Mean Knee Society Score Research Articles

Satisfactory outcomes of patellar tendon reconstruction using achilles’ tendon allograft with bone block after infected total knee arthroplasty

PurposeExtensor mechanism disruption is an uncommon and devastating complication after total knee arthroplasty. It negatively affects patients’ quality of life and leads to significant functional limitations and the inability to stand and walk. The purpose of the present study was to evaluate the outcomes of the extensor mechanism reconstruction using Achilles’ tendon allograft after infected total knee arthroplasty. It was hypothesized that it is a safe procedure and that patients will present good clinical and functional results.MethodsTen patients treated for infra-patellar extensor mechanism disruption after infected total knee arthroplasty were prospectively followed for two years. The mean age of patients was 70.8 (range 55–85), with a median BMI of 28.72 ± 2.2 kg/m2. All patients underwent reconstruction using a fresh frozen Achilles tendon allograft. Preoperative and postoperative evaluation included knee-related clinical and functional assessment based on objective and subjective scores, including the knee flexion, the extension lag, the Knee Society Score (KSS) clinical and functional, and the visual analog scale (VAS) for pain at 12 and 24 months. Radiological evaluation was also performed using the Caton-Deschamps index. Reported complications were also recorded.ResultsClinical and functional outcomes recorded significant improvements (p < 0.05) at the final follow-up compared with baseline as follows: Knee flexion was improved from 66° ± 4.8 to 99.7° ± 3.9, and the extension lag was decreased from 28.3° ± 4.4 to 9° ± 2.7. The mean KSS clinical and functional were also improved from 22.6 ± 7.9 to 73.4 ± 3.9 and from 10 ± 13.8 to 55 ± 13.8, respectively. The VAS for pain was decreased from 8.1 ± 1.2 to 1.9 ± 1.2. The Caton-Deschamps index demonstrated a tendency to patella Alta. Two treatment failures were recorded, one patellar dislocation and one re-rupture revised to arthrodesis.ConclusionsExtensor mechanism reconstruction using Achilles’ tendon allograft after infected total knee arthroplasty is an efficient and safe procedure for infra-patellar disruption. The present study’s findings demonstrate that most of the patients (80%) presented significant clinical and functional improvement at two-year follow-up.

The role of posterior condylar offset ratio on clinical and functional outcome of posterior stabilized total knee arthroplasty: a retrospective cohort study.

Postoperative Range of Motion (ROM) is an important measurement of the success of a Total Knee Arthroplasty (TKA). Much enthusiasm has been recently directed toward the posterior femoral condylar offset (PFCO), with some authors reporting increasing postoperative knee flexion when increasing PFCO. The aim of this study is to retrospectively determine the effect of the PFCO on the clinical and functional outcome of a cohort of patients who underwent a Posterior Stabilized (PS) TKA. Clinical and radiological data of all patients who underwent TKA with PS implant for primary osteoarthritis were retrospectively reviewed. Knee Society Score (KSS), knee ROM, PFCO ratio (PFCOR), and tibial slope (TS) were measured pre and postoperatively. One hundred and twenty-one patients (141 knees) met the inclusion criteria. The mean knee flexion increased from 98 ± 20.2° (range 30-130) to 123 ± 12.1° (range 70-140) and the mean KSS increased from 74.0 ± 3.3 (range 27-130) to 203.9 ± 8.1 (range 26-249). Postoperative PFCOR and TS were 0.492 ± 0.005 (range 0.40-0.57) and 2.36 ± 0.56° (range - 10.9-12.15°), respectively. Neither maximal flexion angle nor KSS showed a significant correlation with postoperative PFCOR (Pearsons'r = - 0.057, p = 0.5 for flexion angle and Pearsons'r = - 0.073, p = 0.5 for KSS) or with postoperative TS (Pearsons'r = 0.042, p = 0.62 for flexion angle and Pearsons'r = 0.002, p = 0.98 for KSS). Posterior femoral condylar offset remains an important parameter and, especially when using anterior femoral referencing TKA, care must be taken to prevent excessive resection of the posterior femoral condyles.

