Surgical Treatment Of Knee Osteoarthritis Research Articles

Functional outcomes and return to sports, work, and daily activities after revision UKA compared to primary UKA and TKA

Unicompartmental knee arthroplasty (UKA), in addition to total knee arthroplasty (TKA), has been shown to be effective in the surgical treatment of knee osteoarthritis with appropriate patient selection. In clinical studies, it has demonstrated superior functional results with lower complication rates. In clinical practice, these advantages must be weighed against the disadvantage of an increased revision rate, especially in younger patients with sports and work activities. The aim of this study was to compare the functional outcome as well as the time to return to daily activities, work, and sports after revision of UKA to TKA with those of primary UKA and primary TKA using amatched-pair analysis. The study was based on amatched-pair analysis at two defined time points, always comparing 28patients who underwent either revision of aUKA to aTKA, primary UKA, or primary TKA. Patients completed the Oxford Knee Score, UCLA score, Knee Society score, and WOMAC score during standardized follow-up. In addition, postoperative patient satisfaction and return to activities of daily living, work, and sports were recorded in astandardized manner, and aclinical examination was performed. The four functional scores studied showed acommon trend in favor of UKA, followed by primary TKA and revision TKA. The differences between converted UKA and primary TKA were not significant. However, at 3.2years after the last surgery, the results of the converted UKA were significantly lower than those of the primary UKA. Return to work and sports tended to occur the earliest after UKA, followed by TKA and the revision group. All groups showed atendency to engage in low-impact sports. The functional results of revised UKA were significantly inferior to those of primary UKA based on a3-year follow-up. Return to work, sports, and activities of daily living tended to take longer after revision than after primary implantation of either aUKA or aTKA.

Early results of high tibial osteotomy versus combined arthroscopic surgery.

To investigate the early effect of high tibial osteotomy (HTO) compared with combined arthroscopic surgery. A retrospective study was conducted on patients who underwent HTO at The First Affiliated Hospital of Shandong First Medical University from January 2018 to January 2022. 138 patients (163 knees) with knee osteoarthritis (KOA) treated with HTO were selected. The medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), femoral tibial angle (FTA), hip-knee-ankle (HKA) angle, weight-bearing line (WBL) ratio of the knee joint, opening gap, opening angle, American Knee Society score (KSS), US Hospital for Special Surgery (HSS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were measured to determine the different effects between HTO and HTO combined with arthroscopic by logistic regression analysis. Patients with HTO combined with arthroscopic surgery have improved functional scores as well as imaging perspectives compared to preoperative. By multivariate logistic analysis, it was concluded that arthroscopic surgery and gender are influential factors in the outcome of HTO surgery. The postoperative KSS score was 2.702 times more likely to be classified as excellent in the HTO combined with arthroscopy group than in the HTO group [Exp (β) = 2.702, 95% CI (1.049-6.961), P = 0.039]; the postoperative KSS score was 0.349 times more likely to be classified as excellent in women than in men [Exp (β) = 0.349, 95% CI (0.138-0.883), P = 0.026]. Better results with HTO combined with arthroscopic surgery. HTO combined with arthroscopy is a better choice in the surgical treatment of KOA.

A multicenter randomized controlled trial of domestic robot-assisted and conventional total knee arthroplasty

