Mean Postoperative Range Of Motion Research Articles

Use of semi-constrained total knee arthroplasty in gonarthrosis with collateral ligament insufficiency: Clinical and functional outcomes

IntroductionAchieving stability in total knee arthroplasty (TKA) is crucial for long-term implant survival. In cases of severe deformity or ligament laxity, constrained implants may be required. Traditionally, increasing constraint involved intramedullary stems. However, there are intermediary alternatives, including employing a constrained polyethylene insert without stems, thereby avoiding complications related to them. The study aims to evaluate our experience with a non-modular constrained (NMC) implant in primary TKA. Material and methodsWe conducted a retrospective review of the clinical and radiographic outcomes of 108 non-stemmed primary TKAs performed at our institution between 2013 and 2021 in patients with at least 10° deformity or 10mm ligament laxity. Data included demographics, preoperative and postoperative deformities, clinical outcomes and revision rates. ResultsA total of 103 patients (108 knees) with a mean age of 74 were followed up for a minimum of 2 years. The mean postoperative range of motion was 105°/0°. The median Oxford Knee Score, Knee Society Score and Knee Society Function Score were 43.5, 92 and 90, respectively. 17 knees had varus deformity (mean tibiofemoral angle of 2.7°), and 87 knees had excessive valgus deformity (mean tibiofemoral angle of 15.1°). The remaining 4 knees had a neutral alignment. The mean postoperative tibiofemoral angle was 6.8°. The overall revision rate was 6.5% (7 patients): 3 deep periprosthetic infections, 2 patellar dislocations, 1 stiffness and 1 aseptic loosening. ConclusionOur experience demonstrates favorable mid-term outcomes with the NMC implant, providing a safe alternative to stemmed implants in primary TKA, particularly in cases of severe deformity or ligament laxity.

Total knee arthroplasty survivorship and outcomes in young patients: a review of the literature and 40-year update to a longitudinal study.

Growing numbers of younger patients are electing to undergo total knee arthroplasty (TKA) for end-stage osteoarthritis. The purpose of this study was to compare established literature regarding TKA outcomes in patients under age 55, to data from an ongoing longitudinal young patient cohort curated by our study group. Further, we aimed to provide a novel update on survivorship at 40years post-TKA from our longitudinal cohort. A literature search was conducted using the electronic databases PubMed, Embase, and Cochrane Library, using terms related to TKA, patients under age 55, and osteoarthritis. Demographic and outcome data were extracted from all studies that met the inclusion criteria. Data were divided into the "longitudinal study (LS) group," and the "literature review (LR) group" based on the patient population of the study from which it came. After screening, 10 studies met the inclusion criteria; 6 studies comprised the LR group, and 4 studies comprised the LS group. 2613 TKAs were performed among the LR group, and 114 TKAs were longitudinally followed in the LS group. The mean patient ages of the LR and LS groups were 46.1 and 51, respectively. Mean follow-up was 10.1years for the LR group. Mean postoperative range of motion was 113.6° and 114.5° for the LR and LS groups, respectively. All-cause survivorship reported at 10years or less ranged from 90.6% to 99.0%. The LS cohort studies reported survivorship ranges of 70.1-70.6% and 52.1-65.3% at 30 and 40years, respectively. Young TKA patients demonstrated improved functionality at each follow-up time point assessed. Survivorship decreased with increasing lengths of follow-up, ultimately ranging from 52.1-65.3% at 40years post-TKA. The paucity of literature on long-term TKA outcomes in this patient population reinforces the necessity of further research on this topic.

Long-term results of the AptisTM total distal radioulnar joint prosthesis after previous failed surgical procedures.

We present a prospective study with the results of ten Aptis total distal radioulnar joint replacements in patients who had one to five previous operations. The mean postoperative follow-up was 9.7 years (range 3-14.7). The mean postoperative range of motion of the wrist improved by 9° for extension, 15° for flexion, 10° for pronation and 14° for supination, achieving values equivalent to 88%, 78%, 97% and 88% of those of the non-operated hand. There were minimal changes in radial and ulnar deviations. Grip strength improved by 7 kg, pain decreased by 8 points, QuickDASH and Mayo wrist scores improved by 51 and 53 points, respectively. Two implants had radiolucency less than 1 mm. Serum titanium ion levels were slightly elevated in two patients. Three prostheses required revision surgery for heterotopic ossification, a prominent radial screw and a periprosthetic fracture. No prostheses were removed. Six patients returned to their former professional activities and four patients adapted their jobs.Level of evidence: IV.