Functional Outcome of Arthroscopic Reconstruction of Anterior Cruciate Ligament Injuries Using Semitendinosis-Gracilis Graft

Aim:To determine the functional outcome of arthroscopic ACL reconstruction using semitendinosisgracilis graft, in patients with anterior cruciate ligament tears.Materials and Methods: This is a prospective observational study, of the patients Aged &gt;18 years to &lt;55 years old, who underwent, Arthroscopic reconstruction of anterior cruciate ligament injuries using semitendinosis-gracilis graft, at Chettinad Hospital and Research Institute (CH&amp;RI), during the period, 11/3/2020 to 15/4/2021(13 months). Follow up period till 15/10/2021. Patients satisfying the inclusion criteria, alone were included, in this study. Total 36 patients were included in this study. The patients, were followed up, at the end of the 3rd, 6th month, from the date of surgery.Results:The mean age of the patients of the study was 33.03 ± 8.89 years with minimum age of 20 years and maximum age of 55 years. In present study at 3 months, 66.67% of patients had fair lysholm score followed by 22.22% had poor score and 11.11% of cases had good score. The mean lysholm score at 3 months was 74.58 ± 8.12 with minimum score of 58 and maximum score of 86. At 6 months 63.89% of patients had good lysholm score followed by 30.56% of cases had excellent score and 5.56% of cases had fair score with mean lysholm score at 6 months was 91.47 ± 5.78 with minimum score of 78 and maximum score of 100. The mean knee society score of patients at 3 months was 76.83 ± 5.71 with minimum score of 61 and maximum score of 86. The mean knee society score at 6 months was 92.97 ± 5.58 with minimum score of 77 and maximum score of 100. The mean distance in single hop test was 81.39 ± 11.05cms with minimum distance of 51cms and maximum distance of 103cms.Conclusion: ACL reconstruction with semi-tendinosis and gracilis graft gives good functional outcomes which might be due to the advancements in the surgical techniques and fixation device. Keywords: Arthroscopic reconstruction, ACL injuries, Semitendinosisgracilis graft, knee ligament injuries.

Outcome of Newer Generation Implant Reducing Post-Operative Co-Morbidity in All Kinds of Tibial Plateau Fracture; An Observational Study

Background: Fractures of the tibial plateau, which are intra-articular injuries of the knee joint, are often difficult to treat and have a high complication rate, including early-onset osteoarthritis. Various treatment options including proximal tibial plating with locking compression plates are available for the treatment of tibial plateau fracture. Objective: The purpose of this research was to evaluate the functional outcome of tibial plateau fractures treated with locking compression plating; a technique found to effectively reduce post-operative co-morbidities. Material and Methods: This prospective and observational study was carried out in Multicentral base with Department of Orthopedic Surgery, Rajshahi Medical College, Rajshahi, Bangladesh from January 2020 to June 2022. All patients (n=256) enrolled in the study for the study were included and treated with a locking compression plate for tibial plateau fractures (Schatzker III-VI) after receiving informed written permission. Patients were monitored continuously with clinically, radiographically, and functionally at 6-weeks and 3-6 Month, fellow-up after surgery. Results: In our study of 256 cases, the mean age was 37.77 ±15.65 years. Most of the cases were Schatzker type VI (161 patients) 63% and type III (89 patients) 35%. The average duration for fractures union was 23.4 ±2.1 weeks. Superficial wound infection was the common complication seen in (6 patient) 2% cases. At six months, the mean knee society score (KSS) was 85 ±7.22 and majority of patients (245 patients) 95% had good results. Conclusion: The radiological and functional outcome of a locking compression plate is quite excellent. Tibial plateau fractures in adults can be effectively treated with this implant.

The distance between new and previous incisions does not affect skin necrosis in total knee arthroplasty: a parallel-randomized controlled clinical trial.

