Tricompartmental Osteoarthritis Research Articles

Evaluation of Knee Radiograph and its Interrelation between Body Mass Index and Range of Motion in Osteoarthritic Knee

Abstract Context: Assessing knee osteoarthritis (OA) radiologically is a well-recognised investigation technique. Range of motion (ROM) measurement gives an idea about the functional status of the joint. Body mass index (BMI) increment is one of the risk factors of worsening knee OA. Aim: The aim of this study was to evaluate OA radiologically and to search the status of BMI, ROM and Kellgren–Lawrence (KL) score of osteoarthritic knee patients and find their interrelations. Settings: This study was conducted at the department of physical medicine and rehabilitation in a tertiary hospital of Bangladesh. Designs: This was a cross-sectional study. Methodology: Purposive selection of 66 primary OA knees was done. Compartmental distribution of osteoarthritic knee was determined. Radiographics were determined by KL score system. BMI was calculated conventionally. Maximum flexion, extension and total excursion were measured by a universal goniometer. Results: Fifty per cent of participants had tricompartmental OA. Patients with maximum KL score 2 had significantly more total excursion (127.44 ± 2.89) compared to maximum KL score 3 (121.51 ± 3.14) and 4 (110.00 ± 3.58). Subjects with normal BMI had significantly more total excursion (125.00 ± 4.21) compared to overweight (121.03 ± 6.84) and obese patients (122.54 ± 4.31) (P = 0.044). 60.9% of subjects with normal BMI had significantly more maximum KL score 2 compared to overweight (33.3%) and obese patients (7.7%). A positive correlation was present between BMI and maximal KL score (r = 0.345, P = 0.005). A significant strong negative correlation was found between maximal KL score and total excursion (r = −0.825, P < 0.001). Conclusion: Different percentages of unicompartmental, bicompartmental and tricompartmental knee OA were found. Osteoarthritic patients with higher BMI had lower ROM and increased KL radiographic scores.

Primary B cell lymphoma of the patella presenting as anterior knee pain: A case report

CaseA 76-year-old female with a history of multiple falls on the patella presented with worsening knee pain, swelling, and reduced range of motion. Radiographs revealed tricompartmental osteoarthritis and subtle erosion of the posterior cortex of the patella that was missed by the referring orthopedist and radiologist. Her persistent pain prompted an MRI, revealing a mass later confirmed to be primary diffuse large B-cell lymphoma of the patella after biopsy and appropriate metastatic workup. ConclusionPrimary B-cell patellar lymphoma is a rarely described cause of knee pain requiring broad differential diagnosis and multidisciplinary workup in order to avoid erroneous treatment and ensure prompt oncologic treatment.

Biplanar Proximal Tibial Opening-Wedge Osteotomy for a Chronic PCL Tear With Medial Compartment Arthritis

Background: Chronic posterior cruciate ligament (PCL) insufficiency leads to instability of the knee, resulting in increased loading of the medial and patellofemoral compartments. Chronic PCL insufficiency progressively damages the menisci and chondral surfaces and can accentuate and worsen varus malalignment. Biplanar proximal tibial opening-wedge osteotomy (BPTO) is a treatment option for chronic PCL tears with medial compartment arthritis which concurrently treats sagittal (flat slope) and varus coronal alignment. Indications: Opening-wedge BPTO is indicated in active patients who present with varus malalignment and flat slope with concomitant degenerative medial compartment osteoarthritis and PCL insufficiency. In general, BPTO is contraindicated in patients with a significantly elevated body mass index (BMI), smokers, or in those who have advanced tricompartmental osteoarthritis. Technique Description: Preoperative long-leg radiographs are essential to preoperative evaluation. Ideal coronal alignment following correction would have the mechanical axis pass through the apex of the lateral tibial eminence to properly off-load the medial compartment. Magnetic resonance imaging (MRI) studies are also useful for determining the presence and extent of concomitant soft tissue and chondral injury, especially in the lateral compartment. This video demonstrates the senior author’s preferred technique for a biplanar proximal tibial opening (PTO) with concomitant chondroplasty and partial medial meniscectomy (PMM). The senior author’s preferred order of operations is also displayed and involves first performing an arthroscopy, then proceeding with the open portions of the case, including the medial approach and subsequent osteotomy. Results: Past studies have supported PTO as a reliable treatment option for varus malalignment. Bode et al reported a 5-year survival rate of 96% of patients with an overall complication rate of 8.6%. The authors also reported that Lysholm scores were also significantly improved at 60-month follow-up compared with preoperative scores. Discussion: This is a technique for the correction of a varus malalignment with concomitant flat slope and PCL insufficiency with biplanar open-wedge PTO. This operation corrects the mechanical axis and sagittal slope of the knee and restores proper load distribution across the tibiofemoral articulation. In conclusion, a biplanar open-wedge PTO is a useful alternative to joint arthroplasty for active patients with a chronic PCL tear, medial compartment arthritis, and varus malalignment. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Combined quadriceps tendon reconstruction and total knee replacement with computer navigation: a case report