Three-dimentional reposition of tibial tubercle and surgical procedure of permanent dislocation of the patella

Four knees of 3 patients were treated with medial patellofemoral ligament (MPFL) reconstruction and Fulkerson osteotomy for the dislocation of the permanent patella. Perioperative flexion limitation was treated with tibial tubercle elevation. In this study, we evaluated newly applied patella height and range of motion (ROM). Four knees of 3 patients (2 females and 1 male) underwent surgery. The mean age was 24.6 years (between 17 and 30 years). The mean follow-up period was 35 months (between 30 and 40 months). Mean preoperative ROM, mean perioperative ROM before tubercle elevation and mean postoperative ROM after tubercle elevation were 126 degrees (between 125 and 130 degrees), 71 degrees (between 60 and 80 degrees), and 131 degrees (between 130 and 135 degrees), respectively. Mean Lysholm score increased from 66 to 100. Tibial tubercle transfer/osteotomy and medial patellofemoral reconstruction are good treatment options for the dislocation of the permanent patella. In addition, during the recentering of the patella located in the outer part of the trochlea or rarely of the lateral condyle, the flexion can be restricted depending on the shortness of the extensor mechanisms. In our study, we elevated the tibial tubercle, and patella height remained within physiological limits. We believe tubercle elevation is a convenient solution for the flexion limitation that occurs during the reconstruction of the dislocation of the patella.

The use of suture anchors in posterolateral corner reconstruction in the setting of multiligament knee injury: Clinical and radiological outcomes in 58 patients with a mean follow-up of 15 months

The two-tailed posterolateral corner (PLC) reconstruction in multi-ligament knee injuries (MLKI) is mostly described with interference screws. Data on the use of suture anchors is limited. Our purpose was to report clinical and radiological outcomes of the modified technique, and to describe a technique for concomitant biceps femoris tendon repair. Demographic data, clinical and radiological outcomes were collected from 60 patients who underwent two-tailed PLC reconstruction in the setting of MLKI between 2017 and 2021. Patients were assessed for range of motion (ROM) and functional outcomes including Tegner, Lysholm and International Knee Documentation Committee (IKDC) scores. Complications and reoperations were also reported. Radiographic parameters focused on measurements of the lateral femorotibial space in varus stress views to evaluate stability and determine failure rate. Analysis based on time from injury to reconstruction was additionally performed. With two (3.3%) loss to follow-up, 58 patients with a mean age of 33.8 and a mean follow-up of 15.1 months (range: 4.2–44.8) were included. Sixty-five percent were men. Knee dislocation grades included KD 3-L, 4 and 5. No isolated PLC reconstructions were performed. Twenty-five patients (43.1%) underwent acute reconstruction and 5 (8.6%) presented with a neurovascular injury. Seventy-five percent had concomitant meniscal tears requiring repair. The mean postoperative ROM was 1.7–133.2 degrees. Mean Tegner, Lysholm, and IKDC scores were 5.1 ± 2.3, 84.6 ± 12.1, and 73.4 ± 18.2, respectively. The mean lateral femorotibial space on varus stress views was 0.3 ± 1.2 mm. Fourteen (24.1%) patients required revision surgery for hardware removal, stiffness, or clinical failure, and 6 (10.3%) had complications including infection and anchor pull-out. In addition, patients with acute reconstructions had better functional outcomes compared to those who presented with a chronic injury. The use of suture anchors as fixation method of choice for fibular head docking in two-tailed PLC reconstruction can reliably restore varus stability and provide fair functional outcomes in patients with either acute or chronic MLKI with posterolateral instability, associated with a low rate of implant-specific complications.

