Knee In Patients Research Articles

Minimal detectable change of measures of knee extension force obtained by hand-held dynamometry from five patient groups: A systematic review

This review used published data to describe the minimal detectable change for make test measurements of knee extension force obtained by hand-held dynamometry. Five studies involving patients contributed data. Depending on the study and side, the minimal detectable change ranged from 7.6 to 92.1 Newtons. These values provide an indication of how much a patient's knee extension force would need to change to concl ude that a real alteration in status had occurred.

Precise landmarking in computer assisted total knee arthroplasty is critical to final alignment

Image-free computer navigation systems build a frame of reference of a patient's knee from anatomical landmarks entered by the surgeon during the initial stage of total knee arthroplasty. We performed tibial cuts on 70 sawbones using computer navigation. All landmarks were marked identically except for the tibial mechanical entry point, which was marked correctly in 10 bones and with offsets of 5, 10, and 15 mm medially and laterally in the others. The actual coronal angle of the tibial cuts was measured directly and compared to the final angle given by the navigation system. Significant deviations of the coronal angle were observed in the trial groups. Landmarking errors during navigated TKA can lead to inaccurate tibial bone cuts. This navigation system did not have an iterative software method to verify landmarking errors that can lead to inaccurate tibia bone cuts.

Challenging surgical management of a giant inguinoscrotal hernia: Report of a case

This report describes the surgical management of a giant inguinoscrotal hernia, which extended below the patient's knees, causing considerable physical discomfort and impairment of his quality of life. Initial management involved improving the patient's general condition and performing progressive preoperative pneumoperitoneum over 18 days. Surgery involved debulking the contents of the massive hernia sac by performing right hemicolectomy and transverse colectomy, repositioning of the small bowel into the abdominal cavity, resection of the giant hernia sac, and plastic reconstruction of the penis and scrotal region. The abdominal wall was reinforced with composite mesh. Despite a complicated postoperative course, the patient recovered well and has progressively returned to normal activities. Although challenging and demanding, surgery represents the only mode of treatment that can offer the patient with a giant inguinoscrotal hernia a satisfactory level of function and quality of life.

Measurement of an intact knee kinematics using gait and fluoroscopic analysis

A method has been introduced in this paper to measure the kinematics of a knee joint and to use it as a boundary condition to model the knee's mechanical behaviour. A mobile C-Arm fluoroscopy system (Ziehm Vision R) and a CCD camera were used for the measurement of a patient's knee kinematics. The fluoroscopic images were recorded with 12fps and then sent to Matlab software (Mathworks, Natick, MA, USA) for image processing. In parallel, CT scan images of the knee bones were used to create the 3D anatomical geometry of the knee by aid of Mimics software (Materialise NV). However, the geometrical model of the two medial and lateral menisci was generated from MRI data. The 3D geometrical model of the knee was then sent to Abaqus finite element software (Simulia Dassault Systems) to analyse the knee joint contact loads by introducing the boundary condition which was obtained from fluoroscopic images. The finite element model was used to evaluate the stress distribution on the cartilages during the gait. The result was then compared with the experimental data of gait analysis. The comparison between the results showed a close agreement between the two outcomes.

Three-dimensional motion study of femur, tibia, and patella at the knee joint from bi-plane fluoroscopy and CT images

In diagnosis and treatment of knee joint diseases, it is effective to study the three-dimensional (3D) motion of the patient's knee joint involving the femur, tibia, and patella. A 2D/3D registration method with use of fluoroscopy and CT images is promising for this purpose. However, there is no report showing whether the dynamic 3D motion of the patella can be obtained. In this study, we tried to examine dynamic 3D motion of the knee joint which included the patella. First, in order to investigate the accuracy of the position estimation, we conducted an experiment on a pig knee joint which had several fiducial markers placed on it, and we found that errors in the estimation of rotation and translation were less than 1 mm and 1 deg. We then carried out an image-acquisition experiment with healthy knee joints of three volunteers and confirmed that 3D motions of the femur, tibia, and patella were successfully obtained for all cases.

