Unicompartmental knee prosthesis (UKP) has been used for 40 years but it is still controversial. Nevertheless, this procedure is positive and it can be a good alternative if it is correctly indicated.

From January 2001 we implanted 51 UKP in 47 patients. The diagnoses were: primary arthritis in 45 cases, post-traumatic degeneration in five and arthritis secondary to meniscectomy and ACL reconstruction in one. The mean age was 64.5 (range 49–81), 32 women and 15 men. Mean follow-up was 26 months (range 6–36). Post-operative recovery starts with physical rehabilitation, rarely with kinetics, and full weight-bearing walking the first day. DVT is prevented by treatment with low-molecular-weight heparin for 25 days and elastic stockings. From September 2002 we performed this procedure by minimally invasive surgery with an 8-cm incision and extramedullary intraoperative tools. We did not observe any infections or loosening: we performed just one revision of the femoral component because of a technical error. In four other cases a malpositioning of the femoral component was reported that was pain-free at follow-up.

Current studies are starting to show valid and encouraging results at mid- and long-term follow-up, too. The best candidates for UKP are patients over 60 years who are not overweight, with asymptomatic patellar degeneration and no anterior instability and who perform light sport activity. In comparison with high tibial osteotomy (HTO), UKP shows some advantages, such as faster recovery and better mid-term results. In comparison with total knee arthroplasty (TKA), UKP gives better range of motion, faster postoperative recovery and an easier operation in case of infection or loosening. Some features should be evaluated and the surgical technique should employ state-of-the-art hardware. We evaluate the advantages of this procedure with particular emphasis on the minimally invasive technique.

In conclusion, although our study is still in progress, correct patient selection, the surgical technique and the updated design of the new prosthesis can give satisfactory results and represent a valid alternative to HTO and TKA. In addition, compared to TKA, UKP shows a real economic advantage.

Introduction: Studies have shown that the Kellgren-Lawrence (K-L) score can differentiate the severity of osteoarthritis (OA). However, this grading system has not been compared with intraoperative assessment. The purpose of this study was to correlate the arthroscopic findings of knees with severe OA with their Kellgren-Lawrence grade.

Methods: Tibiofemoral knee OA was graded according to the K-L scale in 89 knees presenting for arthroscopic treatment for knee OA. The study group consisted of 55 males and 34 females with an average age of 55 (range 37 to 88) years. Each radiograph was examined by two orthopaedic surgeons, and arthroscopic data were collected prospectively.

Results: Radiographic grading yielded five knees with Grade 2 K-L, 47 with Grade 3 K-L, and 37 with Grade 4 K-L. At arthroscopy, ipsilateral tibial/femoral lesions were noted in 66 knees, including 17 knees with tibial/femoral lesions of both compartments. Meniscus pathology was present in 78 knees including 37 knees with both medial and lateral pathology. When comparing knees with radiographic K-L grades of 3 and 4, the following was noted: more males had Grade 4 K-L (p=0.001); knees with Grade 4 K-L were more likely to exhibit Outerbridge Grade III or IV tibial/femoral lesions on 3 or 4 surfaces (p=0.001); Grade 4 K-L knees had significantly more ipsilateral tibial/femoral lesions (p=0.000); and finally, Grade 4 K-L knees were more likely to contain meniscus pathology (p=0.032).

Conclusion: Grade 4 Kellgren-Lawrence scores correlated with more severe chondral degeneration and meniscus pathology. The Kellgren-Lawrence scale can differentiate between moderate and severe osteoarthritis.

