KSS Score Research Articles

Comparison of the therapeutic effect between the simultaneous and staged unicompartmental knee arthroplasty (UKA) for bilateral knee medial compartment arthritis

BackgroundTo compare the efficacy and safety of simultaneous vs staged unicompartmental knee arthroplasty (UKA) for bilateral unicompartmental osteoarthritis of the knee.MethodsWe performed a retrospective analysis of prospectively collected data on 93 patients with bilateral knee medial compartment arthritis underwent simultaneous UKA (Group A, 39) or staged UKA (Group B, 54 cases) from January 2008 to December 2015. Group A: 6 males and 33 females aged 64.9 ± 7.7 years; Group B: 5 males and 49 females aged 64.2 ± 6.4 years. There were no statistically significant differences in pre-operative age, sex ratio, or body weight index between the groups (P > 0.05). Groups were compared in terms of total anesthesia time, volume of drainage, blood transfusion rate, hemoglobin level on post-operative day 3, total post-operative inpatient days, treatment expenses, post-operative therapeutic effect (KSS scores), and complications.ResultsAll patients had follow-up visits post-operatively. The follow-up visit interval was 32–133 months and 41.9 months on average. Total anesthesia time, postoperative length of hospital stay, and hospitalization expenses in Group A were significantly less than those of Group B (P < 0.05). Hemoglobin levels in Group A were significantly lower than those of Group B at post-op day 3 (P < 0.05). However, no significant differences in volume of drainage, the rate of transfusion, complications, and KSS scores were detected between Groups A and B (P > 0.05).ConclusionsBoth simultaneous and staged UKA achieved the desired therapeutic effect in treatment of bilateral knee medial compartment arthritis. However, simultaneous UKA reduced the cost and the postoperative length of hospital stay without increasing post-operative complications.

Open Wedge High Tibial Osteotomy versus High Fibular Osteotomy in Management of Osteoarthritis Knee

Background: osteoarthritis is the most common inflammatory joint condition and is expected to have an increasing prevalence in middle-aged and elderly patients. Objectives: to evaluate the functional outcome of open wedge High Tibial Osteotomy (HTO) versus High Fibular Osteotomy (HFO) with segment resection in management of medial compartment osteoarthritis of the knee. Patients and Methods: we compared 10 cases of HTO and 10 cases of HFO complain with uni-compartment knee osteoarthritis. Results: success in HTO depends on good technique. The determination of the exact localization of the osteotomy site, not to fracture lateral cortex, frequent assessment of the correction angle at every step of the operation, avoidance of overcorrection, the selection of an appropriate Puddu plate size fit for the osteotomy gap. During follow up, mean improvements obtained in KSS scores was 26.70. According to this assessment scale, preoperative score was deemed worse, and postoperative scores was good. HFO relieves pain and improves joint function in human knee osteoarthritis. This new surgery is simple, safe and affordable. Pain relief after surgery occurs in almost all patients. HFO may delay or replace TKA in a subpopulation of patients with knee osteoarthritis. Conclusion: HFO is a simple, safe, fast and affordable surgery to relieve pain and improve joint function and the medial joint space in human knee osteoarthritis.

Contemporary rotating hinge arthroplasty can safely be recommended in complex primary surgery.

The objective was to evaluate clinical and radiological outcomes, survival rate and complications of primary contemporary rotating hinged total knee arthroplasty (CRH-TKA). Through a national multicenter retrospective study (14 centers), 112 primary CRH-TKA performed between 2006 and 2011 were included. Indications were: severe frontal plane deformity (55%), inflammatory, constitutional, congenital or post-trauma arthritis (26%), ligament laxity (10%), primary osteoarthritis (9%). Population was elderly (68 ± 13), sedentary (37.5% with a Devane score ≥ 3) and with important comorbidities (87% with ASA score ≥ 2). A clinical (KSS, Oxford scores) and radiological evaluation (implant loosening), as well as survival and reoperation rates assessment, were performed. At last follow-up (7 ± 3years), KSS and Oxford scores were 64 ± 43 and 33 ± 10 each with a significant improvement of both scores overtime (respectively, p = 0.047 and p < 0.001). Twenty-eight complications (25%) were reported: 12 infections, 6 stiffness, 5 aseptic loosening and 5 patellofemoral instabilities. All in all, 91% (n = 102) of implants were still sealed and in place, 6% (n = 7) required revision and 3% (n = 3) were loose but could not undergo revision due to weak general health status. Mortality rate (18%, n = 20), linked to comorbidities, was high. Clinical outcomes and survival of primary CRH-TKA are acceptable given the difficult and complex clinical situations it faced, but with high infection rate. In primary surgery, for patients with severe deformity, bone loss or ligament laxity, the use of CRH-TKA can be recommended. The choice of these implants must remain cautious and limited to situations not allowing the use of less constrained implants. Retrospective therapeutic and cohort study, Level III; retrospective case series, Level IV.

