, patellar tilt and radiolucent lines), re-intervention and revision rate were compared between the two groups with a minimum follow-up of 3 years. The final study cohort included 29 patients and 63 patients respectively in the revision and primary group, with a mean follow-up of 49.1months (range 36.1-69). Postoperatively, there was no significant difference in IKS scores between the two groups [169.8 for the revision group and 179.6 for the primary group (p = 0.09)]. No statistical difference was observed for post-operative satisfaction 86.2% versus 92.1% (p = 0.46). Between the two groups, there was no difference in mean radiological assessment, including radiolucent lines (p = 0.7). There was no significant difference for overall implant survivorship 96.5% versus 100% (p = 0.13) at 36months. Similar clinical, radiological and survivorship outcomes were found between rTKA and primary TKA groups using the same PS level of constraint in patients undergoing revision surgery for aseptic indications at 3-year follow-up. Use of PS implants in rTKA for the correct indication suggests this to be a safe approach at least in the medium term. IV, retrospective case-control study.

Mechanical alignment for primary TKA may change both knee phenotype and joint line obliquity without influencing clinical outcomes: a study comparing restored and unrestored joint line obliquity.

In total knee arthroplasty (TKA), knee phenotypes including joint line obliquity are of interest regarding surgical realignment strategies. The hypothesis of this study is that better clinical results, including decreased postoperative knee pain, will be observed for patients with a restored knee phenotype. A retrospective analysis was performed on prospective data, including 1078 primary osteoarthritic knees in 936 patients. The male:female ratio was 780:298, mean age at surgery was 71.3years ± 8.0. International Knee Society Scores and standardized long-leg radiographs (LLR) were collected preoperatively and at 2years follow-up after TKA. Patients were categorized using the Coronal Plane Alignment of the Knee (CPAK) classification including the lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) measured on LLR by a single observer, allowing knee phenotypes to be categorized considering the arithmetic hip-knee-ankle (aHKA) angle (MPTA-LDFA) as measure of constitutional alignment, and joint line obliquity (JLO) (MPTA + LDFA). Clinical results were compared between patients with surgically restored preoperative constitutional knee phenotype to patients without restored constitutional knee phenotypes. Descriptive data analysis such as means, standard deviations and ranges were performed. T tests for independent samples were performed to compare group differences. Comparisons of categorical data were performed using the χ2 test. Significance was set at p < 0.05. A third of patients (33.4%) had constitutional knee varus with apex distal JLO. 63.5% of patients had preoperative apex distal JLO. Postoperatively, 57.8% of patients had a neutral HKA (-2° to 2°) and a neutral JLO (-3° and 3°), with only 18% of patients with restored constitutional knee phenotype. Of these patients, statistically less postoperative pain was observed in patients where apex distal JLO was restored compared to non-restored apex distal JLO (pain score 46.7 vs. 44.6; p = 0.02) without clinical relevance. Other categories of restored JLO or arithmetic HKA angle were not associated with improved outcomes. This study showed that performing mechanical alignment for primary TKA resulted in most cases in a change of the preoperative knee phenotype. These results emphasize the relevance of considering joint line obliquity to better understand preoperative knee deformity and better restore knee phenotypes with a more personalized realignment strategy to potentially improve TKA postoperative results. III.

The Effect of Bone Marrow Aspirate Concentrate on Clinical Results Used with Open Wedge High Tibial Osteotomy