BackgroundChronic quadriceps tendon rupture is technically challenging for surgeons due to scarring and tendon retraction. The presence of concurrent ipsilateral knee osteoarthritis compounds the issue even further. Although a combined presentation is rare, treatment options to manage each coexisting pathology simultaneously are scarcely reported. We describe the case of a 67-year-old Caucasian male who had such a presentation, and was subsequently treated with a one-stage extensor mechanism autograft reconstruction and total knee replacement with computer navigation.CaseThe patient was a 67-year-old male Caucasian, who had previously sustained an acute rupture of his right quadriceps tendon that was adequately repaired 6 months prior. Despite an initial satisfactory result, he reported deterioration in his mobility in the few months thereafter, with worsening knee pain. His comorbidities consisted of hypertension, asthma, and a body mass index of 40.4 kg/m2. Otherwise, there were no risk factors for tendon rerupture. Clinical examination later revealed a large palpable gap in the right suprapatellar region and weakness of active knee extension. No traumatic cause for this new presentation was identified. Suspicion of a chronic quadriceps tendon rupture was confirmed on radiological imaging, but the investigations also noted the presence of severe tricompartmental osteoarthritis of the ipsilateral, native knee joint. The combined procedure took place in one surgical sitting. The total knee replacement with patella resurfacing was performed first and assisted by computer navigation. The quadriceps tendon reconstruction was then conducted sequentially using the patient’s hamstring tendons (semitendinosus and gracilis). The tensile strength was reinforced with use of a Ligament Augmentation and Reconstruction System (LARS) ligament. Initial outcomes were excellent, and these results were maintained at 6 months postoperatively, with the patient reporting no pain and having full range of movement.ConclusionOur techniques used have not previously been reported, but are successful options in treating coexisting chronic quadriceps tendon rupture and ipsilateral knee osteoarthritis. The advantage of using computer navigation with an extramedullary femoral jig can lead to improved accuracy of bone cuts, which is important in the presence of anatomical disruption. Chronic failures of the extensor mechanism require different approaches depending on the inherent and underlying pathology. We feel that the multidisciplinary team approach to the management and use of two surgeons with differing expertise added to the successful outcome of this complex case.

High Tibial Osteotomy versus Proximal Fibular Osteotomy in Medial Compartmental Osteoarthritis of Knee: A Longitudinal Study