To investigate the accuracy, safety, and short-term effectiveness of a domestic robot-assisted system in total knee arthroplasty (TKA) by a multicenter randomized controlled trial. Between December 2021 and February 2023, 138 patients with knee osteoarthritis who received TKA in 5 clinical centers were prospectively collected, and 134 patients met the inclusion criteria were randomly assigned to either a trial group ( n=68) or a control group ( n=66). Seven patients had lost follow-up and missing data, so they were excluded and the remaining 127 patients were included for analysis, including 66 patients in the trial group and 61 patients in the control group. There was no significant difference ( P>0.05) in gender, age, body mass index, side, duration of osteoarthritis, Kellgren-Lawrence grading, preoperative Knee Society Score (KSS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between the two groups. The trial group completed the TKA by domestic robot-assisted osteotomy according to the preoperative CT-based surgical planning. The control group was performed by traditional osteotomy plate combined with soft tissue release. Total operation time, osteotomy time of femoral/tibial side, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. The radiographs were taken at 5 and 90 days after operation, and hip-knee-ankle angle (HKA), lateral distal angle of femur (LDFA), and posterior tibial slope (PTS) were measured. The difference between the measured values of the above indexes at two time points after operation and the preoperative planning target values was calculated, and the absolute value (absolute error) was taken for comparison between the two groups. The postoperative recovery of lower limb alignment was judged and the accuracy was calculated. KSS score and WOMAC score were used to evaluate the knee joint function of patients before operation and at 90 days after operation. The improvement rates of KSS score and WOMAC score were calculated. The function, stability, and convenience of the robot-assisted system were evaluated by the surgeons. The total operation time and femoral osteotomy time of the trial group were significantly longer than those of the control group ( P<0.05). There was no significant difference in the tibial osteotomy time and the amount of intraoperative blood loss between the two groups ( P>0.05). The incisions of both groups healed by first intention after operation, and there was no infection around the prosthesis. Nine patients in the trial group and 8 in the control group developed lower extremity vascular thrombosis, all of which were calf intermuscular venous thrombosis, and there was no significant difference in the incidence of complications ( P>0.05). All patients were followed up 90 days. There was no significant difference in KSS score and WOMAC score between the two groups at 90 days after operation ( P>0.05). There was significant difference in the improvement rate of KSS score between the two groups ( P<0.05), while there was no significant difference in the improvement rate of WOMAC score between the two groups ( P>0.05). Radiological results showed that the absolute errors of HKA and LDFA in the trial group were significantly smaller than those in the control group at 5 and 90 days after operation ( P<0.05), and the recovery accuracy of lower limb alignment was significantly higher than that in control group ( P<0.05). The absolute error of PTS in the trial group was significantly smaller than that in the control group at 5 days after operation ( P<0.05), but there was no significant difference at 90 days between the two groups ( P>0.05). The functional satisfaction rate of the robot-assisted system was 98.5% (65/66), and the satisfaction rates of stability and convenience were 100% (66/66). Domestic robot-assisted TKA is a safe and effective surgical treatment for knee osteoarthritis, which can achieve favorable lower limb alignment reconstruction, precise implant of prosthesis, and satisfactory functional recovery.

Surgical treatment of knee osteoarthritis focusing on the patellofemoral joint

Background: Surgical management of the osteoarthritic knee joint consists of osteotomies such as a high tibial osteotomy (HTO), uni-compartmental knee arthroplasty (UKA), and total knee arthroplasty (TKA). These surgeries mainly treat the tibiofemoral joint but can also have an impact on the patellofemoral (PF) joint. These changes in PF joint can affect the surgical outcome.Current Concepts: PF joint problems are relative contraindications in UKA. However, recent studies have reported that these problems do not markedly affect the result of UKA. During HTO, the patella height and tracking can change, affecting the PF joint problem. The effect of the PF joint can be minimized through various methods of closing wedge HTO or modified opening wedge (OW) HTO, such as retro-tubercular biplanar OWHTO. However, this method is controversial regarding its impact on clinical outcomes. In TKA, pain caused by PF joint problems can be reduced using techniques such as patella resurfacing, patelloplasty, and denervation; however, there is no clear consensus.Discussion and Conclusion: The surgical treatment of degenerative knee osteoarthritis has an impact on the PF joint, which can affect the outcome of surgery and vice versa. However, these impacts only occasionally cause clinical difference. Conclusively, these surgeries should be done by considering the PF joint because changes in the joint can affect the surgical outcome.

