Mean Knee Range Of Motion Research Articles

Antibiotic cement-coated locking plate as a temporary internal fixator for femoral osteomyelitis defects.

Recently we modified the Masquelet technique by using an antibiotic cement-coated locking plate as a temporary internal fixator when treating septic bone defects. This modification is in order to prevent the complications related to external fixator use and provides the involved limb with a greater stability to undergo earlier and more vigorous physical therapy for recovery of joint function. The purpose of this study was to assess the outcomes of large femoral osteomyelitis defects managed by Masquelet technique combined with the antibiotic cement-coated locking plate used as a temporary internal fixator. Between November 2013 to November 2014, 13 cases of large femoral osteomyelitis defects were treated by Masquelet technique and the antibiotic cement-coated locking plate was used as a temporary internal fixator in the first stage surgery. All the patients' clinical and imaging results were retrospectively analyzed. After debridement, there was a femoral bone defect with a mean of 9.8cm (range, 5-16cm). The mean follow-up was 17.8months (range 12 to 24months). One patient developed infection in ninemonths after second stage surgery. Radiographic bony union was achieved within a mean 20.3weeks (range, 18-30weeks) in all patients. The mean time period to full weight bearing after the second step procedure was 5.8months (range, 5-8.5months). The mean knee range of motion for the patients at the last follow up was 122° (range 100-135°). Based on our experience, we believe that antibiotic cement-coated locking plate is a viable fixation method in the first stage of Masquelet technique for the management of large femoral osteomyelitis defects. It may offer a better chance of infection eradication as well as improved recovery of joint function without increasing the infection recurrence rate and without compromising bone graft union.

Alongamento ósseo femoral com fixador externo monoplanar associado a haste intramedular bloqueada

ObjectiveThis study aimed to demonstrate that the technique of lengthening external fixator associated with locked intramedullary nail is an efficient method that decreases the duration of the external fixation and improves the rehabilitation period. MethodsFrom January of 2005 to May of 2014, 31 patients with mean lower limb discrepancy of 5.31 centimeters were treated. The etiologies of the deformity were femur fracture sequelae, infection, hip development dysplasia, polio, and congenital short femur. ResultsThe mean duration of external fixation was 2.47 months (external fixation index of 16.15 days per cm). The mean time for bone healing was 6,66 months (consolidation index 43 days per cm). Initial mean knee range of motion was ‐1 to 100 degrees, progressing to 0 to 115 degrees at the end of treatment. The complications observed were incomplete osteotomies, hip subluxation, broken fixator, decrease of knee range of motion, and need for locking screw removal. ConclusionFemur lengthening with monoplanar external fixator associated with locked intramedullary nail allowed for a shorter period of external fixation use, better protection for the regenerated bone tissue, and early rehabilitation with possible complications.

Surgical Management of Tibial Plateau Fractures With 3.5 mm Simple Plates.

BackgroundTibial plateau fractures can be successfully fixed utilizing 3.5 mm locking plates. However, there are some disadvantages to using these plates.ObjectivesIn the current prospective study, we investigated the outcome of treating different types of tibial plateau fractures with 3.5 mm simple plates which, to our knowledge, has not been evaluated in previous studies.Materials and MethodsBetween 2011 and 2013, 32 patients aged 40 ± 0.2 years underwent open reduction and internal fixation for tibial plateau fractures with 3.5 mm simple plates. The patients were followed for 16.14 ± 2.1 months. At each patient’s final visit, the articular surface depression, medial proximal tibial angle, and slope angle were measured and compared with measurements taken early after the operation. The functional outcomes were measured with the WOMAC and Lysholm knee scores.ResultsThe mean union time was 13 ± 1.2 weeks. The mean knee range of motion was 116.8° ± 3.3°. The mean WOMAC and Lysholm scores were 83.5 ± 1.8 and 76.8 ± 1.6, respectively. On the early postoperative and final X-rays, 87.5% and 84% of patients, respectively, had acceptable reduction. Medial proximal tibial and slope angles did not change significantly by the last visit. No patient was found to have complications related to the type of plate.ConclusionsIn this case series study, the fixation of different types of tibial plateau fractures with 3.5 mm simple non-locking and non-precontoured plates was associated with acceptable clinical, functional, and radiographic outcomes. Based on the advantages and costs of these plates, the authors recommend using 3.5 mm simple plates for different types of tibial plateau fractures.