BackgroundTo avoid skin necrosis, an 8 cm distance between the new and previous incision is recommended in patients undergoing total knee arthroplasty (TKA). It was hypothesized that making a new incision less than 8 cm of the prior scar does not increase the risk of skin complications, and the new incision can be made anywhere, regardless of the distance from the previous scar. This study investigated how making a new incision, irrespective of the previous scars, affects skin necrosis.MethodsIn this parallel, randomized clinical trial, by simple randomization method using a random number table, 50 patients with single longitudinal knee scars were randomly assigned to two groups with a 1:1 ratio and 25 participants in each group. Patients with a minimum age of 60 and a single longitudinal previous scar on the knee were included. The exclusion criteria were diabetes mellitus, hypertension, morbid obesity, smoking, vascular disorders, cardiopulmonary disorders, immune deficiencies, dementia, and taking steroids and angiogenesis inhibitors. TKA was performed through an anterior midline incision, regardless of the location of the previous scar in the intervention group. TKA was performed with a new incision at least 8 cm distant from the old incision in the control group. Skin necrosis and scar-related complications were evaluated on the first and second days and first, second, and fourth weeks after the surgery. Knee function was assessed using the Knee Society Score (KSS) six months after the surgery.ResultsThe baseline characteristics of the groups did not differ significantly. The average distance from the previous scar was 4.1 ± 3.2 cm in the intervention group and 10.2 ± 2.1 cm in the control group. Only one patient in the control group developed skin necrosis (P-value = 0.31). Other wound-related complications were not observed in both groups. The mean KSS was 83.2 ± 10.2 and 82.9 ± 11.1 in the intervention and control groups, respectively (P-value = 0.33).ConclusionsIt is possible that in TKA patients, the new incision near a previous scar does not increase the risk of skin necrosis and other complications.

Catastrophic Vascular Injury After Total Knee Arthroplasty.

Vascular injury is a feared complication of any surgical procedure. This study examined the incidence of vascular injury during total knee arthroplasty (TKA), the circumstances and timing of injury intraoperatively, and acute management. Eighteen cases of catastrophic vascular injury after primary TKA (12 of 19,577; 0.06%) or revision TKA (6 of 4453; 0.1%) were identified. Catastrophic injury was defined as any vascular injury requiring vascular surgery. Chart review was performed to identify the timing of vascular injury, the injured blood vessel, and acute management. The Knee Society Score (KSS) was calculated. Mean follow-up was 8 years. Surgical indications included primary osteoarthritis for 12 cases, reimplantation for infection for 3 cases, and aseptic revision for 3 cases. Vessel injury included the popliteal artery in 10 cases, the popliteal artery and vein in 5 cases, and the popliteal vein in 3 cases. Thirteen injuries occurred during tibial preparation. Management included thrombectomy and reanastomosis in 15 cases and vessel bypass in 3 cases. One patient had thrombosis and limb ischemia 2 days after repair, requiring bypass. No amputations had occurred at late follow-up. Mean KSS was 74 at latest follow-up. Catastrophic vascular injury is more common after revision TKA (1 of 1000) than after primary TKA (6 of 10,000). Most injuries occur during tibial preparation. If identified quickly and addressed promptly by vascular surgery, limb salvage is likely. [Orthopedics. 2022;45(6):340-344.].

A PROSPECTIVE STUDY OF PROXIMAL FIBULAR OSTEOTOMY IN YOUNG PRIMARY MEDIAL OSTEOARTHRITIS KNEE AND ITS CLINICAL, FUNCTIONAL AND RADIOLOGICAL OUTCOME.

Background: Osteoarthritis (OA) commonly known as wear and tear arthritis. While it can occur even in young people, the chance of developing osteoarthritis rises after age 45. Proximal bular osteotomy (PFO) for young patients of OA knee joint is turning out to be an emerging concept with promising results. The aim of our study was to evaluate clinical, radiological and functional outcomes of PFO in young patients of primary medial compartment osteoarthritis of knee joint. Total 13 patients (20 knees) with moderate to severe pr Method: imary osteoarthritis of knee joint, who underwent PFO, were enrolled. Clinical data, Visual Analogue Scale score (VAS), Knee Society Score (KSS), Medial Knee Joint Space (MJS) and Femorotibial Angle measurements (FTA) were recorded. Patients were followed up at one, three, six months and yearly, postoperatively. 20 knee joints PFO. The mean VAS scores signicantly decreased from Results: 8.25 preoperatively to 2.21 at 12 months postoperatively. In most of patients, signicant medial pain relief was observed after PFO. Mean KSS at preoperative stage was 44.15, which was improved to 77 at 12 months postoperatively, which further suggests improvement in knee joint functions. There was noteworthy increase in Mean joint space postoperatively (1.17) as compared to preoperative stage (0.34). Mean FTA reduced from 182.64 degrees preoperatively to 178.61 at nal follow up. Our study shows Conclusion: that PFO remarkably causes pain relief and improves knee functions with increase in MJS and slight correction of varus deformity in young patients with primary osteoarthritis of knee joint.