Objectives:Medial open wedge high tibial osteotomy is a widely used treatment method for early stages of medial compartment osteoarthritis, particularly in the middle aged patients. Correction of the malalignment of the knee and even distribution of the body weight through knee joint is considered to facilitate the regeneration of the damaged cartilage. Addition of a regenerative procedure to tibial osteotomies may enhance its potential effects. In this study we analyzed the effect of, if any, simultaneous use of BMAC with high tibial osteotomy.Methods:We have evaluated the clinical results of 46 knees of 38 patients that underwent open wedge high tibial osteotomy for early stage medial compartment arthrosis between 2017-2020. Patients were recruited into two groups as HTO only group (Group 1) and HTO+BMAC group (Group 2). Mean follow up time was 12.6 months. Preoperative International Knee Documentation Committee (IKDC) subjective score and Knee Society Score (KSS) of the patients were compared with those at the 1st, 3rd, 6th and 12th post-operative months. Wilcoxon Ranked Signed test was used to detect the significant difference.Results:Group 1 consisted of 18 female and 4 male patients, Group 2 consisted of 14 female and 2 male patients. Two patients in Group 1 received bilateral HTO and 6 patients in Group 2 received bilateral HTO+BMAC. Twenty four knees in Group 1 and 22 knees in Group 2 were included for evaluation. There was no significant improvement in the KSS and IKDC scores of the patients in Group 1 at the first follow-up, however at the 3rd month follow-up, KSS scores showed significant improvement (p<0,001) whereas IKDC scores did not show any improvement (p>0,005). Both KSS and IKDC scores showed significant improvement at the 6th and 12th months. (p<0,001). In Group 2, only KSS scores showed improvement at the 1st month follow-up (p<0,001). Both KSS and IKDC scores showed significant improvement at the 3rd, 6th and 12th month follow-up compared to preoperative scores.Conclusion:We believe that simultaneous use of BMAC with open wedge high tibial osteotomy for early stage medial compartment arthrosis may relieve pain at the early period and improve patient compliance to rehabilitation. Increase in range of motion promote the recovery period and provide rapid return to daily activities, thereby positively affecting cartilage regeneration.

Iatrogenic injuries of the popliteus tendon during total knee arthroplasty

Introduction:The popliteus tendon is known to play a key role in the stability of the posterolateral corner of the knee. Its role in the stability of the replaced knee remains contentious.Objectives:The aim of this study was to determine the impact of an iatrogenic lesion of the popliteus tendon during total knee arthroplasty surgery on the stability and function of the kneeMethods:We searched in the operating report registers, patients with complete iatrogenic injury of the popliteus tendon during total knee arthroplasty on genu-varum. We evaluated postoperative varus, mobility and stability and we calculated their International Knee Society scoresResults:Among the 423 reports of total knee arthroplasties consulted in the operating report registers, we found seven patients with a complete iatrogenic injury of the popliteus tendon. All patients had preoperative extension deficit. All operated knees were stiff, tight and small. At postoperative follow-up, all the knees had good stability and function. All the patients were satisfied.Conclusion:we concluded that the isolated section of the popliteus tendon does not seem to modify the static stability of the knee. However, it can cause a decrease in long-term functional scores. More work is needed to increase understanding of the impact of this iatrogenic lesion on long-term function.

The influence of joint line position on functional outcome in primary total knee arthroplasty

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; To find out the cut off for position of joint line which will provide a good functional outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 58 patients underwent total knee arthroplasty using standard medial parapatellar approach were included in this study. Pre-operative and post-operative radiological joint line were assessed. Pre-operative and post-operative functional assessment were done using oxford knee score and International knee society score. functional outcome was assessed at 1, 3 and 6 months. Influence of post-operative joint line change on functional outcome was assessed on follow up visit in 6&lt;sup&gt;th &lt;/sup&gt;month.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of 58 patients studied, mean age ± SD was 69.0±7.5 years. Joint line elevation of 36, 16, 8 and 2 patients were between 0-2, 2-4 4-8 and&amp;gt;8 mm respectively with mean ± SD of joint line elevation of 2.24±2.07 mm in the group. Mean OKS-knee score at 6 months follow-up of study group was 36.60 with mean IKSS-knee score of 38.17 at 6 months follow up of group&amp;lt;4 mm which was significant (p&amp;lt;0.05) when compared to mean IKSS-knee score at 6 months follow up of group&amp;gt;4 mm (28.40).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It was concluded that joint line restoration is necessary for getting a good functional outcome after primary total knee arthroplasty. The functional outcome of patients with joint line elevation between 4-8mm showed inferior outcomes in comparison to the patients with joint line elevation within 4 mm.&lt;/p&gt;

No difference between resurfaced and non-resurfaced patellae with a modern prosthesis design: a prospective randomized study of 250 total knee arthroplasties.

