Mean Tibiofemoral Angle Research Articles

Efficacy and Complications of Fixator-Assisted Correction with Internal Fixation in the Genu Valgum.

Two basic methods for genu valgum correction are osteotomy and internal fixation or external fixator assited correction. External fixators have the advantage of stabilizing fragments before osteotomy allowing better control of fragments and preventing secondary displacements. The purpose of this study was to evaluate the efficacy and complications of fixator assisted correction for genu valgum and internal fixation, using the AO distal femur pediatric osteotomy plate. Thirty-six limbs in 26 patients (age 10-16 years) underwent osteotomy in the distal femur at CORA. Open lateral wedge osteotomy was done; the desired position obtained was temporarily stabilized by connecting the pins with the AO external fixator and stabilized with 90 degrees AO distal femur pediatric locking plate and gap grafted with hydroxyapatite bone granules. Translation of distal fragment was required in 17 osteotomies (53.12%). Osteotomies united within 12 weeks; no non-union was observed. The range of motion was full in all patients. The mean tibiofemoral angle was corrected by 12 degrees and the mean mechanical LDFA was corrected to 87 degrees. There was no secondary deformity, either in the rotational or sagittal plane. This method combines the modularity of external fixator and the advantages of internal fixation.

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.

Comparative Analysis of Radiological Evaluation and Early Functional Outcomes of Total Knee Arthroplasty Using an Accelerometer-Based Handheld Navigation System and Conventional Instrumentation: A Prospective Study.

BackgroundAn accelerometer-based handheld navigation system (HHNS) for total knee arthroplasty (TKA) does not require a large console needed for computer-assisted navigation systems and has been shown to decrease component malalignment in TKA. The study aimed to use HHNS with conventional instrumentation to compare the radiological evaluation and functional outcomes of TKA.Materials and methodsThis was a multi-surgeon, prospective, assessor-blinded comparative study of 122 patients undergoing unilateral TKA. We used a stratified randomized sampling method to select 35/48 patients undergoing TKA using a handheld navigation system and 35/74 patients undergoing TKA using conventional instrumentation and divided them into two groups: the HHNS group and (conventional) CONV group. Postoperative radiographic evaluation was based on the tibial and femoral alignment angle, posterior tibial slope, and tibiofemoral angle measured from full-length lower-limb anteroposterior and lateral views of the knee. The Oxford Knee Score (OKS) and Knee Society Score (KSS) with a two-year serial follow-up were used to evaluate functional outcomes.ResultsThe mean tibial alignment angle and posterior tibial slope were 0.78° ± 1.27° and 4.38° ± 0.86°, respectively, in the HHNS cohort and 2.63° ± 1.54° and 2.12° ± 1.82°, respectively, in the CONV group (p < 0.001). There was no significant difference in the femoral alignment angles. The overall alignment using the mean tibiofemoral angle was 179.21° ± 1.82° in the HHNS group and 177.31° ± 2.18° in the CONV group (p = 0.002). There were no significant differences in the KSS and OKS at the two-year follow-up between the groups.ConclusionsThe use of HHNS in TKA significantly increased accuracy in limb and implant alignment, but there was no significant difference in the two-years functional outcomes.

Single-stage medial plateau elevation and metaphyseal osteotomies in advanced-stage Blount's disease: a new technique.

PurposeSurgical treatment in advanced-stage infantile Blount’s disease with medial plateau (MP) depression is challenging. Several osteotomies and fixation methods have been described with no established benchmark. We conducted this study to evaluate the efficacy and safety of a new single-stage technique for acute medial condyle elevation and metaphyseal osteotomies with internal fixation.MethodsA prospective case series of 19 consecutive patients (21 knees) with severe infantile Blount’s disease underwent a single-stage MP elevation and metaphyseal osteotomies, with internal fixation. The mean age was 10.3 years (8.2 to 13.6) and the mean follow-up was 5.1 years (3.2 to 8.3). The outcome measures included clinical and radiological parameters and patient-reported pediatric outcomes data collection instrument (PODCI) score.ResultsThe mean PODCI score improved significantly from 50% to 88%. The mean internal tibial torsion improved from -27° to 11°. All cases maintained full knee extension, no limitation in flexion range of movement and no signs of instability or lateral thrust gait. All the radiographic parameters improved significantly; the mean tibiofemoral angle improved from -29° to 7°, the metaphyseal-diaphyseal angle improved from 33.4° to 4.7° and the angle of depressed MP improved from 38.3° to 2.4° (p < 0.001). At the latest follow-up, no cases of deformity recurrence were identified, the final limb-length discrepancy was < 1 cm in all patients.ConclusionSingle-stage MP elevation and metaphyseal osteotomies with internal fixation significantly improved the clinical and radiographic parameters and PODCI score in advanced infantile Blount’s disease and precluded the use of external immobilization, with no evidence of deformity recurrence.Level of evidenceIV