Customised bi-compartmental knee arthroplasty shows encouraging 3-year results: findings of a prospective, multicenter study.

The purpose of this study was to assess the clinical and patient-reported outcomes of a customised, individually made (CIM) bi-compartmental knee arthroplasty (BKA). A prospectively recruited cohort of 79 patients was implanted with a CIM-BKA (patello-femoral plus either medial or lateral tibio-femoral, iDuo G2 system, Conformis, Billerica MA) at eight centres in the US and Germany. Patients were assessed for the 2011 KSS, KOOS, and ROM pre-operatively and at 2weeks, 6weeks, 12weeks, 1 year, and 2 years post-operatively. The objective KSS score significantly improved from 69 at the pre-operative visit, to 94 at the 2-year post-operative time-point. Similar improvements were observed for the KSS function and satisfaction domains. Significant improvements from pre-operative levels were observed across all five domains of the KOOS. Two patients have undergone surgery to revise their CIM-BKA implant to total knees, resulting in a survivorship rate of 97.5% at an average follow-up of 2.6years. CIM-BKA compares favourably to published scores as well as revision rates for previously available monolithic OTS-BKA implants. CIM-BKA implants provide surgeons with a viable and patient-specific monolithic implant solution as an option for patients presenting with bi-compartmental disease, who might, otherwise, be treated by performing uni-condylar + patello-femoral joint or bicruciate sparing TKA surgeries. Longer follow-up and higher numbers have to be awaited for further validation of these encouraging early results. 3b (individual case-controlled study).

Acupoint puncture combined with Ilizarov technique for the treatment of elderly paitents with knee osteoarthritis

To explore the clinical effect of acupoint puncture combined with Ilizarov technique in the treatment of knee osteoarthritis in the elderly. From March 2015 to February 2016, 76 patients with primary knee osteoarthritis were treated with tibial osteotomy acupoint puncture grouop and Ilizarov technique anatomical puncture group, including 24 males and 52 females, aged 56 to 75 years old with an average of 61.4 years old, and a course of 3 to 17 years with an average of 5.2 years. Among them, 38 cases were treated with external fixation of acupoint puncture needle and 38 cases were treated with external fixation of anatomical puncture needle. Preoperative full-length X-ray of both lower limbs showed tibial varus deformity, narrowing of medial knee joint space and enlargement of lateral knee joint space. The force line of the affected knee and lower limb was moved inward by body surface measurement, and the KSS knee function score was decreased. Symptoms included medial knee pain, flexion and extension, and conservative treatment for more than 2 years. The lower limb force lines of both groups were corrected and the osteotomy ends healed well. No nonunion of osteotomy, inadequate correction of lower limbs or recurrence of deformity were found. Seventy-five patients were followed up for 3, 6, 12 and 24 months after operation. There was no significant difference in knee joint mobility between the two groups before operation and on 6, 12, 24 months after operation(F=1.346, P>0.05). There were significant difference in KSS pain and total score between the two groups at 3 months after operation, acupoint puncture group was better than anatomical puncture group(P<0.05); there was no significant difference in KSS score at 12 months after operation(P>0.05). The acupoint puncture group formed a potential acupuncture effect in the acupoint area by continuously tightening the steel needle on Ilizarov ring external fixator during the post-operative adjustment. Within three months after wearing external fixator, the knee pain symptoms of knee osteoarthritis were relieved rapidly, continuously and effectively, which was significantly better than that of the anatomical puncture group.