Predicting hip-knee-ankle and femorotibial angles from knee radiographs with deep learning

BackgroundKnee alignment affects the development and surgical treatment of knee osteoarthritis. Automating femorotibial angle (FTA) and hip-knee-ankle angle (HKA) measurement from radiographs could improve reliability and save time. Further, if HKA could be predicted from knee-only radiographs then radiation exposure could be reduced and the need for specialist equipment and personnel avoided. The aim of this research was to assess if deep learning methods could predict FTA and HKA angle from posteroanterior (PA) knee radiographs. MethodsConvolutional neural networks with densely connected final layers were trained to analyse PA knee radiographs from the Osteoarthritis Initiative (OAI) database. The FTA dataset with 6149 radiographs and HKA dataset with 2351 radiographs were split into training, validation, and test datasets in a 70:15:15 ratio. Separate models were developed for the prediction of FTA and HKA and their accuracy was quantified using mean squared error as loss function. Heat maps were used to identify the anatomical features within each image that most contributed to the predicted angles. ResultsHigh accuracy was achieved for both FTA (mean absolute error 0.8°) and HKA (mean absolute error 1.7°). Heat maps for both models were concentrated on the knee anatomy and could prove a valuable tool for assessing prediction reliability in clinical application. ConclusionDeep learning techniques enable fast, reliable and accurate predictions of both FTA and HKA from plain knee radiographs and could lead to cost savings for healthcare providers and reduced radiation exposure for patients.

Total Joint Replacement and Joint-Saving Techniques for the Treatment of Knee Osteoarthritis: The Problems of Decision-Making

Background: Recently, there has been an increasingly insufficient use of conservative methods of therapy and an unreasonable increase in indications for total replacement of large joints. According to the literature, more than 25% of cases of knee joint replacement could have been avoided if patients had been provided with optimal non-surgical methods of treatment. In addition, orthopedic traumatologists have once more focused on unheralded joint-saving surgeries like corrective osteotomy, arthrodesis, arthroscopic techniques, arthromedullary bypass grafting, distraction of the knee joint, tunneling, or osteoperforation due to an increase in the number of revision surgeries and unsatisfactory results of knee joint replacement. Aim: This reviewed the international literature on knee joint replacement and consider alternative methods of surgical treatment of knee osteoarthritis. Materials and Methods: The analysis of international scientific publications on the treatment of osteoarthritis of the knee joint was performed. Results: Joint-saving surgeries for knee osteoarthritis represent an alternative to arthroplasty and improve the quality of life of patients. Such interventions do not require specialized expensive equipment. The intervention is accompanied by a shorter recovery period, with a lower rate of complications than in the case of the replacement of the affected joint.

Возможности туннелизации в лечении остеоартрита коленного сустава

Introduction Surgical treatment of knee osteoarthritis is a controversial issue. Knee replacement is the treatment of choice in the orthopedic practice for patients with severe knee osteoarthritis. However, total knee arthroplasty (TKA) has not only beneficial results and implant survivorship is limited in time. In recent years, the number of publications devoted to the limitation of indications for TKA in patients with osteoarthritis has been increased. The use of drilled tunneling in its modern modifications enables to delay or, in some cases, avoid knee joint arthroplasty. Purpose To substantiate the safety, low invasiveness and effectiveness of the tunneling method as a minimally invasive organ-preserving treatment for knee joint osteoarthritis. Materials and methods The electronic Pub-Med/MEDLINE and eLibrary databases were searched for works published for the last 30 years. The search was carried out with keywords and phrases: knee joint osteoarthritis, articular cartilage, bone drilling, arthroscopy of the knee joint. Results The effectiveness of tunneling is based on the concept of simultaneous revascularization, drainage and decompression of the subchondral sections of the knee joint and the medullary cavity of the tubular bones. Up to 96 % of patients report a positive effect of tunneling immediately after surgery. Intraosseous pressure decreases for up to 2 years in 88 % of patients. Discussion The tunneling method in the treatment of knee osteoarthritis helps to reduce pain in the projection of the femur and tibia, including night pain, improves the functional parameters of the joint, inhibits the progress of cartilage destruction, improves the quality of life of patients and reduces the need for replacement of the affected joint. In addition, tunneling does not require serious economic costs. Due to the fact that this method is a minimally invasive surgical intervention, the risk of infection is noticeably lower than with TKA. Conclusion Thus, the tunneling of the articular ends is a simple, safe, low invasive and effective method of treating knee joint osteoarthritis.