Predicting Satisfaction for Unicompartmental Knee Arthroplasty Patients in an Asian Population

BackgroundDespite renewed interest in unicompartmental knee arthroplasty (UKA), there is a paucity of published literature with regard to patient satisfaction after UKA within Asian populations. The purpose of this study is to identify characteristics and factors which may contribute to patient dissatisfaction after UKA in a multiracial Asian population. MethodsSeven hundred twenty-four UKAs were performed between January 2007 and April 2013. Preoperative and postoperative variables were prospectively captured, such as standardized knee scores, knee range of motion, and patient satisfaction scores. These variables were then analyzed with a multiple logistic regression model to determine statistically significant factors contributing to patients' satisfaction. ResultsMinimum duration of follow-up was 2 years, with an overall patient satisfaction rate of 92.2%. There was improvement in mean knee range of motion and across various standardized knee scores. Preoperative variables associated with patient dissatisfaction included a poorer preoperative Mental Component Summary, better preoperative knee extension, and better preoperative Oxford Knee Scores. Significant postoperative variables included better Oxford Knee Score at 6 months and Mental Component Summary at 2 years. ConclusionDespite the impressive patient satisfaction rate of UKA in this Asian population, these findings suggest that there is a targeted group of patients with select preoperative factors who would benefit from preoperative counseling.

Combined approaches for fixation of Schatzker type II tibial plateau fractures involving the posterolateral column: a prospective observational cohort study.

This study aimed to investigate the surgical techniques and the clinical efficacy of combined approaches for the treatment of Schatzker type II tibial plateau fractures involving the posterolateral column [lateral and posterolateral columns (LPCs) fractures] in a prospective cohort. From January 2007 through December 2010, a total of 65 patients with LPCs underwent dual-plate fixation via a combined anterior and posterior approach. The anterior and posterior approaches were the conventional anterolateral approach and a posteromedial inverted L-shaped approach, respectively, with the patients in a floating position. Ultimately, 41 patients were followed up for a mean period of 52.5months. All fractures healed. The mean time to radiographic bony union was 15.2weeks and the mean time to full weight-bearing was 18.7weeks. No parameter associated with knee alignment changed significantly between immediately postoperation and 2years postoperation. No collapse of the reduced articular surface was detected. Two years postoperation, the mean Hospital for Special Surgery score was 92.3; the mean Short Form-36 score was 90.1, and the mean range of knee motion was 1.7°-123.6° (extension-flexion). Two patients suffered dehiscence of the anterolateral incision and another suffered partial necrosis at the margin of the posteromedial incision postoperatively. All healed in response conservative treatment. Another two patients experienced numbness in the posteromedial inferior region of the calf. No implant loosening, breakage, fixation failure, or other complication was observed during follow-up. LPCs are not uncommon. Careful preoperative analysis of computed tomography images and impeccable preparation are necessary to avoid neglecting a posterolateral column fracture. It is inappropriate to generalize one scenario for all Schatzker type II fractures: a single approach cannot address all subtypes of these fractures. Dual-plate fixation via a combined approach is an effective treatment for LPCs.

Fixation of delayed union or non-union posterior cruciate ligament avulsion fractures.

To report the outcome of fixation for delayed union or non-union posterior cruciate ligament (PCL) avulsion fractures. Seven men and 4 women aged 24 to 35 (mean, 28) years underwent lag screw or suture fixation for non-union or delayed union of avulsion fracture of PCL tibial attachment after a mean delay of 8.6 (range, 4-14) months. Patient satisfaction was assessed using a visual analogue scale (VAS). Functional outcome was evaluated using the Lysholm scale. The mean follow-up period was 17 (range, 8-36) months. The mean Lysholm score improved from 82 preoperatively to 92 at the final follow-up (p=0.34), the mean range of knee motion improved from 82º to 87º (p=0.008), and the mean VAS score for patient satisfaction improved from 4.3 to 7.4 (p=0.0004). All patients but one achieved bone union after a mean of 7.5 (range, 7-9) weeks. Functional outcome was excellent for 6 patients, good for 4, and fair for one. Posterior drawer test was positive (grade I laxity) in 3 patients whose outcome was good for 2 and fair for one. The latter had non-union after Ethibond suture repair for a communited fracture. There were no instances of wound complications or implant loosening. Fixation with lag screw or suture combined with bone grafting for delayed union or non-union of PCL avulsion fractures achieves acceptable functional outcome.