Abstract. Objective. Meta-analysis of clinical trials highlights that non-operative management of degenerative knee meniscal tears is as effective as surgical management. Surgical guidelines though support arthroscopic partial meniscectomy which remains common in NHS practice. Physiotherapists are playing an increasing role in triage of such patients though it is unclear how this influences clinical management and patient outcomes. Methods. A 1-year cohort (July 2019–June 2020) of patients presenting with MRI confirmed degenerative meniscal tears to a regional orthopaedic referral centre (3× ESP physiotherapists) was identified. Initial clinical management was obtained from medical records alongside subsequent secondary care management and routinely collected outcome scores in the following 2-years. Management options included referral for surgery, conservative (steroid injection and rehabilitation), and no active treatment. Outcome scores collected at 1- and 2-years included the Forgotten Joint Score-12 (FJS-12) questionnaire and 0–10 numerical rating scales for worst and average pain. Treatment allocation is presented as absolute and proportional figures. Change in outcomes across the cohort was evaluated with repeated measures ANOVA, with Bonferroni correction for multiple testing, and post-hoc Tukey pair-wise comparisons. As treatment decision is discrete, no direct contrast is made between outcomes of differing interventions but additional explorative outcome change over time evaluated by group. Significance was accepted at p=0.05 and effect size as per Cohen's values. Results. 81 patients, 50 (61.7%) male, mean age 46.5 years (SD13.13) presented in the study timeframe. 32 (40.3%) received conservative management and 49 (59.7%) were listed for surgery. Six (18.8%) of the 32 underwent subsequent surgery and nine of the 49 (18.4%) patients switched from planned surgery to receiving non-operative care. Two post-operative complications were noted, one cerebrovascular accident and one deep vein thrombosis. The cohort improved over the course of 2-years in all outcome measures with improved mean FJS-12 (34.36 points), mean worst pain (3.74 points) average pain (2.42 points) scores. Overall change (all patients) was statistically significant for all outcomes (p<0.001), with sequential year-on-year change also significant (p<0.001). Effect size of these changes were large with all Cohen-d values over 1. Controlling for age and BMI, males reported superior change in FJS-12 (p=0.04) but worse pain outcomes (p<0.03). Further explorative analysis highlighted positive outcomes across all surgical, conservative and no active treatment groups (p<0.05). The 15 (18%) patients that switched between surgical and non-surgical management also reported positive outcome scores (p<0.05). Conclusion(s). In a regional specialist physiotherapy-led soft tissue knee clinic around 60% of degenerative meniscal tears assessed were referred for surgery. Over 2-years, surgical, non-operative and no treatment management approaches in this cohort all resulted in clinical improvement suggesting that no single strategy is effective in directly treating the meniscal pathology, and that perhaps none do. Clinical intervention rather is directed at individual symptom management based on clinical preferences. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Introduction. Transtibial osseointegration (TFOI) for amputees has limited but clear literature identifying superior quality of life and mobility versus a socketed prosthesis. Some amputees have knee arthritis that would be relieved by a total knee replacement (TKR). No other group has reported performing a TKR in association with TTOI (TKR+TTOI). We report the outcomes of nine patients who had TKR+TTOI, followed for an average 6.5 years. Materials & Methods. Our osseointegration registry was retrospectively reviewed to identify all patients who had TTOI and who also had TKR, performed at least two years prior. Four patients had TKR first the TTOI, four patients had simultaneous TKR+TTOI, and one patient had 1 OI first then TKR. All constructs were in continuity from hinged TKR to the prosthetic limb. Outcomes were: complications prompting surgical intervention, and changes in daily prosthesis wear hours, Questionnaire for Persons with a Transfemoral Amputation (QTFA), and Short Form 36 (SF36). All patients had clinical follow-up, but two patients did not have complete survey and mobility tests at both time periods. Results. Six (67%) were male, average age 51.2±14.7 years. All primary amputations were performed to manage traumatic injury or its sequelae. No patients died. Five patients (56%) developed infection leading to eventual transfemoral amputation 36.0±15.3 months later, and 1 patient had a single debridement six years after TTOI with no additional surgery in the subsequent two years. All patients who had transfemoral amputation elected for and received transfemoral osseointegration, and no infections occurred, although one patient sustained a periprosthetic fracture which was managed with internal fixation and implant retention and walks independently. The proportion of patients who wore their prosthesis at least 8 hours daily was 5/9=56%, versus 7/9=78% (p=.620). Even after proximal level amputation, the QTFA scores improved versus prior to TKR+TTOI, although not significantly: Global (45.2±20.3 vs 66.7±27.6, p=.179), Problem (39.8±19.8 vs 21.5±16.8, p=.205), Mobility (54.8±28.1 vs 67.7±25.0, p=.356). SF36 changes were also non-significant: Mental (58.6±7.0 vs 46.1±11.0, p=.068), Physical (34.3±6.1 vs 35.2±13.7, p=.904). Conclusions. TKR+TTOI presents a high risk for eventual infection prompting subsequent transfemoral amputation. Although none of these patients died, in general, TKR infection can lead to patient mortality. Given the exceptional benefit to preserving the knee joint to preserve amputee mobility and quality of life, it would be devastating to flatly force transtibial amputees with severe degenerative knee joint pain and unable to use a socket prosthesis to choose between TTOI but a painful knee, or preemptive transfemoral amputation for transfemoral osseointegration. Therefore, TTOI for patients who also request TKR must be considered cautiously. Given that this frequency of infection does not occur in patients who have total hip replacement in association with transfemoral osseointegration, the underlying issue may not be that linked joint replacement with osseointegrated limb replacement is incompatible, but may require further consideration of biological barriers to ascending infection and/or significant changes to implant design, surgical technique, or other yet-uncertain factors