Introduction: Osteoarthritis (OA) is a chronic degenerative intra-articular disorder of cartilage and bone. Knee joint is most commonly involved due to its pivotal role in weight bearing as it is constantly exposed to wear and tear. Osteotomy procedures can achieve normal alignment of the weight bearing axis of the lower limbs. Aim: To evaluate and compare the functional outcome of High Tibial Osteotomy (HTO) and Proximal Fibular Osteotomy (PFO) in medial compartmental osteoarthritis of knee joint. Materials and Methods: This prospective longitudinal study was conducted in a tertiary healthcare centre, IPGMER and SSKMH, Kolkata,West Bangal, India from October 2019 to November 2021 for a duration of 26 months, in which 40 osteotomies were performed around the knee. Considering the inclusion and exclusion criteria 20 proximal fibular osteotomies and 20 high tibial osteotomies were operated avoiding the patients with advanced stage or tricompartmental OA. The scoring system considered for evaluation of the functional outcome was Oxford Knee Score (OKS) and Visual Analouge Scale (VAS) Score. The analysis was done through paired t-test with determining of p-value where value ≤0.05 was considered for statistically significant. Results: Majority of the patients in the present study were more than 45 years of age. The most frequent age group was 46-50 years followed by 51-55 years. The follow-up period was at least 15 months where the OKS score was 39.35±3.51 and 41.20±4.50 with p-value of 0.1556 and VAS score was 5.50±1.10 and 3.80±1.10 with p value of <0.0001 for PFO and HTO respectively. Only two of the patients developed surgical site infection in both cases. Conclusion: In long term follow-up the final functional status of both treatment modalities were comparable although HTO was considered superior with significant improvement in pain relief perspective than PTO.

A rare case of bilateral medial femoral condylar cyst in OA knee managed with cruciate retaining TKA

Introduction: We report an osteoarthritic patient with huge sub-chondral cyst-like lesions in the medial femoral condyle of distal femur. This large bone defects due to advanced osteoarthritis was successfully treated with Cruciate retaining implant in total knee replacement. Case Report: A 60yrs old obese Female presented in our institution diagnosed with bilateral tricompartmental Osteoarthritis. The x-rays showed bone on bone Tricompartment OA Knee with Varus Malalignment. The left knee was operated first. After exposure, Distal Femoral Cuts where taken wherein a huge bony defect of about 2cm*1 cm was found in medial femoral condyle, but as lateral border of medial femoral condyle was intact the contained defect was managed with bone grafting and Hebert’s screw and a Cruciate retaining implant was done in femur. The right knee was the mirror image of left and managed similarly with bone grafting and Hebert’s screw and implanted a CR femur. Conclusion: Any cystic /defect management in knee replacement traditionally always require extra armamentariumin form of augments, rods, wedges, but sometimes reverse thinking can also work if we understand the intraoperative scenario objectively and CR femur, the least constraint implant also, if used judiciously can bail us out from such a difficult situation. Usually one should keep rods, augments, wedges and constrain implants ready for difficult cases. Read your x ray carefully, if suspected a Preoperative MRI /CT scan should be done to exclude any sub-chondral cysts osteochondral defects and good planning of the cases, which will avoid any surprise during surgery. No benefits or funds were received in the support of this study. The authors reports no conflict of interest.

Medial bicompartmental arthroplasty patients display more normal gait and improved satisfaction, compared to matched total knee arthroplasty patients

PurposeMedial bicompartmental arthroplasty, the combination of ipsilateral medial unicompartmental and patellofemoral arthroplasty, is an alternative to total knee arthroplasty for patients with medial tibiofemoral and severe patellofemoral arthritis, when the lateral tibiofemoral compartment and anterior cruciate ligament are intact. This study reports the gait and subjective outcomes following medial bicompartmental arthroplasty.MethodsFifty-five subjects were measured on the instrumented treadmill at top walking speeds, using standard metrics of gait. Modular, single-stage, medial bicompartmental arthroplasty subjects (n = 16) were compared to age, body mass index, height- and sex-matched healthy (n = 19) and total knee arthroplasty (n = 20) subjects. Total knee arthroplasty subjects with pre-operative evidence of tricompartmental osteoarthritis or anterior cruciate ligament dysfunction were excluded. The vertical component of ground reaction force and temporospatial measurements were compared using Kruskal–Wallis, then Mann–Whitney test with Bonferroni correction (α = 0.05). Oxford Knee and EuroQoL EQ-5D scores were compared.ResultsObjectively, the medial bicompartmental arthroplasty top walking speed of 6.7 ± 0.8 km/h was 0.5 km/h (7%) slower than that of healthy controls (p = 0.2), but 1.3 km/h (24%) faster than that of total knee arthroplasty subjects (5.4 ± 0.6 km/h, p < 0.001). Medial bicompartmental arthroplasty recorded more normal maximum weight acceptance (p < 0.001) and mid-stance forces (p = 0.03) than total knee arthroplasty subjects, with 11 cm (15%) longer steps (p < 0.001) and 21 cm (14%) longer strides (p = 0.006). Subjectively, medial bicompartmental arthroplasty subjects reported Oxford Knee Scores of median 41 (interquartile range 38.8–45.5) compared to total knee arthroplasty Oxford Knee Scores of 38 (interquartile range 30.5–41, p < 0.02). Medial bicompartmental arthroplasty subjects reported EQ-5D median 0.88 (interquartile range 0.84–0.94) compared to total knee arthroplasty median 0.81 (interquartile range 0.73–0.89, p < 0.02.)ConclusionThis study finds that, in the treatment of medial tibiofemoral osteoarthritis with severe patellofemoral arthritis, medial bicompartmental arthroplasty results in nearer-normal gait and improved patient-reported outcomes compared to total knee arthroplasty.Level of evidenceIII.

