Total Knee Replacement Arthroplasty Research Articles

Does Perioperative use of Bisphosphonate Affect Implant Revision Rate of Total Ankle Arthroplasty?

Category: Ankle Arthritis; Other Introduction/Purpose: It is unknown whether perioperative bisphosphonate (BP) use reduces revision rates in total ankle replacement arthroplasty (TAR) although its effect has been demonstrated to be effective in reducing revision rates in total knee or hip replacement arthroplasty. Therefore, the purpose of this study was 1) to investigate whether there is a relationship between the use of BP and the revision rate of TAR, and (2) to determine the effect of BP medication period on the revision rate of TAR. Our hypothesis was that the use of BP would lower the revision rate of TAR. Methods: We reviewed National Health Insurance Service data based on national health insurance service claim data and health care utilization, health screening, socio-demographic variables, medication history, operation codes, and mortality data for 50 million Koreans. From 2002 to 2014, 6391 of 7300 patients who underwent TAR were BP non-users, while 909 patients were BP users. The revision rate according to BP medication and co-morbidities was investigated. The Kaplan-Meier estimate and extended Cox proportional hazard model were also used. Results: The revision rate of TAR was 7.9% for BP users and 9.5% for BP non-users, which showed no significant difference (p=0.251). Implant survival over time decreased constantly. Adjusted hazard ratio for hypertension was 1.242 (p=0.017), while other co-morbidities such as diabetes had no effect on revision rate of TAR. Conclusion: We found that the perioperative BP use do not reduce the revision rate of TAR. Co-morbidities except hypertension did not affect the revision rate of TAR. More research regarding various factor affecting revision of TAR could be warranted.

Does Perioperative Use of Bisphosphonate Affect the Implant Revision Rate of Total Ankle Arthroplasty?

It is unknown whether perioperative bisphosphonate (BP) use reduces revision rates in total ankle replacement arthroplasty (TAR) although its effect has been demonstrated to be effective in reducing revision rates in total knee or hip replacement arthroplasty. We reviewed National Health Insurance Service data based on national health insurance service claims data and health care utilization, health screening, sociodemographic variables, medication history, operation codes, and mortality data for 50 million Koreans. From 2002 to 2014, 6391 of 7300 patients who underwent TAR were BP nonusers, whereas 909 patients were BP users. The revision rate according to BP medication and comorbidities was investigated. The Kaplan-Meier estimate and extended Cox proportional hazard model were also used. The revision rate of TAR was 7.9% for BP users and 9.5% for BP nonusers, which showed no significant difference (P = .251). Implant survival over time decreased constantly. Adjusted hazard ratio for hypertension was 1.242 (P = .017), whereas other comorbidities such as diabetes had no effect on the revision rate of TAR. We found that the perioperative BP use did not reduce the revision rate of TAR. Comorbidities (except hypertension) did not affect the revision rate of TAR. More research regarding various factors affecting the revision of TAR could be warranted. Level III, retrospective cohort study.

Knee Joint Replacement: A Study Of The Patient Profile In Central India

Total knee arthroplasty (TKA) are increasing worldwide [1]. The rates have almost increased to 60% more in the last decade in theelderly. Total knee replacement or Knee arthroplasty has made a revolution the field of orthopedics as the earlier thought of painfulconditions like osteoarthritis or rheumatoid arthritis could now be solved by replacing the damaged joint with an artificial joint whichdramatically improves the pain of the patient and the person who could barely walk due to pain starts walking again pain free. Whilemost years these joint replacement surgeries were out of reach for common patients, various schemes implemented by the Govt hasmade it possible that even poor needy patients can get the total knee arthroplasty done and can live a better quality of life free of painand suffering.Methodology: This study was a record based observational study conducted retrospectively in the department of Orthopaedics in atertiary care hospital in central India from 1st March 2021 to 28th February 2022.Observation and Results: A total of 40 patients were studied in total. Out of them 22 were males and 18 were females. The mean ageof the patients was 58.2 years. Out of the 40, 15 patients had yellow ration card i.e. belonging to lower socio economic status while 15had saffron ration card and only 10 had white ration card. Majority of the population was Hindu (40%) followed by Muslims (25%),Buddhist (25%) and 10% were Christians, Sikhs and Jains. Majority of the population was educated up to 10th standard while 15%were illiterate. Osteoarthritis was the most common indication for hip joint replacement (70%).Conclusion: Knee joint replacement is being done commonly in the right candidate and helps in alleviating patients from theirsufferings.