Management of periprosthetic distal femur fractures using distal femoral arthroplasty and fixation - Comparative study of outcomes and costs

PurposeOur study compares the outcome and cost of distal femoral arthroplasty to that of Fixation (Plating/Retrograde Nailing) in the management of distal femur peri-prosthetic fractures. MethodsWe reviewed our database for patients admitted with peri-prosthetic distal femoral fractures between 2005 and 2013 (n = 61). The patients were stratified into 2 groups based on management method. The Distal Femoral Arthroplasty group (Group A) had 21 patients and the Fixation group (Group B) had 40 patients. Outcome & cost were compared. Minimum follow-up was 3 years. ResultsThe mean length of stay in group A was 9 days whereas in group B was 32 days. All patients were fully weight bearing by day 3 in group A, compared to a mean of 11 weeks in group B. Mean OKS was 28 and KSS score was 70 in group A compared to 27 and 68 in group B. In group A, there were 2 deaths, 1 superficial infection, and 1 DVT. In group B, there were 6 deaths, 1 failure of fixation, 6 mal-unions, 1 non-union and 2 infections. Overall, the distal femoral arthroplasty procedure costs approximately £9600 and the fixation group costs were on average of £9800. ConclusionDistal femoral arthroplasty appears to provide good clinical results, with comparable overall costs to fixation.

Follow-up study on autogenous osteochondral transplantation for cartilage defect of knee joint

To evaluate clinical effect of autologous osteochondral transplantation in treating localized knee cartilage defects. Fifteen patients with knee cartilage defects were treated by autologous osteochondral transplantation from January 2007 to January 2008, including 8 females and 7 males, aged from 23 to 45 years old. Preoperative and postoperative KSS score at 10 years were compared. All patients were followed up for 10.0 to 10.7 years, with an average of(10.2±0.3) years. Clinical score of KSS was improved from 38.86±4.09 to 85.07±2.19 at 10 years after operation(P<0.05), functional score increased from 3.33±4.88 to 82.67±4.58 at 10 years after operation(P<0.05), KSS score was improved form 42.20±7.84 befor operation to 167.73±6.29 at 10 years after operation, and had statistical differences before and after operation. While there was no statistical difference in stability of knee joint(P>0.05). All patients had no other complications. Through long-term follow-up of patients with cartilage defect in knee treated by autologous bone cartilage transplantation showed that this method could effectively improve function of knee joint and alleviate pain. So it is an effective method for repair of osteochondral defect.

Minimum twelve-year follow-up of fixed- vs mobile-bearing total knee arthroplasty: Double blinded randomized trial

BackgroundTotal knee arthroplasty (TKA) with fixed-bearing (FB) implants have demonstrated impressive functional results and survival rates. Meanwhile, rotating-platform (RP) constructs have biomechanically shown to reduce polyethylene wear, lower the risk of component loosening, and better replicate anatomic knee motion. There is growing question of the clinical impact these design changes have long-term.Questions/purposes: The aim of this double-blinded prospective randomized trial was to compare function and implant survival in patients who received either FB or RP press-fit condylar Sigma (PFC Sigma, DePuy, Warsaw, IN) total knee replacements at a minimum follow-up of twelve years. Patients and methodsPatient reported outcome measures used included the functional Knee Society Score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores, Medical Outcomes Short Form-36 (SF-36) score, and satisfaction assessment on a four-point Likert scale. The data was collected from times preoperative, two-years, and final encounter (mean 13.95 years). A total of 28 RP and 19 FB knees (58.8%) were analyzed at the final follow-up. ResultsAmong all patients, KSS and WOMAC scores statistically improved from pre-op to 2-year, while KSS statistically worsened from 2-year to final follow-up. The RP group averaged better follow-up scores in all assessments at the final follow-up with exception of overall satisfaction. There was no statistically significant difference in the functional Knee Society Score, Short Form-36, WOMAC scores, patient satisfaction or implant survival between the two groups at any measured period. ConclusionsThe use of a fixed-bearing or rotating-platform design does not convey significant superiority in terms of function or implant longevity at a minimum twelve years after total knee arthroplasty. Level of evidenceLevel I, Experimental study, randomized controlled trial (RCT).