Not all degenerative knees need a total knee replacement. Over the last few decades we have shifted our surgical treatment of end-stage osteoarthritis (OA) of the knee to a “compartmental approach” resulting in approximately half of end-stage OA knees receiving a partial knee replacement. Of these an emerging procedure is isolated lateral compartment replacement with the indications being isolated bone-on-bone osteoarthritis or avascular necrosis of the lateral compartment of the knee. Associated significant patellofemoral disease and inflammatory arthritis are contraindications. The purpose of this study is to present the indications, surgical technique, and early outcome of lateral partial knees from our institution. From Aug 2011 until June 2017 we have performed 3,548 knee arthroplasties. Of these 147 were fixed bearing lateral partial knee replacements via a lateral parapatellar approach (4%), 1,481 medial partial knee replacements (42%), and 1,920 total knee replacements (54%). The average age was 66 years old and 76% were female. Average follow-up in the lateral partials was 1.3 years (range 0.5 years to 6 years). Knee Society Scores improved from 41 (pre-op) to 86 points (post-op). Range of motion improved from 6 – 113 degrees (pre-op) to 0 – 123 degrees (post-op). No knees were revised to a TKA. One knee required I&D for traumatic wound dehiscence. This is the largest single center series of lateral partial knee replacements. We have observed this cohort to have more female patients and gain additional range of motion compared to our historic cohorts of TKA's. Longer-term follow-up is needed for determination of implant and unreplaced compartment survivorship. We believe the lateral partial knee replacement to be a viable option for isolated lateral compartment disease in approximately 4% of patients

Today several therapeutic options exist for the management of early degenerative lesions in the knee. These include marrow stimulation techniques (abrasion arthroplasty, sub-chondral drilling, microfracturing), periosteal and perichondral graft interposition, the implantation of synthetic matrices (collagen, carbon fibres, or glycosaminoglycan gel), autologous chondrocyte transplantation, osteochondral mosaic autografts or allografts, or simple arthroscopic lavage and debridement. It appears that some of these techniques are moderately successful in the short-term, especially in younger patients with relatively recent localised chondral lesions or erosion, and in joints with normal stability and alignment. In these optimal conditions, it is possible to achieve repair in 70% of the diseased area. However, the cartilage remains substandard, with a one-third decrease in stiffness and increased tissue permeability. In the early degenerative knee, conservative treatment options include unloader bracing and the use of chondroprotective agents. Unloader braces have been shown to improve the disease-specific quality of life and the functional status of patients with varus osteoarthritis in prospective randomised clinical trials. However, patients often find braces uncomfortable and of doubtful effectiveness. Current information about the use of chondroprotective agents in the treatment of osteoarthritis suggests that intra-articular hyaluronic acid improves lubrication in the joint and helps to decrease swelling and inflammation. Used as dietary supplements, oral glucosamine and chondroitin sulphate appear to work synergistically together to cause a net increase in the amount of healthy articular cartilage, hereby slowing the progression of osteoarthritis. Convenient and safe, these intra-articular and oral chondroprotective agents present an exciting new approach in the treatment of early degenerative knee lesions

Objectives: Partial meniscectomy is the current standard of care for torn menisci not suitable for repair. Arthroscopic partial meniscectomy is the most commonly performed orthopaedic surgical procedure. The purpose of this study was to determine what specific factors influence longevity of improvements in function and activity levels following arthroscopic partial meniscectomy. Methods: Six hundred forty (640) knees which had undergone isolated partial meniscectomy were identified from a clinical database. One hundred ninety-three (193) knees had partial lateral meniscectomy, 342 had partial medial meniscectomy, and 105 had partial medial and lateral meniscectomy. Average age was 52 years (range, 15 to 79) with 207 females and 433 males. Patients were excluded if they had concurrent ACL reconstructions or microfracture for chondral defects. Lysholm function and Tegner activity scores were collected for a minimum of 8 years after the index partial meniscectomy. Results: For all knees, Lysholm scores improved significantly from preoperative (54) to 1 year postoperative (76) (p< 0.001). Lysholm scores did not change from year 1 to year 5. At year 6, average Lysholm score decreased to 69, and by year 8, the score decreased further to 63. When comparing degenerative knees to non-degenerative knees, the non-degenerative group had greater improvement and maintained it longer. Medial meniscus patients maintained their improvement at 6 and 7 years while the lateral meniscus group showed less improvement and decreased at years 6 and 7. Anatomic location of meniscus tear (anterior, middle or posterior thirds) was not associated with changes in improvement of Lysholm or Tegner scores. Tegner activity levels improved significantly from preoperative (3.6) to 1 year postoperative (4.7) (p< 0.001). This improvement was maintained at years 2, 3, and 4. There was no significant difference between preoperative Tegner and year-5 Tegner scores (4.0) (p> 0.05). This same finding was also seen at years 6, 7, and 8. In degenerative knees, there was less improvement, and levels declined at years 6, 7, and 8. Conclusions: Patients who undergo partial meniscectomy can expect 4 to 5 years of improved function and activity levels. Knee function continues to improve up to 5 years, but it decreases as activity levels decrease. Patients who delay treatment or have degenerative changes experience a decrease in function and activity levels sooner. Meniscectomy provides a short term improvement in function and activity levels, but long term improvement seems unlikely. Our findings confirm that specific factors such as which meniscus (medial or lateral) undergoes meniscectomy, chronicity of the tear, and preexisting degenerative changes might be expected to influence longevity of improvements after partial meniscectomy