Arthroscopic Retrograde Intramedullary Nailing of Periprosthetic Fractures After Total Knee Arthroplasty—Technique, Safety, and Outcomes

BackgroundPeriprosthetic fractures after total knee arthroplasty are notoriously challenging entities to manage. The 2 major fixation techniques utilized include locking compression plates and retrograde intramedullary nailing. The challenges in obtaining correct entry points in the presence of the superimposing femoral component in retrograde intramedullary nailing often warrants a full knee joint arthrotomy. Thus, the purpose of this first series is to describe the arthroscopy-assisted retrograde intramedullary nailing (ARIN) technique and evaluate clinical results and potential risks and benefits. MethodsThis was a retrospective review of prospectively collected data obtained from 16 patients treated with the ARIN technique. Data obtained included operative time, size of incision, and intraoperative complications. In the postoperative course, patients were assessed for time to union, functional outcomes using the Knee Society Score, and the presence of complications. ResultsNine male and 7 female patients were included with a mean age of 70.8 years. The patients were followed up for a minimum of 24 months. The mean operative time was 86.5 minutes. Union was achieved in all fractures with an average union time of 15.9 weeks. The mean Knee Society Score obtained at 2 years postoperatively was 84.6. No major complications were documented during the follow-up period. None of the cases required conversion to the conventional open technique. ConclusionsThe ARIN technique has demonstrated results comparable with those from previous resources. Although results from this series suggest that the utilized technique is safe and offers a less invasive approach, direct clinical comparisons in larger scale trials are required.

Failure modes in malrotated total knee replacement.

Achieving normal rotational alignment of both components in total knee arthroplasty (TKA) is essential for improved knee survivorship and function. However, malrotation is a known complication resulting in higher revision rates. Understanding malrotation of the components and its concomitant clinical and functional outcomes are important for early diagnosis and management. The purpose of this study was to evaluate the effect of malrotation on clinical outcomes and failure modes in both single and combined rotational malalignment. From our hospital database of 364 revisions, a cohort of 76 knees with patellar maltracking, stiffness, reduced range of motion and early aseptic failure were reviewed and investigated for component malrotation using computed tomography following Berger protocol. CT findings confirmed component malrotation in 70 of these patients. Investigations included (1) measurement of femoral component malrotation using surgical transepicondylar axis, (2) measurement of tibial component malrotation using anteroposterior axis and (3) measurement of combined component rotational errors. The correlation of CT analysis and clinical outcomes after primary TKA revealed association of patellar maltracking with femoral internal rotation, pain and instability with tibial internal rotation and knee stiffness in patients with combined component malrotation as the commonest mode of presentation. Our study showed that patients with isolated femoral, tibial and combined malrotation presented at a mean period of 3.4 ± 1.34, 1.7 ± 0.8 and 2.3 ± 0.69years, respectively, after the index surgery. Post-revision, the mean Knee Society Score and Oxford Knee Score improved from 29.1 to 78.7, and 10.5 to 32.8, respectively, and the mean range of motion improved from 74.9 ± 24.8 to 97.1 ± 12.7 degrees at a mean follow-up of 42months. Early detection of malrotation in TKA and its management with revision of both components can lead to better clinical and functional outcomes. III.

A Mid-term Follow-up Study on the Reimplantation of Autoclaved Femoral and Tibial Components as Spacers for Treating Infected Total Knee Arthroplasty.