Transfusion Trends of Knee Arthroplasty in Korea: A Nationwide Study Using the Korean National Health Insurance Service Sample Data.

Knee arthroplasties are strongly associated with blood transfusion to compensate for perioperative bleeding. The purpose of this study was to evaluate trends of transfusion associated with knee arthroplasties using nationwide data of the National Health Insurance Service-National Sample Cohort (NHIS-NSC). Using data from the nationwide claims database of the Health Insurance Review Assessment Service managed by the NHIS, 50,553 knee arthroplasties under three categories (total knee replacement arthroplasty, uni-knee replacement arthroplasty, and revision arthroplasty) from 2012 to 2018 were identified. Overall transfusion rate, transfusion count, proportion of each type of transfusion, and cost associated with each type of operation were investigated. Overall transfusion rate was 83.4% (5897/7066) in 2012, 82.7% (5793/7001) in 2013, 79.6% (5557/6978) in 2014, 75.9% (5742/7557) in 2015, 73.1% (6095/8337) in 2016, 68.2% (4187/6139) in 2017, and 64.6% (4271/6613) in 2018. The proportion of each type of transfusion was 1.8% for fresh frozen plasma, 0.5% for platelets, and 97.7% for red blood cells. The average cost of transfusion was $109.1 ($123 in 2012, $124 in 2013, $123.3 in 2014, $110.6 in 2015, $100 in 2016, $92.9 in 2017, and $90.1 in 2018). In this nationally representative study of trends in transfusion associated with knee arthroplasty, we observed significantly high rates of blood transfusion among patients undergoing knee arthroplasties. Although the overall rate of transfusion had declined, the allogeneic transfusion rate was still high from 2012 to 2018 in Korea. Thus, surgeons need to develop various patient blood management plans and minimize the use of allogeneic transfusion when performing knee arthroplasties.

Q&A: Total Knee Replacement: Alignment

QUESTION: Following a total knee replacement (TKR) or total knee arthroplasty (TKA), a patient has valgus angulation of 10°. When rating the resulting impairment using Table 17-35, Rating Knee Replacement Results (5th ed, 549) of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is it correct to make an alignment deduction of 30 points (3 points for each of the 10° of valgus)?ANSWER: The answer is not as simple as it may seem. The post-TKA knee reportedly has 10° of valgus alignment (also known as knock knee); however, the question does not state whether this measurement was made on physical examination or using a radiograph. The most accurate method for measuring lower limb alignment in the frontal (coronal) plane would be a full-length, standing anteroposterior radiograph, with the patella centered between the femoral condyles to ensure the condyles are oriented parallel to the frontal plane and image.The shorter the arms on a protractor, and the higher the examinee's body mass index (and resultant limb obesity), the greater the potential discrepancy between measurements on physical examination compared with measurements from a radiograph. Hence, many measurements of knee alignment on physical examination have only moderate to poor correlation with measurements derived radiographically.Note that Table 17-35 (5th ed, 549) does not state which measurement to use, but references Insall and colleagues1 and the Knee Society Scoring System (KSS©).2 The current KSS© Licensed User Manual states that alignment is measured by the femoral tibial axis on radiographs.2 Therefore, when rating impairment, clinicians should measure the anatomic, not mechanical, axes of the femur and tibia, and preferably on a radiograph.Table 17-35 (5th ed, 549) was written when findings from long-term follow-up of knee replacement were not yet published.Modern reviews of 1-year outcomes3 and 20-year outcomes4 have not identified coronal malalignment as a cause of chronic knee pain or the need for revision. However, most published studies consider “ideal” alignment on coronal full-length lower limb radiographs as a hip-knee-ankle angle between 3° of valgus and 3° of varus. This measurement of the mechanical axes is made by drawing a line from the center of the femoral head to the center of the knee, and then a line from the center of the knee to the center of the talus. Note that mechanical axes are used in outcome studies, rather than the anatomical axes employed in the KSS.Outcome studies use a different radiographic measurement that more accurately assesses the bio-mechanical consequences of implant alignment after TKA; however, when rating impairment using the AMA Guides, Fifth Edition, Table 17-35, one should measure the femoral shaft to tibial shaft angle (anatomic axes), as the KSS specifies, because this is the basis for Table 17-35.Assuming a femoral-tibial angle has been accurately measured on a postoperative full-length lower-limb radiograph, 10° of valgus is outside the desired range for component position. A range from 0° to 4° of either valgus or varus alignment is considered the goal, with no deduction of points in the scoring system. Ten degrees of valgus would qualify for 3 points per degree beyond 4°, or 3 points each for 5°, 6°, 7°, 8°, 9°, and 10°. This sums to an 18-point deduction, not 30.As an aside, the question does not state the degree of preoperative coronal plane deformity. Correcting alignment in knees with severe valgus deformity is challenging.In a situation where different examiners provided different post-TKA impairment ratings, the trier of fact may lend greater credibility to the examiner adhering to the KSS methodology and using measurements from radiographs rather than from physical examination of lower limb alignment.