Minimal invasive MPFL reconstruction using quadriceps tendon graft with lateral release: 2 years follow up

BackgroundMedial Patellofemoral Ligament (MPFL) reconstruction is a popular procedure to repair recurrent patellar dislocation. Many methods of reconstruction describe the use of hamstring tendons as the graft of choice. This study aimed to compare the functional outcome of MPFL reconstruction using quadriceps tendon graft with arthroscopic lateral release and to identify possible risks. MethodsThis is a retrospective cohort study in patients with a history of recurrent dislocation trauma from 2014 to 2016 that already done MPFL reconstruction using quadriceps tendon grafts with arthroscopic lateral release. Patient reported outcomes were evaluated pre-operative and 2 years post-operatively using IKDC score, Lysholm knee score, Kujala score, KSS Score, thigh circumference size, and kneel down ability. Patellar fracture, redislocation, and other complications were also assessed 2 years post-operative. ResultsEight patients included in this study and showed significant improvement in clinical outcomes. The Lysholm score increased from 64.37 ± 8.23 to 90.87 ± 3.23 (p = 0.011), IKDC score increased from 62.93 ± 7.52 to 88.36 ± 3.64 (p < 0.001). Kujala score increased from 60.87 ± 7.94 to 88.37 ± 4.34 (p < 0.001), KSS knee score increased from 83.25 ± 11 to 93.87 ± 1.73 (p = 0.012). KSS function also increased from 57.50 ± 11.65 to 88.13 ± 3.72 (p = 0.011) with decreased in thigh circumference (1–3 cm). Five patients have full ROM, able to kneeling, while 3 patients were able to kneeling with adjustments. There were no postoperative infection, patellar fractures nor redislocations. ConclusionMPFL reconstruction using quadriceps tendon grafts with arthroscopic lateral release can provide improved clinical results without complications of patellar fracture or stiffness of the knee, infection, and redislocation. Level of evidenceLevel 3, Retrospective Cohort Study.

Influence of limb alignment and prosthetic orientation on patient-reported clinical outcomes in total knee arthroplasty

BackgroundThe relationship between postoperative limb alignment and clinical outcomes in primary total knee arthroplasty (TKA) is well reported, but the instruments used to evaluate clinical outcomes of TKA are mainly scoring systems from the physician's viewpoint, not patient-reported outcomes. The purpose of this study was to investigate retrospectively the relationship between postoperative limb alignment and patient-reported clinical outcomes using the 2011 Knee Society Knee Scoring System (2011 KSS). MethodsThe present study included 155 knees of patients (median age, 74 years) who underwent primary TKA for varus osteoarthritis, with a mean follow-up period of 46 months. The subjects were divided into three groups based on postoperative limb alignment and femoral and tibial component positioning angle (varus, neutral, and valgus). The 2011 KSS scores were compared among the groups. ResultsFor limb alignment, the postoperative objective knee indicator score was significantly lower in the valgus group than in the varus and neutral groups, whereas no significant differences were observed in any subjective categories of the 2011 KSS. However, for the femoral component angle, functional activity scores were significantly lower in the valgus group than in the varus and neutral groups. ConclusionsThe subjective patient-reported score was not affected by the postoperative limb alignment. However, the valgus femoral component angle resulted in lower subjective functional scores. For clinical relevance, postoperative valgus positioning of femoral component should be avoided from patient-reported functional aspects during TKA.

Primary Total Knee Arthroplasty (TKA) with revision Total Stabilizer Prosthesis in a 66-year-old patient with secondary knee osteoarthritis and valgus deformity. Case Report

Abstract Knee osteoarthritis (gonarthrosis) is the most prevalent knee pathology encountered nowadays in the third age population, leading to severe disability and reduced life quality. Secondary gonarthrosis may be caused by a traumatic event, which subjects the knee joint to a transitory highly increased mechanical stress, initiating a rapidly progressive degrading process of the articular cartilage and subjacent bone tissue. TKA is intended to replace all the intra-articular components with artificial parts, in order to relieve pain, compensate for ligament instability, correct deformities, and restore proper joint functionality. Semi-constrained, non-hinged implants are usually used for revision TKA, in knees that already had a primary TKA but sustained complications. Nevertheless, here we reported the case of a 66-year-old female patient diagnosed with posttraumatic gonarthrosis who underwent TKA with a revision total stabilizer implant as primary treatment due to severe joint instability and high grade valgus deviation. The outcome of the surgical procedure was positive, with significant pain relief and increased knee stability. The valgus angle was reduced from 37° to 4° and the KSS score increased from 3 to 87 points. Therefore, revision semi-constrained prosthesis may be used as a primary implant with promising result in severe cases.