ObjectiveInfection after total knee arthroplasty (TKA) is a rare but devastating complication. Different types of spaces have been used in two‐stage revision. The study aimed to evaluate the effect of autoclaved femoral and tibial components as spacers for treating periprosthetic infections after TKA.MethodsA retrospective study was performed for 13 patients (five males, eight females) with a mean age of 69 ± 6 (range, 57–80) years and suffering from periprosthetic infection after TKA. They were treated with unconventional two‐stage revision from May 2008 to June 2017. In the first‐stage surgery, the autoclaved femoral and tibial components were reimplanted with a new liner as a spacer after a thorough debridement. After 4–6 months, the second‐stage surgery was performed according to the patients' requirements. The knee society score (KSS) and knee range of motion (ROM) were assessed before and after surgery. The reinfection rate was calculated.ResultsThe mean duration of follow‐up was 5.7 ± 2.1 (range, 3.1–8.8) years. Culture‐positive infections comprised 69% of the cohort. All patients were able to walk 24 h after the first stage surgery, and the knee ROM could reach 90° in 1 week. Two patients (15.4%) experienced an infection recurrence. One patient was reinfected 1 year after the first stage surgery. Another patient developed reinfection 3 years after surgery but did not choose re‐revision and died of pneumonia. Only one patient underwent the second stage revision. The remaining 10 patients refused to receive a new prosthesis. At the time of the final follow‐up, six patients had slight pain in the knee while walking, and one patient required crutches to walk. There were no signs of prosthesis dislocation, rupture, deep vein thrombosis, pulmonary embolism, or delayed wound healing. No radiolucent lines or osteolysis were found. The mean KSS improved from 51 ± 10 (range, 35–63) points preoperatively to 79 ± 5 (range, 60–85) points at the final follow‐up. The average ROM before and after the first stage surgery were 62° ± 29° (range, 10°–100°) and 104° ± 9° (range, 90°–120°) (t = 4.659, P < 0.01) respectively. The infection control rate was 84.6%.ConclusionReimplantation of the autoclaved original femoral and tibial components as an articulating spacer during the first stage surgery is a valuable addition for treating an infected TKA.

Coronally Oriented Intra - Articular Distal Femur Hoffa Fracture - How We Deal with It

BACKGROUND&#x0D; Hoffa fractures are intra-articular femoral condyle fractures in the coronal plane. These are very uncommon injuries. The purpose of this study was radiologic and functional outcome assessment of surgically managed Hoffa fractures with headless compression screws.&#x0D; METHODS&#x0D; We prospectively studied 11 patients with isolated Hoffa fractures who were treated with open reduction and internal fixation using two or more headless compression screws. Antiglide plate was used only in one case. We used the midline parapatellar approach for all cases. All patients had gone through aggressive physiotherapy after the operation. All patients were evaluated radiologically and functionally on a regular interval. The functional outcome was recorded in terms of Lysholm score, Knee society score (KSS), Range of motion (ROM) and VAS score.&#x0D; RESULTS&#x0D; All fractures united radiologically with an average time of 3.3 months with no evidence of subsequent fixation failure. The mean Lysholm score and KSS at final follow-up were 88.6±7.1 and 86±7.6 respectively. The mean knee range of motion was from 0˚ to 120.5˚ ± 9.3˚. At the final follow-up, the mean VAS score dropped significantly to 0.63±0.8.&#x0D; CONCLUSIONS&#x0D; Operative management of Hoffa fractures with at least two headless compression screws can yield satisfactory functional and radiologic outcomes. Stable fixation and timely physiotherapy are the keys to success.

Iliotibial band (ITB) release for ITB friction syndrome following total knee arthroplasty (TKA) improves knee function

BackgroundIliotibial (ITB) friction syndrome is a known syndrome in patients’ native knees, however, is not commonly reported following TKA. PurposeThe purpose of our study was to investigate whether ITB release following TKA due to ITB friction syndrome imparted a clinical improvement in patients’ knee function. Materials and methodsThis was a retrospective study of 7 patients suffering from ITB friction syndrome following TKA. Patient's knee function was compared using the Knee Society Score (KSS) before and after ITB release. ResultsThe final study population consisted of 7 patients that underwent ITB release following primary TKA. Six patients (85.7%) were male and 1 (14.3%) was female. The mean age of patients that underwent the ITB release procedure was 63.29 (SD ​± ​7.2) years. Median time from primary TKA to ITB release procedure was 19 months (range: 10–113 months). The mean KSS scores of patients before and after ITB release were 41.29 and 71.14, respectively, with a mean difference of 29.86 (SD ​± ​19.35), which was statistically significant (p ​= ​0.006). ConclusionITB release procedure improve knee function for patients with ITB friction syndrome following primary TKA.