A Technical Tip: Surgical Exposure of Proximal Tibia in Total Knee Replacement Arthroplasty Using a Pin to Retract Patellar Tendon

A Technical Tip: Surgical Exposure of Proximal Tibia in Total Knee Replacement Arthroplasty Using a Pin to Retract Patellar Tendon

Aquatic Exercise and Land Exercise Treatments after Total Knee Replacement Arthroplasty in Elderly Women: A Comparative Study.

Background and Objectives: Early intensive exercise after total knee replacement arthroplasty (TKRA) has become increasingly popular due to its ability to enhance knee physical function and reduce pain. When implemented exclusively, aquatic exercise (AE) appears to be more advantageous than land exercise (LE), particularly in the early phase after TKRA. Our study aimed to compare the clinical efficacy of AE and LE with respect to their effects on pain and physical function after TKRA. Materials and Methods: Between February 2008 and January 2020, 100 female patients who underwent TKRA were enrolled in this retrospective study. We measured the range of motion (ROM) of the knee, the isokinetic strength of the knee joint (function), and pain both initially and one month after TKRA. Two weeks after TKRA, the participants were enrolled in either the AE or the LE program for a total of two weeks. Two 30 min sessions of intensive ROM and knee strengthening exercises and balance training were provided to the AE and LE groups for 10 days. The home exercise group (HE) only received information on ROM and strengthening exercises. There were 33, 21, and 46 patients allocated to the AE, LE, and HE groups, respectively. Results: The ROM of the side on which surgery was performed improved significantly in all groups, as did the pain scores. In the AE group, the knee flexor strength showed a tendency toward improvement. Contrastingly, there was no significant improvement in the knee extensor strength in the AE group. Conclusions: Overall, the AE and LE groups showed superior outcomes compared with HE. In addition, the AE group demonstrated some improvement in knee muscle strength even with a short hospital stay. Further study with long-term follow-up should be performed to better define the outcomes.

Linear mixed modeling on the effects of varus knee surgery on the ankle joint weight-bearing axis

BackgroundVarus knee correction may affect the ankle and subtalar joints and impact the prognosis of ankle arthritis because the weight-bearing load on the lower extremity extends from the hip to the foot. We aimed to evaluate the changes in the mechanical axis and the weight-bearing axis of the ankle after varus knee surgery. MethodsPatients with a varus knee were followed up after undergoing high tibial osteotomy or total knee replacement arthroplasty. The inclusion criteria were age (>18 years) and a history of preoperative and postoperative scanograms. The postoperative change to the ankle joint axis point on the mechanical axis and weight-bearing axis according to the hip–knee–ankle angle correction was adjusted by multiple factors using a linear mixed model. ResultsOverall, 257 limbs from 198 patients were evaluated. The linear mixed model showed that the change in the ankle joint axis point on the mechanical axis was not statistically significant after high tibial osteotomy and total knee replacement arthroplasty (p = 0.223). The ankle joint axis point on the weight-bearing axis moved laterally by 0.9% per degree of postoperative hip–knee–ankle angle decrease (p < 0.001). ConclusionsVarus knee correction could affect the subtalar joint and the ankle joint. Our findings require consideration when utilized during pre- and postoperative evaluations using the weight-bearing axis of patients undergoing varus knee correction.