Transfer of gastrocnemius muscle flap for postoperative infection with patellar internal fixation

To investigate clinical effect of gastrocnemius muscle flap for repairing postoperative infection of patellar internal fixation. From January 2011 to January 2017, 15 patients with postoperative infection of patellar internal fixation were treated, including 9 males and 6 females ranged from 31 to 66 years old with an average age of (42.5±11.2) years old. The courses of disease ranged from 2 to 8 months with an average of (4.3±1.5) months. All wounds were repaired by gastrocnemius muscle flap after debridement. The coverage of muscle flap was performed by free skin graft and donor site was closed directly. Survival of muscle flap, healing of incision were observed. HUANG Yong-xin clinical criteria and KSS score criteria were used to evaluate knee joint function 9 after operation. All muscle flaps were survived without necrosis. Incision of 13 patients were healed at stageI, and 2 patients had wound dehiscence after operation and healed after symptomatic treatment. All patients were followed up from 9 months to 30 months with an average of(20.6±8.3) months. No recurrence of infection was observed, and texture of muscle flap, skin color, appearance were good. According to HUANG Yong-xin clinical criteria, 13 excellent and 2 moderate. The clinical score of KSS score was 83.3±7.8, and functional score of KSS score was 86.3±10.4. Gastrocnemius muscle flap is an effective method in repairing postoperative infection of patellar internal fixation with stable curative effect and low recurrence rate, which is worthy popularizing.

Intra- operative fractures in primary Total Knee Arthroplasty

BackgroundIntraoperative fracture during primary Total Knee Arthroplasty (TKA) is very rare and there is little literature available which has defined the possible reasons for the occurrence of these fractures. Further, no study till date has defined the various management options available to treat these fractures. This study aims to define (1) the possible reasons for different fracture patterns occurring intraoperatively, (2) the ideal management options for each type of fracture geometry, (3) whether this intraoperative complication affects the physiotherapy protocol and long term outcomes. MethodsOut of 3168 primary TKA done between 2010 and 2017, 19 patients developed intraoperative fracture, whose data was evaluated retrospectively. Patients were assessed radiologically to determine the time to union and clinical outcomes were assessed using Knee Society Score. ResultsOut of the 19 intraoperative fractures, 19 were in Tibia and 4 in Femur. Majority of fractures occurred during cementing and final implantation (8 cases), followed by exposure and bone preparation (6 cases) and the least during trialing (4 cases). Out of 15 Tibia fracture, 9 fractures involved the Tibial cortex which were managed with screws (4 cases), sutures and bone cement (5 cases). Stemmed tibial component was used for all Plateau type fracture patterns (6 cases). Out of 4 distal femur fractures, condylar type fracture pattern were fixed with plates and screws (3 cases) and epicondyle avulsion with screws alone (1 case). All the cases showed union (average union time 8.9 weeks) and good KSS scores which remained till their last follow-up. None of the patient developed any other complications or required revision surgery. ConclusionsIntraoperative fracture during TKA, although rare but a significant complication which can affect the outcome, if not managed properly. We have shown methods of management for such cases, which have given excellent results.

Pre-existing patellofemoral disease does not affect 10-year survivorship in fixed bearing unicompartmental knee arthroplasty.

The purpose of this study was to assess 10-year functional outcome and survivorship analysis of patients with significant radiographic evidence of patellofemoral joint arthritis treated with fixed bearing unicompartmental knee arthroplasty. Two hundred and sixteen patients (263 knees) that underwent UKA from 2003 to 2005 for a mean of 10.5 ± 2.1years were prospectively followed up. Preoperative radiological assessment of the patellofemoral joint state was assessed according to the Ahlback classification by an independent assessor and radiographically significant patellofemoral disease was defined as grade 2 or more. Patients with significant bone-on-bone contact in the patellofemoral joint were excluded. Of the 263 knees, 222 (84.4%) had normal patellofemoral joint state and 41 (15.6%) radiologically significant patellofemoral disease. At 10years' follow-up, the normal and patellofemoral groups had similar OKS (20 ± 7 vs 20 ± 8, n.s.) and KSS scores (79 ± 20 vs 81 ± 20, n.s.), respectively. There were 12 revision surgeries in the normal group and the most common indication for revision was progression of contralateral compartment osteoarthritis (6 of 12 cases). There was only one revision in the patellofemoral group and it was due to progression of contralateral compartment osteoarthritis (n.s.). When all secondary surgeries to the operated knee were considered as failures, the 10-year survival rate was 95.1% (CI 95%: 92.2-97.7%). The presence of significant preoperative radiological patellofemoral disease does not affect long-term implant survival and patients have excellent functional outcomes 10years postoperatively. These patients should not be contraindicated from undergoing unicompartmental knee arthroplasty. III.