Study on the correlation between the severity of patellofemoral arthritis and the morphology of the distal femur

PurposeDistal femoral torsion is a key factor for poor alignment of patellofemoral joint. This study aims to evaluate the correlation between distal femoral torsion and the severity of patellofemoral arthritis, and to analyze the correlation between distal femoral torsion and the morphology of femoral condyle.MethodsA retrospective analysis was performed on 125 patients awaiting surgical treatment for knee osteoarthritis from January 2021 to March 2022(79 females, 46 males, average age: 65.78 years, SD 6.61). All patients underwent knee joint radiography, lower-limb digital radiography, and knee joint CT scans. The ratio of length of each distal femoral condyle, TT-TG, patellar tilt, DFL-PCL, DFL-TEA, TEA-PCL and TEA-ACL were measured. The Pearson correlation coefficient was used to evaluate the correlation between distal femoral torsion and ratio of distal femoral condyle, TT-TG and patellar tilt. Logistic regression was used to evaluate the correlation between each parameter and the severity of PFOA.ResultsWith the increased severity of PFOA, TT-TG, patellar tilt, DFL-PCL, DFL-TEA and PCA all tended to increase. Patellar tilt was correlated with DFL-PCL (r = 0.243) and TEA-PCL(r = 0.201), but TT-TG had no evident correlation with distal femoral torsion. Compared with Grade I patients of PFOA, DFL-PCL, DFL-TEA, and TEA-PCL were risk factors for increased severity of patellofemoral arthritis in Grade III patients of PFOA, but there was no significant statistic difference in Grade II patients of PFOA.ConclusionsDistal femoral torsion correlates with the severity of patellofemoral arthritis. Variation of the femoral transepicondylar axis caused by the change of ratio of the femoral condyle is particularly important in the distal femoral torsion. In patients with severe PFOA, abnormal variation of the femoral condyle axis should be not ignored.

A novel 3D-printed patient-specific instrument based on \u201cH-point\u201d for medial opening wedge high tibial osteotomy: a cadaver study

BackgroundOpening wedge high tibial osteotomy (OWHTO) is an effective surgical treatment for knee osteoarthritis. This study aimed to explore the feasibility and accuracy of a novel 3D-printed patient-specific instrument (PSI) based on “H-point” for medial OWHTO in a prospective cadaver study.MethodsTwenty-six fresh-frozen lower limbs were collected and randomly divided into two groups: PSI group treated with 3D virtual preoperative planning and a novel 3D-printed PSI; control group with the standard technique. 3D models were reversely reconstructed for preoperative surgical planning, guide plate design, and simulated osteotomy. Anatomic features of “H-point,” surgical time, fluoroscopic dose, correction accuracy including tibiofemoral angle (FTA) and posterior tibial slope (TS) angle were measured.ResultsFirst, H-point was always described as a bony bulge in the posteromedial to the proximal tibia and had a relatively constant relationship with the osteotomy site. Second, the absolute correction error of mFTA and TS were significantly smaller in the PSI group. The effective rate of TS in the PSI group was more concentrated with absolute correction error within 1° and within 2° for 53.3% and 93.3%, compared to 9.1% and 45.5% in the control group. The total operation time, positioning osteotomy time, distraction correction time and fluoroscopy dose in the PSI group were significantly less than those in the control group.ConclusionsThe novel 3D-printed PSI based on H-point is feasibility and accuracy with advantages in terms of TS, surgery time and radiation dose for OWHTO.

Measuring appropriate need for unicompartmental knee arthroplasty: results of the MANUKA study

PurposeIndications for unicompartmental knee arthroplasty (UKA) are controversial. Studies based solely on radiographic criteria suggest up to 49% of patients with knee osteoarthritis (OA) are suitable for UKA. In contrast, the ‘Appropriate use criteria’ (AUC), developed by the AAOS, apply clinical and radiographic criteria to guide surgical treatment of knee OA. The aim of this study was to analyze patient suitability for TKA, UKA and osteotomy using both radiographic criteria and AUC in a cohort of 300 consecutive knee OA patients.MethodsIncluded were consecutive patients with clinical and radiographic signs of knee OA referred to a specialist clinic. Collected were demographic data, radiographic wear patterns and clinical findings that were analyzed using the AUC. A comparison of the radiographic wear patterns with the treatment suggested by the AUC as well as the Surgeon Treatment Decision was performed.ResultsThere were 397 knees in 300 patients available for analysis. Median age was 68 [IQR 15], BMI 30 [6] with 55% females. Excellent consistency for both the radiographic criteria and the AUC criteria was found. Based on radiological criteria, 41% of knees were suitable for UKA. However, when using the AUC criteria, UKA was the appropriate treatment in only 13.3% of knees. In 19.1% of knees, no surgical treatment was appropriate at the visit, based on the collected data.ConclusionApplication of isolated radiologic criteria in patients with knee OA results in a UKA candidacy is misleadingly high. AUC that are based on both radiological and clinical criteria suggest UKA is appropriate in less than 15% of patients.Level of evidenceIII retrospective study.