A Mid-term Comparison of the Functional Outcomes of Medial Pivot and Rotating Platform Mobile-Bearing Total Knee Arthroplasty in the Indian Population.

Both medial pivot (MP) and rotating platform (RP) mobile-bearing (MB) total knee arthroplasty (TKA) have been developed to better mimic the natural knee kinematics and femoral roll back in flexion. The purpose of this retrospective study was to compare the mid-term functional outcomes and range of motion (ROM) of MP and RP types of total knee arthroplasty. 116 patients (mean age of 66.3years) undergoing TKA (52 Medial pivot design and 64 Rotating Platform design) were evaluated retrospectively with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee score, knee society score (KSS) with its subgroups namely, Knee Score (KSKS) and Functional Score (KSFS) and forgotten joint score (FJS) at a mean follow-up of 7.1years. Range of motion (ROM) and tibiofemoral anatomic angle on the radiographs were also compared. Mean ROM, WOMAC and KSKS improved significantly from pre-operative to postoperative knees in both the groups. There was, however, no significant difference between the two groups at the final follow-up. In contrast, mean KSFS score improved to 89.5 ± 8.1 in MP group and 86.3 ± 7.1 in RP Group (p = 0.025), while mean FJS was 85.6 ± 4.1 and 80.9 ± 5.4 in the MP and RP groups, respectively (p = < 0.0001). Satisfactory clinical and functional outcomes can be obtained using either a MP or RP knee joint in tricompartmental osteoarthritis of knee. The MP design scores better on the KSFS score and FJS than the RP-TKA.

Is It Water On The Knee?! Operation!

HISTORY: A 53-year-old male with history of knee osteoarthritis presented with worsening right knee pain 2.5 months following MVA. He also noted a mobile mass over the superior lateral knee. There was no relief with NSAIDs or rest. PHYSICAL EXAMINATION: Antalgic gait with crutches. Right knee with moderate effusion, limited range of motion to 100 degrees flexion and 10 degrees extension with crepitus, tenderness to palpation over the lateral joint line with a palpable mass superior to the lateral femoral condyle. Positive McMurray’s test. DIFFERENTIAL DIAGNOSIS: 1. Osteoarthritis flare2. Meniscal tear3. Avulsion fracture of the femur4. Crystalline arthropathy5. Synovial osteochondromatosis TEST AND RESULTS: Right Knee X-Ray: Linear bony density along the medial femoral condyle, suspicious for an acute to subacute avulsion fracture. Stable findings of synovial osteochondromatosis. Synovial Fluid Analysis: No organisms or crystals identified. Right Knee MRI without contrast: Tricompartmental osteoarthritis with secondary synovial osteochondromatosis with large calcified intra-articular body within the suprapatellar recess measuring 4.7 cm. Moderate joint effusion. Moderate synovitis. Medial and lateral complex meniscal tears. Pellegrini-Stieda lesion, compatible with sequela of prior MCL injury without periligamentous edema. FINAL WORKING DIAGNOSIS: Synovial osteochondromatosis with a large loose body with underlying osteoarthritis and medial and lateral complex meniscal tears. TREATMENT AND OUTCOMES: Aspiration was performed for 47 cc serous synovial fluid followed by intra-articular corticosteroid injection. At 3 week follow-up visit, the patient noted 50% improvement in pain, but recurrent effusion and increased buckling. Case was discussed with an orthopedic surgeon and recommendation was made for loose body excision and possible total knee arthroplasty. After discussion, the patient preferred to avoid surgery and continue conservative care with bracing and physical therapy.

