Mean Knee Society Score Research Articles

Variations in functional outcome based on hamstring autograft thickness estimated using transportal technique in arthroscopic anterior cruciate ligament reconstruction

Objectives: We aimed to study the functional outcome difference in arthroscopic anterior cruciate ligament reconstruction (ACLR) using hamstring autograft thickness between more than 85% and ≤85%. Materials and Methods: In our study, 50 patients with anterior cruciate ligament (ACL) tears were operated with arthroscopic ACLR using an autologous hamstring graft. The anteroposterior diameter (APD) of the tibial footprint of ACL is measured using an arthroscopic ruler using a transportal and the graft thickness of more than 70% of the tibial footprint APD was used. The international knee documentation committee and knee society score (KSS) were compared between the groups in the 1st month, 6th month, and 12th month between autograft thickness of >85% and ≤85%. Results: The mean IKDC scores of patients with graft thickness >85% were higher compared to graft thickness ≤85% in the 6th and 12th post-operative months, with a statistically significant difference at the 12th post-operative month. The mean KSS scores of patients with graft thickness >85% were higher compared to graft thickness ≤85% at the 3rd, 6th, and 12th post-operative months, with a statistically significant difference at the 12th post-operative month. Conclusion: The functional scores were better for autograft thickness of more than 85% compared to autograft thickness of ≤85% at short-term follow-up of the 3rd and 6th post-operative month with a statistical difference at long-term follow-up of the 12th month.

Volume and Distribution of Early Knee Effusion After TKA with a PEEK-Based Knee Prosthesis: Correlation with Changes in Serum Inflammation Marker Levels, Knee Functional Score, and Range of Motion.

Early knee effusion is a common phenomenon after total knee arthroplasty (TKA), with potential clinical implications. Unlike traditional alloy knee prostheses, the polyetheretherketone (PEEK) knee system has radiographic transparency on magnetic resonance (MR) scans, which allows analysis of prosthetic knee effusion. We aimed to identify the distribution and volume of knee effusion after TKA with the PEEK prosthesis with use of MR imaging and to analyze whether dynamic changes in effusion were correlated with serum inflammatory marker changes and knee function recovery. Nine patients with osteoarthritis who were 59 to 74 years old underwent unilateral TKA with the PEEK prosthesis between June 2021 and August 2021. Dynamic early postoperative changes in the volume and distribution of knee effusion were evaluated with use of 3D MR stereoscopic images. Serum inflammatory markers were measured via blood tests, and joint function was evaluated with use of the subjective functional score of the Knee Society Score (KSS) and knee range of motion (ROM). Linear regression analyses were performed to assess for correlations between knee effusion volume and inflammatory markers and between knee effusion volume and joint function. The mean serum inflammatory marker levels increased significantly at 1 week after TKA with the PEEK prosthesis and then gradually decreased with time from 1 to 6 months. The mean total knee effusion volume gradually decreased over time. Concurrently, the mean KSS subjective functional score and mean knee ROM improved with time. Total knee effusion volume was positively correlated with C-reactive protein level (R2 = 0.16; p = 0.007) and negatively correlated with the change in KSS score between the preoperative and postoperative time points (R2 = 0.19; p = 0.003). Using the 1-week total knee effusion volume as a reference, a positive correlation was observed between the reduction in total knee effusion volume and the actual value of the ROM (R2 = 0.36; p = 0.0001) from 3 to 24 months postoperatively. Through 3D MR imaging, the precise distribution and volume of, and dynamic changes in, knee effusion after TKA with the PEEK prosthesis were confirmed and were found to be correlated with inflammation and joint function in the early postoperative period. The results demonstrate the potential clinical benefit of the PEEK-based knee system for future use. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison of Clinical and Patient Reported Outcomes in One-Sided Cruciate-Retaining Versus Other-Sided Posterior Stabilizing Protheses in Bilateral Simultaneous Total Knee Arthroplasty.