The French word debridement means the removal of the foreign matter or devitalised tissue from a lesion until surrounding healthy tissue is exposed. Arthroscopic techniques facilitated the removal of the intra-articular torn menisci, loose bodies, degenerated articular cartilage, and osteophytes. However, debridement procedure itself cannot induce tissue regeneration thus, the basic goal of the procedure is relief of pain. If pain can be relieved by non-surgical means very few patients can be considered for arthroscopic management. Debridement of early osteoarthritic knees can be carried out with a minimally invasive procedure with extremely low risk of infection and morbidity. However, it should be understood that this procedure is basically indicated for early degenerative knee disease with mechanical problems such as torn menisci or flap lesion of the cartilage. The general principle is to resect and remove less tissue and preserve the anatomical structure as much as possible. For example in the case of a degenerated horizontal tear of the medial meniscus, the torn fragment can be left alone as long as the remaining segment is not unstable. Arthroscopic removal and shaving of the fibrillated articular cartilage can minimise and reduce crepitation and abnormal sensation of the patello-femoral and tibio-femoral joint but the articular cartilage will not regenerate by this procedure. The longer-term knee function will be better if the anatomical structure is preserved as much as possible. With increasing awareness of the important functions of the meniscus and the improved understanding of the operative procedure, arthroscopic meniscal repair has become a widely accepted method of treatment for the symptomatic peripheral meniscal tears in the younger athletic population. However, in the patients with degenerative arthritis this procedure is rarely recommended due to the degenerative nature of the repaired meniscus itself. Recent studies and publications have shown that articular cartilage defects in the younger population can be managed by cartilage cell transplantation, periosteal or perichondral graft, osteochondral autograft, and osteochondral allograft. Good results can be expected by these procedures as long as the cartilage defect is contained and the rest of the cartilage is healthy. Unfortunately, this is not the story for most of the degenerative knee problems thus, excellent results are expected to be limited by arthroscopic treatment. Relatively large chondral defects with associated degenerative change can be managed by arthroscopic drilling, abrasion arthroplasty, and microfracture. Although cartilage regeneration by these techniques is not predictable and consistent, reasonable results can be obtained in the selective cases with controlled postoperative management. The patients should not be too old and 4 to 8 weeks postoperative non-weight-bearing is needed. Cases treated with this type of approach will be presented and discussed in this presentation

Aims

The purpose of this study was to compare the clinical outcomes, mortalities, implant survival rates, and complications of total knee arthroplasty (TKA) in patients with or without hepatitis B virus (HBV) infection over at least ten years of follow-up.

Background. Total knee arthroplasty (TKA) is a cost-effective surgical procedure for degenerative knee disease and has good long-term results. However, these results are not always related to patient satisfaction and functional outcome. With an increasing demand of surgeons and patients on functioning of total knee implants, the need for adequate objective outcome measures is high. Imaging of the knee is commonly used in clinical practice and research to objectively measure many different outcome parameters concerning the implant, such as alignment and complications.1 However, techniques on comparison of the sagittal contour of the knee before and after implant placement are scarce. Goal. To develop and describe a standardized method for measuring the sagittal contour of the implant in a 3D model of the knee before and after implant placement. Methods. Images of the static knee of a subject are obtained in-vivo using fluoroscopy over a 180° sweep at 15 frames per second (MultiDiagnost Eleva, Philips, The Netherlands). A 3D model of the knee is constructed in accompanying software (3D-RX, Philips, The Netherlands) and is subsequently imported in OsiriX imaging software (Pixmeo, Switzerland). In Osirix, a reproducible coordinate system is obtained using the bone stub axis and the anatomical epicondylar axis as references [Fig. 1]. We quantified the sagittal contour of the distal femur in two parameters: the flexion angle of femoral component and the sagittal profile of the implant. To measure the flexion angle, the image is located in the midtrochlear plane. The angle is measured between the bone stub axis and the neutral line of the femoral component [Fig. 2]. To measure the sagittal profile of the distal femur, the lengths of three lines connecting the anatomical epicondylar axis of the distal femur and the outer border of the femur/prosthesis are summed. This is done both anterior and posterior [Fig. 3]. These profiles are measured in planes of the lateral and medial condyle and of the midtrochlear plane. Due to the reproducible coordinate system, the profiles can be compared for the knee before and after implant placement. Conclusion. Using fluoroscopy and readily available 3D imaging software we have developed a technique for measuring valuable parameters concerning implant placement in TKA. This technique can be used for scientific purposes concerning comparison of the knee before and after implant placement and to study its effect on functional and biomechanical outcome after TKA