IN FEMALE PRIMARY OSTEOARTHRITIC PATIENTS, UNDERGOING TOTAL KNEE ARTHROPLASTY, IS GENDER-SPECIFIC CRUCIATE RETAINING HIGH-FLEXION KNEE, SUPERIOR TO STANDARD CRUCIATE RETAINING FLEXION KNEE, FROM THE VIEW OF CLINICO-FUNCTIONAL OUTCOMES.

Anthropometric measurements of the human knee, have differences in the women's and the men's knee. Total Knee Arthroplasty (TKA), aim is to relieve pain in an osteoarthritic knee, to improve the functional range of movements, and thereby improve the quality of life, of the patient. In this study, which was specically done for women patients with primary tri-compartmental osteoarthritis of the knee, the implant design for total knee arthroplasty was either “Standard CR Flex Knee” or “Gender-Specic CR High-Flex Knee”. This prospective study had a recruitment period of 2 years and a minimum follow-up period of 1 year and was done between March 2018 to February 2021. 23 female subjects aged between 51 to 80 years, were recruited in the “Standard CR Flex Knee” group and 25 female subjects aged between 51 to 80 years, were recruited in the “GenderSpecic CR High-Flex Knee” group. 60.42% (n=29) had a right sided involvement and remaining 39.58% (n=19) had a left sided involvement. Post-operative Knee Society Clinical Rating System (KSS), mean clinical outcome for “Standard CR Flex” and “Gender-Specic CR High-Flex Knee” were scored as 87.5 and 92.0 points respectively. With regard to the mean functional outcome, as per KSS both the groups averaged 85.0 points. Thus, this study could not establish any potential additional benets, by opting for the “Gender-Specic CR High-ex knee prosthesis”. Both the “Standard CR Flex Knee” and the “Gender-Specic CR High-Flex Knee” TKA yielded nearly similar clinico-functional outcomes.

Retrospective immediate post-operative comparative study of sequential bilateral total knee replacement versus unilateral total knee replacement for knee primary osteoarthritis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The study is to compare the immediate post operative outcomes of sequential bilateral versus unilateral total knee replacement (TKR) for the treatment of primary knee osteoarthritis. Study comprised of 96 cases of tricompartmental knee primary osteoarthritis who have undergone unilateral and sequential bilateral total knee arthroplasty at Manipal Hospital, Goa from January 2016 to December 2018. The observations for each group was analysed and duration of hospital stay, post operative mobilisation, fall in haemoglobin level immediate post operative, need for blood transfusion, post operative complications, post operative pain and duration of surgery was recorded. The results were statistically compared. The mean duration of hospital stay, post operative blood loss in terms of fall in HB, post operative pain control, need of transfusions and duration of surgery revealed statistically significant differences.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Total 96 patients diagnosed with primary tricompartmental osteoarthritis were divided into two groups retrospectively. Group 1 operated with sequential bilateral TKR under single anaesthetic procedure and group 2 with unilateral TKR both operated by same surgeon and anaesthetist.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;It was observed that longer duration of surgery and hospital stay, higher fall in HB levels, increased need of analgesics and higher requirement of blood transfusions were associated with group 1 as compared to 2. Complication rates and post op mobilisation was similar in both groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Sequential bilateral TKR is a viable option for patient with symptomatic bilateral knees but patient selection and pre op counselling takes the priority. &lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Retrospective comparative study of IV+ local tranexamic acid versus IV tranexamic acid only in primary total knee replacement