Despite numerous well-conducted studies and meta-analyses, the management of the patella during total knee arthroplasty (TKA) remains controversial. The aim of our study was to compare the clinical and radiological outcomes between patients with and without patellar resurfacing and to determine the influence of resurfacing on patellar tracking with a "patella-friendly" prosthesis. A single-centered prospective randomized controlled study was performed between April 2017 and November 2018. Two hundred and forty-five consecutive patients (250 knees) scheduled for TKA were randomized for patellar resurfacing or patella non-resurfacing. All patients received the same total knee prosthesis and were evaluated clinically and radiologically, including the International Knee Society Score (KSS knee and function), Forgotten Joint Score (FJS), anterior knee pain (AKP), pain when climbing stairs, patellar tilt, and patellar translation. Two hundred and twenty-nine knees were available for clinical evaluation and 221 knees for radiographic analysis. The revision rate for patellofemoral cause was 3.1% (7 cases) with no difference between the groups (p = 0.217). There was no difference in survival rate between patellar resurfacing (88.3%) and non-resurfacing (85.3%) after 24months (p = 0.599). There were no differences in KSS functional component (p = 0.599), KSS knee component (p = 0.396), FJS (p = 0.798), and AKP (p = 0.688) at a mean follow-up of 18months. There was twice as much stair pain for the non-resurfacing group (17.1% versus 8.5%) (p = 0.043). There was patellar tilt in 43% of resurfaced knees (n = 50/116) versus 29% in non-resurfaced knees (n = 30/105) (p = 0.025); however, there was more patellar translation in the non-resurfaced group (21.0% versus 7.8%) (p < 0.001). There were no specific complications attributed to the patellar resurfacing procedure. There were four secondary patellar resurfacing procedures (3.6%) in the non-resurfaced group after a mean of 10 ± 7months (1-17) postoperatively. There is no superiority of patellar resurfacing or non-resurfacing in terms of clinical or radiological outcomes at mid-term. Secondary patellar resurfacing is rare. There is not enough evidence to recommend systematic patellar resurfacing with a "patella-friendly" prosthesis.

Rotating-hinge prosthesis for aseptic revision knee arthroplasty: A multicentre retrospective study of 127 cases with a mean follow-up of five years

BackgroundThe use of third-generation rotating-hinge knee prostheses has increased considerably in recent years. The more anatomical design of these prostheses, together with their controlled rotation system that reduces constraints generated by the single degree of liberty, have produced better outcomes. The objective of this study was to evaluate the clinical and radiological outcomes of revision knee arthroplasty for aseptic failure using rotating-hinge prostheses. HypothesisThe rotating-hinge knee prostheses currently used in France provide significant improvements in function and self-sufficiency of patients undergoing revision knee arthroplasty, with outcomes comparable to those reported with constrained condylar knees. Material and methodsA multicentre retrospective study was conducted in 17 centres, under the auspices of the SoFCOT. The cohort consisted of 127 patients (127 knees) operated on before 2013. The main reasons for knee revision were aseptic loosening, major instability, mechanical failure, and extensor apparatus failure. Function and self-sufficiency were assessed using the International Knee Society (IKS) score and the Devane score, respectively. Survival was defined with all-cause surgical revision as the end point. ResultsMean follow-up was 67.3±11.8 months (range, 13–180 months). Significant improvements (p<0.001) were seen in the total IKS score (+42 points), the IKS function score (+12 points), and the knee IKS score (+30 points). Paradoxically, the Devane score decreased by 0.44 point. The 5-year survival rate was 77% (95% confidence interval, 0.70–0.85). Postoperative complications developed in 29% of patients (infection, n=12; aseptic loosening, n=11; and fracture, n=7). DiscussionRotating-hinge prostheses provide satisfactory outcomes of knee arthroplasty revision and remain an effective option for complex cases, confirming our working hypothesis. Self-sufficiency diminishes slightly. The long-term outcomes obtained using rotating-hinge prostheses are, however, less satisfactory than those observed with constrained condylar knees for aseptic TKA revision, and the complication rate is higher, although the population and local circumstances are different. Discernment is therefore in order when determining the indications of rotating-hinge prostheses. Level of evidenceIV; retrospective cohort study.