Rectus femoris transfer in cerebral palsy patients with stiff knee gait

BackgroundAlthough several studies have reported on the outcomes of rectus femoris transfer (RFT), few have investigated the multiple factors that could affect the results. Therefore, we evaluated the outcomes of RFT and analyzed factors that influence improvement and annual change in knee motion after surgery in patients with cerebral palsy (CP). MethodsWe reviewed ambulatory patients with CP who were followed up after they had undergone RFT as part of a single-event multilevel surgery (SEMLS) and who had undergone preoperative and postoperative three-dimensional (3D) gait analysis between January 1995 and December 2012. Relevant kinematic values, including peak knee flexion, knee range of motion, and timing of peak knee flexion in the swing phase and gait deviation index (GDI) score, were the outcome measures. Improvements in rate of angle and GDI score were adjusted by multiple factors such as sex, Gross Motor Function Classification System (GMFCS) level, anatomic type of CP, and concomitant surgeries as the fixed effects, and follow-up duration, laterality, and each subject as the random effects, all of which was performed using a linear mixed model. ResultsA total of 290 patients (487 limbs) and 612 3D gait analysis (2–4 per patient) results were finally included in this study. At 2 years after RFT, estimated mean peak knee flexion (1.2°, p=0.005), estimated mean knee range of motion (10.7°, p<0.001), and estimated mean GDI score (7.3, p<0.001) increased significantly. Peak knee flexion in the swing phase occurred 5.4% earlier after surgery compared with that at baseline (p<0.001). In serial postoperative gait analyses, peak knee flexion in the swing phase occurred 0.8% earlier per year in patients with GMFCS level I or II (p=0.021). ConclusionsRFT as part of a SEMLS was effective in treating stiff knee gait. In serial postoperative gait analyses, patients with GMFCS level I or II showed better prognosis than those with level III with regard to timing of peak knee flexion in the swing phase. Level of evidencePrognostic level IV.

External fixator followed by a plate for distraction, reduction, and fixation in neglected femoral diaphyseal fractures

IntroductionThis study aims to investigate the outcome of a two-stage surgery in the treatment of neglected femoral diaphyseal fractures which are not uncommon in developing nations. Patients and methodsTen patients with neglected or late-presenting femoral diaphyseal fractures were considered in this study. All patients underwent a two-stage surgery, which consisted of distraction by an external fixator and open reduction by internal plate fixation. All patients received a supervised regimen of physiotherapy. Patients were followed up clinically and with radiographs at 2 months to assess union and at monthly intervals thereafter. ResultsAll patients achieved bony union in an average of 3.7 months (2–6 months) with no one lost follow-up. Seven patients regained full range of motion, and the mean knee range of motion was 139.5°. No wound related or neurovascular complications were detected. One patient with stiff knee was re-admitted 1 year after surgery for metal removal, arthrolysis and quadricepsplasty for improving knee range of motion to 90° flexion. ConclusionsWe conclude that the treating of neglected femoral diaphyseal fractures with a two-stage surgery is a satisfactory therapy showing reliable bony union, however continuing medical education is necessary for physicians in primary medical facilities as well as for patients with traditional views.

Outcome of complex tibial plateau fractures treated with external fixator

Background:Tibial plateau fractures are usually associated with communition and soft tissue injury. Percutaneous treatment of these complex fractures is intended to reduce soft issue complications and postoperative stiffness of the knee joint. We assessed the complications, clinical outcome scores, and postoperative knee range of movements, after fluoroscopic assisted closed reduction and external fixator application.Materials and Methods:Seventy eight complex tibial plateau fractures in 78 patients were included in the study. All fractures were managed with closed reduction and external fixator application. In 28 cases with intraarticular split, we used percutaneous cancellous screw fixation for reduction and fixation of condylar parts. In nine open fractures, immediate debridement was done. In 16 cases, elevation of depressed segment and bone grafting was required, which was done from a very small incision. All patients were clinically and radiographically evaluated at a mean followup of 26.16 months (range 6–60 months).Results:Clinical results were evaluated according to the Rasmussen's criteria. Average healing time was 13.69 weeks (range 12– 28 weeks). Mean knee range of motion was 122.60° (range 110°–130°). Forty seven results were scored as excellent, 25 good, 2 fair, and 1 as poor.Conclusion:We believe that minimally invasive treatment by percutaneous techniques and external fixation is a fairly reasonable treatment alternative, if near anatomical reduction of joint surface can be confirmed on fluoroscopy.