Patients with skeletal dysplasia are prone to developing advanced degenerative knee disease requiring total knee replacement (TKR) at a younger age than the general population. TKR in this unique group of patients is a technically demanding procedure due to the bone deformity, flexion contracture, generalised hypotonia and ligamentous laxity. We set out to retrospectively review the outcome of 11 TKR's performed in eight patients with skeletal dysplasia at our institution using the SMILES custom-made rotating-hinge total knee system. There were 3 males and 5 females with mean age 57 years (range, 41–79 years), mean height 138 cm (range, 122–155 cm) and mean weight 56 kg (range, 40–102 kg). Preoperative diagnoses included achondroplasia, spondyloepiphyseal dysplasia, pseudoachondroplasia, multiple epiphyseal dysplasia, morquio syndrome, diastrophic dysplasia and Larson's Syndrome. Patients were followed clinically and radiographically for a mean of 7 years (range, 3–11.5 years). Knee pain and function improved in all 11 joints. Mean Knee Society clinical and function scores improved from 24 (range, 14–36) and 20 points (range, 5–40) preoperatively to 68 (range, 28–80) and 50 points (range, 22–74) respectively at final follow-up. Four complications were recorded (36%), including a patellar fracture following a fall, a tibial periprosthetic fracture, persistent anterior knee pain and a femoral component revision for aseptic loosening. Our results suggest that custom rotating-hinge TKR in patients with skeletal dysplasia is effective at relieving pain, optimising movement and improving function. It compensates for bony deformity and ligament deficiency and reduces the need for corrective osteotomy. Patellofemoral joint complications are frequent and functional outcome is worse than primary TKR in the general population. Submission endorsed by Mr Peter Calder, Consultant Orthopaedic Surgeon and Society member

Purpose: To see if the symptoms of mild to moderate degenerative knee osteoarthrosis are improved clinically by magnetic resonance therapy (MRT). Method: This a double blind randamised control mono-centric study involving 100 volunteer patients recruited form the outpatient clinics who met the set inclusion and exclusion criteria of mild to moderate Osteoarthrosis of the knee joint. AD Elektronik GmbH, Wetzlar, Germany supplied the devices for giving MRT, which involved five sessions of one hour each on five consecutive days. These devices work with a coded chip card and only half of the 100 cards were coded to provide MRT. Base line assessment and follow up at 1 week, 1 month, 3 month and 6 months included clinical examination and Oxford and WOMAC Knee scores. Radiological assessment included baseline plain radiographs of the knee joint in standing position (AP and Lateral views) and positional MRI scan. At three months MRI scan was repeated. Data was analysed using SPSS 16.0 software and Mann-Whitney and Chi–square Tests were used. Results: No adverse effects were reported during the study. The treatment and the placebo groups were comparable except that the male: female ratio was 1: 2. Placebo group had statistically significant improvement in the WOMAC Pain OA index at 3 months (p=0.017). There was statistically significant improvement in the range of movements at 6 months (p=0.010), but this was clinically not significant as the mean increase in Range of Movement was 4°. At the end of 6 months there was not difference between the two groups. Conclusion: This study has found that five 1 hour sessions of MRT is a safe mode of treatment, but fails to support that it has a beneficial effect on Knee Joint Osteoathrosis