Cruciate retaining and posterior stabilizing knee systems are frequently used in total knee replacements. Most researchers compare the results of Cruciate Retaining (CR) and Posterior Stabilizing (PS) knees with those of a control group. The results of using both knee systems in a single patient in simultaneous Total Knee Arthroplasty (TKA) have been studied less. A total of 50 patients with primary bilateral osteoarthritis with varus which is not fixed and valgus deformity of not more than 10 degrees, age between 55 and 85years, BMI < 35kg/m2, ASA I or II, and non-inflammatory arthritis were taken up for simultaneous bilateral TKR with one-side CR and other-sided PS surgeries. Patients were followed up periodically at 6weeks, 3months, 6months, and 1year with Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Differences in scores were tested with the help of an independent sample Student's t test. A p value of less than 0.05 was considered statistically significant. During the first 6weeks after surgery, mean KSS was lower in PS knees, though statistically not significant, this difference reduced considerably over a while. By the end of the 1-year post-surgical intervention, KSS was similar among both knees. WOMAC score was similar between CR and PS preoperatively as well as during the entire post-operative follow-up period. Functional outcomes, patient-reported outcomes, and objective knee indicators in one-sided cruciate-retaining and other-sided posterior stabilizing total replacement in bilateral simultaneous two-team surgery were similar between both knees.

A Systematic Review of Fixation Modalities in Supracondylar Fracture Femur in Geriatric Age Patients

Abstract Background Surgical management has become the preferred treatment strategy for distal femur fractures due to improvements in alignment and functional outcomes over nonsurgical management, although bracing may be sufficient in stable, non-displaced fractures or for patients who are non-ambulatory or of high surgical risk Aim and Objectives The aim of this study was to systematically review the literature regarding Fixation modalities in supracondylar fracture femur in geriatric age patients with an emphasis on recent advances. Subjects and Methods In this systematic review, we searched Medline (Ovid), PubMed, Cochrane library, and EMBASE from Jan 2000 to July 2020. The search retrieved 779 unique records. We then retained 13 potentially eligible records for full-texts screening. Finally, 10 studies were included Results Mean Modifed RUST score pre − 3 changes to 10.1 post operation, mean Lysholm knee score post was 65.3, mean Knee society score was 83.5 and mean HSS knee score was 85.1 as shown in table8 Conclusion The current systematic review suggested that the surgical fixations with different fixation techniques were all safe and effective in the treatment of supracondylar fracture femur in geriatric age patients, however minimally invasive treatments were recommended among this age group.

Arthroscopic Debridement and Proximal Fibular Osteotomy in the management of knee Osteoarthritis: A Descriptive Longtudinal Study

Introduction: Knee osteoarthritis commonly occurs in the medial compartment. Arthroscopic debridement eases pain by irrigating debris and inflammatory cytokines. Proximal fibular osteotomy shifts the loading force more laterally from the medial compartment, eliminating pain and delaying degenerative progression. This study aims to evaluate pain relief by combining both procedures in knee osteoarthritis of the medial compartment. Methods: The study was conducted in Nepal Medical College Teaching Hospital from November 2021 to December 2022 after the ethical approval from institutional review committee (IRC Ref. No. 025-078/079). The outcome was assessed by visual analog score and knee society scores, who underwent a combined procedure of arthroscopic debridement and proximal fibular osteotomy during a study period of 12 months.Results: Diagnostic arthroscopy was done in 32 patients, out of which, 27 patients underwent combined procedure with arthroscopic debridement and proximal fibular osteotomy. The mean visual analog score in combined procedure was 6.89 ± 0.93 initially and 3.11 ± 0.69 at 12 months follow up. The mean knee society score in combined procedure was 46.85 ± 6.1 preoperatively and 84.26 ± 8.27 postoperatively at 12 months follow up. Common peroneal nerve neuropraxia was observed in 8 (29.62%) patients, which resolved spontaneously during 6 months of time period. Conclusions: Combined arthroscopic debridement and proximal fibular osteotomy procedure is effective in treating knee osteoarthritis of the medial compartment, as it decreases pain and improves knee society score.

Artrosis de rodilla asociada a deformidad extraarticular tratada mediante prótesis total de rodilla y osteotomía correctora de forma simultánea

Background and objectiveCorrect mechanical limb alignment is crucial in Total Knee Arthroplasty (TKA) and is particularly difficult to achieve when the knee osteoarthritis (KOA) is associated with an Extra-Articular Deformity (EAD). Our objective is to present a surgical option in cases of severe knee arthritis associated with an EAD (indications, mechanical planning and surgical technique), pros and cons and discuss the results with this one-stage technique. Material and methodsWe retrospectively reviewed all cases of severe KOA associated with EAD treated surgically in our institution from 2010-2016. In our study, we only included cases treated via simultaneous TKA and corrective osteotomy (CO) and with a minimum follow-up period of three years. In terms of imaging, we determined the apex and angulation of the EAD as well as the modification of the mechanical parameters post-treatment. The pre- and postoperative clinical assessment was performed using the Knee Society Score (KSS). ResultsTen patients (10 knees) underwent combined surgery (simultaneous TKA and CO). The mean age was 67.7 years and the mean follow-up period was 49.2 months. The mechanical parameters were consistently corrected in the post-operative period. The mechanical axis deviation (MAD) shifted from a mean value of 6.9cm to 0.45cm and the joint line was rendered horizontal in all cases. In none of the cases did the bone resection affect the insertion of the colateral ligaments. The mean KSS value improved from 32.3 points preoperatively to 79.4 postoperatively. There were no major complications, but there were two planning errors that did not impact upon the end result. ConclusionsIn severe associated KOA and EAD, the combined surgical treatment proposed achieves in one stage an effective anatomical and mechanical correction which is crucial to optimise clinical results and implant durability. The surgery is complex and requires careful planning.