Results Following Operative Treatment of Tibial Plateau Fractures

A total of 96 displaced tibial plateau fractures in 94 patients (average age, 48 years) were treated with open reduction and internal fixation. At 12 months postoperatively, mean range of knee motion was 126 degrees and 10 (10%) of the patients had required a secondary surgery. Using a binary regression model, no demographic variable such as age, gender, smoking history, diabetes, BMI; or fracture characteristic such as mechanism of injury, initial plateau depression, Schatzker classification was identified that correlated with short-term functional outcome such as a complication, range of motion, healing time, or residual depression. We determined that radiographic fracture reduction was not superior following fractures with less initial displacement, and increased plateau collapse at 12 months postoperatively was not indicative of decreased function. However, an increased postoperative articular step-off was found to be associated with an increased risk of plateau collapse (p < 0.01). Furthermore, at 12 months, 76% of the patients had returned to their preinjury employment and the overall complication rate was 13%.

The Outcome of Sequential Repeated Tibial Tubercle Osteotomy Performed in 2-Stage Revision Arthroplasty for Infected Total Knee Arthroplasty

Thirteen patients with infected total knee arthroplasty treated by 2-stage revision requiring tibial tubercle osteotomy in both stages for extensile exposure were retrospectively analyzed. The preoperative mean range of knee motion improved from 60° (range, 30°-90°) to 94° (range, 70°-120°) at latest follow-up. The Knee Society knee scores and function scores were 39 and 18 preoperatively and 78 and 67 at latest follow-up, respectively. Although proximal migration occurred in 3 cases and a partial proximal avulsion fracture of the osteotomy segment occurred in 1 case after the second-stage reimplantation, radiographic bony union was observed in all cases. Sequential repeated tibial tubercle osteotomy can be a useful extensile surgical approach in staged revision for infected total knee arthroplasty with satisfactory clinical and radiographic outcomes.

Correcting Fixed Varus Deformity with Flexion Contracture During Total Knee Arthroplasty: The “Inside-Out” Technique

Traditional methods for correcting a severe varus and flexion deformity of the knee during total knee arthroplasty can often lead to excessive release of the medial collateral ligament, hematoma formation, and reliance on constrained implants. The "inside-out" technique for correction of varus deformities involves performing a posteromedial capsulotomy at the level of the tibial cut and incising the superficial medial collateral ligament in a pie-crust manner in extension followed by serial manipulations with valgus stress. Our hypothesis was that this technique effectively corrects severe knee varus and flexion deformity with a reduced risk of complications. Thirty-one consecutive patients (thirty-four knees) with a severe fixed varus and flexion deformity (varus alignment of ≥ 15° and flexion contracture of ≥ 5°) underwent total knee arthroplasty with use of the inside-out technique between October 2006 and December 2009. Physical examination, radiographs, and multiple outcome instruments were used to evaluate the results. The mean duration of follow-up was 3.1 ± 1.1 years (range, 1.7 to 4.9 years). There were no cases of hematoma formation, excessive release of the medial collateral ligament, or acute or delayed instability. A semi-constrained TC3 implant was used in two cases. The mean preoperative coronal alignment was 21.1° ± 4° of varus, which was corrected to 4.5° ± 1.6° of valgus after surgery. The mean preoperative flexion contracture was 10° ± 3.5°. Postoperatively, two patients (three knees) had a residual flexion contracture, which was ≤5° in all cases. The mean range of knee motion improved from 103.3° ± 14.1° preoperatively to 119.1° ± 8° at the time of final follow-up. The mean Knee Society Score pain subscore improved from 39.5 ± 12.6 to 93.2 ± 10.5, and the function subscore improved from 47.1 ± 17.8 to 78.5 ± 21.9. There was no evidence of implant loosening or osteolysis on radiographs. The technique described was safe, reproducible, and effective in treating combined varus and flexion deformity of the knee during total knee arthroplasty. It reduced the risks of over-release of the medial collateral ligament, hematoma formation, and the need for constrained implants.