Diagnosis and treatment of bullous pemphigoid that developed twice after total knee replacement arthroplasty: a case report

BackgroundTotal knee replacement arthroplasty (TKA) is frequently performed in South Korea. Simple swelling-associated blistering around the periphery of the operative wound is a well-known adverse effect. However, in rare cases, the blisters are bullous pemphigoid (BP).Case presentationA 75-year-old male presented with knee pain that had not improved despite 5 years of medication. We performed TKA of the left knee, placing a Stryker posteriorly stabilized prosthesis. Three days later, blisters developed near the buttocks and thighs and, on day 10 after surgery, around the operative site. A skin biopsy revealed BP. Commencing on day 14 after surgery, prednisolone 10 mg was administered twice daily. The symptoms improved by 3 weeks after surgery and were healed at 4 months. After 1 year, we performed TKA of the right knee. On day 2 after surgery, as formerly, blisters developed on the buttocks and an immediate biopsy revealed BP. Commencing on day 3 after surgery, prednisolone 10 mg was administered twice daily. On day 10 after surgery, the blisters on the buttocks had improved and no blisters were observed at the surgical site. All symptoms had resolved by 2.5 months after surgery.ConclusionsAfter TKA surgery, generalized BP may develop, diagnosed via skin biopsy. A quick diagnosis is important because early treatment can prevent symptom progression and shorten treatment.

Functional outcome of bilateral total knee replacement arthroplasty in bilateral tricompartmental osteoarthritis of knee

Background & Objectives: Total knee arthroplasty is a well documented surgical procedure. It relieves pain and functional disability experienced by patients with moderate to severe arthritis of the knee, improving their quality of life. The success of Total knee Replacement arthroplasty is its ability to relieve the pain associated with knee joint pathology, while maintaining the mobility and stability of the knee joint. The most common condition for which total knee arthroplasty is done is severe osteoarthritis of the knee. The primary indication for this procedure is severe pain and the limitation in activities of daily living that it causes. To warrant doing total knee replacement, pain must be refractory to conservative measures such as oral nonsteroidal anti-inflammatory medication, weight reduction, activity restriction, and the use of supports such as a cane. The purpose of this study was to evaluate the clinical and functional outcomes of Total knee Replacement using Knee society score and radiological assessment. Methods: The study was carried out on 30 patients of Total knee Replacement operated in the Department of Orthopedics. Information on the patients was compiled from clinical details, case files and operation theater records. This was a prospective study. Patient follow up was for a minimum of 6 months to a maximum of 24 months (2 years). Results: Excellent or good pain relief and function were obtained in 29 patients after TKR, which was performed in a population of active patients. The mean total pre-operative score was poor (

Profile and Trends in Comorbidity for Patients Undergoing Hip and Knee Arthroplasty Using the Rx-Risk Measure with Pharmaceutical Dispensing Records

IntroductionPatient comobidity at time of primary joint replacement (JR) impacts on outcomes including revision and mortality. Understanding changes in comorbidity profiles is important when assessing change in outcomes over time. Most arthroplasty registries have limited comorbidity information due to their minimum dataset. One approach to obtaining additional comorbidity data is linking registry data with national administrative data. Objectives and ApproachObjectives were to quantify pre-operative comorbidity profile of patients undergoing primary total hip replacement (THR) and total knee replacement (TKR) for osteoarthritis. Also, to examine temporal trends in individual comorbidities for THR and TKR patients. National pharmaceutical dispensing data were linked with THR and TKR arthroplasty patients. Medication dispensing histories in 12-months preceding JR (2003-2017) for 237,333 THR and 394,965 TKR patients, were mapped to 47 comorbidity classes using the Rx-Risk-V measure - a pharmacy-based measure of comorbidity. Comorbidity scores were calculated by summing comorbidity categories for individual patients. Trends in comorbidity scores/categories were described, with comorbidity information presented by PBS beneficiary category (concessional/general), stratified by age (&lt;65/≥65 years). ResultsMedian (interquartile range) comorbidity scores were higher in concessional patients ≥65y, THR:5(3-6), TKR:5(3-7); &lt;65y,TKR:5(3-6) but not THR:4(2-6). Comparative scores for general patients (both ages) were THR:4(2-6) and TKR:3(2-5). Trends in median comorbidity scores were consistent across study period, THR:4- 5(concessional)/2-3(general) and TKR:4-5(concessional)/4(general). Commonly identified comorbidities in younger concessional THR patients were pain, measured by opioid use (62.4%), inflammation/pain, measured by use of non-steroidal anti-inflammatories (62.2%), GORD (36.2%) and hypertension (36.1%). Individual comorbidities remained generally stable over time. However, increased patient proportions were seen in THR concessionals &lt;65y for opioid pain (59.1%-71.1%), depression (24.5-42.5%), whilst inflammation/pain (82.1-56.1%) and antiplatelet use (≥65y:23.5-9.2%) declined. Conclusion / Implicationsn THR or TKR patients no appreciable change in comorbidity score or comorbidity profile occurred over time. This suggests that improving JR outcomes over time are unlikely due solely to variation in patient comorbidity profiles.