Role of hemi-epiphysiodesis using 8-plate system in the correction of coronal plane deformities around the knee

Introduction: Angular deformities around the knee in children is a common finding, these deformities are from diverse group of etiologies. Most of these deformities are physiological in nature corresponding to the changes in the alignment of tibio-femoral angle from birth to adolescence. Angular deformities can also be developed due to pathological causes like skeletal dysplasias, metabolic bone disorders, Blount’s disease and trauma. Osteotomies were the mainstay of treatment for correcting deformities in both adults and children been replaced by Hemiepiphysiodesis using 8 plates having less complication rate. Materials and Methods: A total of 49 knees (35 genu valgum, 14 genu varum) of 30 patients were studied. 8 -plates were used for correction of coronal plane deformities around the knee. All cases were followed for minimum period of 12 months. Preoperative clinical and radiological measurements were compared to post-operative measurements. Results: There was statistically significant improvement in clinical and radiological outcome measures. In genu valgum group preoperative mean Tibio-femoral angle (TFA) improved from 24.16 to 8.36. Mean Mechanical axis deviation (MAD) improved from 4.26 to 1.09. Rate of correction of TFA is 1.1/month, rate of correction of MAD is 0.22/month. In genu varum group preoperative mean TFA improved from 34.58 to 21.47. Mean MAD improved from 4.92 to 0.63. Rate of correction of TFA is 0.77/ month, rate of correction of MAD is 0.12/month. Conclusion: Hemi-epiphysiodesis using 8-plate systemin the correction of coronal plane deformities around the knee is a safe and effective procedure. Keywords: Hemiepiphysiodesis, Guided growth modulation, Genu varum, Genu valgum.

CORR Synthesis: Can Guided Growth for Angular Deformity Correction Be Applied to Management of Pediatric Patellofemoral Instability?

CORR Synthesis: Can Guided Growth for Angular Deformity Correction Be Applied to Management of Pediatric Patellofemoral Instability?

Treatment of Infantile Blount's Disease (Infantile Tibia Vara) with a Novel Brace: Preliminary Results

ABSTRACT Introduction Over the years, several types of braces have been used to treat the proximal tibial varus deformity of infantile Blount's disease. The purpose of this study was to evaluate the effectiveness of the JMMR Blount's KAFO (JMMR Inc, Ridgewood, NJ, USA) in correcting infantile tibia vara. Methods From November 2011 to June 2014, four patients with Blount's disease completed treatment with JMMR Blount's KAFOs. The dynamic quality of the brace differentiates it from the standard orthotic treatment of Blount's disease. The active movement of the swivel hinge located on the posterior of plastic lower leg cuff and the telescoping lateral ankle hinge facilitate the application of the valgus stress force below the knee. This, in turn, permits full knee and ankle motion. As the corrective forces are produced during weight bearing, the orthosis is worn only during waking hours. Prebracing and postbracing anterioposterior radiographs were reviewed by an examiner who was blinded to patient's name and date of the radiograph. Results The four patients (two males, two females) had a mean age of 23 months (range, 21–27) at initiation of bracing. Two were bilateral and two were unilateral. Prebracing to postbracing comparison demonstrated Langenskiöld stage improved by at least one stage and metaphyseal-diaphyseal angle decreased from a mean of 15° to 4.3°. The mean tibiofemoral angle was 19.2° varus prebracing and 0.7° valgus postbracing. The mean duration of brace use was 11 months (range, 7–15). Conclusions When the treatment of Blount's disease was started before 3 years of age, the JMMR Blount's KAFO corrected the tibia vara.

Clinical measurement of angular profile of the knee and correlation with intermalleolar distance in children in Enugu metropolis.