KNEE DEFORMITIES AND KNEE REPLACEMENTS IN SAUDI POPULATION: OUR EXPERIENCE AND LITERATURE REVIEW

It takes precise alignment, adequate balance, and deformity correction to accomplish a successful total knee arthroplasty (TKA). In main TKA, this can be successfully achieved with a posterior stabilized (PS) design, either with or without sub-periosteal release. However, severe abnormalities with a major bone defect, stiffness, and instability are often associated with these disorders in some circumstances, such as knee osteoarthritis. Additional restrictive prostheses are required since it is extremely difficult to balance these anomalies with soft tissue release alone, even after main TKA. In this situation, the constrained condylar knee (CCK) design is the optimum choice. This studys primary objectives were to characterize the clinical outcomes, function recovery, and complications of patients who underwent primary CCK-TKA for severe knee osteoarthritis related knee deformity. The secondary aim was to find out the mid-term prostheses survival. Methods: Between March 2021 and March 2022, 36 consecutive patients with knee osteoarthritis had cemented primary CCK-TKA. Twenty-Eight women and eight men, totaling 36 patients, had at least a 6 month follow-up for this retrospective analysis. We used the Knee Society Score (KSS), the Hospital for Special Surgery (HSS) score, and the roentgenographic evaluation form to assess the patients. The survival of prosthesis was assessed using Kaplan-Meiers survival analysis. The patients follow-up periods averaged 12 month. The KSS knee score rose from 44 points (23–68) to 91 points (76–100) following surgery [P &lt; 0.001]. Following the procedure, the mean KSS functional score rose from 20–75 points to 91 points (65–100) [P &lt; 0.001]. The average HSS score rose from 51 points (27–83) to 91 points (75–100) following surgery [P &lt; 0.001]. The average range of motion (ROM) also increased after surgery, going from 68.09° ± 35.99° (0°–120°) to 113.68° ± 8.90° (100°–130°) [P &lt; 0.001]. The average hip-knee-ankle (HKA) angle was 180.24° ± 1.77° (175°–184°) following surgery, compared to 176.88° ± 14.48° (135°–199°) before to surgery. Radiolucencies were seen in thirteen knees, mostly on the tibial side. After an average follow-up of 12 month, 94.7% of prosthesis were still in use. Despite severe deformity, instability, and stiffness at a relatively young age, the mid-term follow-up of primary CCK-TKA in knee osteoarthritis gives satisfactory clinical and functional outcomes with 94.7% prosthesis survival. However, there are a few issues.

Postero-Central Slice Osteotomy of the Proximal Tibia: A Novel Technique for Correcting Resistant Tight Extension Gaps in Posterior-Stabilized Total Knee Arthroplasty for Varus Osteoarthritis

BackgroundThe aim of total knee arthroplasty (TKA) is to circumvent the pain due to advanced osteoarthritis of the knee joint and correct the limb alignment and biomechanics to improve patients’ quality of life. Apart from medio-lateral balancing, balancing flexion and extension gaps is a prerogative to achieve good results. This study proposes a novel surgical technique of postero-central slice osteotomy of the proximal tibia (PCSO-PT) for correcting tight extension gaps in posterior-stabilized knees and assesses its clinical and functional outcomes. MethodsA prospective study was conducted on 84 consecutive knees with tricompartmental osteoarthritis and varus deformity, requiring PCSO-PT during posterior-stabilized TKA between January 2016 and July 2018. Knee Society scores, flexion deformity, range of motion, antero-posterior instability, and complications were assessed at regular intervals for a minimum of 2 years postoperatively. ResultsResidual flexion deformities less than 11° after posterior capsular release were successfully corrected by the osteotomy. The mean preoperative flexion deformity of 18.1 ± 2.5° improved to 8.6 ± 2.2° intraoperatively after posterior capsular release from the femoral end and to 0.65 ± 0.76° intraoperatively immediately after the osteotomy, with no residual flexion deformity noted in any patient 6 weeks postoperatively. It had no negative effect on the significant post-TKA improvement of the mean Knee Society score from 32 ± 12 preoperatively to 94 ± 3 at the terminal follow-up. A direct correlation between preoperative flexion deformity and a resistant, tight extension gap (P = 0.003) was noted. There was no increase in coronal plane or sagittal plane instabilities in midflexion or on mobilization throughout the follow-up period, nor were any major adverse effects noted in this period. ConclusionsA PCSO-PT is an effective and safe alternative to overcoming tight extension during TKA after femoral-end capsular release, instead of capsular release from the tibial end or midcapsular region. Level of evidenceLevel IV, therapeutic study.