Early Recovery After Total Knee Arthroplasty Performed with and without Patellar Eversion and Tibial Translation

Proponents of minimally invasive total knee arthroplasty claim that patellar eversion and anterior tibial translation during total knee arthroplasty have a deleterious effect on early patient rehabilitation and the early clinical outcome. Our purpose was to identify differences in knee preference and clinical outcome measures in a series of patients who had undergone bilateral total knee arthroplasty with each knee randomized to one of two different surgical approaches: patellar eversion and anterior tibial translation, or patellar subluxation and no tibial translation. The knees of forty patients were prospectively randomized to one of two treatment groups, patellar eversion or patellar subluxation, with each patient having one knee treated with each type of approach. Three patients were withdrawn, leaving a final study group of thirty-seven patients. The patients and physical therapists were blinded to the type of treatment. Clinical outcomes, including the Knee Society scores, range of motion, quadriceps strength as tested with a dynamometer, and the patient's preferred knee on the basis of pain, motion, and strength, were collected preoperatively and at six weeks, twelve weeks, and six months postoperatively and were analyzed. At six weeks after the surgery, there were no significant differences between the two groups with regard to the range of motion, quadriceps strength, or Knee Society scores. With regard to the patient's knee preference at six weeks, the two knees were rated as being the same in terms of pain, whereas a higher percentage preferred the knee treated with eversion in terms of motion (43% compared with 35% who preferred the knee treated with subluxation) and strength (43% compared with 22%). The mean arc of motion in both groups was approximately 113 degrees. At twelve weeks and six months after the surgery, we found no significant differences between the treatment groups in terms of the range of motion, quadriceps strength, or Knee Society scores, and there was no difference with regard to the patient's knee preference. We found no significant differences between the two treatment groups (patellar eversion and anterior tibial translation compared with patellar subluxation and no tibial translation) at six weeks, twelve weeks, or six months after the surgery. We concluded that patellar eversion and anterior tibial translation appear to have no adverse effects on the range of motion, quadriceps strength, or patient's knee preference during the early postoperative recovery period after total knee arthroplasty.

Ceramic Hemi-unicondylar Arthroplasty in an Adolescent Patient With Idiopathic Tibial Chondrolysis

Despite recent advances in cartilage regeneration and restoration procedures, isolated, large, full-thickness cartilage lesions in young patients continue to pose significant challenges to patients and orthopedic surgeons. Treatment options for this difficult problem have traditionally included arthrodesis, osteotomy, osteochondral allograft, and prosthetic reconstruction. We present a case of an adolescent patient with isolated idiopathic lateral tibial chondrolysis treated with a custom ceramic hemi-unicondylar hemiarthroplasty. Preoperatively, a 3-dimensional computed tomography scan of the patient's knee was obtained to begin manufacturing a conforming custom ceramic insert that would articulate between the tibial base plate and the patient's native lateral femoral cartilage. Through a lateral parapatellar approach, the tibial preparation was carried out using the Zimmer M/G unicompartmental knee system (Warsaw, Indiana), and the tibial base plate was cemented into position in the standard fashion. A custom, conforming, prefabricated ceramic insert (CeramTec, Memphis, Tennessee) was then inserted onto the tibial base plate. At 5-year follow-up, this salvage procedure was successful in relieving pain and restoring function in this young patient. There were no signs of implant loosening or lysis. Magnetic resonance imaging of the knee at last follow-up revealed that the cartilage thickness of the patient's lateral femoral condyle remained unchanged. Unicondylar hemiarthroplasty performed in patients with large unipolar lesions in the knee can provide durable and reliable pain relief. Ceramic is a viable material that can be considered for articulation with native cartilage.

Predicting outcomes of rectus femoris transfer surgery

Rectus femoris transfer surgery is a common treatment for stiff knee gait in children with cerebral palsy. Unfortunately, the improvement in knee motion after surgery is inconsistent. There is great interest in understanding the causes of stiff knee gait and determining predictors of improved knee motion after surgery. This study demonstrates that it is possible to predict whether or not a patient's knee motion will improve following rectus femoris transfer surgery with greater than 80% accuracy. A predictive model was developed that requires only a few preoperative gait analysis measurements, already collected as a routine part of treatment planning. Our examination of 62 patients before and after rectus femoris transfer revealed that a combination of hip power, knee power, and knee flexion velocity at toe-off correctly predicted postoperative outcome for 80% of cases. With the addition of two more preoperative measurements, hip flexion and internal rotation, prediction accuracy increased to nearly 88%. Other combinations of preoperative gait analysis measurements also predicted outcomes with high accuracy. These results provide insight into factors related to positive outcomes and suggest that predictive models provide a valuable tool for determining indications for rectus femoris transfer.