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;The study is to compare the immediate post-operative outcomes with use of intravenous (IV) tranexamic acid (TXA) versus IV and local TXA combination in primary unilateral total knee arthroplasty. Study comprised of 72 cases of tricompartmental knee primary osteoarthritis who have undergone unilateral total knee arthroplasty at Manipal Hospital, Goa from January 2016 to December 2018. The observations for each group was analysed and post op blood loss in drain, fall of haemoglobin levels and need of blood transfusion was recorded. The results were statistically compared. The mean blood loss fall in HB levels and need of blood transfusions revealed statistically significant differences.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Total 72 patients diagnosed with primary tricompartmental osteoarthritis were divided into two groups retrospectively. Group 1 (IV only): 1 gm IV Tranexamic acid bolus 10 min before deflating the tourniquet. Group 2 (IV + Local): 1 gm IV Tranexamic acid bolus 10 min before deflating the tourniquet and 1 gm Tranexamic Acid in 50 ml saline locally at the time of closure.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;It was observed that higher post op blood loss, higher fall in haemoglobin (HB) levels and higher requirement of blood transfusions were associated with group 1 as compared to 2.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The study inferred that the combination of local and systemic tranexamic acid was superior than systemic administration alone with lower post op blood loss, lower rates of blood transfusion and lower fall in haemoglobin levels without any added complications.&lt;/p&gt;

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 (

Patient-specific cruciate-retaining total knee replacement with individualized implants and instruments (iTotal™ CR G2).

Treatment of tricompartimental osteoarthritis (OA) using customized instruments and implants for cruciate-retaining total knee arthroplasty. Use of patient-specific instruments and implants (ConforMIS iTotalTM CR G2) together with a 3D-planning protocol (iView®). Retropatellar resurfacing is optional. Symptomatic tricompartmental OA of the knee (Kellgren-Lawrence stageIV) with preserved posterior cruciate ligament (PCL) after unsuccessful conservative or joint-preserving surgical treatment. Knee ligament instabilities of the posterior cruciate or collateral ligaments. Infection. Relative contraindication: knee deformities >15° (varus, valgus, flexion); prior partial knee replacement. Midline or parapatellar medial skin incision, medial arthrotomy; distal femoral resection with patient-specific cutting block; tibial resection using either acutting jig for the anatomic slope or afixed 5° slope. Balancing the knee in extension and flexion gap using patient-specific spacer.The final tibial preparation achieved with gap-balanced placement of the femoral cutting jigs. Kinematic testing using anatomic trial components. Final implant components are cemented in extension. Wound layers are sutured. Drainage is optional. Sterile wound dressing; compressive bandage. No limitation of the active and passive range of motion. Optional partial weight bearing during the first 2weeks, then transition to full weight bearing. Follow-up directly after surgery, at 12 and 52weeks, then every 1-2years. Overall 60patients with tricompartmental knee OA and preserved PCL were treated. Mean age was 66 (range 45-76) years. Minimum follow-up was 12months. There was 1septic revision after alow-grade infection, 1reoperation to replace the patellar due to patellar osteoarthritis and 3manipulations under anesthesia (MUAs) to increase range of motion. Radiographic analyses demonstrated an ideal implant fit with less than 2 mm subsidence or overhang. The WOMAC score improved from 154.8points preoperatively to 83.5points at 1 year and 59.3points at 2years postoperatively. The EuroQol-5D Score also improved from 11.1points preoperatively to 7.7points at 1year postoperatively.

Proximal Fibular Osteotomy in the Management of Osteoarthritis of Medial Compartment of Knee Joint.