Purpose of the study: The purpose of rotating the femoral piece, using an indepenent cut strategy, is to «correct» for epiphyseal torsion of the distal femur and thus obtain a biepicondylar axis parallel to the posterior bicondylar axis. It is known however that epiphyseal torsion of the distal femur is highly variable from one individual to another. Intraoperative identification of the biepicondylar line enables appropriate rotation, as long as the data collected are reliable. The purpose of this study was to determine the reliability of intraoperative biepicondylar axis measurements made with navigation systems and to compare the results with the preoperative scan taken as the gold standard. Material and methods: This prospective study included 60 degenerative knees undergoing total knee arthroplasty. The angle of epiphyesael rotation of the distal femur was measured on the preoperative computed tomography scan and intraoperatively with the navigation system which identified the biepicondylar line and the posterior bicondylar line. Statistical regression lines were determined. Results: The rotation measured on the preoperative scan was 7.1±2.4° and by the intraoperative navigation system 3.2±4.3°. There was a very weak statistical correlation between the preoperative measurement and the intraoperative navigation measurement (p=0.234, R =0.320). Discussion: Intraoperative identification of the biepicondylar axis is not reliable. Navigation does not enable an accurate assessment of the distal epiphyseal torsion of the femur and thus the proper rotation to give to the femoral piece. The only reliable measurement of the epiphyseal rotation of the distal femur is made on the preoperative computed tomography

Aims: To investigate the clinical and radiological (MRI) effectiveness of Nuclear Magnetic Resonance Therapy (NMRT) on mild to moderate degenerative knee osteo-arthrosis (OA). Methods: A double blind randomised control mono-centric study of 100 volunteer patients with mild to moderated knee OA. All patients underwent clinical examination, pain was recorded on visual analog scale (VAS) and Oxford knee score and WOMAC osteoarthritis index at baseline and at follow up intervals (1 week, 1 month, 3 months and 6 months). The treatment group (n=50) received five sessions of one hour NMRT on five consecutive days. Radiological assessment included baseline standing plain radiograph of the knee joint (AP and Lateral views) and positional MRI scan which was repeated at 3 months. Cartilage thickness in weight bearing areas and bone and cartilage MRI score (BAC-MS) were used to assess response of the cartilage to NMRT. Data was analysed using SPSS 16.0 software and non-parametric tests. Results: Ninety six patients completed six months follow-up. The treatment and placebo groups were comparable except that the male: female ration was 1:1 and 1:2 respectively. No adverse effect was reported during the study. The treatment group showed mean increase of 4° in the range of movement at 6 six months, which was statistically significant (p=0.01). There was no difference in other outcome variables at any time interval between the two groups. Radiologically, BAC-MS and cartilage thickness at three months had no significant difference between treatment and placebo groups (p-value = 0.81 and 0.88 respectively). The change in BAC-MS and cartilage thickness at 3 months was also not significant (p-value = 0.09 and 0.41 respectively). Conclusion: Five 1 hour sessions of NMRT is a safe mode of treatment, but has no radiological (at 3 months) and clinical (6 months) beneficial effect on mild to moderate Knee Joint Osteoathrosis

Purpose of the study: Total knee arthroplasty (TKA) is considered to be an effective treatment for degenerative knee joint disease when the functional impairment and the pain fail to respond to medical treatment. The success of TKA is determined by the degree of pain relief, functional recovery, and implant survival. For many years, those advocating or not preservation of the posterior cruciate ligament (PCL) have animated lively debates. Although a consensus has not been reached, posterior stabilised prostheses and prostheses with a mobile plateau are commonly implanted. The purpose of our study was to compare the outcomes obtained with fixed plateau TKA with preservation of the PCL with those obtained with other prostheses with or without sacrifice of the PCL with a fixed or mobile plateau. Material and methods: This was a prospective study in a single centre including a homogenous consecutive series of 12 TKA (cemented EUROP) with a fixed plateau and preservation of the PCL implanted from 1994 to 1996 in 117 patients aged 73 years on average. The International Knee Society scores were used for the clinical and radiographic assessment at ten years. Results: At ten years follow-up, 23 patients had died, 14 were lost to follow-up and 80 (82 knees) were evaluated clinically and 43 (45 knees) radiographically. The IKS knee score varied from 31 points (0–60) preoperatively to 88 points (30–98) postoperatively at last follow-up. The IKS function score was 40 points (0–90) preoperatively and 80 (25–100) at last follow-up. Lucent lines were noted for 59% of the condyles and 60% of the tibial plateaus. The lucencies were mainly located in the anterior and posterior zones of the femur (zones 1 and 4) and medially on the tibia (zones 1 and2). Two prostheses were revised at 8 and 11 years for loosening. The overall survival was 98.8% at ten years using the Kaplan-Meier method. Discussion: The clinical and radiological outcomes of prostheses with fixed plateaus and preserving the PCL in our series with one revision at 10 years were very satisfactory. Our results are comparable with earlier reports in the literature with or without sacrifice of the PCL with a fixed or mobile plateau. Conclusion: Longer term follow-up will be needed to confirm these results beyond ten years