Angular deformities of the lower limbs are commonly encountered deformities in pediatric orthopedic clinics. The values of the tibiofemoral angle undergoes changes as the child grows and these changes are self-limiting. The aim of the study is to establish the normal variation of knee angles of children between 2 and 12 years of age in Enugu metropolis and to establish any correlation between the knee angles and the intermalleolar distances (IMDs). This study was done on 630 school children in Enugu metropolis between the age groups of 2 and 12 years. Multistage sampling was used in the study. The tibiofemoral angles and intermalleolar/intercondylar distances were measured. The maximum tibiofemoral angle from this study was 7.6° ± 2.4° and the age corresponding to this value was 4 years. Only 23 subjects (3.5%) had varus knee angle. The values of the mean tibiofemoral angle and IMDs plateaued from 8 to 12 years. There was a significant positive correlation between average knee angle and IMD (r = 0.785, P < 0.001). The physiological changes in the knee angle (tibiofemoral) follow a similar pattern as established in the literature and there was positive correlation between IMD and the tibiofemoral angle.

Severe infantile blount's disease: Hemiplateau elevation and metaphyseal correction with use of the taylor spatial frame

Aims: Severe infantile Blount's disease can result in a challenging multiplanar deformity of the proximal tibia with intra-articular and metaphyseal components. We describe our results using the Taylor's spatial frame (TSF) for acute tibial hemiplateau elevation combined with gradual metaphyseal correction in patients with severe infantile Blount's disease with an associated physeal bony bar. Patients and Methods: Eight patients (ten knees) underwent tibial hemiplateau elevation and metaphyseal correction from 2012 to 2016. We undertook a retrospective case note and radiographic review of clinical and radiographic outcomes. The mean age at the time of surgery of was 11.7 years and the mean length of follow-up was 18.2 months. Results: Improvement in radiographic parameters was seen in all patients. The mean tibiofemoral angle improved from −28.3° to −5.9° postoperatively. The angle between femoral condyles and the tibial shaft improved from the mean of 56.3° to 90.3°. The joint depression angle was also seen to improve from the mean 47.4° to 9.8°. No significant complications were seen. Conclusion: This technique is effective in correcting the complex deformity encountered in severe infantile Blount's disease. Use of the TSF may provide certain advantages in comparison to previously described approaches.

Proximal tibia stress fracture with Osteoarthritis of knee - Radiological and functional analysis of one stage TKA with long stem.

Introduction: Proximal tibia stress fractures with knee osteoarthritis pose a challenging situation. We evaluated the radiological and functional outcome of one-stage total knee arthroplasty (TKA) and long stem for patients with varied grades of knee arthritis and proximal tibia stress fractures. Methods: We analysed 20 patients from April 2012 to March 2017 with proximal tibia stress fractures associated with knee osteoarthritis of varied grades. Out of 20 patients, five were acute fresh fractures. The mean age was 64 years (range, 52–78) which includes three men and 17 women. Previous surgery in the same limb, rheumatoid arthritis, valgus deformity were excluded. All patients were treated with posterior stabilised TKA with long stem, of which, four patients had screw augmentation for medial tibial bone defect and two patients with malunited fracture at stress fracture site required osteotomy, plating and bone grafting. Two patients had two level stress fracture of tibia in the same leg.Results: The mean follow-up period was 28 (range, 6–60) months. The mean tibiofemoral angle improved from 18.27° varus to 1.8° valgus. The mean knee society score improved from 21.9 (range, −10 to 45) to 82.8 (range, 15–99) [p < 0.05]. The mean Knee Society functional score improved from 15.5 (range, −10 to 40) to 76.8 (range, 10–100) [p < 0.05]. All fractures got united at the last follow-up. One patient had infection and wound dehiscence at six months for which debridement done and had poor functional outcome.Conclusion: TKA with long stem gives excellent outcome, irrespective of severity of arthritis associated with stress fracture. By restoring limb alignment and bypassing the fracture site, it facilitates fracture healing. Early detection and prompt intervention is necessary to prevent the progression to recalcitrant non-union or malunion.

Developmental pattern of tibiofemoral angle in healthy north-east Indian children.

PurposePhysiological range of tibiofemoral angle (TFA) is poorly defined and may lead to unnecessary therapeutic interventions. Studies on TFA developmental pattern suggest that racial and ethnic differences are present; children in north-east India who have not yet been studied need to be evaluated.Patients and methodsCross-sectional study of clinical TFA, intermalleolar distance and intercondylar distance in 1020 healthy north-east Indian children aged from 2 to 18 years was done. Height, weight and body mass index were also recorded.ResultsAt two years of age the mean TFA was valgus. The values reached a peak of 8.55° (standard deviation (SD) 1.01) valgus at seven years of age. The TFA then gradually stabilised to 3.18° (SD 1.18) valgus by 18 years of age. There was no significant difference in TFA between male and female patients.DiscussionThe present study is the largest and only the third such study on Indian children and the first on healthy northeast Indian children. By the end of two years most children had valgus angulation. This, along with the peak angulation observed, was similar to most of the other studies. The age at peak angulation and subsequent stabilisation of valgus angulation varied greatly among children of different origins, especially non-Indian children.ConclusionsData can be used to identify children who require further follow-up/evaluation and can serve as guidelines during deformity correction and future studies. The development of TFA in this cohort is not different from other children of India but differs from children of other ethnic origins.