Preoperative radius head dislocation affects forearm rotation after mobilization of congenital radioulnar synostosis

BackgroundThe present study was carried out to answer three questions: 1) How much forearm rotation can be expected after mobilization of congenital radioulnar synostosis (CRUS)? 2) Does preoperative radius head dislocation affect forearm rotation after mobilization? 3) What factors other than radius head dislocation affect postoperative forearm rotation? MethodsWe performed mobilization of CRUS with a free vascularized fascio-fat graft and a radius osteotomy (Kanaya’s procedure) on 26 forearms of 25 patients. The age at the surgery ranged from 5.3 to 13.4 years. The follow-up duration ranged 24–111 months. We classified CRUS into 3 groups according to the dislocation of the radius head: posterior dislocation (N = 13), anterior dislocation (N = 9) and no dislocation (N = 4). Since major complaints of patients and parents were poor forearm rotation and lack of supination, they were evaluated separately. ResultsMean preoperative forearm ankylosis angle was 34.8° (range; neutral to 90° pronation). Preoperative pronation ankylosis angle was higher in the posterior dislocation group (mean 55.3°) than the anterior dislocation (mean 11.6°) and no dislocation groups (mean 5.0°). There was no re-ankylosis after mobilization and the mean postoperative active range of motion (ROM) was 86.5°. The mean active ROM was 75.7° in the posterior dislocation group, 96.1° in anterior dislocation group and 100.0° in no dislocation group. The mean active supination was 6.9, 33.9 and 47.5° respectively. The posterior dislocation group showed less ROM and less supination than other groups. Preoperative pronation ankylosis angle showed negative correlation with postoperative ROM (ρ = − 0.59) and postoperative supination (ρ = − 0.73). ConclusionThe mean postoperative active ROM of this mobilization was 86.5°. Posterior dislocation group showed higher pronation ankylosis angle preoperatively, and less postoperative ROM and less supination than anterior and no dislocation groups. Preoperative pronation ankylosis angle showed negative correlation with postoperative ROM and supination.

Short-term outcomes of instability related anterior glenoid fractures treated with open repair utilizing subscapularis split technique.

The purpose of this series is to report on the one-year clinical outcomes of instability related anterior glenoid fractures treated with open repair utilizing the subscapularis split technique. Patients with displaced anterior glenoid fractures who underwent open surgical treatment via deltopectoral incision and subscapularis split were identified from a single surgeons database. Fractures were repaired using screw fixation or with distal tibia osteochondral allograft reconstruction. Patient Reported Outcome Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Test (UE), PROMIS Pain interference (PI), PROMIS pain intensity (Pi), American Shoulder and Elbow Surgeons (ASES), Visual Analog Scale (VAS) pain, and Subjective Shoulder Value (SSV) scores were obtained at minimum one-year follow-up. Twelve patients with a mean age of 54 (range 28-72) years were included in our study with a follow-up at an average of 16.6 (range 12-30) months.Ten patients underwent internal fixation and two patients underwent allograft reconstruction. Postoperative imaging (n = 10) at latest follow-up demonstrated healed fractures without any hardware complication. Mean postoperative range of motion included forward elevation of 147 ± 44.0° and external rotation of 44 ± 17°. Postoperative PROMs were obtained from nine patients with a mean PROMIS UE, PI, and Pi score of 49.4 ± 4.1, 39.9 ± 3.8 and 35.6 ± 4.3, respectively. The respective mean ASES, VAS, and SSV scores were 91.8 ± 7.2, 1.2 ± 1.0, and 91.0 ± 8.0. Open surgical repair of anterior glenoid fractures utilizing subscapularis split results in good functional outcomes and low complications including risk of recurrent instability. III case series.

Evaluation of the Clinical Outcomes of the Arthroscopic Treatment of Rotator Cuff Tears Using the Modified Suture Bridge Technique.