Mid term outcome of total knee arthroplasty using sub vastus approach and mobile bearing rotating platform implant design: A prospective study

In orthopaedic surgery, long-term outcome and prognosis are very crucial. Surgical methods to the knee joint and its surrounding structures vary, but they are all designed to provide the best access to a pathological area while protecting vital surrounding tissues. A perfectly aligned knee is required for installing a rotating platform device, which MPA can easily create. The subvastus method, on the other hand, allows for a perfect lateral exposure and a completely positioned knee.Currently, the medial patellar approach is favoured for Total Knee Replacement, however our theory suggests that the lateral corner can be better viewed with the subvastus approach, making it a superior option for Rotating Platform Device insertion in varus, valgus, and stiff knee situations. To determine the outcome of subvastus approach in all types of knee pathologies using mobile bearing rotating platform implant design. We conducted prospective analysis of patients with limited preoperative ROM (flexion ≤90°) of the knee who underwent TKA using subvastus approach and presenting the 6 months results. There were a total 60 patients (60 knees) with mean age 63 (range 49–79 years) years. The mean preoperative flexion was 44°. Postoperatively knee flexion improved by mean 95° (P &amp;#60; 0.05) which was significant as assed by paired t-test. The mean knee society score improved from 34 (range 20–60) preoperative to 78 (range 70–90) postoperatively (P &amp;#60; 0.05). Our findings show that employing the subvastus method, gratifying TKA results can be achieved in varus, valgus, and stiff knee cases with restricted preoperative ROM while maintaining the benefits of early mobilisation, reduced post-operative discomfort, and patient satisfaction.

Revision Total Knee Arthroplasty With a Rotating-Hinge Prosthesis Mated to a Well-Fixed Femoral Sleeve.

Some knee systems have the unique capability to mate a new hinged femoral component to a well-fixed metaphyseal sleeve from a prior revision. We compared survivorship, radiographs, and clinical outcomes of a rotating-hinge total knee arthroplasty mated to a new metaphyseal sleeve vs a well-fixed sleeve. Sixty patients with an S-ROM Noiles (DePuy Synthes, Warsaw, IN) rotating-hinge total knee arthroplasty implanted from 1998 to 2019 were retrospectively reviewed. Nine patients (15%) had the femoral component mated to a well-fixed sleeve and 51 patients (85%) had a new sleeve. Mean age was 68 years, 68% were female, and mean body mass index was 33 kg/m2. The incidences of re-revision and reoperation were calculated, Knee Society Scores were measured, and radiographs were reviewed. Mean follow-up was 5 years. There were 2 re-revisions (22%) in patients with a well-fixed sleeve: 1 for infection and 1 for aseptic loosening of the femur and tibia. There were no unique failures including the taper junction. Nine patients (18%) with a new sleeve were re-revised: 7 for infection and 2 for tibial aseptic loosening. The mean Knee Society Score for all patients improved from 39 to 73. Radiographically, all components were well fixed except for one loose femur in a patient with a new sleeve. Mating an S-ROM femur to a well-fixed sleeve from a prior revision is a safe, simple, and durable option in the short term that prevents morbidity associated with removal of a well-fixed sleeve. No new modes of failure were observed. IV (retrospective), Therapeutic.

Long-term outcomes of primary total knee arthroplasty in patients with hepatitis B virus infection.

AimsThe purpose of this study was to compare the clinical outcomes, mortalities, implant survival rates, and complications of total knee arthroplasty (TKA) in patients with or without hepatitis B virus (HBV) infection over at least ten years of follow-up.MethodsFrom January 2008 to December 2010, 266 TKAs were performed in 169 patients with HBV (HBV group). A total of 169 propensity score–matched patients without HBV were chosen for the control group in a one-to-one ratio. Then, the clinical outcomes, mortalities, implant survival rates, and complications of TKA in the two groups were compared. The mean follow-up periods were 11.7 years (10.5 to 13.4) in the HBV group and 11.8 years (11.5 to 12.4) in the control group.ResultsThe mean Knee Society scores in the HBV and control groups improved from 37.1 (SD 5.6) and 38.4 (SD 5.4) points preoperatively to 78.1 (SD 10.8) and 81.7 (SD 10.2) points at final follow-up (p = 0.314), while the mean function scores in the HBV and control groups improved from 36.2 and 37.3 points preoperatively to 77.8 and 83.2 points at final follow-up (p = 0.137). Nine knees in the HBV group required revision surgery, including seven due to septic loosening and two due to aseptic loosening. Four knees in the control group required revision surgery, including three due to septic loosening and one due to aseptic loosening. Kaplan–Meier survivorship analysis with the revision of either component as an endpoint in the HBV and control groups estimated 96.6% and 98.5% chances of survival for ten years, respectively (p = 0.160).ConclusionTKA in patients with HBV infection resulted in good clinical outcomes and survivorship. However, there was a higher revision rate over a minimum ten-year follow-up period compared to TKA in patients without HBV infection.Cite this article: Bone Jt Open 2022;3(6):470–474.