Intra-articular corrective osteotomies combined with the Ilizarov technique for the treatment of deformities of the knee

To present our experience of using a combination of intra-articular osteotomy and external fixation to treat different deformities of the knee. A total of six patients with a mean age of 26.5 years (15 to 50) with an abnormal hemi-joint line convergence angle (HJLCA) and mechanical axis deviation (MAD) were included. Elevation of a tibial hemiplateau or femoral condylar advancement was performed and limb lengthening with correction of residual deformity using a circular or monolateral Ilizarov frame. At a mean follow-up of 2.8 years (1.5 to 4.1), the mean HJLCA improved from 15.6° (10° to 23°) pre-operatively to 0.4° (0° to 2°). The mean MAD improved from 70.0 mm (20.1 to 118.5) pre-operatively to 9.1 mm (3 to 15). The mean tibiofemoral angle improved from 31.0° (8° to 54°) pre-operatively to 4.9° (2° to 8°). The mean limb-length discrepancy decreased from 6.3cm (2.9 to 13.6) pre-operatively to 1.1 cm (0 to 5). All osteotomies and distraction zones healed without complications. The use of intra-articular corrective osteotomies combined with the Ilizarov technique allowed correction of deformities of the knee joint with satisfactory HJLCA and overall mechanical axis in six patients with a good functional and cosmetic outcome in the short term. Cite this article: Bone Joint J 2017;99-B:204-10.

Navigation assisted total knee arthroplasty - Evaluation of correction of clinico - Radiololgical parameters in substantial varus deformity

Background: In the present scenario arthritis of knee joint is inevitable. Total- knee replacement is the final solution in severely deformed joints for pain free mobility. Longevity of the replaced joint is mainly dependent on good mechanical alignment. The navigation system was introduced with a claim to achieve near normal parameters of weight bearing axis thereby increasing the life of implanted knee. Material and Method: This was a prospective study from January 2012 to August 2015 done in Department of Orthopaedics at our institute. A cohort of 20 patients were taken with varus deformity more than 15 degree and operated with the help of navigation system. The result were compared with a cohort of 20 patients suffering from more than 15 degree varus deformity and operated without navigation. Informed consent was taken. Clearance from ethical committee of the institute was taken. Patients were evaluated pre operatively and post operatively at 1, 3, 6 and12 months post operatively with the help of knee society knee score and function score and radiographically. Results: Using computer assisted navigation and measured resection technique of ligament balancing in total knee replacement, mean tibio-femoral angle of 16.40 degrees varus preoperatively (range, 15degrees -24 degrees) was corrected to 2.4 degrees varus (range 5 degree valgus- 4 degree varus) postoperatively. Mean Knee Society score improved from 23.4 (range 0-44) to 86 (range 72 -98), and function score from 21 (range, 0-46) to 98.50 (range 55-100) at 12 months (range 12 month -34 months).No patient reported significant instability. Correction of severe varus deformity by the technique reported can successfully restore alignment, pain free motion, and stability. Conclusion: Substantial Varus knee deformity is very well corrected when total knee arthroplasty is done with the help of navigation system. Here, in our study, either no varus or residual varus deformity was 1-2 degree. Navigation system assisted surgery produces good functional outcome and near normal radiological parameters.

Clinical Results of Lateral Unicompartmental Knee Arthroplasty: Minimum 2-Year Follow-up.