Clinical outcomes of two-stage revision arthroplasty using a spiked tibial cement spacer in infected total knee arthroplasty.

A tibial cement spacer (TCS) with spikes offers better initial stability than a conventional TCS and reduces spacer-related problems in two-stage revision total knee arthroplasty (R-TKA) for infection. We compared the clinical outcomes of two-stage revision arthroplasty for infected TKA using spiked TCS with that of conventional TCS. This retrospective cohort study included 29 patients who underwent two-stage revision arthroplasty using an articulating cement spacer and who could be followed up for at least one year. Group S comprised 14 patients using spiked TCS, whereas Group C comprised 15 patients using conventional TCS. Demographic data, the interval from first to second stage revision, motion arc, numerical rating scale (NRS), Knee Society (KS) score, serum levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and frequency of repeating the first-stage and infection recurrence after R-TKA between the groups were analyzed. No significant differences were observed in the female ratio and mean age between both groups. The mean interval between the first and second stage revision was significantly shorter in Group S than in Group C. The mean motion arc was significantly larger in Group S than in Group C. The mean NRS was significantly lower in Group S than in Group C. The mean KS score in Group S was significantly higher than that in Group C. Serum ESR and CRP levels did not differ between the groups. The frequency of repeating the first stage was lower in Group S than in Group C. However, the recurrence rate after R-TKA was higher in Group S than in Group C. Compared with conventional TCS, spiked TCS shortened the period until R-TKA and improved pain and function levels. However, no significant difference existed in the rate of infection recurrence after R-TKA.

Use of Hinged Implants for Multi-Stage Revision Knee Arthroplasty for Severe Periprosthetic Joint Infection: Remission Rate and Outcomes After a Minimum Follow-Up of Five Years

BackgroundIn severe periprosthetic joint infection after total knee arthroplasty (TKA), multistage procedures are indicated for ongoing signs of infection after implant removal during the spacer interval of an intended 2-stage exchange. In these cases, several additional debridement and spacer exchange surgeries may be necessary. Herein, we analyzed the complications, remission rates, and functional outcomes after multistage revision arthroplasty using hinged TKAs. MethodsPatients (n = 79) treated with multistage revision arthroplasty after chronic periprosthetic joint infection of the knee were included (2010 to 2018). During the prosthesis-free interval, a static spacer containing antibiotic-loaded bone cement was implanted. The mean number of surgeries, including implant removal and revision arthroplasty, was 3.8 (range, 3 to 8). The mean duration from implant removal to revision arthroplasty was 83 days (range, 49 to 318). Complications, remission, and mortality were analyzed after a minimum follow-up of 5 years. Outcomes were assessed based on the Knee Society Score (KSS) and the Western Ontario McMasters University Osteoarthritis Index. ResultsDuring follow-up, 24 (30.4%) patients underwent revision surgery, with a mean time to surgical revision of 99 weeks (range, 1 to 261). After follow-up, the infection-free remission rate and overall mortality were 87.3 and 11.4%, respectively. The mean KSS was 74.3 (range, 24 to 99), the KSS Function Score was 60.8 (range, 5 to 100), and the Western Ontario McMasters University Osteoarthritis Index 30.2 (range, 5 to 83). ConclusionsIn difficult-to-treat cases, multistage revision arthroplasty showed high remission rates and low mortality after a follow-up of 5 years. The overall revision rate was comparably high, accounting for early and late reinfections most of the time. In cases of implant survival, functional outcomes comparable to those of revision hinge TKA reported in the literature can be achieved. Therefore, multistage procedures with additional debridement steps should be performed in cases of ongoing infections in intended 2-stage procedures.