Objective To evaluate the postoperative clinical outcomes of the arthroscopic repair of rotator cuff injuries using a suture configuration we have developed based on a modification of the Suture Bridge (Arthrex, Naples, FL, United States). Methods A retrospective study with 28 male (41.2%) and 40 female (58.8%) subjects with a mean age of 60 years. All patients underwent rotator cuff repair with the modified Suture Bridge technique and follow-up for a minimum period of 18 months. The clinical assessment was performed using the University of California, Los Angeles (UCLA) Shoulder Score. Results The mean postoperative range of motion was of 134° (range: 110° to 140°) for elevation, 58° (range: 40° to 70°) for lateral rotation, and T10 (range: L4 to T7) for medial rotation. The mean increase was of 15° for elevation, 14° for lateral rotation, and 2 vertebral levels for medial rotation. The outcomes were excellent in 61 (83.6%) cases, good in 8 (10.9%), and regular in 4 cases (5.5%). Conclusion The modified Suture Bridge technique for the arthroscopic repair of rotator cuff injuries led to excellent or good postoperative clinical outcomes in most cases (69; 94.5%).

Correlation Between Patient-Reported "Happiness" With Knee Range of Motion and Objective Measurements in Primary Knee Arthroplasty.

The purpose of this study was to evaluate the correlation between objective knee range of motion (ROM) and patient "happiness" with knee ROM after total knee arthroplasty. This was a retrospective review of all primary total knee arthroplasties from June through December 2019, yielding 902 patients (1,009 knees). Records were reviewed for knee ROM preoperatively and postoperatively at 6-week follow-up as well as whether patients self-reported being "Happy with their ROM" (HWROM). Clinical records were reviewed for documents ROM as well as manipulation under anesthesia (MUA). The mean preoperative ROM was 110 ± 16 degrees, and 40% of patients were happy with their ROM. Postoperatively, the mean ROM was 106 ± 13 degrees (P < .001), and 76% of patients were HWROM (P < .001). The mean change in knee ROM was (-) 5 ± 17 degrees. The mean postoperative ROM and change in ROM of patients who were HWROM after surgery were 109 ± 12 degrees and (-)2 ± 16 degrees. In patients not HWROM postoperatively, the mean ROM and change in ROM were 98 ± 14 degrees and (-)12 ± 18 degrees (P < .001). Patients with a lower preoperative ROM were statistically significantly more likely to have a positive change in their HWROM (f ratio= 41, P < .001). MUAs were performed in 7.2% of knees, and 28% of patients who underwent an MUA were HWROM before MUA. Early postoperative knee ROM was correlated with patient HWROM. However, further longer term follow-up and more detailed analysis of patient happiness with ROM are needed.

Comparison of Clinical Results Between Locking Plate Fixation and Screw Fixation for Intra-Articular Calcaneal Fractures

Category:Trauma; HindfootIntroduction/Purpose:The purpose of this study is to compare the results of the two fixation groups for intra-articular calcaneal fractures based on the hypothesis that the locking plate group (P-group) can have a less corrective loss but smaller range of motion due to soft tissue contracture than the screw alone group (S-group).Methods:P-group included ten feet, five feet of which were categorized as Sanders classification type 2, four as type 3, one as type 4. S-group included 11 feet, nine as type 2, two as type 3. In both groups, small incisions such as sinus tarsi approach were used, and P-group was fixed with a locking plate, and canulated cancellous screws if necessary, while S-group was fixed with canulated cancellous screws only. We assessed range of motion of the ankle joint and subtalar joint, Creighton-Nebraska scale (CN scale) and pre- and postoperative width and height of the calcaneal body and step of subtalar joint surface.Results:The mean postoperative range of motion in the P-group / S-group was 15°/46.2° / 13.2°/45.9° for ankle dorsiflexion/plantarflexion, and 5°/13° / 5.5°/16° for subtalar joint eversion/inversion, respectively. The mean postoperative clinical score was 89.8+-9.5 points / 93.9+-8.0 points on the CN scale, and the mean pre- and postoperative imaging evaluation showed improvements in the mean width from 120.7+-8.9% to 107+-6.7% / 122.6+-13.4% to 112.9+-10.7%, in the mean height from 88.7+-4.6% to 97.8+-3.3% / 88.3+-5.8% to 99.4+-5.3%, and in the mean step of subtalar joint surface from 6.2+-5.3 mm to 0.7+-1.1 mm / 10.5+-7.6 mm to 1.5+-2.5 mm. As complications, peroneal tendinopathy and transient peroneal neuropathy were observed in one case each in the both groups.Conclusion:There was no significant difference between the two groups in the corrective loss and postoperative range of motion.