Minimally Invasive Plate Osteosynthesis for Tibial Plateau Fractures

To evaluate radiological and clinical outcome of minimally invasive plate osteosynthesis (MIPO) for tibial plateau fractures. 35 men and 6 women aged 19 to 75 (mean, 40; standard deviation [SD], 14) years underwent MIPO for displaced tibial plateau fractures. According to the Schatzker system, the tibial plateau fractures were classified as types I (n=3), II (n=9), III (n=11), IV (n=6), V (n=7), and VI (n=5). Six patients had open fractures; 2 of them underwent debridement before MIPO. 10 patients needed additional bone grafting. Radiological (at immediate postoperation) and clinical (at the 12-month follow-up) assessments based on the Rasmussen anatomic and functional scoring system were recorded using a proforma. Patients with acceptable and unacceptable outcomes were compared in terms of age. The mean Rasmussen anatomic score was 15.1 (SD, 2.2; range, 10-18); the mean Rasmussen functional score was 25.3 (SD, 3.2; range, 14-29); and the mean range of knee motion was 118 (SD, 10; range, 90-140) degrees. Anatomic outcome was excellent in 10, good in 28, and unacceptable in 3 patients (one each had Schatzker type-I, -II, and -III fractures). 27 (71%) of the 38 patients with acceptable anatomic outcome were aged 45 years or younger, whereas 2 (67%) of the 3 patients with unacceptable anatomic outcome were aged 60 years or older (p=0.001). Functional outcome was excellent in 18, good in 19, and unacceptable in 4 patients (2 had Schatzker type-III and another 2 had Schatzker type-I or -II fractures). 37 of the patients had a range of knee motion of 120 degrees or more; 27 (73%) of them were aged 45 years or younger, whereas 3 (75%) of the 4 patients with unacceptable functional outcome were aged 60 years or older (p=0.001). MIPO for tibial plateau fractures achieved good outcome with minimal soft-tissue complications. Older age was the predictor of unacceptable outcome.

Patelloplasty with patellar decompression to relieve anterior knee pain in total knee arthroplasty

Anterior knee pain continues to be an important problem following total knee arthroplasty (TKA). The aim of this study was to present the early results of patelloplasty with patellar decompression to relieve anterior knee pain in patients who undergo TKA. We prospectively reviewed 49 knees from 46 patients (35 females, 11 males; mean age: 69.2 years; range: 54 to 82 years) who underwent TKA between January 2004 and December 2008. Decompression and patelloplasty were performed in patients in whom Grade 3 and 4 chondropathy was detected during operation according to the Outerbridge classification. All knees were rated according to the Knee Society Knee and Function Scores, before surgery and during the final follow-up. The patella score was evaluated according to a specific patellofemoral pain questionnaire used by Feller, and the mean knee range of motion was measured preoperatively and postoperatively. Additionally, a patient satisfaction questionnaire used by Levitsky was performed during the final follow-up exam. The mean follow-up period was 41.1 (range: 24 to 68) months. The mean preoperative and final follow-up knee scores were 48.6 ± 8.8 and 87.70 ± 9.3, and function scores were 48.4 ± 10.4 and 81.4 ± 12.6, respectively. The mean preoperative patellar score was 18.1 ± 3.5, and the final follow-up patellar score was 25.7 ± 2.8. The mean patellar scores were significantly greater in knees with Grade 3 chondropathy compared to Grade 4 chondropathy (26.47 ± 2.38 and 24.29 ± 3.19, respectively). Postoperative anterior knee pain was present in four knees (8.2%). The mean preoperative knee range of motion was 85.1 ± 12.7, and the final follow-up knee range of motion was 117.0 ± 9.8. Patients were "extremely" or "very" satisfied with 93.8% of their operative outcomes on their knees. Patellar decompression with patelloplasty in TKA is an option for the reduction of anterior knee pain, but there is a lack of significant evidence in the literature, demonstrating that this method is superior to patellar resurfacing and patellar retention.