Bacteroides fragilis: a case study of bacteremia and septic arthritis.

A 67-year-old African-American male presented with nausea, vomiting, diarrhea, fever, and knee pain. Four sets of blood cultures were collected and resulted in the growth of Bacteroides fragilis in all anaerobic bottles. Later, a fluid and tissue sample from the patient's knee grew the same species of bacteria. The patient was placed on intravenous antibiotics to fight the infection.

Ipsilateral femoral shaft and vertical patella fracture: a case report

IntroductionA femoral shaft fracture with an ipsilateral patella fracture has been, to our knowledge, given only cursory attention in English-speaking literature.Case presentationA 15 year old male patient had hitten by a car to his motorcycle came to emergency room and he had been operated for his femoral shaft freacture and vertical patellar fracture which was iniatally missed.ConclusionTo us it is vital to obtain CT scan of the patient’s knee if there is an ipsilateral femoral fracture with an ipsilateral knee effusion and a punction which reveals hematoma even in the absence of a fracture line seen in AP and lateral projections.

Isolated Knee Pain: A Case Report Highlighting Regional Interdependence

Case report. A number of pain referral patterns for sacroiliac dysfunction have been reported in the literature. However, very little has been written about pain localized to the knee joint for cases involving sacroiliac dysfunction. A 25-year-old female runner was self-referred to physical therapy for medial knee pain of 4(1/2) weeks' duration without a significant onset event. The pain completely curtailed her training for the Boston Marathon. Examination of the patient's knee and hip did not reveal any abnormal findings and there was no reproduction of pain with any test procedures except for medial knee joint tenderness to palpation. Additional, more proximal examination suggested significant asymmetry of sacral bony landmarks of the pelvic girdle without significant findings on the provocation tests of the sacroiliac joint. A single session of manual therapy procedures directed to the pubic symphysis and sacroiliac joint ipsilateral to the side of knee pain was provided. The patient was able to return to running without further incident of knee pain after a single therapy session. This case suggests the importance of regional interdependence in the examination of patients with an apparently common clinical problem. Furthermore, the case describes a previously unreported presentation of local knee pain possibly attributable to sacroiliac joint dysfunction.

Myths and Legends in Orthopaedic Practice: Are We All Guilty?

Over years of practice, many beliefs and practices become entrenched as tried and tested, and we subconsciously believe they are based on scientific evidence. We identified nine such beliefs by interviewing orthopaedic surgeons in which studies (or lack thereof) apparently do not support such practices. These are: changing the scalpel blade after the skin incision to limit contamination; bending the patient's knee when applying a thigh tourniquet; bed rest for treatment of deep vein thrombosis; antibiotics in irrigation solution; routine use of hip precautions; routine use of antibiotics for the duration of wound drains; routine removal of hardware in children; correlation between operative time and infection; and not changing dressings on the floor before scrubbing. A survey of 186 practicing orthopaedic surgeons in academic and community settings was performed to assess their routine practice patterns. We present the results of the survey along with an in-depth literature review of these topics. Most surgeon practices are based on a combination of knowledge gained during training, reading the literature, and personal experience. The results of this survey hopefully will raise the awareness of the selected literature for common practices.

Damages of the tibial post in constrained total knee prostheses in the early postoperative course – a scanning electron microscopic study of polyethylene inlays

BackgroundInvestigation of the risk of fracture of the polyethylene (PE) inlay in constrained total knee prostheses.MethodsThree unused and seven polyethylene inlays that had been implanted in a patient's knee for an average of 25.4 months (min 1.1 months, max 50.2 months) were investigated using scanning electron microscopy (SEM). All inlays were of the same type and size (Genesis II constrained, Smith & Nephew). The PE surface at the transition from the plateau to the post was analyzed.ResultsThe unused inlays had fissure-free surfaces. All inlays that had been implanted in a patient's knee already had distinct fissures at the front and backside of the post.ConclusionThe fissures of the transition from the plateau to the post indicated a loading-induced irreversible mechanical deformation and possibly cause the fracture of the inlay.