Short-term Outcomes of Semi-constrained Implants in Patients With Complex Primary Total Knee Arthroplasty

Background: Semi-constrained implants are developed to reduce the detrimental impact of constrained implants in patients with complex primary total knee arthroplasty (TKA). However, the outcomes of TKA using semi-constrained implants are mainly unknown. Objectives: This study aims to report the short-term outcomes and complications of primary TKA in patients managed with a semi-constrained implant. Methods: Twenty-three patients (33 knees) who underwent TKA with semi-constrained implants were included in this study. The outcomes of patients were evaluated radiographically and clinically. Clinical evaluation was performed using the knee society score (KSS) and oxford knee score (OKS) at 6 and 12 months. The subjective satisfaction of the patients was also evaluated at 6 and 12 months using yes/no questions. Postoperative complications were inspected through the patient’s medical records. Results: The study population included six men and 17 women with a mean age of 70.7±7.6 years. The mean follow-up of the patients was 12.5±4.8 months. The average postoperative ‎tibiofemoral alignment was 0.26±1.1º of valgus (ranging from 3º of valgus to 2º of varus). The mean KSS of the patients were 93.8±8.1 and 94.7±8.3 at 6 and 12 months, respectively. The mean OKS of the patients were 43.6±3.7 and 44.1±3.8 at 6 and 12 months, respectively. All patients were satisfied with the surgery at 6 and 12 months. No postoperative complications were recorded during the follow-up period. Conclusion: The use of a semi-constrained prosthesis is safe and effective as a primary implant in TKA ‎patients having severe deformity or ligamentous laxity.

Periprosthetic Tibial Plateau Fractures After Unicompartmental Knee Arthroplasty Are Successfully Treated With Open Reduction and Internal Fixation.

Periprosthetic tibial fractures after unicompartmental knee arthroplasty (UKA) are rare but devastating events. Given the relative infrequency of these injuries, treatment strategies are not well defined. The goal of this retrospective case series is to report the findings for a series of patients who underwent open reduction and internal fixation (ORIF) of periprosthetic fracture after UKA, including radiographic alignment, Knee Society Score (KSS), and failure rate. Patients were identified by the International Classification of Diseases code for periprosthetic tibial plateau fractures. Electronic medical records and radiographs were retrospectively reviewed. Fracture patterns and coronal and sagittal alignment of UKA components were measured on radiographs. Clinical outcomes, including range of motion assessment, visual analog scale pain score, and KSS, were collected at final follow-up. Eight patients satisfied the inclusion criteria for this study. Fractures occurred at a median of 14 days (range, 5-52 days) after UKA, and all showed a vertical shear pattern that exited at the meta-diaphyseal junction. Of the 8 fractures, 7 (87.5%) healed to radiographic and clinical union after the initial ORIF. One patient required reoperation for hardware failure. Mean visual analog scale pain score and KSS at final follow-up were 3 and 85±14, respectively. Periprosthetic tibial plateau fractures after UKA commonly occur as a vertical shear fracture exiting at the metadiaphyseal junction. The use of ORIF with a 3.5-mm plate in buttress mode is a reliable method for treatment of these fractures. Restoration of alignment and motion is achievable, but residual pain may affect patient-reported outcome scores. [Orthopedics. 2022;45(5):287-292.].

Is medial open wedge high tibial osteotomy is good option for unicondylar osteoarthritis of knee? A prospective study