The Optimal Combination of Monochromatic and Metal Artifact Reconstruction Dual-energy CT to Evaluate Total Knee Replacement Arthroplasty

PurposeTo evaluate the effects of gemstone spectral imaging-metal artifact reduction (GSI-MAR) on different dual-energy CT monochromatic images for patients with total knee replacement arthroplasty (TKRA) and to identify an appropriate protocol for clinical practice. MethodWe enrolled 34 patients with TKRA. CT images were iteratively reconstructed with or without GSI-MAR at different energy levels (70, 95, 115, and 140 keV). Two radiologists evaluated the objective and subjective image qualities and MAR-related new artifacts at the femoral and tibial levels. For objective analysis, the mean CT number and image noise of the selected regions of interest in the bone and muscle were recorded. To quantitatively evaluate the performance of GSI-MAR, a structural similarity index (SSIM) was used. For subjective analysis, streak artifacts and diagnostic confidence in detecting periprosthetic complications were assessed. Objective and subjective indicators were compared among the image combinations. ResultsIn the femoral component, 140 keV monochromatic energy images with GSI-MAR showed the lowest mean CT number, image noise, SSIM value, and streak artifacts, and the best diagnostic confidence. In the tibial component, the image noise differed significantly, but the SSIM and subjective indicators were similar among the image combinations. MAR-related new artifacts were noted in 14.7% of images, and all of them were observed in only the femoral component. ConclusionGSI-MAR with higher-energy monochromatic images showed fewer metal artifacts and better visualization. We recommend 140 keV with GSI-MAR for improving image quality and 140 keV without GSI-MAR for identifying MAR-related new artifacts when evaluating TKRA.

Low levels of salicylic acid and salicyluric acid are present in synovial fluid of patients taking aspirin at the time of knee arthroplasty surgery

Low doses of acetylsalicylic acid (aspirin) are recommended in some venous thromboembolism prophylaxis guidelines for total knee replacement arthroplasty surgery. As salicylic acid has antimicrobial activity it would be advantageous if aspirin's use reduced the risk of prosthetic joint infection. We measured salicylate levels in the synovial fluid of patients taking long term low dose aspirin who were having knee arthroplasty surgery. Low levels of salicylic and salicyluric acids were present in synovial fluid immediately pre surgery. Acetylsalicylic acid was not measurable in synovial fluid. The measured salicylic acid levels were lower than those previously shown to have antibacterial activity against any of the bacteria that typically cause prosthetic joint infection.

Multimodal Conservative Treatment of Complicated Open Wound After Total Knee Replacement Arthroplasty in Patients With Comorbidities.

Total knee replacement arthroplasty is a common procedure and postoperative wound complications are sometimes inevitable. Although invasive reconstructive surgery may be an option for nonhealed wounds, such procedures can limit early rehabilitation, adversely affecting the range of joint motion. Patients can achieve a wider range of motion if they undergo early rehabilitation with a conservative approach. From 2015 to 2017, 5 patients with comorbidities who underwent total knee replacement arthroplasty were referred to the reconstructive surgery department for nonhealed open wounds. Depending on their comorbidities and conditions, the patients underwent negative-pressure wound therapy based on multimodal conservative treatment. During the treatment, the patients continued rehabilitation. In the 5 patients, the mean duration of complete wound healing was 65.2 days (range = 57-81), during which all open wounds were well healed. For final wound closure, the patients underwent skin grafting, dermatotraction, or collagen dressing. Four patients achieved ranges of joint motion over 100 degrees after treatment. We believe that early coverage is important for open wounds. For complicated open wounds after total knee replacement arthroplasty in patients with comorbidities, less invasive multimodal treatment along with early rehabilitation may be more effective to achieve adequate final range of joint motion.