Introduction: Microfracture is found to be effective for isolated chondral defect of knee in young adults however controversy exists over the relevance of microfracture treatment in degenerative knee. The purpose of the study is to assess the outcome and patient satisfaction with the arthroscopic microfracture of osteoarthritic knee. Materials: We collected the demographic details of the patient, weight, procedure and follow up details from June 2000 to Dec 2002. We reviewed the case notes retrospectively and assessed the patient satisfaction with Oxford knee score and Lysholm score. Results: There were total of 194 patients but only 76 patients returned the questionnaire. The average patient age was 57 years (range: 27–87 years) with majority of the patients being male patients (43 patients). The average weight of the patient was 82 kg (44–119) and the mean duration of operation was 28 minutes. The patients were evaluated at an average follow-up of 51 months (range: 36–66 months). The average Lysholm score was 49 (4–100) with mean oxford score of 32.5(13–56). 21 patients required knee replacement at an average of 24 months (range: 6–48 months) from the initial microfracture. 17 out of 21 patients had kissing lesion and all showed grade 4 degenerative changes. Discussion: Age and weight does not appear to have any effect on microfracture treatment however more number of female patients seem to have more kissing lesion and poor result. With shorter duration of operation and proper explanation to patient give short term symptomatic relief before replacement surgery. It is worth considering this treatment for isolated grade 4 lesion or less than grade 4 degenerative chondral lesions in appropriately selected patients

Purpose of the study: The purpose of this study was to assess radiological outcome of double (femoral and tibial) osteotomy for severe genu varum. Between August 2001 and November 2004, eleven double osteotomies were performed amoung a series of 157 knee osteotomies (7%). Material and methods: The series included four women and seven men, mean age 48.5 years (range 20–62 years). The right knee was involved in seven. One femal patient presented a particularly serious deformity but without oseoarthritic degeneration of the knee joint. The ten other patients all presented overtly degenerative knees. According to the Ahlback modified classification there were six grade III knees, three grade IV and one grade V. Mean preoperative radiological varus was 167.5±2.1° (ange 164–170°°. Orthopilot® was used in all cases. The first step was to insert percutaneously rigid bodies, one into the distal femur and the other into the proximal tibia. Kinematic acquisitions of the hip, the knee and the tibiotalar joint yielded the HKA for the lower limb. The second step was to perform the closed wedge lateral femoral osteotomy (5–6°) which was stabilized with an AO T-plate. The final step was to perform an open-wedge medial tibial osteotomy. After checking the desired alignment (182±2°) on the monitor, the osteotomy was fixed with Biosorb® and plated with an AO LCP. Results: There were no complications. The mean intraopeartive HKA was 168.1±2.21° (range 164–170°), identical with the preoperative findings. After osteotomy, the mean angle provided by the computer system was 182.7±1.1° (range 182–184°). Three months after surgery, the mean alignment on the standing x-ray was 180.8±1.6° (range 177–182°). The preoperative objective was achieved for all knees but one (91% success). There were no x-rays with an oblique joint space. Conclusion: Computer-assisted double osteotomy for major genu varum is a reliable accurate and reproducible technique. Use of a navigation simplifies a generally difficult procedure known to require much surgical skill to achieve the preoperative goal. This technique can be considered as an important development since it can help avoid an oblique joint space which can give rise to further problems and the need for a subsequent prosthesis

Purpose: The role of arthroscopic treatment for degenerative knee joint disease remains controversial. The aim of this work was to evaluate the efficacy of arthroscopic debridement and to establish its indication for the treatment of knee osteoarthritis in patients aged less than 50 years. Material and methods: Arthroscopic debridement was performed from 1994 to 2002 in 192 patients, 72 men and 120 women, mean age 59 years (51–75). We noted clinical history, particularly conditions contraindicating major surgery, and prior lower limb trauma, particularly involving the same knee. Patient weight and activity level were considered. The preoperative work-up included a functional examination (Freeman), and a radiographic study used to class the osteoarthritis as early, moderate or advanced and measure the knee axis. We performed joint wash out in all cases associated with different debridement procedures. Chondropathy was evaluated with the Marshall classification. A new functional evaluation and subjective evaluation was performed at last follow-up. Results: Severe disease was present in the history of 5.2% of the knees; 9.3% had had prior surgery and 82% presented moderate osteoarthritis, mainly involving all three compartments. Type II or III chondropathy was found in 92% of knees. At mean follow-up of 28 months (5–108), the mean function score improved from 69.4/110 preoperatively to 89.5/110 and 75.4% of patients considered their knee had improved. Five patients required secondary arthroplasty. Poor outcome was associated with type III or IV chondroplasty involving the three compartments and the presence of the mentioned history. Age was not correlated with poor outcome. Discussion: We studied a population with overt osteoarthritis who were treated with a minimally aggressive method, mainly for palliation. Only 2.6% underwent total arthroplasty after arthroscopic treatment. There was a clear improvement in function, mainly pain relief. The large majority of the patients were satisfied with the outcome and did not require further medical treatment except occasionally. The less satisfactory results were obtained in patients with more advanced disease who could not undergo arthroplasty because of concomitant medical conditions