Measuring Appropriate Need for Unicompartmental Knee Arthroplasty: Results of the MANUKA study

Purpose:Indications for unicompartmental knee arthroplasty (UKA) are controversial. Studies based solely on radiographic criteria suggest up to 49% of patients with knee osteoarthritis (OA) are suitable for UKA. In contrast, the ‘Appropriate use criteria’ (AUC), developed by the AAOS, apply clinical and radiographic criteria to guide surgical treatment of knee OA. The aim of this study was to analyse patient suitability for TKA, UKA and osteotomy using both radiographic criteria and AUC in a cohort of 300 consecutive knee OA patients.Methods:Included were consecutive patients with clinical and radiographic signs of knee OA referred to a specialist clinic. We collected demographic data, radiographic wear patterns and clinical findings that were analyzed using the AUC. We compared the radiographic wear patterns with the treatment suggested by the AUC as well as the Surgeon Treatment Decision.Results:There were 397 knees in 300 patients available for analysis. Median age was 68 [IQR 15], BMI 30 [6] with 55% females. We found excellent consistency for both the radiographic criteria and the AUC criteria. Based on radiological criteria, 41% of knees were suitable for UKA. However, when using the AUC criteria, UKA was the appropriate treatment in only 13.3% of knees. In 19.1% of knees, no surgical treatment was appropriate at the visit, based on the collected data.Conclusion:Application of isolated radiologic criteria in patients with knee OA results in a UKA candidacy is misleadingly high. AUC that are based on both radiological and clinical criteria suggest UKA is appropriate in less than 15% of patients.

What does the "Cochrane Database of Systematic Reviews" Say with Regard to the Surgical Management of Knee Osteoarthritis?

Introduction: The Cochrane Library makes the outcomes of well-conducted controlled trials quickly accessible and is an essential resource for evidence-based medicine. Purpose: The purpose of this article is to review the data on the surgical treatment of knee osteoarthritis currently provided by the Cochrane database of systematic reviews (CDBSR). Results: The main results included the following: Joint lavage and arthroscopic debridement have no benefit for osteoarthritis; valgus high tibial osteotomy (HTO) reduces pain and improves knee function in patients with medial compartmental osteoarthritis of the knee; in primary total knee arthroplasty (TKA) cemented fixation of the tibial components demonstrated less displacement compared with cementless fixation (with and without hydroxyapatite) after a follow‐up of two years; however, the cemented fixation presented a greater risk of future aseptic loosening than cementless fixation; clinically irrelevant differences have been found between retention and sacrifice of the posterior cruciate ligament (PCL) in primary TKA; moderate‐ to low‐quality evidence suggests that mobile-bearing prostheses can have similar effects on various parameters compared with fixed-bearing prostheses in PCL-retaining TKA. Conclusion: The CDBSR discourages joint lavage and arthroscopic debridement, demonstrates the utility of the valgus HTO in patients with medial compartmental osteoarthritis of the knee, and suggests that the various design types in primary TKA offer similar results.