Sequential reconstruction of complex femoral fractures with circular hybrid Sheffield frame in polytrauma patients

The timing of definitive fixation for major fractures in polytrauma patients is controversial. We investigated the outcome of the Sheffield hybrid system (SHF) as a solution in the role of primary and definitive fixator for patient with open femoral fractures in whom definitive osteosynthesis with intramedullary nail can be associated with higher rate of complications. Eleven patients (7 men and 4 women), mean age of 40.4 years (range 14-75 years) with previous injury severity score (ISS) greater than or equal to 16 were treated from a damage control orthopedics perspective. Time in the fixator averaged 28 weeks (range 10-64 weeks). Mean follow-up was 3 years (2-4.5). All fractures united. Paley functional and bone results in most cases were good to excellent. Final mean knee range of motion was 113 degrees. We found that SHF for complex fractures of the femur combine maximum support for the bone and preservation of soft tissues. SHF is an effective technique compared to internal nails and earlier external fixator devices, attributable to its advantages such as continuity of frame till union, preventing any second-hit phenomenon, early mobilization, and restoration of primary defect due to bone loss by differential distraction osteogenesis without additional surgery.

Simultaneous bilateral versus unilateral computer-assisted total knee arthroplasty: A prospective comparison of early postoperative pain and functional recovery

Whether simultaneous bilateral TKAs (SBTKAs) are more painful and the postoperative functional recovery slower compared to staged bilateral TKAs or unilateral TKAs are issues that frequently concerns patients. The purpose of the current study was to compare the early postoperative pain, function and recovery in simultaneous bilateral versus unilateral computer-assisted TKA. In this prospective study, 50 consecutive patients undergoing unilateral computer-assisted total knee arthroplasties (TKAs) were compared with 50 consecutive patients undergoing SBTKAs in terms of pain, length of hospital stay and rehabilitative milestones during the immediate postoperative period. The mean visual analogue pain scores, mean knee range of motion, straight leg raising and extensor lag were equal in both the groups at the time of discharge. Patients in the SBTKA group lagged behind the unilateral group in stick walking by approximately 24 h. The results of this study demonstrate excellent pain relief and functional recovery with simultaneous bilateral computer-assisted TKAs comparable to unilateral TKAs. Patients eligible for bilateral TKAs can undergo them simultaneously without excessive pain or slower functional outcome.

Comparative Study for the Results of Unicompartmental Knee Arthroplasty in Patients Younger and Older than 60 Years of Age

Purpose: We wanted to assess the relations between age and the outcome of unicompartmental knee arthroplasty (UKA) based on a comparative study of UKA patients younger than 60 years and UKA patients older than 60 years of age. Materials and Methods: Among the patients who underwent a UKA between January 2002 and June 2003, 230 cases (the group of patients with ages under sixty consisted of 89 knees - group I, and the group of patients with ages over sixty consisted of 141 knees - group II) were followed up for at least 5 years after the operation. Clinical assessments were made usi ng the Knee Society Score (KSS) rating system. Results: The average KSS knee and function scores improved from 54.2 and 57.1 preoperatively to 87.3 and 85.2 at the last follow-up in group I, and from 54.7 and 54.3 to 89.5 and 81.7 in group II, respectively. The mean range of knee motion also improved from 129.4 o to 132.9 o in group I and from 126.8 o to 133.2 o in group II, respectively. There were 5 cases of failed UKAs in each group, and the survival rate of the implant at 5 years was 94.7% in group I and 96.6% in group II. Conclusion: The clinical results of UKA were satisfactory in both age groups. Group I had better results on the knee function score at the last follow-up, but there was no significant difference between both age groups. UKA can be a one of the reliable methods for the treatment of osteoarthritis in patients younger than 60 years of age.