Review of complications, functional outcome, and long-term survival following conversion of hip fusion to total hip arthroplasty.

Improvements in functional results and long-term survival are variable following conversion of hip fusion to total hip arthroplasty (THA) and complications are high. The aim of the study was to analyze the clinical and functional results in patients who underwent conversion of hip fusion to THA using a consistent technique and uncemented implants. A total of 39 hip fusion conversions to THA were undertaken in 38 patients by a single surgeon employing a consistent surgical technique and uncemented implants. Parameters assessed included Harris Hip Score (HHS) for function, range of motion (ROM), leg length discrepancy (LLD), satisfaction, and use of walking aid. Radiographs were reviewed for loosening, subsidence, and heterotopic ossification (HO). Postoperative complications and implant survival were assessed. At mean 12.2 years (2 to 24) follow-up, HHS improved from mean 34.2 (20.8 to 60.5) to 75 (53.6 to 94.0; p < 0.001). Mean postoperative ROM was flexion 77° (50° to 95°), abduction 30° (10° to 40°), adduction 20° (5° to 25°), internal rotation 18° (2° to 30°), and external rotation 17° (5° to 30°). LLD improved from mean -3.36 cm (0 to 8) to postoperative mean -1.14 cm (0 to 4; p < 0.001). Postoperatively, 26 patients (68.4%) required the use of a walking aid. Complications included one (2.5%) dislocation, two (5.1%) partial sciatic nerve injuries, one (2.5%) deep periprosthetic joint infection, two instances of (5.1%) acetabular component aseptic loosening, two (5.1%) periprosthetic fractures, and ten instances of HO (40%), of which three (7.7%) were functionally limiting and required excision. Kaplan-Meier Survival was 97.1% (95% confidence interval (CI) 91.4% to 100%) at ten years and 88.2% (95% CI 70.96 to 100) at 15 years with implant revision for aseptic loosening as endpoint and 81.7% (95% CI 70.9% to 98.0%) at ten years and 74.2% (95% CI 55.6 to 92.8) at 15 years follow-up with implant revision for all cause failure as endpoint. The use of an optimal and consistent surgical technique and cementless implants can result in significant functional improvement, low complication rates, long-term implant survival, and high patient satisfaction following conversion of hip fusion to THA. The possibility of requiring a walking aid should be discussed with the patient before surgery. Cite this article: Bone Joint J2021;103-B(7 Supple B):129-134.

Outcomes and complications of distal humeral hemiarthroplasty for distal humeral fractures - A systematic review.

BackgroundDistal humeral hemiarthroplasty has been performed for a variety of indications with the most common being management of distal humeral fractures. This systematic review evaluates the outcomes and complications of distal humeral hemiarthroplasty for this pathology.MethodsWe searched PubMed, EMBASE, and MEDLINE for studies reporting indications and outcomes of patients undergoing distal humeral hemiarthroplasty. Study screening, risk of bias assessment, and data extraction were performed. Summery statistics were provided.ResultsWe included 11 studies (N = 163) in this review. In all studies, the indication for distal humeral hemiarthroplasty was the presence of an intraarticular, comminuted, unreconstructable fracture. The mean post-operative MEPS, FullDASH, and QuickDASH (SD) scores were 83.6 (6.1) points, 25.4 (10.3), and 15.7 (7.4) points, respectively. The mean post-operative range of motion (SD) was 106° (11°) in the flexion and extension arc and 153° (19°) in the protonation and supination arc. The overall rate of adverse events and complication was 63%. The rate for major complications was 11%. The mean total revision rate was 4% (0% to 15) and total re-operation rate was 29% (0% to 88%).ConclusionDistal humeral hemiarthroplasty is a suitable option for unreconstructable distal humeral fractures and offers good functional outcomes with acceptable complication rates.