A qualitative study of impediments to total knee replacement among indians with severe knee osteoarthritis

Objective: The objective of this study is to determine the barriers for seeking a total knee replacement (TKR) in Indians with osteoarthritis, despite an increasing need for the surgery. Materials and Methods: Interviews were conducted with 350 Indian patients (109 males, 241 females) who underwent TKR at a tertiary care orthopedic center. The interviews were conducted with each individual based on a questionnaire of 18 questions, which emphasized the patient's reasoning and perceptions regarding TKR. Questions were asked after the patients were admitted but before undergoing TKR. Pain severity and disability before receiving TKR were measured with the Lequesne Index and Oxford Knee Score. Results: Patients requiring TKR were undergoing surgery 13 months after being advised for surgery. Multiple barriers in choosing surgery were identified: (i) wanting to manage pain and disability for as long as possible, (ii) loss of autonomy in making the decision to undergo surgery, (iii) financial issues in affording surgery, (iv) belief that the patients themselves are unfit for surgery and fear of postsurgical complications and morbidity. Conclusions: Despite there being several barriers to the surgical treatment of knee osteoarthritis, physicians must develop strategies to help bridge the gap between patients requiring TKR and the patients electing to undergo the surgery.

Usability of the AAOS Appropriate Use Criteria (AUC) for the surgical management of knee osteoarthritis in clinical practice

PurposeThe Appropriate Use Criteria (AUC) for the surgical treatment of knee osteoarthritis were developed by the American Academy of Orthopedic Surgeons (AAOS) to guide surgeons in selecting the most evidence-based surgical option. This study aimed to assess the usability of the AUC by comparing the actual surgical treatment provided at our institution with that recommended by the AUC.MethodsA retrospective review of the medical charts and radiographs of all patients who underwent surgery for knee osteoarthritis (OA) at our hospital was performed between January and December 2017. Data including each patient’s age, gender, pain level, mechanical symptoms, range of motion (ROM) and instability, radiographic pattern and severity, limb alignment, and type of surgical interventions received were collected.The collected data were input into the AUC application to determine the rate of appropriateness of the treatments. Afterwards, the agreement between the actual treatment provided and the AUC recommendation was assessed.ResultsA consecutive series of 100 patients were included. The mean age was 63.1 years, with the majority of the patients aged (73%) between 50 and 69 years. Most of the patients were females (74%), and 61% had left knee OA. The most frequent type of patient was a middle-aged patient with function-limiting pain at short distances, no mechanical symptoms or functional instability with full ROM, severe knee multicompartmental radiographic features, and varus or valgus malalignment. Out of the 100 patients, total knee arthroplasty (TKA) was performed in 85 patients, unicompartmental knee arthroplasty (UKA) was performed in 11 patients, and high tibial osteotomy (HTO) was performed in four patients.According to the AUC, 90 (90%) cases were treated with an appropriate surgical treatment, whereas 10 (10%) cases were treated with a maybe appropriate treatment. The actual surgical treatment performed at our hospital was in agreement with the AUC recommendation in 100% of the TKA cases, 90.9% of the UKA cases, and 100% of the HTO cases. Thus, the agreement rate with the AUC was 99% in all surgical cases.ConclusionThis study demonstrated that the AUC for the surgical treatment of knee OA can be applied easily in a clinical setting. Most of the treatments provided at our institution were appropriate and in agreement with the AUC recommendations. Additionally, the AUC had a web-based application that was easy to use and simple for identifying treatment recommendations.Level of evidenceRetrospective study, level IV.

Do patellar degeneration and obesity have an impact on anterior knee pain in total knee arthroplasty without patellar resurfacing?

Aim: Purpose of this study was to determine clinical and radiological outcomes of total knee arthroplasty (TKA), and analyze correlation between the degree of the patellar degeneration and anterior knee pain.Materials and Methods: We identified all patients at our institution underwent TKA between January 2009 and March 2011. Patients were classified into two groups according to Outherbridge classification system. The effect of patellar resurfacing on clinical and radiological outcomes was evaluated. Results: A total of 326 patients were included in the present study. The female to male ratio was 254/72. The preoperative, early postoperative and last follow-up range of motion, Knee Society Score and functional scores were similar between groups (p=0.707, p=0.241, p=0.123, p=0.864, p=0.212, p=0.320, p=0.966, p=0.117, p=0.232, respectively). Patient satisfaction rates were similar between groups at last follow-up (p=0.127). Conclusion: In the present study there is no significant relationship between the severity of the patellar cartilage defect and clinical/radiological outcomes at long-term follow-up. Therefore, we do not suggest resurfacing the patella in the surgical treatment of knee osteoarthritis to decrease knee pain and improve knee functionality.