Association between preoperative anaemia and blood transfusion with long-term functional and quality of life outcomes amongst patients undergoing primary total knee arthroplasty in Singapore: a single-centre retrospective study.

Preoperative anaemia affects up to one-third of patients undergoing total knee arthroplasty (TKA) and is associated with increased blood transfusion and prolonged hospitalisation. Prior studies have associated preoperative anaemia with poorer functional recovery after total hip arthroplasty. However, the association between preoperative anaemia and functional outcomes following TKA is unknown. We aim to determine whether preoperative anaemia and perioperative blood transfusion affect health-related quality of life (HRQoL) and functional outcomes following TKA. Retrospective analysis of 1994 patients who underwent primary unilateral TKA from 2013 to 2014 was performed. Anaemia was defined according to the World Health Organisation definition. Baseline and 6-month postoperative HRQoL was assessed with the 36-Item Short Form Survey (SF-36), while function was assessed with Oxford Knee Score (OKS) and Knee Society Function Score (KSFS). Physical function (PF), role physical (RP), bodily pain (BP), social function (SF) and role emotional (RE) domains of SF-36, OKS and KSFS demonstrated significant change greater than the minimal clinically important difference between baseline and 6 months. Analysis of covariance (ANCOVA) was performed to identify predictors of 6-month scores. The incidence of preoperative anaemia was 22.3%. 4.3% of patients received blood transfusions. Preoperative anaemia and perioperative blood transfusion did not significantly affect SF-36, KSFS and OKS scores at 6 months postoperatively. Poor baseline SF-36, KSS and OKS scores and high BMI ≥ 37.5kg/m2 are consistently associated with lower scores at 6months. Preoperative anaemia and perioperative blood transfusion did not significantly affect HRQoL and functional outcomes following primary TKA. Poor baseline and obesity were associated with poorer outcomes.

Fixed-bearing unicompartmental knee arthroplasty tolerates higher variance in tibial implant rotation than mobile-bearing designs.

UKA necessitates a learning period. From this point of view, it would be logical to prefer the design that tolerates suboptimal tibial rotations better, especially for inexperienced surgeons. The aim of this study was to evaluate and compare the clinical and radiological results of mobile-bearing and fix-bearing UKA designs in case of suboptimal tibial rotations. A retrospective case-control evaluation was made of all the patients with medial compartment osteoarthritis, treated between January 2011 and January 2015. 324 patients ideal femoral rotation were enrolled in the study. 153 patients (Group 1) were treated with fix-bearing design with a mean 28.8 ± 11.3 month follow-up and 171 patients (Group 2) were treated with mobile-bearing design with a 31 ± 14.3 month follow-up. Each patient in groups was subdivided into (A): optimal tibial rotation, (B): external rotation of tibial component > 5°, (C): internal rotation of tibial component > 5° subgroups. WOMAC and KSS scores of each patient at preoperative and postoperative final control were compared between groups and subgroups. No significant differences were determined between the groups in terms of mean follow-up time (p = 0.0612), preoperative WOMAC, and KSS scores (p = 0.754 and p = 0.832, respectively). No significant differences were determined between subgroups 1A and 2A in terms of WOMAC and KSS scores at the final evaluation (p = 0.314 and p = 0.546, respectively). A significant difference was determined between subgroups 1B and 2B in terms of WOMAC and KSS scores (p = 0.021 and p = 0.012, respectively). In addition, the difference between subgroups 1C and 2C was significant (p = 0.047 and p = 0.034, respectively) at the final evaluation. Both mobile- and fix-bearing designs are beneficial in the treatment of medial compartment osteoarthritis of the knee. However, in case of both tibial internal or external suboptimal tibial rotations, fix-bearing design have better results compared to mobile-bearing design. Level III retrospective comparative clinical study.