Purpose: Use of a mobile tibial plateau for total knee arthroplasty (TKA) is designed to reduce wear and improve prosthetic kinetics. The purposes of this study were: 1) to compare the kinetics of a posterior stabilised TKA implanted with a fixed plateau (FP) or a mobile plateau (MP) and, 2) to determine whether the mobile plateau improves axial rotation. Material and methods: Ten patients with a unilateral TKA (HLS) with a fixed or mobile plateau were selected for this study according to the following criteria: arthroplasty for degenerative knee disease, healthy contralateral knee, age < 80 years, pain-free prosthesis, IKS > 80/100, flexion > 90°, follow-up > 1 year. There were five patients with a fixed plateau and five patients with the same prosthesis except with a mobile plateau. Knee movement (flexion-extension, axial rotation, valgus-varus) were measured with an electromagnetic goniometer on the implanted and healthy sides. Four movements were recorded: walking, standing up sitting down, flexion-extension without loading. Amplitudes were compared with non-parameteric statistical tests between the healthy side and the implanted side and between the two types of implants. Results: The FP knees were more mobile in valgus-varus due to greater residual frontal laxity than the MP knees. This extra laxity generated excessive axial rotation on the FP during non-loaded movements. Conversely, when loaded, axial rotation of the MP knees was 10° greater (mean, p < 0.05) than for the FP knees, giving better stability in the frontal plane. This study did not demonstrate any difference in flexion between FP and MP. Patients with an MP prosthesis did not have significantly different amplitudes of the three movements for the healthy versus implanted knee. For the patients with a FP prosthesis, axial rotation and frontal plane movement was lower in the implanted knee than in the healthy knee (p< à.05). Discussion: This study devoted to the design of a single prosthesis demonstrated the usefulness of the mobile plateau for axial rotation during loaded movement. The kinetics of MP prostheses is similar to that of the healthy knee. Better axial rotation with MP prostheses during loaded movements suggests the persistence of the plateau mobility which should be confirmed with a cinematographic study

Purpose: Re-establishment of correct patellofemoral kinetics is a major challenge in patients with major dislocation of the patella. Several factors affect the position of the patella, rotation of the prosthetic components, lateral section of the patella, and …perhaps…surgical access. Material and methods: Between 1994 and 1999, 26 knees with major dislocation of the patella were treated by the same operator with total knee arthroplasty (TKA) using a Cedior (Sulzer) implant. The operative technique was the same for all patients with the exception of the surgical access. For group 1 knees (n=13) a medial access was used (medial parapellar approach, 2 lateral patellar sections). For group 2 knees (n=13) a lateral access was used (lateral parapatellar approach lifting the anterior tibial tendon and refixing it after the procedure with systematic lateral fixation of the patella). Patellar tilt and lateral displacement and the patellar index (PI) (distance using head of the fibula as the fixed point) were the main judgement criteria. Student’s t test was used for statistical analysis. The two groups were comparable for: preoperative axial deviation (176.8±6.45°), lateral displacement (8.65±3.74 mm), and PI (0.789±0.166), and postoperative position of the femorotibial implants. Results: Patellar displacement persisted in one knee in group 1 requiring a new prosthesis. Anterior impaction of the tibial piece in one knee in group 2 did not require reoperation. Radiographically, lateral displacement was minimal in both groups (0.692 and 0 mm in groups 1 and 2) (p=0.17). Residual postoperative tilt was +3.8° in group 1 and −3.3° in group 2 (p=0.06). PI was 0.859 in group 1 and 0.956 in group 2 (p=0.24). In group 2, the postoperative PI (0.956±0.231) was not changed from the preoperative PI (0.831±0.152) an expression of the absence of ascension of the anterior tibial tendon (p =0.1). Dicussion: Lateral displacement of the patella was entirely corrected in both groups. Unlike the lateral access, medial access, even with lateral section of the patella, did not correct for the tilt. Raising the anterior tibial tendon did not in our experience have any iatrogenic effect in itself. Irrespective of the femorotibial axis, lateral access for degenerative knees with major dislocation of the patella appears to be the best approach for implantation of total knee arthroplasty