Surgical management of combined osteoarthritis knee and proximal tibial stress fracture via long tibial stem total knee arthroplasty: assessment of medium-term results

Background The combined osteoarthritis knee and proximal tibial stress fracture is an uncommon condition that increases the complexity of the management for both. No common consensus among surgeons regarding management guidelines. We assessed the medium-term results (minimum 5 years) of using long tibial stem total knee arthroplasty (TKA) to restore limb alignment, achieve fracture union, and resurface the arthritic joint in a single procedure. Methods Total of 23 patients with combined osteoarthritis knee and proximal tibial stress fracture were enrolled in this study. Of those 23 patients, 18 were females and five were males. All patients were managed surgically by TKA (PCL sacrificing) with a long tibial stem (straight or with offset). Assessments of union and tibiofemoral alignment were carried out using radiographs. Clinically, patients were evaluated by assessment of knee range of motion, knee society score (KSS), and knee injury and OA outcome score. Results The average follow-up period was 6.5 ± 2.3 years (range from 5 to 9 years) all fractures united in 3–8 months (average 3.2 months), and mean range of motion improved from 89°±8° to 119°±6°, mean knee society score improved from 32 ± 8 to 87 ± 5, mean knee injury osteoarthritis outcome score improved from 27 ± 6 preoperatively to 79 ± 5 after a minimum of 5 years follow-up. no complications (instability, infection, or patella mal-tracking) were reported, although 1 case had a femoral intraoperative condyle fracture which was fixed by screws with no effect on the outcome. Conclusion The use of a long tibial stem TKA is an effective and reproducible single surgical procedure in the management of combined osteoarthritis knee and proximal tibial stress fracture. Satisfactory clinical scores and radiological outcomes were achieved and proper limb alignment was restored obviating the need for further fixation or grafting.

The Lateral Para-Patellar Approach for Intramedullary Tibia Nailing in Distal Tibia Extra-articular Fractures: A Prospective Cohort Study.

The treatment of extra-articular distal tibiafractures is still a subject of debate and frequently necessitates surgical treatment, and intramedullary nailing (IMN) offers a minimally invasive approach with excellent results. Important factors in these procedures are positioning, operative duration, and radiation exposure. This study details the semi-extended lateral para-patellar approach for IMN of distal tibia extra-articular fractures and documents our findings regarding operative time, intra-operative radiation exposure, residual anterior knee pain, knee functional and radiological outcomes at six months follow-up. We reviewed the cases of 60 patients who underwent IMNfor distal tibia extra-articular fractures from May 2022 to March 2024, employing an extra-articular lateral para-patellar approach in the semi-extended position. Patients were evaluated clinically and radio-graphically for a minimum follow-up period of six months. Data collected included duration of surgery, intraoperative radiation exposure, and knee functional scorefor all patients. Assessment of fracture healing, residual deformities, residual anterior knee pain, and range of motion of the treated knee compared to the contralateral knee was done at a six-monthfollow-up. The average surgery duration was 54 ± 5 minutes, with intraoperative imaging averaging 48 exposures. The average time to union was 16 ± 3 weeks. Six months post-surgery, the mean Knee Society Score was 86.4 ± 3.5 (out of 100). At the six months follow-up, all patients exhibited clinical and radiographic healing, with only two cases showing mal-alignment (angular deformity <10 degrees).All patients regained a comparable range of motion in their knees. The semi-extended lateral para-patellar approachfor nailing of distal tibiaextra-articular fracturesenhances reduction, simplifies nail insertion,reduces both fluoroscopy and operative time, minimizes anterior knee pain and improves knee functional outcomes at six months follow-up.

Mid-term outcomes using a ‘kinematic retaining’ total knee replacement – A multicentre prospective study at five years follow-up