The clinical comparison of simultaneous bilateral total knee arthroplasty in treatment of osteoarthritis

Objective To evaluate the risk and efficacy of simultaneous bilateral total knee arthroplasty(TKA) in treatment of osteoarthritis when compared with sequential bilateral TKA and unilateral TKA. Methods A retrospective analysis was performed on 162 patients who underwent TKA from 2003 to 2006. The analyses were adjusted for demographics, preexisting medical conditions, and osteoar-thritis diagnosis. Results Patients undergoing simultaneous bilateral TKA had significantly lower amounts of blood loss, shorter surgical time, shorter hospitalization time, less hospital charges and lower rates of perioperative complications compared with patients undergoing sequential bilateral TKA. No significant difference was found with regard to postoperative complications between the simultaneous bilateral and the unilateral TKA groups. Patient's knee range of motion and the postoperative Hospital for Special Surgery scores(HSS) were similar for the three groups. Conclusion When there are adequate indications for bilateral TKA, simultaneous bilateral TKA is beneficial to patients compared with sequential bilateral or unilateral TKA.

Reproducibility of x-rays of the spinal column while standing

Standing x-rays, especially of children, are often used for therapeutic decisions. As it is known, wrong decisions happen because of temporary one--sided bearing when different weight is put on the feet. This can be avoided by using a new pair of scales which compares the weight of both feet. The patient and the technologist are given optical and acoustic signals when the weight of both feet is the same. Using this pair of scales means that correctly reproducible x-rays can be taken, provided that the patient's knees are extended.

A Woman with Knee Pain and Soft-Tissue Calcification

The patient reported a history of having had a thread-like worm at 10-12 years of age (i.e., >50 years before presentation). At that time, she was a resident of Najran, Saudi Arabia, and recalled experiencing intense itching in the lower limbs, followed by the emergence of a small worm that her family removed by wrapping it around a stick. Since then, she had experienced no associated problems. Radiographs of the patient's knees revealed guinea worm calcifications. Serpentine soft-tissue calcification is seen within the distal aspect of the right thigh and around the left knee (figure 1). The calcification appears nodular, beaded, and fragmented because of the breaking up of the worm (figure 2). The characteristic appearance, combined with the patient's background, led to a diagnosis of infection due to D. medinensis (guinea-worm), a nematode parasite that causes dracunculiasis. After the death of an adult worm, D. medinensis may undergo calcification in several forms, especially if it was not fertilized or did not release its larvae. In its typical location in the lower extremities, the female D. medinensis appears as a long, stringlike, serpiginous or curvilinear calcification, which may extend to 1 meter in length [1]. A description of D. medinensis infection was given by ArRazi Al Hawi several hundred years ago [2]. The disease is a debilitating and painful infection that begins with a blister, usually on the leg, followed by itching, fever, swelling, and burning sensations. Once the infected person immerses the infected part in open water, the worms emerge and release thousands of larvae into the water. The larva is then ingested by a water flea (cyclops), where it develops and becomes infective. Humans acquire infection by drinking water contaminated with cyclops. The D. medinensis larva then penetrates the gut wall and migrates through the subcutaneous tissue,

A computational framework to predict post-treatment outcome for gait-related disorders

Clinicians often use intuitive models based on clinical experience or regression models based on population studies to plan treatment of gait-related disorders. Because such models are constructed using data collected from previous patients, the predicted clinical outcome for a particular patient may not be reliable. We propose a new approach that uses computational models based on engineering mechanics to predict post-treatment outcome from pre-treatment movement data. The approach utilizes a four-phase optimization process built around a dynamic, patient-specific gait model. The first three phases calibrate the model's joint, inertial, and control parameters, respectively, where the control parameters are weights in an optimization cost function that tracks the patient's pre-treatment gait motion and loads. The last phase predicts the patient's post-treatment gait pattern by performing a tracking optimization with the calibrated model modified to simulate the selected treatment. We demonstrate the approach by simulating how two treatments for knee osteoarthritis (OA) – gait modification and high tibial osteotomy (HTO) surgery – alter the external knee adduction torque for a specific patient. By performing multiple tracking optimizations, we calibrated the model's parameter values to reproduce the patient's knee adduction torque curve for a toe out gait motion. When we performed a tracking optimization with the calibrated model using a modified footpath to simulate an increased stance width, the predicted reduction in both adduction torque peaks matched experimental results to within 4.8% error. When we performed a tracking optimization with the same model using modified leg geometry to simulate HTO surgery, the predicted reductions were consistent with published data. The approach requires further evaluation with a larger number of patients to determine its effectiveness for planning the treatment of gait-related disorders on a patient-specific basis.