The effect of body mass index on functional outcome in total knee replacement

Background: Osteoarthritis is one of the leading causes of disability. TKR is the most common procedure for end stage arthritis. Although obesity is assumed to bring out a negative influence on survival of TKR, there is no definitive proof in literature. The impact of obesity on the outcomes of TKA is still debated. Aim: To investigate the effects of body mass index on the rehabilitation process in patients with a recent TKR. Design: This prospective study included patients (N= 50) who underwent TKR between 2018 and 2019 for primary OA. Materials and Methods: Patients undergoing TKR were identified from a prospective arthroplasty database. 50 patients were included in the study. Age, gender, BMI, pre- and post-operative functional scores [International knee society score: KSS], complications were recorded. WHO BMI classification was used to group the patients. The functional outcome of the normal weight group (BMI < 25) was compared to the overweight and obese group (BMI ≥ 25). Results: Mean age in the study was 65.8 (52-78). 60% (30) were female. The mean BMI was 28.8 (18-52). 70% of patients were either overweight or obese. Mean follow-up was 12.33 mo (6-24 mo). No significant difference was identified in pre or post-operative KSS in normal weight (BMI < 25) group compared with that of patients with a BMI ≥ 25. Overall, there was 1 case of infection (2%), with no complications or revisions in the normal weight group (BMI < 25) Conclusion: BMI did not show any influence on post-operative outcome comparing normal weight individuals and the ones with BMI > 25. Patients should not be denied total knee replacement based solely on BMI alone.

Original Research Article Comparision of outcomes of posterior cruciate ligament substituting vs retaining in total knee arthroplasty-a prospective, randomised, open labelled study of 30 cases

Original Research Article Comparision of outcomes of posterior cruciate ligament substituting vs retaining in total knee arthroplasty-a prospective, randomised, open labelled study of 30 cases - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2020.052, Indian Journal of Orth

Role of body mass index on total knee replacement rehabilitation and outcome

Aim: To evaluate the effect of body mass index on functional outcome in total knee replacement. Materials and methods: This is a prospective study conducted in Katuri medical college and hospital, Guntur; from November 2017 to November 2019 for total knee replacement. Total 50 patients were included. Age, gender, pre-operative body mass index, pre-operative and post-operative functional scores [International knee society score: KSS], complications were recorded. Based on WHO BMI classification patients were grouped. The functional outcome of the normal weight group (BMI < 25) i.e. group 1 was compared to the overweight and obese (BMI ≥ 25) group i.e. group 2. A separate sub-group analysis was performed to compare all five WHO BMI groups’ i.e. Normal weight, overweight, class 1, 2&3 obese. Results: With a mean age of 65.8 (52-78), 50 primary total knee replacements were included. 60% (30) were female. The mean body mass index was 28.8 (18-52). Seventy percent of patients were either overweight or obese. Follow-up was 1 year. There was no statistically significant difference in pre or post-operative KSS in the normal weight (BMI < 25) group compared to patients with a BMI ≥ 25 (P > 0.05). Sub-group analysis revealed poorer KSS in class 2 obese (74.8) compared to overweight (86.4) and class 1 obese (82.2). Overall there was 1 case of infection (2%) in obese group with no complications in the normal weight group. Conclusion: Post-operative functional outcome was not influenced by BMI comparing normal weight ones with the ones in overweight or underweight category. So, there is no need to deny TKR basing on weight alone.