BackgroundAlthough total knee replacement (TKR) surgery has succeeded in improving pain and deformity, a proportion of patients remain incompletely satisfied with their outcome. This prospective study aims to assess the survivorship, clinical, and radiological outcomes using a novel ‘kinematic retaining’ (KR) implant. Methods156 patients underwent TKR surgery for primary osteoarthritis using the Physica KR implant at three European Centres. Patients were followed up for five years using both radiographic and clinical evaluations. ResultsWithin 6 months post-operatively, 79.4% and 85.9% had good-excellent clinical and functional KSS values, this was maintained to 76.9% and 79.5% at five years. Mean Knee Society Score (KSS) improvement at 5 years was 32.8 (from 23 to 40) and 37.4 (from 30 to 50) (p < 0.01). All Knee Injury and Osteoarthritis Outcome Score (KOOS) sub-scores showed statistically significant improvement from before surgery at a mean of 34.7 (SD ± 16.1) to a mean of 86.6 (SD ± 16.1) at five years. The mean Oxford Knee Score (OKS) was 43.7 (±5.6), with over 80% of the patients having a good-excellent outcome at five years. OKS improved significantly by six weeks after surgery (p < 0.01) and remained constant throughout the 5-year follow-up. Visual Analogue Score (VAS) Satisfaction scores improved significantly after the post-operative time point of six weeks. From 1 year to 5 years, the average VAS was over 85 mm. The Forgotten Joint Score (FJS) increased from 64.5 at 1 year to 79.2 at 5 years after surgery (p < 0.01). No progressive adverse radiographic features were noted. Two patients were revised during the study period: one for infection and the other for aseptic loosening. ConclusionsThis novel ‘kinematic retaining’ knee prosthesis has shown exceptional clinical and patient-reported improvements, with a remarkable 99.4% survivorship (95.5–99.9) at five years.

Outcome after total knee arthroplasty with or without patellar resurfacing

Background: Anterior knee pain is one of the most important nagging factors following ‘total knee arthroplasty’. It requires adequate redressal to avoid patient dissatisfaction, undue psychological stresses and inflated costs due to readmission and reoperation. Aims: To assess the functional outcome prospectively in total knee arthroplasty with or without patellar resurfacing. Materials and Methods: A prospective randomised study involving 25 patients undergoing bilateral total knee arthroplasty (TKA) was carried out to study the outcome after TKA with patellar resurfacing (group I) and without patellar resurfacing (group II). The onlay surgical technique was used for patellar preparation, and a cemented all-polyethylene dome-shaped patellar button with three pegs was used for implantation. The Knee Society Score (KSS), Knee Functional Score (KFS) and visual analogue score were used for clinical assessment. Results: All outcomes were assessed after 1 year of follow-up in both the groups. There was a statistically significant difference between the group I and group II knees in the mean pain score (P &lt; 0.001), 47.8 and 41.2, respectively, in the visual analogue score (P = 0.002), 0.76 and 1.56, respectively, and the mean KSS (P &lt; 0.001), 90.28 and 84.16, respectively. However, there was no difference in the mean pre-operative and post-operative KFS between the two groups (P = 1.000), 45.00 (standard deviation [SD] ± 12.22) and 88.72 (SD ± 10.33), respectively. There was no statistical difference in the complication rates between the two groups. Conclusions: There is a significant improvement in anterior knee pain after patella resurfacing resulting in higher patient satisfaction.

Porous Tantalum Tibial Metaphyseal Cones in Revision Total Knee Arthroplasty: Excellent 10-Year Survivorship

BackgroundHighly porous metal tibial metaphyseal cones (TMCs) are commonly utilized in revision total knee arthroplasty (TKA) to address bone loss and obtain biologic fixation. Mid-term (5 to 10 year) studies have previously demonstrated excellent survivorship and high rates of osseointegration, but longer-term studies are lacking. We aimed to assess long-term (≥ 10 year) implant survivorship, complications, and clinical and radiographic outcomes after revision TKA with TMCs. MethodsBetween 2004 and 2011, 228 revision TKAs utilizing porous tantalum TMCs with stemmed tibial components were performed at a single institution and were retrospectively reviewed. The mean age at revision was 65 years, the mean body mass index was 33, and 52% were women. Implant survivorship, complications, and clinical and radiographic outcomes were assessed. The mean follow-up was 6.3 years. ResultsThe 10-year survivorship free of aseptic loosening leading to TMC removal was 97%, free of any TMC removal was 88%, free of any re-revision was 66%, and free of any reoperation was 58%. The most common indications for re-revision were periprosthetic joint infection, instability, and aseptic femoral component loosening. The 10-year nonoperative complication rate was 24%. The mean Knee Society scores increased from 38 preoperatively to 69 at 10 years. There were 8 knees that had evidence of partial, progressive tibial radiolucencies at 10 years. ConclusionsPorous tantalum TMCs demonstrated persistently durable longer-term survivorship with a low rate of implant removal. The rare implant removals for component loosening or instability were offset by those required for periprosthetic joint infection, which accounted for 80% of cone removals. Porous tantalum TMCs provide an extremely reliable tool to address tibial bone loss and achieve durable long-term fixation in revision TKA. Level of EvidenceIV.

Short-term functional outcomes of robotic-assisted TKA are better with functional alignment compared to adjusted mechanical alignment.