RESIDUAL DEFORMITY AFTER BILATERAL KNEE ARTHROPLASTY: IMPACT ON SHORT TERM OUTCOMES

Purpose — to evaluate the impact of frontal positioning of prosthesis components after bilateral Tka on short term functional outcomes. Material and Methods. The authors performed a retrospective analysis of teleroentgenograms of 466 patients after bilateral Tka with initial varus deformity. Functional and roentgenological outcomes were evaluated at average in 16,4±2,9 months postoperatively. Mean preoperative varus deformity was 10° (from 5 to 25°), initial angle between the anatomical and mechanical femoral axis (FVa) was 6,7±2° (from 3 to 12°). The neutral axis of both lower limbs (Hka = 180±0,5°) was obtained in 99 (21,2%) out of 466 patients. Residual deformity in one of the limbs above 3° with the neutral alignment of the contralateral limb was observed in 44 (9,4%) patients, bilateral residual deformity – in 32 (6,9%) patients. Other 291 patients demonstrated the deviation from mechanical axis in the range from 1 to 3° (±0,5°). all patients were divided into three groups: first group consisted of 10 patients with neutral axis of one limb and varus deformity of the other limb above 3°; second group — 10 patients with bilateral residual varus deformity above 3°; third group — 12 patients with neutral axis of both limbs (Hka = 180°). The angle of residual deformity averaged 3,7° (from 3,2 to 5,1°).Results. No statistically significant differences between the groups were observed for dynamometric parameters and SF-36 scores, as well as for functional kSS scores (p0,05). However, the authors reported in patients of the first group a stance phase on the side of residual varus deformity longer at 15% (p0,05) and transfer phase shorter at 17% (p0,05) as compared to contralateral limb (with neutral alignment, Hka = 180°), which is indicative of load asymmetry and can have a negative impact at a later stage.Conclusion. Symmetrical residual varus deformity of lower limbs in the rage of 3,2–5,1° has no negative impact of short term clinical and functional outcomes of Tka. Muscular function and gait properties in patients with neutral axis of the lower limbs and in patients with symmetrical residual varus deformity after Tka were similar 16,4±2,9 months postoperatively.

Outcomes of total knee arthroplasty in the adult Kashin-Beck disease with severe osteoarthritis.

Kashin-Beck disease (KBD) is an endemic osteoarthropathy, and the severe knee pain and functional limitations were seriously affecting the quality of life in patients with end-stage KBD. We retrospectively evaluated the clinical outcomes and the quality of life in KBD patients with total knee arthroplasty (TKA). A total of 22 subjects (25 knees) suffered KBD with severe knee pain and underwent primary TKA. Knee pain was measured by visual analogue scale (VAS), and the knee function was evaluated by Knee Society Clinical Rating System Score (KSS). KBD Quality of Life (KBDQOL) was used to evaluate the quality of life in KBD patients before and after TKA. There were no major complications after TKA. The levels of VAS score were obviously deceased in post-operation than that in pre-operation. The levels of KSS score were increased in one year after TKA compared with the pre-operative values, and it maintained a higher level on three years after TKA. The average KBDQOL score level of each domain in pre-operation and one and three years after TKA was increased accordingly. The average scores of physical function, activity limitation, support of society, mental health, and general health in one year after TKA were significantly higher than those in pre-operation. TKA can reduce knee pain, improve knee function, and improve the quality life in KBD patients. KBDQOL questionnaire may be a promising instrument for assessing the quality life in KBD patients.

5-year follow-up of 210 Columbus knee prostheses : Aprospective multicentre study

As part of 10-year documentation using the Columbus system, the interim evaluation was carried out 5years after implantation with a collection of clinical scores, evaluation of radiological imaging and collection of statistics concerning complications. There was amulticentre prospective recruitment of consecutive patients with the indication of implantation of asurface replacement prosthesis (Columbus CR, Deep Dish fixed inlay). Preoperatively, clinical scores were recorded (KSS and Oxford score). Five years postoperatively anew evaluation of clinical scores, the range of motion (ROM) and a radiological check-up including full leg imaging under load was performed. During this period, detailed complication documentation was made. Atotal of 210 patients were recruited in five centres. 187 patients were available for examination 5years after surgery. Cumulative KSS increased from 87.5 (±26.6) preoperatively to 170 (±29.1) 5years postoperatively. The cumulative KSS improvement was 81.5 (±35.2) points and was highly significant (p < 0.0001; t‑test). The average functional improvement in the Oxford score between the preoperative and 5‑year follow-up was 21.7 (±8.8) points and was also highly significant (p < 0.0001). The ROM improved from 106.3° (±20.2) preoperatively to 114.0° (±12.1) 5years postoperatively (p < 0.0001; ttest). Five years after implantation, the average mechanical leg axis was 178.0° (±2.1). There was no clinically apparent or native radiologic visible aseptic loosening of the femoral or tibial joint component. There were 33complications, but no implant-related complications such as inlay dislocation, material fracture or aseptic loosening. In total, 6revision surgeries were performed during the follow-up period, which corresponds to asurvival rate of 97.1% (CI 95%) for the implanted Columbus knee in the present patient collective for 5years. The interim analysis at 5years of long-term observation of the Columbus system provided good clinical and radiographic results.