Preoperative Osteopathic Manipulative Therapy Improves Postoperative Pain and Reduces Opioid Consumption After Total Knee Arthroplasty: A Prospective Comparative Study.

Pain is a therapeutic challenge after total knee arthroplasty (TKA), and it could lead to the overuse of opioids. Few methodologically robust clinical studies have been performed to assess the effectiveness of osteopathic manipulative therapy (OMTh; manipulative care performed by non-US-trained osteopaths) for postsurgical pain. To evaluate the effectiveness of standardized preoperative OMTh on early postoperative pain and opioid consumption after TKA. This comparative, nonrandomized study took place from 2013 to 2015 and included patients who had primary unilateral TKA for osteoarthritis in a knee that had not undergone any previous surgery. Patients were divided into 2 consecutive groups: 1 group received traditional preoperative management, and the other group received associated preoperative OMTh (general OMTh [rhythmic mobilization of all the body joints, from the ankles to the skull, using long-lever manipulation] and myofascial relaxation). The primary evaluation criterion was knee pain at rest 1 month after surgery: 0 (no pain) to 100 (the worst imaginable pain). The secondary evaluation criteria were: (1) knee pain while walking 1 month after surgery, (2) average weekly knee pain during the first month after surgery, (3) the presence of night pain and the consumption of sleeping pills and opioids or morphine at least once per week, (4) the International Knee Society scores and the Western Ontario and McMaster University Osteoarthritis index at postoperative 6 months and 1 year. The number of patients needed for a superiority trial was determined. No eligible patient refused OMTh when proposed. Seventy patients were evaluated (mean [SD] age, 75 [8] years; 47 women and 23 men). The 2 treatment groups contained 35 patients each. At postoperative month 1, the OMTh group had significantly less pain at rest (mean [SD], 6.8 [6] vs 20.9 [17.3]; P=.00001) and while walking (7.9 [9.4] vs 23.5 [20.6]; P=.0001) compared with the group that received traditional preoperative management. The consumption of opioids during the first postoperative week was significantly lower in the OMTh group (P=.0001). No statistically significant difference was found in the International Knee Society or Western Ontario and McMaster University Osteoarthritis scores between the 2 groups at 6 months and 1 year of follow-up. Standardized preoperative OMTh was found to be effective in reducing pain in the first month after TKA for osteoarthritis and significantly reduced opioid consumption during the first postoperative week.

The Influence of Patellofemoral Degenerative Changes on the Outcome of the Unicompartmental Knee Replacement: A Prospective Study.

Unicompartmental knee arthroplasty (UKA) is a recognized procedure for treatment of medial compartment osteoarthritis. Patellofemoral (PF) joint degeneration is widely considered to be a contraindication to medial compartment UKA. We examined the validity of this preconception using information gathered prospectively on 147 consecutive patients who underwent the Repicci II UKA for medial compartment osteoarthritis between July 1999 and September 2000 by the same surgeon. The status of the PF joint was assessed intraoperatively in all patients, and accordingly patients were divided into two groups. Among them, 69 had associated PF osteoarthritis (group A), while 78 patients had a normal PF compartment (group B). Variables measured included the International Knee Society (IKS) score, limb alignment, and range of motion. Radiographs, demographic data, length of hospital stay, perioperative complications were also measured. All subsequent surgery and survivorship at 10 years were recorded. The mean follow-up was 9.4 years (range: 5-10.7 years) and results of the two groups were compared. We found no significant differences in terms of IKS scores, alignment, and flexion between the two groups. However, measured extension was significantly increased postoperatively in those patients with minimal or no PF joint degenerative disease (p < 0.05).