Development and Evaluation of Progressive Lower-extremity Exercise Program for Patients with Total Knee Replacement Arthroplasty

Development and Evaluation of Progressive Lower-extremity Exercise Program for Patients with Total Knee Replacement Arthroplasty

Changes in the Mechanical Axis and Weight-Bearing Line of the Ankle After Varus Knee Correction

Category:Ankle, HindfootIntroduction/Purpose:Varus limb malalignment results in an imbalance of force transmission to the knee joint, resulting in a concentrated load in the medial compartment. A varus knee correction may affect the ankle and subtalar joint, because the weight-bearing load on the lower extremity extends from the hip to the foot. A previous study suggested that the true mechanical axis of the lower limb should be calculated with a line from the center of the femoral head to the lowest point of the calcaneus, not to the center of the tibial plafond. Therefore, we performed this study to evaluate changes in the mechanical axis and weight- bearing line of the ankle after varus knee correction.Methods:Patients with a varus knee who were followed-up after they had undergone high tibial osteotomy (HTO) or total knee replacement arthroplasty (TKA) at an age of >20 years, and who had undergone preoperative and postoperative scanogram were included in this study. The hip-knee-ankle (HKA) angle, mechanical axis, and weight-bearing line (line from the center of the femoral head to the lowest point of the calcaneus) were measured on the radiographs. The point at which the mechanical axis and weight-bearing line passed through the tibial plafond was the ankle joint axis point. The postoperative change in the ankle joint axis point on the mechanical axis and weight-bearing line according to the HKA angle correction was adjusted by multiple factors using a linear mixed model.Results:A total of 257 limbs from 198 patients were included in this study. The preoperative HKA was 7.3 ± 4.7° and corrected to 0.4 ± 3.8°. Although the ankle axis points on both axes moved laterally after HTO and TKA, the ankle joint axis of the weight- bearing line showed a significant larger lateral movement (22.5±35.7%) (Fig.) than that of the mechanical axis (15.7±16.0%) in terms of rate of change (p = 0.006). The ankle joint axis point on the weight-bearing line moved laterally by 0.9% per degree of postoperative HKA angle decrease (p < 0.001). The change in the ankle joint axis point on the mechanical axis was not statistically significant after HTO and TKA (p = 0.223).Conclusion:The mechanical axis and weight-bearing line of the ankle moved laterally after the varus knee correction. The ankle joint axis on the weight-bearing line moved laterally as the HKA angle decreased after the surgery, whereas the varus knee correction did not significantly affect the ankle joint axis on the mechanical axis. The varus knee correction might affect the subtalar joint as well as the ankle joint. Therefore, we believe that our findings warrant consideration in pre- and postoperative evaluations using the weight-bearing line of patients undergoing varus knee correction.

Perioperative anaesthesia and coagulation management of haemophilia patients receiving total hip and knee replacement arthroplasty: Experience from a case series.

To report 13 consecutive cases of successful triad of anaesthesia, blood and coagulation management (ABC protocol) in haemophilic total joint arthroplasty (TJA) and its feasibility and safety on haemophilic TJA. All the clinical data of 13 consecutive cases were descend from electronic medical record. Patients who suffered from haemophilia A, undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) with ABC protocol at the academic hospital from December 2014 to November 2018 were included, and demographic, perioperative characteristics according to the classified method were further analysed. All 13 haemophilic patients had undergone successful surgery with ABC protocol. No massive blood loss was observed in perioperative period. The mean external blood loss was 876.92 ± 592.86 mL. The mean change in haemoglobin was 5.42 ± 2.43 g dL-1 at 5 days post-operatively. The mean allogeneic transfusion volume was 1.23 ± 1.35 units, and the mean volume of autotransfusion was 237.5 ± 76.93 mL. The average clotting factor consumption for per operated joint was 458.26 ± 226.45 IU kg-1 in all cases. No severe perioperative complications were occurred. ABC-related series of measures were appropriate management mode for patients received THA and/or TKA with mild or moderate haemophilia. However, more robust evidence came from larger samples is needed.