Proximal fibular osteotomy to treat medial compartment knee osteoarthritis: Preoperational factors for short-term prognosis.

ObjectiveThe purpose of this study was to determine the association between preoperational factors and patients’ short-term outcome after proximal fibular osteotomy (PFO) and to provide a basis for detailed surgical indication and patient selection.MethodsThis was a retrospective study of patients undergoing PFO between January 2015 and December 2015. Preoperational clinical data including gender, age, duration of disease, visual analogue score (VAS) and American Knee Society (KSS) score were collected. The radiological factors including hip-knee-ankle angle (HKA angle), condyle-plateau angle (CP angle), Kellgren and Lawrence grade (KL grade), joint space width of both compartments and settlement value were also considered. Patients were followed for at 12 months postoperatively. Both clinical and functional KSS scores were obtained. The outcome of interest was divided into clinical outcome and functional outcome. For each, two criteria were defined: satisfaction and significant improvement. Satisfaction is characterized by a KSS clinical or functional score over 70 points (excellent and good results); significant improvement refers to an increase in KSS scores of more than 15 points. Bivariate logistic regression for the association between preoperational factors and outcomes of interest was performed. Multivariable logistic regression analyses were used to detect the independent factors affecting the outcomes.ResultsA total of 84 patients and 111 knees were followed-up. Of these, 17 knees were from males and 94 were from females. The average age was 59.45±8.82 years. The average preoperational VAS score, KSS clinical and functional score were 7.08±1.41 points, 49.14±10.95 points and 44.97±17.71 points, respectively. According to KL grading, there were 17 knees of grade 2, 47 knees of grade 3, and 47 knees of grade 4. In clinical outcomes, there were 51 knees in the satisfaction group and 77 knees in the significant improvement group. In functional outcomes, 43 knees were in the satisfaction group and 76 knees in the significant improvement group. KSS clinical score (OR = 1.134, 95%CI = 1.067–1.205, P = 0.000) was the independent factor associated with clinical satisfaction. Age (OR = 1.072, 95%CI = 1.000–1.150, P = 0.048), VAS score (OR = 1.679, 95%CI = 1.041–2.706, P = 0.033), KSS clinical (OR = 1.072, 95%CI = 1.005–1.144, P = 0.034) and functional (OR = 1.100, 95%CI = 1.044–1.159, P = 0.000) score, HKA angle (OR = 1.345, 95%CI = 1.119–1.617, P = 0.002) and settlement value (OR = 7.540, 95%CI = 1.307–43.484, P = 0.024) were the independent factors associated with functional satisfaction. KSS clinical (OR = 0.905, 95%CI = 0.850–0.963, P = 0.002) score, CP angle (OR = 0.760, 95%CI = 0.593–0.973, P = 0.030) and medial joint space width (OR = 0.001, 95%CI = 0.000–0.107, P = 0.003) were the independent factors associated with significant clinical improvement; VAS score (OR = 1.582, 95%CI = 1.042–2.402, P = 0.031), KSS functional (OR = 0.888, 95%CI = 0.838–0.942, P = 0.000) score, HKA angle (OR = 1.292, 95%CI = 1.101–1.518, P = 0.002) and settlement value (OR = 9.990, 95%CI = 1.485–67.197, P = 0.018) were the independent factors associated with significant functional improvement.ConclusionsThe independent factors affecting postoperative clinical outcome after PFO were KSS clinical score, CP angle and medial joint space width. In addition, the independent factors that influenced functional outcome included age, VAS score, KSS score, HKA angle and settlement value. As objective radiological evidence, HKA angle and settlement value could be used as an important basis for patient selection for PFO.