Joint replacement surgery for elbow tumours: a systematic review of outcomes

Tumour resection followed by joint reconstruction is a surgical option in the appropriate patient. The evidence for such reconstructive surgery of the elbow joint is limited. The aim of this study is to review the literature to evaluate the outcomes of joint replacement surgery in tumours of the elbow. A systematic review of PUBMED and EMBASE databases was conducted. Case series and comparative studies reporting results after total elbow arthroplasty, modular endo-prosthetic replacement and custom prosthesis were eligible for inclusion. Eleven eligible studies were identified (n = 134). At mean follow-up of 44 months, the overall revision rate was 14% and complication rate was 28%. The mean Mayo Elbow Performance Score was 75, with 56% of patients reporting good or excellent outcomes. The mean post-operative range of motion was 97°. Elbow prosthesis reconstruction after tumour resection can provide good functional outcomes at mid-term follow-up. The complication and revision rates are comparable to other indications for elbow replacement surgery. Further prospective studies are required to compare outcomes between different elbow arthroplasty options after tumour resection.

Comparison of Two Surgical Techniques for Periprosthetic Supracondylar Femoral Fractures: Minimally Invasive Locking Plate Versus Retrograde Femoral Nails.

Objectives:This study aimed to compare minimal invasive locking plate and retrograde intramedullary nailing in the treatment of supracondylar femur fracture following total knee arthroplasty (TKA) in respect of fracture healing, complications, and functional results.Methods:A retrospective analysis was made of 32 supracondylar femur fractures comprising 20 cases treated with minimal invasive locking plate fixation and 12 with retrograde femoral nailing. The two techniques were compared in respect of range of motion (ROM), functional scores, intraoperative blood loss, surgery time, and radiological examination findings.Results:The mean functional scores did not differ between the nailing and plate fixation groups. In the minimal invasive locking plate group, 2 (10%) patients had delayed union, so revision surgery was applied. The mean post-operative ROM was comparable between two groups (86.2° vs. 86°). Reduction quality in the sagittal plane and maintenance of the initial reduction were better in the minimal invasive locking plate group. Greater shortening of the lower extremity was seen in the retrograde femoral nailing group than in the minimal invasive locking plate group (20.3 vs. 9.3 mm). Perioperative blood loss was greater (2 units vs. 1.2 units) and mean operating time was longer in the minimal invasive locking plate group (126.5 min vs. 102.2 min).Conclusion:In patients with good bone stock, supracondylar femur fracture following TKA can be treated successfully with retrograde nailing or minimal invasive locking plate. Retrograde femoral nailing has the advantage of less blood loss and a shorter operating time. Reduction quality may be improved with the minimal invasive locking plate fixation technique. Both surgery techniques can be successfully used by orthopedic surgeons taking a case-by-case approach.

Range of Motion after the Sauvé-Kapandji and Darrach Procedures without Extensor Tendon Rupture.

Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé-Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

Functional Outcome of Open Reduction and Internal Fixation of Displaced Extra-Articular Scapula Fractures

Scapular fractures are uncommon injuries of upper extremity resulting mostly from high-energy trauma. Extra-articular fractures form the majority of them. Un-displaced fractures can be managed conservatively with good results. But displaced fracture does not yield satisfactory results and needs surgical fixation. In this case series, we report our experience about such fractures. This was a retrospective study of 12 patients with displaced scapular body and neck fractures treated between 2015 and 2018. Scapular fractures were exposed by modified Judet approach and fixed with either 3.5mm T buttress or recon locking plate and screws. One case had associated clavicle fracture which was fixed along with scapula. Patients were put on structured rehabilitation and followed up regularly. Functional outcome and range of motion were analyzed. The patients included 10 males and two females. Mean age was 42years. Average follow-up was 33months. Average constant and Murley score was 80. Excellent results were seen in four patients, good results in seven patients and one patient has got fair result. The mean post-operative range of motion of the shoulder at the time of final follow-up was 140° of forward flexion, 136° of abduction, and 34° of external rotation. Displaced extra-articular scapular fractures managed by internal fixation using T buttress locking plates and reconstruction plates give good functional outcome.