BackgroundWe investigated the clinical results and early complications after lateral unicompartmental knee arthroplasty (UKA) using the Zimmer unicompartmental high-flex knee (ZUK) prosthesis with a minimum follow-up of 2 years.MethodsTwenty-seven patients (30 cases) who underwent lateral UKA with the ZUK prosthesis between January 2011 and February 2014 were selected for this study. The mean age of the patients was 63.3 years at the time of surgery, and the mean followup was 3 years and 2 months (range, 24 to 48 months). A retrospective investigation method was used to evaluate the clinical and radiographic results with use of the Knee Society (KS) clinical rating system and plain radiography.ResultsThe mean KS pain score was improved from 17.9 points (range, 10 to 30 points) preoperatively to 40.5 points (range, 30 to 45 points) at the final follow-up (p < 0.001). The mean KS knee score and function score significantly increased from 63.2 points (range, 48 to 70 points) and 68.6 points (range, 35 to 80 points), respectively, preoperatively to 86.0 points (range, 74 to 95 points) and 92.4 points (range, 60 to 100 points), respectively, at the final follow-up (p < 0.001). The mean range of motion of the knee was recovered from 127.1° (range, 110° to 135°) preoperatively to 131.6° (range, 120° to 135°) at the final follow-up. The mean tibiofemoral angle changed from 6.2° of valgus (range, 0.1° to 11.4° of valgus) preoperatively to 3.4°of valgus (range, 0.2° to 9.5° of valgus) at the final follow-up. The overall results classified based on the KS knee score were "excellent" in 21 cases and "good" in 8 cases. Revision total knee arthroplasty was required in one case because of consistent pain on the medial side of the knee after surgery.ConclusionsThe early clinical results of lateral UKA using the ZUK prosthesis were satisfactory for improvement of pain, knee score, function score, and recovery of knee motion. Therefore, the lateral UKA could be a useful method in the treatment of osteoarthritis in the lateral compartment of the knee. Long-term survivorship remains to be confirmed through ongoing follow-up.

Effects of Reduction Osteotomy on Gap Balancing During Total Knee Arthroplasty for Severe Varus Deformity

This study aimed to assess the effects of down-sizing and lateralizing of the tibial component (reduction osteotomy) on gap balancing in TKA, and the clinical feasibility of an uncemented modular trabecular metal tibial tray in this technique. Reduction osteotomy was performed for 39 knees of 36 patients with knee OA with a mean tibiofemoral angle of 21° varus. In 20 knees, appropriate gap balance was achieved by release of the deep medial collateral ligament alone. Flexion gap imbalance could be reduced by approximately 1.7° and 2.8° for 4-mm osteotomy and 8-mm osteotomy, respectively. Within the first postoperative year, clinically-stable tibial component subsidence was observed in 9 knees, but it was not progressive, and the clinical results were excellent at a mean follow-up of 3.3 years.

Clinical Measurement of the Tibio-femoral Angle in Malay Children.

Background: This study was conducted to find out the age when tibiofemoral angle starts to be in valgus and reaches maximum angle. The differences of the angles between genders were also studied.Methodology: This cross sectional study on tibiofemoral angle was conducted among 160 normal healthy children using clinical measurement method. The children between 2 18 months to 6 years old were assigned to 5 specific age groups of 32 children with equal sex distribution.Result: This study had shown a good inter-observer reliability of tibiofemoral angle measurement with intraclass correlation coefficient (ICC) of 0.87 with narrow margin of 95% confident interval (95% CI: 0.73, 0.94). The mean tibiofemoral angle for children at 2 , 3 , 4 , 5 and 6 years old were 2.25° (SD=0.53), 8.73° (SD=0.95), 7.53° (SD=1.40), 7.27° (SD=1.14) and 6.72° (SD=0.98) respectively. The age when they achieved maximum valgus tibiofemoral angle was 3 years old. The maximum mean (SD) tibiofemoral angle for boys, girls and all children were 8.91° (SD=1.17), 8.56° (SD=0.62) and 8.73° (SD=0.95)respectively. The mean tibiofemoral angle showed no statistically significant difference between girls and boys except for the 5-year-old group, in which the mean TF angle for girls was 7.560 (SD=0.95) and for the boys was 6.970 (SD=1.26) with p-value of 0.037.Conclusion: Measurement of tibiofemoral angle using the clinical method had a very good inter-observer reliability. The tibiofemoral angle in Malay population was valgus since the age of 2 years with maximum angle of 8.730 (SD=0.95) achieved at the age of 3 years.

Periprosthetic fractures after total knee arthroplasty.