Ligament balancing is essential to the functional outcome of total knee arthroplasty (TKA). The optimal method of alignment remains a controversial issue. The primary objective was to compare the clinical outcomes of TKA between functional and adjusted mechanical alignment techniques. The secondary objectives were to compare bone resection, robotic alignment, and radiological assessment. This was a retrospective case-control series comparing TKA performed with functional alignment (FA) and adjusted mechanical alignment (aMA). Sixty-four FA subjects were matched with 64 aMA controls. These two groups were matched for age, gender, body mass index (BMI), surgeon, and type of frontal deformity. Both surgical procedures were performed using the MAKO® haptic robotic system. Functional scores (Forgotten Joint Score (FJS), Knee Society Score (KSS), and Oxford Knee Score (OKS)) were measured at the final postoperative follow-up. A radiographic evaluation was performed at the same time. Mean FJS were respectively 63.4±25.1 [0-100] and 51.2±31.8 [0-100] in FA versus aMA group (p=0.034). Mean OKS were respectively 40.8±6.3 [21-48] and 34.9±11.8 [3-48] in FA versus aMA group (p=0.027). Mean KSS were respectively 184.9±17.0 [126-200] and 175.6±23.1 [102-200] in FA versus aMA group (p=0.02). The main residual symptom was "none" for 73.0% versus 57.8%, "instability" for 6.4% versus 21.9%, "Pain" for 19.1% versus 12.5%, and "effusion" for 1.6% and 7.8% respectively for FA and aMA group (p=0.016). There were 4 complications in the FA group versus 5 in the aMA group (p>0.999). Mean postoperative hip-knee-ankle (HKA) robotic assessment were respectively 177.3°±2.0 [172-180] and 178.2°±2.0 [173-180] for FA and aMA group (p=0.018). The median difference between HKA robotic and HKA radiological was -3.0° (IQR=3.0; p<0.001). With greater residual deformity and without release, functional alignment showed a statistically significantly better short-term clinical outcome than adjusted mechanical alignment. This difference may not be clinically significant.

Staged Fixation with Respect to Soft Tissue in Tibial Plateau Fractures with Acute Compartment Syndrome: Correlation Analysis of Complications.

Staged operations are commonly employed in the management of high-energy tibial plateau fractures (TPF) complicated by acute compartment syndrome (ACS); however, complications, such as nonunion, deep wound infection, and traumatic arthritis, often occur due to severe bone and soft-tissue damage. We aimed to report the radiological and clinical outcomes of staged surgical interventions performed following complete closure of the fasciotomy wound for the treatment of TPF complicated by ACS. Additionally, we analyzed factors associated with complications arising from these procedures. Thirty patients with TPF and ACS were included (23 men and 7 women; average age, 59.7 years). The mean follow-up period was 33.2 months (range, 12-85 months). An external fixator was initially applied with emergency fasciotomy, and open reduction and plate fixation were performed after complete closure of the fasciotomy wound and soft-tissue stabilization (mean, 31 days; range, 9-55 days). Radiological evaluation of bone union and alignment was conducted, functional evaluation of the knee and ankle joints was performed using the Knee Society and American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications and related factors were analyzed. Primary bone union was achieved in 29 of the 30 cases (96.7%) at an average of 20.8 weeks (range, 12-35 weeks). Malalignment was not observed in any case. At the final follow-up examination, the mean Knee Society and AOFAS scores were 92.5 (range, 65-100) and 95.5 (range, 74-100), respectively. Complications included 1 case of nonunion (3.3%), 2 cases of deep wound infection (6.7%), and 5 cases of traumatic arthritis (16.7%). A statistically significant correlation was noted between complications and patients who underwent dual approaches for the fixation of bicondylar TPFs. A staged operation coupled with sufficient soft-tissue healing can achieve excellent bone union and functional outcomes in patients with TPF and ACS. However, complications may occur more often in patients undergoing dual approaches for bicondylar TPFs, necessitating vigilant monitoring and management.