ACROMIOCLAVICULAR AND CORACOCLAVICULAR RECONSTRUCTIONBY NYLON TAPE VERSUS CORACOCLAVICULAR SCREW IN MANAGEMENT OF ACUTE ACROMIOCLAVICULAR DISLOCATION

Background & Purpose: A number of different surgical techniques were described to treat acute acromioclavicular (AC) joint dislocations which aim to restore joint congruity and mechanical stability. The purpose of this study was to compare functional, radiological outcomes and fixation related complications of acromioclavicular and coracoclavicular (CC) reconstruction by nylon tape versus coracoclavicular screw in management of acute acromioclavicular dislocation.Patients &Methods: In the periodfrom September 2017 to December 2019, a prospectiverandomized controlled clinical trial was conducted in Ain Shams University hospitals including 30 cases with types III and V AC injuries. They were divided into two groups, 15 patients underwent AC and C Creconstruction by nylon tape (Group A) and the other 15 patients underwent coracoclavicular screw (Group B).The patients were evaluated forpain, range of motion (ROM), radiologic findings (CC distance difference between both sides was measured), American Shoulder and Elbow Surgeons(ASES), and Constant scores. Postoperative complications were recorded and assessment of time of returning to the work was done. The evaluation was done preoperatively and each time of follow up with a minimum period of one year.Results: After a mean follow up period of 15±2.7 months for group A and 14.37±4.74 months for group B, patients of both groups showed highly significant improvement between mean preoperative and postoperative pain, ROM, Constant, ASES scores and CC distance difference. Group A showed better results as regard mean postoperative ROM, Constant score and ASES score than group B, while group B showed better results as regard mean postoperative pain score and CC distance difference. However, there was no statistically significant difference between the 2 groups. In group A the mean post-operative pain and ROM scores (both as a part of constant score) was 12.67 (±3.2) and 33.53 (±2.9) respectively while in group B was 12.92 (±3.34) and 32.83 (±2.98) respectively. The mean post-operative Constant and ASES scores was 86.93 (±7.22) and 89.93 (±7.5) respectively for group A and 86.17 (±8.33) and 87.58 (±6.08) respectively for group B. Radiographic CC distance difference (mm) between both shoulders at one year postoperatively was 2.27 in group A and 2.13 in group B. There was a statistically significant difference between the mean time to return to work for patients in group A (3.2 months) and patients in group B (4.2 months). Complete loss of reduction occurred in three patients in group B, two cases of subluxation (50 % of the preoperative CC distance difference) in group A, one case of wound infection in each group and one case of fracture clavicle in group B. Conclusion: Both AC and CC reconstruction by nylon tape and CC screw procedures are valid surgical options and have adequate outcome in treatment of patients with acute AC dislocation. However there are some concerns about the failure rate and the need of another operation for screw removal that was present in CC screw group which affects patient satisfaction in that group.

Posterior condylar offset changes and its effect on clinical outcomes after posterior-substituting, fixed-bearing total knee arthroplasty: anterior versus posterior referencing

BackgroundWe sought to determine whether there was a difference in the posterior condylar offset (PCO), posterior condylar offset ratio (PCOR) and clinical outcomes following total knee arthroplasty (TKA) with anterior referencing (AR) or posterior referencing (PR) systems. We also assessed whether the PCO and PCOR changes, as well as patient factors were related to range of motion (ROM) in each referencing system.MethodsThis retrospective study included 130 consecutive patients (184 knees) with osteoarthritis who underwent primary posterior cruciate ligament (PCL)-substituting fixed-bearing TKA. The difference between preoperative and postoperative PCO and PCOR values were calculated. Clinical outcomes including ROM and Western Ontario and McMaster University (WOMAC) scores were evaluated. Furthermore, multiple linear regression analysis was performed to determine the factors related to postoperative ROM in each referencing system.ResultsThe postoperative PCO was greater in the AR group (28.4 mm) than in the PR group (27.4 mm), whereas the PCO was more consistently preserved in the PR group. The mean postoperative ROM after TKA was greater in the AR group (129°) than in the PR group (122°), whereas improvement in WOMAC score did not differ between the two groups. Preoperative ROM was the only factor related to postoperative ROM in both groups.ConclusionsThere was no difference in postoperative PCO in AR and PR group and the PCO was not associated with postoperative ROM. PCO was more consistently preserved after surgery in the PR group. The postoperative PCO and PCOR changes did not affect the postoperative ROM. Furthermore, similar clinical outcomes were achieved in the AR and PR groups.Trial registrationRetrospectively registered (Trial registration number: 06-2010-110).