Partial meniscectomy provides the favorable outcomes for symptomatic medial meniscus tear with an intact posterior root

This study aimed to investigate the long-term outcomes of arthroscopic partial meniscectomy for medial meniscus tear (with intact posterior root) and to analyze the risk factors for treatment failure. The records of 165 patients who underwent partial meniscectomy for medial meniscus tear with intact posterior root with a minimum 5-year follow-up were included. Modified Lysholm score and radiologic outcomes were compared between preoperative and latest follow-up periods. The cumulative Outerbridge grade of the medial compartment was defined as follows: 0-4, low chondral wear; 5-6, intermediate wear; or 7-8, high wear. Kaplan-Meier survival and Cox hazard regression analyses were performed to assess the survivorship after partial meniscectomy. Conversion to total knee replacement arthroplasty, high tibial osteotomy or a Lysholm score of < 65 points indicated treatment failure. Mean Lysholm score improved from 66.3 ± 14.2 preoperatively to 81.8 ± 17.9 at the latest follow-up (p = 0.001). The postoperative 10-year survival rate of the low chondral wear group [97% (95% confidence interval (CI) 141.7-152.6months)] was higher than that of the intermediate [83.1% (95% CI 129.6-147.9months)] and high wear groups [76.1% (95% CI 115.2-135.0months)]. A 1mm joint space width narrowing led to a 37.7% increase in the failure rate [B = - 0.473; hazard ratio, 0.623 (95% CI 0.423-0.917); p = 0.016]. The high chondral wear group showed a higher failure rate compared to the low wear group [B = 1.870; hazard ratio, 6.488 (95% CI 0.853-49.333); p = 0.041]. Partial meniscectomy offers pain relief and functional improvement for medial meniscus tear with intact posterior root. Preoperative joint space narrowing and higher chondral wear at surgery were significant risk factors of treatment failure. Partial meniscectomy should be considered as an effective treatment for irreparable medial meniscus tear with intact posterior root without joint space narrowing and chondral wear. Case series, Level IV.

Is proximal fibular osteotomy a boon or bane for medial compartment osteoarthritis? - Our experience

Objective: To evaluate the functional and radiological outcome in medial compartment osteoarthritic knee treated with proximal fibular osteotomy as a new modality of treatment.Materials and Methods: Fifteen patients (10 men and 5 women, age range between 50-68 years) from May 2016 to May 2018 who had undergone proximal fibular osteotomy for medial compartment osteoarthritis knee were followed prospectively. Pre-operative and post-operative weight bearing scan gram obtained to analyse the alignment of lower limb (Femoro tibial angle) and ratio of joint space (medial/lateral joint space). Functional Outcome was assessed with American Knee Society Score (KSS) and Knee pain was assessed with Visual analogue scale.Results: At final followup the mean Femoro-Tibial angle and joint space ratio were 180.4 and 0.54 respectively. The limb alignment is corrected in few cases and joint space ratio is increased postoperatively. Mean Knee Society Score at final follow up was 75.13 which was higher than the mean preoperative score 52.5.Mean Vas score is reduced significantly up to 4(preoperative mean Vas score was 8).Conclusion: The present study demonstrates the proximal fibular osteotomy effectively relieves the pain and improves the joint function in the patients with medial compartment osteoarthritis of knee by shifting the mechanical axis. Conversion to total knee replacement or unicompartmental arthroplasty is also less complicated.

Association of Asian mitochondrial DNA haplogroup B with new development of knee osteoarthritis in Koreans.

The aim of this study was to determine which mitochondrial DNA (mtDNA) haplogroup is associated with new development of knee osteoarthritis (OA). Epidemiologic data and knee radiographs with the Kellgren-Lawrence (K/L) score of the Ansung cohort study were prospectively obtained from the 2nd (2005-2006) and 6th follow-up periods (2013-2014). The mtDNA was analyzed by multiplex mutagenetically separated polymerase chain reaction to determine Asian mtDNA haplogroups (M, G, D, D4, D5, M7, M8, M9, M10, N, A, N9, R, F and B). The frequency of the mtDNA haplogroup was compared between participants with knee OA (K/L score ≥2 or total knee replacement arthroplasty [OA group]) and those without knee OA (K/L<2 [control group]) at the 6th follow-up. Multiple logistic regression was used to determine the relative risk (RR) of mtDNA haplogroups for OA by adjusting for sex, age, body mass index, smoking and metabolic syndrome. There were 1115 participants with epidemiological data, knee radiographs and DNA samples. Of these, 572 participants had a K/L score of 0 at the 2nd follow up, and 438 underwent knee radiography at the 6th follow up. Among the 438 participants, 160 were classified as having knee OA, and 278 were classified as the control group. The haplogroup B showed a significantly higher frequency in the OA group than in the control group (unadjusted RR=1.794, P=0.030; adjusted RR=2.389, P=0.004). Our data suggest that mtDNA haplogroup B contributed to the new development of knee OA in Koreans.