Cruciate-retaining Arthroplasty in Patients with Severe Varus Deformity: A Retrospective Comparative Study

Introduction: There has been debate regarding the advantages of cruciate-retaining over posterior stabilized (PS) knee arthroplasty and vice versa. Many authors consider any coronal plane deformity &gt;15° as a contraindication for cruciate-retaining total knee arthroplasty. We aimed to compare whether functional outcome, deformity correction, and survivorship of cruciate retaining knee arthroplasty (CR) for severe varus deformity are equivalent to that of posterior cruciate ligament substituting (PS) for 6 years. Materials and Methods: We conducted a retrospective comparative study among patients who underwent Total Knee Replacement in the Orthopedics Department of a tertiary care hospital between 2016 and 2018 August who had a varus deformity of more than 15°. The first author exclusively performed CR operation (Group A) for all complex knees. In contrast, the second author performed PS surgery (Group B) for any coronal plane deformity over 15°. Clinical evaluation included completing a Knee Society Score (KSS) Evaluation Form. Pre-operative scoring was collected from the hospital database. All clinical examinations and radiographs at the final follow-up were done by the third author, who was unbiased and not involved with the initial patient care. Results: There were 39 patients in Group A (CR) and 28 patients in Group B (PS). In Group A, the mean pre-operative varus was 22.05 ± 2.72° and the pre-operative KSS was 32.94 ± 6.79. Postoperatively, the deformity corrected to a mean valgus of 5.48 ± 1.8° and mean KSS of 89.17 ± 5.79. In Group B, the mean pre-operative varus was 22.14±3.82° and pre-operative KSS was 32.82 ± 5.98. Postoperatively, the deformity corrected to a mean valgus of 4.85 ± 2.1° and mean KSS of 90.17 ± 5.13. The mean insert thickness was 11.76 ± 1.75 mm and 11.42 ± 1.75mm among the CR and PS groups, respectively. Concerning deformity correction (P = 0.19) and functional outcome (P = 0.46), both groups showed equal improvement with a 100% survival rate for 6 years. Conclusion: We concluded that CR knee replacements are possible with excellent functional and radiological outcomes in severe varus arthritic knees with a 100 % survival rate. Keywords: Arthritis, total knee arthroplasty, cruciate retaining, posterior stabilizing, varus deformity.

Malposition is main cause of failure of Oxford mobile-bearing medial unicompartmental knee arthroplasty.

Unicompartmental knee arthroplasty (UKA) is the preferred treatment for anterior medial knee osteoarthritis (OA) owing to the rapid postoperative recovery. However, the risk factors for UKA failure remain controversial. The clinical data of Oxford mobile-bearing UKAs performed between 2011 and 2017 with a minimum follow-up of five years were retrospectively analyzed. Demographic, surgical, and follow-up data were collected. The Cox proportional hazards model was used to identify the risk factors that contribute to UKA failure. Kaplan-Meier survival was used to compare the effect of the prosthesis position on UKA survival. A total of 407 patients who underwent UKA were included in the study. The mean age of patients was 61.8 years, and the mean follow-up period of the patients was 91.7 months. The mean Knee Society Score (KSS) preoperatively and at the last follow-up were 64.2 and 89.7, respectively (p = 0.001). Overall, 28 patients (6.9%) with UKA underwent revision due to prosthesis loosening (16 patients), dislocation (eight patients), and persistent pain (four patients). Cox proportional hazards model analysis identified malposition of the prostheses as a high-risk factor for UKA failure (p = 0.007). Kaplan-Meier analysis revealed that the five-year survival rate of the group with malposition was 85.1%, which was significantly lower than that of the group with normal position (96.2%; p < 0.001). UKA constitutes an effective method for treating anteromedial knee OA, with an excellent five-year survival rate. Aseptic loosening caused by prosthesis malposition was identified as the main cause of UKA failure. Surgeons should pay close attention to prevent the potential occurrence of this problem.

Gradual distraction on hinged-based Ilizarov ring fixator to correct fixed flexion deformity of knee: description of the surgical technique

Knee deformity in flexion is the most disabling deformity. Surgical correction can be attempted with soft tissue release, osteotomy, or both. However, acute correction can cause serious complications. Ilizarov technique has become an appealing alternative to open surgery, where skeletal traction is used to distract the joint gradually and steadily in order to reduce the risk of skin problems or neurovascular injuries. Two patients and three limbs, male aged 28-42 (mean=35 years) with severe fixed flexion deformity were corrected by a hinged-based Ilizarov ring fixator. Mean flexion of the knee was pre-operatively 86.66 degrees (80-90 degrees). The mean extension angle at the last follow-up was 168.3 degrees (165-170). The mean knee society score (KSS) was 44.3 (35-50), mean KSS functional score was 43.3 (0-65). One patient had satisfactory outcomes and could stand without walking aids and walks on extended knee with walking aids. Arthrodesis of knee or creating a stiff knee in the most extended position may be most effective for severe, fixed contractures.With the gradual, calculated distraction, the Ilizarov apparatus is an effective tool for treating severe cases of knee contracture.