Predicting the knee adduction moment after high tibial osteotomy in patients with medial knee osteoarthritis using dynamic simulations

BackgroundHigh tibial osteotomy (HTO) is a surgical treatment for knee osteoarthritis, which alters the load distribution in the tibiofemoral joint. To date, all surgical planning methods are based on radiographs, which do not consider the loading characteristics during ambulation. This study aimed to develop and validate a simulation tool for predicting the knee adduction moment (KAM) expected after a HTO using the patient pre-operative gait analysis data and dynamic simulations. MethodsTen patients selected for a HTO underwent a gait analysis before surgery. Pre-operative gait data along with the planned correction angle were used for simulation of the KAM expected after leg realignment. After surgery, the same procedures of gait analysis were performed and post-operative KAM was compared to the simulation results. ResultsSignificant reductions of the KAM were observed after surgery. During gait at 1.2 m/s, means of the 1st peak KAM were 3.19 ± 1.03 (standard deviation), 1.21 ± 0.80 and 1.21 ± 0.71% BW × Ht for the conditions pre-operative, post-operative and simulation, respectively. Mean root-mean-square error for the KAM was 0.45% BW × Ht (range: 0.23–0.78% BW × Ht) and Lin's concordance coefficient for the 1st peak KAM was 0.813. An individual analysis showed high agreement for several patients and lower agreement for others. Possible changes in gait pattern after surgery may explain this variability. ConclusionA novel approach for surgical planning based on dynamic loading of the knee during ambulation is presented. The simulation tool is based on patient-specific gait characteristics and may improve the surgical planning procedures used to date.

Current Concept of Surgical Treatment for Knee Osteoarthritis

Current Concept of Surgical Treatment for Knee Osteoarthritis

Surgical treatment for knee osteoarthritis subsequent to previous femur fractures

Objective To investigate the indications and clinical outcomes of total knee arthroplasty or osteotomy for knee osteoarthritis subsequent to previous femur fractures. Methods Six patients (three male and three female) with knee osteoarthritis subsequent to previous femur fractures were analyzed retrospectively between February 2006 and February 2017. The average age of patients was 58.2±10.3 years old, ranged from 51 to 79 years. Four patients underwent total joint replacement and two underwent osteotomy. The average age of patients in joint replacement group was 60.5±12.3 years old. The age of the two patients in the osteotomy group was 51 and 55 years old, respectively. The extra-articular deformity angle of the coronal plane of the femur, lateral distal femur angle of mechanical axis, hip-knee-ankle angle (HKA) of preoperative and postoperative were determined on long-standing radiography. The mean angle of the extra-articular deformity in the joint replacement group was 17.0±7.7 degrees. The angle of the extra-articular deformity in the osteotomy group was 34 and 20 degrees. Lateral distal femur angle of mechanical axis in the joint replacement group was within the range of 87±7 degrees. Lateral distal femur angle of mechanical axis in the osteotomy group was out of the range of 87±7 degrees. The mean preoperative HKA of the joint replacement group was 161.8±8.0 degrees. The preoperative HKA of the osteotomy group was 155 and 160 degrees, respectively. Knee function was estimated according to knee range of motion and Knee Society Score (KSS). The results of postoperative hip-knee-ankle angle, knee range of motion (ROM) and knee society score were compared between the two groups. Results The mean HKA of the joint replacement group reached 176.0±2.8 degrees at one year postoperatively. The HKA of the osteotomy group improved to 177 and to 175 degrees at one year postoperatively. The average preoperative knee ROM improved significantly from 71±16 degrees preoperatively to 113±5 degrees postoperatively. The mean knee ROM of the joint replacement group was 113.0±6.8 degrees. The knee ROM of two patients in the osteotomy group was 110 and 115 degrees, respectively. The average preoperative KSS score improved significantly from 46±3 preoperatively to 88±3 postoperatively. The mean KSS of the joint replacement group was 88.8±3.0, while the KSS of the osteotomy group was 85 and 82. No bone nonunion was observed in the two patients in osteotomy group. Conclusion For patients with knee osteoarthritis subsequent to previous femur fractures, satisfactory short-term clinical outcomes could be obtained by total knee arthroplasty or osteotomy with the strict selection of proper operative indications. Key words: Femoral fractures; Osteoarthritis; Arthroplasty, replacement, knee

Histological characteristics of knee menisci in patients with osteoarthritis.