Short term outcome of total knee replacement in Kashmiri population without co-morbidities

Background: The aim of the study was to evaluate the patients of osteoarthritis of knee prior to surgery and then 6 weeks after the total knee replacement surgery with regards pain, range of motion, stability, deformity, quadriceps power and support.Methods: This is a prospective follow up study. A minimum of 20 patients have been included in this study conducted in Department of Orthopedics, Bone and Joint Hospital Barzullah Srinagar, during the period of September 2014 to November 2016.Results: The average age of patients was 59.63 years, more than 35% of the patients belonged to the age group 66-70 years, majority of the patients were females (70%) in the whole study group. Most (88.89%) cases were bilateral, affecting both knees. The mean pre-operative range of motion in 94.38 degrees. The mean postoperative range of motion was 113.75 degrees. Patients were followed up at 2, 4, 6 weeks postoperatively. The average blood loss was 500 ml and the average operating time was one hour and 15 minutes and one hour. There was one deep vein thrombosis, one delayed wound healing, one common peroneal nerve palsy and one valgus deformity.Conclusions: The patients with more severely deformed knees, are more elderly, have more pain perception, their functional quality of life was impaired more, they were physically more dependent and their quality of life improves significantly after surgery.

Tibial Tubercle Osteotomy vs the Extensile Medial Parapatellar Approach in Revision Total Knee Arthroplasty: Is Tibial Tubercle Osteotomy a Harmful Approach?

BackgroundAs the frequency of total knee arthroplasty (TKA) is increasing, long-term follow-up of patients has become essential, and the frequency of revision total knee arthroplasty (R-TKA) due to the occurrence of various complications has also increased. There is controversy regarding which approach has minimal complications and an adequate visual field in R-TKA. Therefore, we compared the clinical and radiological results between the extensile medial parapatellar (EMP) approach and tibial tubercle osteotomy (TTO) for R-TKA. MethodsBetween March 1, 2000, and December 31, 2015, we compared 35 patients who underwent the EMP approach and 31 who underwent the TTO approach for R-TKA. In this study, the preoperative range of motion (ROM) was an important criterion for the choice of approach in R-TKA. The EMP approach was applied to patients with a ROM above 60°. The TTO approach was applied to patients with knee flexion limited to 0°-30°. We clinically assessed knee ROM, Knee Society scores, and Hospital for Special Surgery scores at the time of the last follow-up. We radiographically measured femorotibial alignment and patellar height. We also examined the complication rates. The average length of the TTO was 1.0 × 2.5 cm × 10 cm. We used 3 or more 3.5-mm half-threaded screws. ResultsThe mean postoperative ROM of the knee joint at the time of the last follow-up was 103° (flexion contracture 5° and further flexion 108°) in the group that underwent the EMP approach and 101° (flexion contracture 4° and further flexion 109°) in the group that underwent the TTO approach. The mean Knee Society scores were 86 (71-96) and 85 (72-94), and the mean Hospital for Special Surgery scores were 82 (70-93) and 83 (68-92) for the 2 groups, respectively, with no statistically significant difference. The mean femorotibial angles were 0.6° (±3.3°) and 0.1° (±2.9°), and the mean Insall-Salvati ratios were 1.0 (±0.34) and 0.8 (±0.14), respectively, with no statistically significant difference. The group that underwent TTO achieved bone union at an average of 11.8 weeks after surgery. In the group that underwent the EMP approach, 2 patients had extensor lag of more than 10°. In the group that underwent TTO, 2 subjects had skin necrosis at the operative site. ConclusionThe clinical and radiological outcomes were similar in the 2 groups after R-TKA. To increase the ROM and obtain adequate exposure, TTO is also considered a useful surgical approach. However, complications related to TTO should be minimized. Level of EvidenceTherapeutic level III, retrospective comparative study.