Introduction: A recent World Health Organization report on the worldwide burden of disease suggests that knee Osteoarthritis (OA) alone is likely to become the 4th most important cause of disability in women and the 8th in men. High tibial osteotomy is an accepted surgical technique for the treatment of medial compartment osteoarthritis of the knee in younger patients, It will provide relief of pain and deformity and preserve normal anatomical structure in a selected patient. Aims and Objective: High tibial osteotomy and Unicondylar knee replacement (Or Total knee replacement) are the mainstay of treatment for Medial compartment OA knee. Here we analyzed the functional outcome of the High tibial osteotomy for the medial compartment OA knee. Methodology: Prospective study was conducted for 2 years (2019-2021) among 30 patients who meet our criteria, with a mean age group of 47.33 years (26-58), with mean BMI of 25.22kg/m2 (22-29), the selected patient underwent medial open wedge high tibial osteotomy with plate & screw fixation, with or without bone grafting, on follow up visits patients are evaluated at 6 weeks,3 months,6 months and 1 year clinically, radiologically & complications noted. Based on these data final outcome was assessed with a Knee society score. Results: All patients showed progressive improvement in Range of motions, pain relief, return to normal activities and improved assessment scores.At the end of 1 year mean knee society score improved to 185.67 from 98.83 (P value

The mid-term clinical outcomes of total knee arthroplasty in the management of end-stage hemophilic arthropathy.

This study aimed to evaluate the mid-term clinical outcomes of total knee arthroplasty (TKA) in the management of end-stage hemophilic arthropathy. Eleven patients (15 knees) undergoing TKA with stiff knees were retrospectively evaluated. TKA was performed in all patients without additional surgical interventions such as posterior capsular release, hamstring release, synovectomy, VY quadricepsplasty, or tibial tubercle osteotomy. All patients were evaluated for clinical and radiological results at follow-ups. Functional evaluation and pain status were assessed using the Knee Society Score and Visual Analogue Scale. The mean age at the time of operation was 40.8 ± 11.8 years (range=30-64 years). The mean follow-up was 51.2 ± 20.6 months (range=24-95). The mean flexion contracture significantly decreased from 17.6 ± 11.3 to 1.7 ± 2.8 degrees, and the mean maximum flexion increased dramatically from 55.6 ± 20.5 to 109.2 ± 16.2 degrees (P < 0.001). Statistical significant improvement in flexion and flexion contracture degrees continued up to the postoperatively 18 months. The mean Knee Society Score increased from 22.7 ± 2.4 points preoperatively to 87.8 ± 3.8 points at the last follow-up (P < 0.001). The mean cost of coagulation factor consumption and blood transfusion accounted for 78% of the total cost. This study has shown that TKA is an effective treatment for relieving pain and improving both ranges of motion and quality of life in managing end-stage hemophilic arthropathy of the knee joint. Level IV, Therapeutic Study.

The use of tantalum cones and diaphyseal-engaging stems in tibial component revision: a consecutive series

IntroductionRevision knee arthroplasty presents a number of challenges, including management of bone loss. The goal in managing moderate to large bone defects is fixation that is sufficient enough to allow early weight-bearing. The purpose of this study was to describe the surgical technique and clinical and radiographic outcomes of patients treated with porous tantalum metaphyseal cones in combination with long uncemented diaphyseal-engaging stems to manage tibial bone loss in revision total knee arthroplasty (TKA).Materials and methodsThirty-six aseptic revision TKAs were performed at our institution between 2016 and 2019 by two senior authors. A single trabecular metal tantalum cone combined with a long (100 or 155 mm) press fit, diaphyseal-engaging stem was used in all cases to reconstruct metaphyseal bone defects and to augment tibial fixation. Cemented stems were excluded. The tibiofemoral angle was measured along the tibial and femoral shaft axes on the weight-bearing anteroposterior radiograph at final follow-up (range 15–56 months). All clinical and surgical complications, reoperations, and revisions of any component were recorded. Survivorship free of revision was evaluated at the time of the latest follow-up.ResultsThe mean Knee Society Score (KSS) and Knee Society Function Score (KSS-F) improved significantly from 29.7 points preoperatively (range 11–54 points) to 86 points (range 43–99 points) and from 20.4 points preoperatively (range 0–55 points) to 72.3 points (range 30–90 points) (p < 0.05), respectively. Eleven tibial constructs (30.5%) had incomplete, nonprogressive radiolucent lines (≤ 2 mm). All tibial cones demonstrated osteointegration. One patient underwent a full revision for periprosthetic joint infection, and survivorship free of any component revision was 91.7% at final follow-up.ConclusionsHybrid fixation with uncemented diaphyseal-engaging stems and porous tantalum metaphyseal cones resulted in radiographic lack of osteolysis, good clinical outcomes, and survivorship of 91.7% at a median follow-up of 33 months when considering all-cause revision as the endpoint.