Open intramedullary nailing in neglected femoral diaphyseal fractures

Introduction Neglected femoral diaphyseal fractures are not uncommon in developing nations however there is a paucity of literature in this regard. Due to lack of effective traction, reduction or immobilisation these fractures are invariably associated with shortening and adjacent joint stiffness, presenting a challenging problem to the treating surgeon. The socioeconomic constraints in our society which result in patients seeking non-medical forms of treatment in the first place also warrant the need for an economically viable, simple effective form of treatment which can be carried out in a less advanced setup, gives reliable outcomes and allows early return to work. Methods Eleven patients with neglected or late presenting femoral diaphyseal fractures were considered for the study. All patients underwent open intramedullary nailing, bone grafting and manipulation of the knee under anaesthesia. Iliac crest graft was harvested when local callus did not suffice. All patients received a supervised regimen of physiotherapy. Patients were followed up clinically and with plain radiographs at 6 weeks and 3 months to assess union and at monthly intervals thereafter. Results The mean patient age was 28.8 years (15–48). The mean delay in presentation was 14 weeks (3–32 weeks). The mean shortening was 3.8 cm with four fractures showing signs of malunion. Five patients were given preoperative traction and bone resection was performed in only one patient. The mean hospital stay was 11 days (5–25 days). One patient was lost to follow up, of the remaining 10 patients all united at a mean of 11.9 weeks with 7 patients regaining full range of motion. The mean knee range of motion was 142.5°. There were no wound related or neurological complications. One patient had a patellar tendon rupture which was repaired and another required dynamisation and bone marrow injection for delayed union. Conclusion We conclude that the treatment of neglected femoral diaphyseal fractures with open intramedullary nailing and bone grafting followed by manipulation of the knee with preoperative traction in selected cases is a satisfactory method of treatment showing reliable bony union however knee mobilisation should be undertaken with caution.

Unicompartmental versus Total Knee Arthroplasty in the Same Patient

Purpose: To compare the clinical and radiographic results of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in the same patient, and to investigate patient preference and satisfaction. Materials and Methods: Among the 56 patients who underwent a UKA in one knee and a TKA in the opposite knee between January 2002 and December 2004, 51 patients were followed up. The average follow-up period was 4 years. Results: The average Knee Society Score (KSS) improved from 53.5 preoperatively to 90.7 at last follow-up in the UKA knee, and from 50.4 to 89.8 in the TKA knee. The mean range of knee motion also improved from 124.7˚ to 133.2˚ in the UKA knee, and from 122.5˚ to 127.1˚ in the TKA knee. The tibiofemoral angle changed from 0.3˚ of varus to 5.6˚ of valgus in the UKA knee, and from 2.4˚ of varus to 5.8˚ of valgus in the TKA knee. For patient preference, 23 patients (45%) preferred the UKA knee and 19 patients (37%) preferred the TKA knee. Most patients (42 patients, 82%) reported being ‘very satisfied' or ‘satisfied' with both knees. Conclusion: The clinical and radiographic results of both the UKA and the TKA in the same patient were satisfactory at the 4-year follow-up. The UKA knee had a slightly better range of knee motion, but there was essentially no difference between the UKA knee and the TKA knee.

High tibial osteotomy for osteoarthritis of the knee with varus deformity utilizing the hemicallotasis method

A hemicallotasis method has been developed utilizing an external fixator as high tibial osteotomy (HTO), and satisfactory results of this method with the external fixator have been reported. This external fixator has a universal joint that moves in all directions. We have recently designed a hemicallotasis device for this operation. HTO for the knee with varus deformity utilizing the hemicallotasis method was performed on 44 knees. The patients had a mean age at operation of 65 years (range 49-82 years), a mean follow-up period of 68 months (range 36-119 months), and a mean preoperative knee score of 66 points (range 27-90 points). The operated knees had a mean knee score at the final follow-up of 86 points (range 51-98 points), but the mean range of knee motion was not changed as follows. Before surgery, the mean flexion was 129 degrees (range 90-150 degrees) and the mean extension was -5 degrees (range -30 to 0 degrees), whereas at the final follow-up, the corresponding values were 127 degrees (range 85-150 degrees) and -4 degrees (range -25 to 0 degrees), respectively. Radiographically, the femorotibial joint was classified as grade 2 in 9 knees, grade 3 in 21 knees, and grade 4 in 14 knees according to the classification of osteoarthritis (Kellgren and Laurence). The patellofemoral joint was also classified as grade 1 in 39 knees, grade 2 in 2 knees, and grade 3 in 3 knees. The mean femorotibial angle was 184 degrees (4 degrees varus) before surgery, 169 degrees (11 degrees valgus) after pin extraction, and was maintained at the final follow-up. The complications of this method were relatively few and consisted of pin-tract infection (8 knees), deep vein thrombosis (3 knees), and delayed union (2 knees). No peroneal nerve palsy or compartment syndrome was encountered. No knee was converted to total arthroplasty. However, administration of analgesics was necessary in ten knees at the final follow-up. The hemicallotasis method easily determined the angle of correction even in the knees with ligamentous laxity. Nevertheless, one of the major demerits of this method was a longer period of application of the external fixator. The level of evidence was level IV (case series).