Introduction: This study was conducted to evaluate the efficacy of proximal fibular osteotomy (PFO) in terms of pain relief, and improvement in function in medial compartment osteoarthritis (OA) of the knee joint.Materials and methods: This case series study was conducted at the Shaheed Mohtarma Benazir Bhutto Medical College Lyari and United Medical and Dental College of Karachi. Patients with medial compartment knee joint OA were included in the study and patients with bicompartmental or tricompartmental OA, inflammatory joint disease, valgus knee deformity, morbid obesity, or any infectious pathology involving the knee joint were excluded from the study. The medial and lateral joint spaces were measured and recorded preoperatively and postoperatively. Pre- and postoperative values of visual analog scale (VAS) results and the Oxford knee score were recorded. A PFO was performed after getting informed written consent.Results: A total of 60 patients were enrolled in the study; 16 (26.7%) were men, and 44 (73.3%) were women. The mean age of patients was 51.8 ± 4.1 years. The mean preoperative medial joint space measurement on standard anteroposterior radiograph was 1.45 ± 0.28 mm. The mean preoperative lateral joint space was 8.86 ± 1.27 mm. The recorded mean preoperative Oxford knee score was 20.82 ± 1.97 mm. Recorded levels of mean postoperative medial joint space improved to 4.63 ± 0.668 mm, and mean postoperative lateral joint space was 4.72 ± 0.79 mm. Mean recorded levels of VAS for pain postoperatively were 2.32 ± 0.792, which improved significantly from 7.90 ± 0.79.Conclusions: PFO is a good surgical technique for pain relief and functional improvement in patients suffering from medial compartment OA.

Patellar Resurfacing Does Not Improve Clinical Outcome in Patients with Symptomatic Tricompartmental Knee Osteoarthritis. An RCT Study of 40 Patients Receiving Primary Cruciate Retaining Total Knee Arthroplasty.

There is some evidence that patellofemoral (PF) joint osteoarthritis (OA) causes anterior knee pain (AKP) after total knee arthroplasty (TKA). We hypothesized that patellar resurfacing in primary TKA for patients with symptomatic tricompartmental knee OA yields better clinical results after 2 years than non-resurfacing. A single center randomized controlled clinical trial comparing 40 patients receiving 42 cruciate retaining TKAs with (n = 21) or without patellar resurfacing (n = 21) was conducted. Primary outcome was the specific PF joint score HSS Baldini and secondary outcomes were the Knee Society Score (KSS) and the Knee Osteoarthritis Outcome Scale (KOOS). After 2 years no significant differences between both groups and between the groups in time for HSS Baldini, KSS, and KOOS were found. HSS Baldini score improved significantly after 6 weeks in both groups (p < 0.001) and did not improve in time afterward. At final follow-up the HSS Baldini mean score improved from a preoperative mean of 39 to 88 (difference of 49 points; p < 0.001)) for without patellar resurfacing group, and from a preoperative mean of 37 to 81 for patellar resurfacing group (difference of 47 points; p < 0.001). One patient in the patellar resurfacing group underwent a soft tissue re-alignment procedure because of patellar subluxation. Two patients in without patellar resurfacing group received secondary patellar button placement. Patellar resurfacing in primary TKA for patients with symptomatic tricompartmental OA has no beneficial effect over non-resurfacing and seems unnecessary. A special PF joint outcome measurement tool (HSS Baldini) and common knee scores showed no better knee function or AKP outcomes for with patellar resurfacing over without patellar resurfacing group in time and after 2 years of follow-up.

Posterior Knee Dislocation Following a Knee Arthroplasty

Total knee arthroplasty is one of the most commonly performed surgeries in the United States. Complications following knee arthroplasty are uncommon, especially dislocations. Knee dislocations can be associated with popliteal artery injuries, which are potentially catastrophic and limb threatening. Emergency Department (ED) physicians should be familiar with the management of knee dislocations and complications following total knee arthroplasty. A 61-year-old female presented to the ED with acute right knee pain approximately 10 weeks after undergoing a total knee replacement for tricompartmental osteoarthritis. While at her first outpatient physical therapy evaluation, the patient felt a pop while going from a seated to standing position. Subsequently, she experienced a popping sensation and was unable to bear weight or extend the knee. On exam, she was in obvious pain, her surgical scar was well healed, and her knee was flexed to about 90 degrees and could not be extended. She had a palpable dorsalis pedis pulse and brisk capillary refill. Radiography revealed a posterior dislocation of her tibial prosthesis relative to her femoral prosthesis. Under procedural sedation, the dislocation was reduced and placed in a knee immobilizer. Her neurovascular exam was intact pre and post-reduction. Several months later she experienced another episode of spontaneous dislocation during a routine office visit requiring a second ED visit for reduction under procedural sedation. She was subsequently scheduled to undergo a revision of her total knee replacement due to suspected flexion instability with an inadequate extensor mechanism.