To evaluate outcome in 20 patients treated for periprosthetic fractures after total knee arthroplasty (TKA). Records of 14 women and 6 men aged 45 to 85 (mean, 67) years who underwent operative (n=18) or conservative (n=2) treatment for periprosthetic fractures of the supracondylar femur (n=15), patella (n=3), and tibia (n=2) following minor falls (n=18) or high-velocity injury (n=2) were reviewed. The mean time from TKA to fracture was 43 (range, 14-98) months. Of the 15 supracondylar femoral fractures, 2 were managed with immobilisation in a long leg cast, 11 with internal fixation using locked compression plating, and 2 with revision arthroplasty. All 3 patellar fractures were managed with tension band wiring. Both tibial fractures were managed with revision arthroplasty. Radiographic and functional outcomes (the Knee Society scores) were assessed. The mean follow-up was 35 (range, 24-48) months. All fractures healed after a mean of 15 (range, 12-38) weeks. One patient had delayed union. Postoperative alignment was satisfactory in all patients except one (with 5º varus). The mean tibiofemoral angle was 4º valgus. The mean range of motion was 98.5º. The mean Knee Society knee score was 85 (range, 75-89) and the functional score was 76 (range, 70-85). No patient had implant failure, loss of reduction, deep infection, deep vein thrombosis, or pulmonary embolism. The locked compression plate is effective in managing periprosthetic femoral fractures. Periprosthetic patellar and tibial fractures are uncommon. The latter often warrant revision arthroplasty owing to the loose implant.

The Result of Treatment of Femoral Periprosthetic Fractures after Total Knee Arthroplasty

Purpose: We assessed and compared the clinical and radiologic outcomes of treatment in periprosthetic fractures of the femur after total knee arthroplasty. Materials and Methods: We compared 22 knees, 22 patients of femoral periprosthetic fractures which had been fixed with absolute stabilization such as plate or screw fixation in 16 cases (group A), and with relative stabilization such as retrograde intramedullary nailing or Ender nailing in six cases (group B) from November 2004 to March 2013; the mean follow-up period was 51.9 months. Results: The mean tibio femoral angle and the mean mechanical axis showed statistically significant change in group B, between before fracture and last follow-up. The mean bone union time and the mean hospital for special surgery score were not significantly different between group A and B. Nonunion was demonstrated in one case in each group, malunion was demonstrated in one case in group B. Conclusion: In the treatment of periprosthetic fractures of the femur after total knee arthroplasty, absolute stabilization had an advantage for regain of limb alignment. Among the complications, more cases of refracture and infection were observed in the absolute stabilization group, while more cases of nonunion and malunion were observed in the relative stabilization group.

Relationship between Coronal Alignment and Posterior Tibial Slope in the Lower Extremity

Purpose: To restore the normal axial alignment of the lower extremity is important in reconstructive knee surgery. The aim of this study was to evaluate lower-limb alignment and posterior tibial slope. Methods: Thirty-two male and 32 female outpatients aged 22 to 46 were recruited. A full weight-bearing anteroposterior radiograph of the entire lower limb was obtained for each subject. The axial alignment was measured based on the centers of the femoral head, knee, and ankle. The tibiofemoral (TF), tibial joint (TJ), and posterior tibial slope (TS) angles were determined. Results: The mean TF angle was more varus in women (177.8°) than men (179.2°), and the mean TJ angle was more medially inclined in women than men. Women had a greater TJ angle than men (93.3° vs. 91.6°). The mean posterior TS was greater in men than women (16.0° vs. 12.5°, p < 0.05), while the mean TS angle was greater in women (14.8°) than men (12.3°). Conclusion: Knee alignment and geometry vary among populations. In our study, the TF angle was varus among all participants. The knee joint was more medially inclined in women than men. And also the posterior TS was greater in women than men.

One-Stage Long-Stem Total Knee Arthroplasty for Arthritic Knees with Stress Fractures

PURPOSE. To evaluate the outcome of one-stage long-stem total knee arthroplasty (TKA) for patients with arthritic knees and tibiofemoral stress fractures. METHODS. Records of 11 men and 18 women aged 47 to 78 (mean, 66) years who underwent fixed-bearing posterior-stabilised TKA for osteoarthritis or rheumatoid arthritis of the knee with tibial (n=31) and femoral (n=3) stress fractures were reviewed. All the tibial fractures involved the proximal half. There were 7 associated fibular stress fractures. Of the 31 knees with tibial stress fractures, 26 and 5 manifested varus and valgus deformity, respectively. RESULTS. The mean follow-up period was 51 (range, 24-96) months. The mean tibiofemoral angle improved from 23.2 to 1.9 degrees varus. The mean Knee Society knee score improved from 38.5 (range, 15- 63) to 89.6 (range, 80-95) [p<0.05]. The mean Knee Society functional score improved from 25.5 (range, 0-40) to 86.5 (range, 60-100) [p<0.05]. All fractures were united at the last follow-up. No complications were encountered. CONCLUSION. One-stage long-stem TKA restores limb alignment and facilitates fracture healing, with excellent outcome.