Existing data indicate knee menisci in patients with osteoarthritis (OA) show tearing, maceration, and fragmentation, but little is known about the change in histological structure. The aim of this study was to evaluate the change in the menisci histological structure in patients with clinically diagnosed knee OA. Fourteen patients undergoing surgical treatment of knee OA (OA group) and 14 cadaveric knees (control group) were assessed. Demographic data, medical history, synovial fluid, OA severity, medial meniscus (MM) tissue, and lateral meniscus (LM) tissue were collected from the OA group. Three nonconsecutive 10 μm cross-sectional tissue slices of menisci were analyzed for percentage of tissue calcification. Exact Mann-Whitney tests and Spearman correlation coefficients tested for relationships between variables. The major change in the histological structure of the menisci in patients with OA was calcification of the matrix, which was significantly greater in the OA group compared with the control group for MM (OA: 11.9%, cadaver: 5.17%; P < 0.001) and LM tissues (OA: 11.1%, cadaver: 4.2%; P < 0.001). A correlation between percent calcification of the MM and LM tissues existed in the OA group (ρ = 0.56, P = 0.04) but not the control group (P = 0.20). The most pronounced pathological change in the histology of menisci was calcification of the cartilage matrix, significantly greater in the OA group than the control group. A strong correlation between percent calcification of MM and LM tissues in patients with OA indicates changes in fibrocartilage matrix of menisci progress similarly in the medial and lateral compartments of the knee. Clin. Anat. 30:805-810, 2017. © 2017Wiley Periodicals, Inc.

Clinical outcome after total knee replacement: forgotten knee. a single-centre prospective pragmatic study

Purpose: Total knee replacement is the radical surgical treatment of knee osteoarthritis and usually produces good or very good results in terms of pain and function. However the patient may report that the knee, although free of pain, does not feel normal. As a result, the patient's assessment may be less favourable than the surgeon's assessment of the outcome. A “forgotten” knee is a joint that feels completely normal to the patient and is therefore the best possible outcome from the patient's viewpoint. To evaluate the prevalence of “forgotten knee” in a single-centre pragmatic prospective study of a uniform patient population, from January 2001 to December 2008. Methods: The study patients were selected for TKR by a specialized surgeon based on tibiofemoral and/or patellofemoral knee osteoarthritis stage IV in the Alback radiological classification, with a >70-mm visual-analogue-scale (VAS) pain score and non response to appropriate medical management. All procedures were done by the same surgeon (MB). A mobile-bearing posterior cruciate ligament-substituting prosthesis was used. The following were recorded at baseline and during regular post-surgery visits: VAS pain score, Knee Society knee and function scores, and four functional scores (KOOS, Oxford, WOMAC, and Lequesne). Forgotten knee was assessed at last follow-up based on the patient's answer to the following question: “Do you feel your knee is completely normal all the time?” Knee radiograph findings before and after TKR were recorded. The chi-square test was used for qualitative parameters and the t test and analysis of variance for quantitative parameters. Results: We included 498 knees in 406 patients (63% of women). Mean age was 70±8.6 years, mean body mass index was 29 Kg/m2, and mean follow-up was 6.4 (3-10) years. Varus deformity was noted in 63% and valgus deformity in 36% of patients. At last follow-up, 375 patients were still active. All functional scores improved significantly (p<0.001) from baseline to last follow-up: KOSS, 40±14 to 95±9; Oxford, 38±9 to 14±4; global WOMAC, 51±18 to 12±7; and Lequesne, 14±9 to 1±3. Among the patients, 80% felt satisfied with the procedure and 87% felt the results were consistent with their expectations, but only 44% met our criterion for “forgotten” knee. There were 17 complications (3.4%) including 5 cases of sepsis with favourable outcomes after reoperation. Conclusions: Only 44% of patients had a forgotten knee after TKR, although 80% were satisfied and free of pain. A forgotten knee may be a criterion for complete recovery that might be of use in future studies of TKR outcomes.