One-Stage Total Knee Arthroplasty Plus Corrective Osteotomy for Osteoarthritis Associated With Severe Extra-articular Deformity

The mainstay for treatment of articular deformity caused by advanced tricompartmental osteoarthritis of the knee is total knee arthroplasty. When this is also associated with an extra-articular deformity, this also must be compensated or corrected. In this scenario, it is essential to achieve an optimal mechanical situation by restoring the anatomical and mechanical limb axes and an adequate soft-tissue balance. These premises are necessary to relieve pain and achieve satisfactory functionality and implant survival over time. A reconstructive single-stage technique is proposed for patients with knee osteoarthritis amenable to arthroplasty and a severe extra-articular deformity, aiming at addressing both problems simultaneously.

Good correlation of the maximal relative bone tracer uptake in SPECT/CT and intraoperative findings of chondral lesions graded with the ICRS

Aims and Objectives: It is a pertinent question if SPECT/CT is able to reflect the cartilage status of the knee. Hence, it was the purpose of this study to evaluate the correlation between maximal relative bone tracer uptake (mrBTU) of preoperative SPECT/CT and intraoperative findings of chondral lesions assessed with the International Cartilage Repair Society (ICRS) scoring. Materials and Methods: Thirty-three consecutive patients (male: female=11: 22; mean age ± standard deviation 61±15) with bi- or tri-compartmental osteoarthritis of the knee who underwent SPECT/CT before total knee arthroplasty (TKA) were included. The knee was divided into 11 anatomical regions. In each region, mrBTU values were calculated twice by two observers within a six weeks interval. The intraclass correlation coefficient (ICC) was calculated and mean values were used. Intraoperatively, for every region the cartilage status with regards to ICRS score was assessed. A non-parametrical Spearman’s correlation was performed. A factor analysis was performed on mrBTU and ICRS scores (p&lt;0.05). Results: The ICC presented excellent correlations. The Spearman’s correlation performed separately on mrBTU and ICRS scores showed diffuse significant correlations which were especially strong between regions of the same knee compartment (p &lt; 0.01). The Spearmann correlation calculated between rmBTU and IRCS scores evidenced very strong correlations on the medial femoral condyle, on the ventral two third of the medial tibia plateau (p &lt; 0.01) and good correlations on the proximal femoral trochlea and on the medial patellar facet (p &lt; 0.05). Conclusion: A highly significant correlation between SPECT/CT and intraoperative findings was demonstrated. The use of an objective measure as the rmBTU for osteoarthritis could overcome the limit of the subjectivity of MRI findings.

Dervan dermatome syndrome often missed but surprisingly common coexistent spine pathology in ‘Knee Pain’, ignore at your own risk

Introduction: Knee pain is among the commonest complaints in the outpatient orthopedic department. However the cause does not always originate from knee itself. and knee pain is used by the patient more as an umbrella term. In fact very few patients give the complete list of accompanying symptoms. They have more often than not to be coaxed out of the patient. To make matters more complex, Referred pain from the Spinal nerves, Hip and Ankle joints join the many structures around the knee to make knee pain an umbrella term for this Pandora’s Box. Misdiagnosis or partial diagnosis leads to inadequate or wrong treatment and continued suffering for patient and treating doctorsMaterials & Methods: 78 patients with knee pain attended the OPD of Walawalkar hospital, Dervan. On x-ray, 28 were found to have different grades of osteoarthritis. Of these 25 agreed to be part of this pilot study. They underwent standing x rays & MRI of the lumbosacral spine.Results: This study found an unusually high rate of coexistent knee and spine pathologies. All patients had some degree of disc disease accompanying medial or tricompartmental osteoarthritis. It undermines the need for investigating this important contributor to the umbrella term of knee pain.The commonest affected disc segment was L4-5 i.e 92% with two patients having L5- S1 prolapse 8%. The purpose of this pilot study is only to alert the surgical and rehabilitation colleagues of the frequent coexistence of the spine and knee conditions for Counseling, consent, surgery & rehabilitation and thus improve patient satisfaction.