SU-FF-T-154: Development of An Immobilization Device for Improving Setup Reproducibility for Patients with Prostate Cancer

Purpose: To design the device improving the setup reproducibility of prostate cancer patients during radiation therapy. Method and Materials: A customized device made of polyurethane was designed to immobilize patient's knee, thigh and foot. It was composed of ‘Foot rest supine’, ‘Knee rest supine’ and ‘Knee rest prone’. 61 patients with prostate cancer were selected and divided into two groups to examine the performance of the devices; patients in one group used immobilization device and patients in the other group did not use that. The setup error was measured with respect to bony landmark in the three axes; medial-lateral (ML), anterior-posterior (AP) and cranial-caudal (CC). 1) The difference between digitally reconstructed radiograph (DRR) and simulation film, 2) the difference between DRR and portal film, and 3) the standard deviation among portal films are measured to evaluate the reproducibility. The setup error over 3 mm and 5 mm were measured. Finally, the results were analyzed statistically by using standard t-test. Results: Without immobilization device, the ML, AP and CC error between DRR and simulation film were 1.5±0.9 mm, 3.6±3.6 mm and 1.6±0.9 mm respectively and between DRR and portal film were 1.6±1.2 mm, 4.0±4.1 mm, and 4.2±5.5 mm respectively. The standard deviations along each axis among the portal films were 1.1 mm, 2.1 mm and 1.0 mm. With immobilization device, the ML, AP and CC error were 1.3±1.9 mm, 1.8±1.5 mm and 1.1±1.1 mm respectively between DRR and simulation film and 1.0±1.8 mm, 1.2±0.9 mm, and 1.2±0.8 mm respectively between DRR and portal film. The standard deviations were 0.9 mm, 1.6 mm and 0.8 mm. The percentage set up error greater than 3 mm and 5 mm were reduced by using immobilization device. The data were statistically significant. Conclusion: The immobilization device improved setup reproducibility and reduced critical set up error.

Dr Jacob Mackiewicz (1887–1966) and his sign

Dr Jacob Mackiewicz, a Jewish-Polish neurologist, described the cruralis phenomenon related to injury of the femoral nerve or of the fourth lumbar root. In 1912, only one year after graduation maxima cum laude from Moscow University, the 25-year-old Dr Jacob Mackiewicz described the cruralis phenomenon, regarded in the German and Slavic medical literature as the Mackiewicz sign: 'the patient lies prone, the examiner lifts the thigh in one hand, with the other hand, bends the patient's knee slowly; this manoeuvre causes severe pain in the anterior part of the thigh and over the groin. This manoeuvre indicates a femoral nerve injury'.

Arthroscopic Treatment of Nonunited Anterior Cruciate Ligament Tibial Avulsion Fracture With Figure-of-8 Suture Fixation Technique

The purpose of this study was to evaluate the clinical results of arthroscopic treatment of nonunited anterior cruciate ligament (ACL) tibial avulsion fracture with a figure-of-8 suture fixation technique. Nineteen cases of nonunited ACL tibial avulsion fracture were treated with an arthroscopic figure-of-8 suture fixation technique. The patients were followed up and evaluated according to the International Knee Documentation Committee, Lysholm, and Tegner rating scales. The time interval between the previous injury and this operation was 1 to 8 years, with a mean of 3.6 years. Eighteen patients were followed up for more than 2 years (range, 24 to 30 months; mean, 26 months). The fracture was united within 3 months after surgery in all cases. At the latest follow-up, there was neither extension nor flexion limitation in all patients. With the exception of 1 patient who had a 1 degrees positive Lachman test with a firm end-point, all of the patients had a negative Lachman test. The side-to-side difference in knee anterior laxity was 0 to 2 mm in 17 patients and 4 mm in 1 patient. The Lysholm score was 91 to 100, with a mean of 96.7 +/- 1.9 (compared with 74.3 +/- 4.6 before surgery, P < .05). Fifteen patients returned to their former activity level. The Tegner scores before injury, preoperatively, and at latest follow-up were 6.1 +/- 0.6, 3.6 +/- 1.0, and 6.0 +/- 0.8, respectively; there was no statistically significant difference between the preinjury and postoperative Tegner scores (P > .05). According to the International Knee Documentation Committee scale, 17 patients' knees were graded as normal and 1 patient's knee was nearly normal. Arthroscopic treatment of nonunited ACL tibial avulsion fracture with a figure-of-8 suture fixation technique can ensure fracture healing and restore the stability and function of the joint in most patients. Level IV, therapeutic case series.