Aims. While residual
Abstract. Introduction. This study compared biomechanical and functional parameters of a total knee arthroplasty (TKA) implant (Cemented Zimmer Hi-Flex) against healthy older adults to determine whether knee biomechanics was restored in this patient population. Methodology. Patients with a primary TKA and healthy adults >55 years old with no musculoskeletal deficits or arthritis participated. Bilateral knee range of motion (RoM) was assessed with a goniometer, then gait patterns were analysed with a 3D motion-capture system. An arthrometer then quantified anterior-posterior laxity of each knee. Statistical analyses were performed in SPSS (α=0.05; required sample size: n=21 per group). Results. 25 knees were replaced in 21 patients. Nine presented with
Introduction. At Sheffield Children's Hospital, treatment of leg length discrepancy is a common procedure. Historically, this has been done with external fixators. With the development in intramedullary technology, internal nails have become the preferred modality for long bone lengthening in the adolescent population. However, it is important to review whether this technology practically reduces the known challenges seen and if it brings any new issues. Therefore, the aim of this review is to retrospectively evaluate the therapeutic challenges of 16 fit-bone intramedullary femoral lengthening's at Sheffield Children's Hospital between 2021–2022. Materials & Methods. The international classification of function (ICF) framework was used to differentiate outcomes. The patient's therapy notes were retrospectively reviewed for themes around structural, activity and participation limitation. The findings were grouped for analysis and the main themes presented. Results. There were 8 males, mean age 17.4 years (range 17–18) and 8 females, mean age 15.9 years (range 14–18). 5 right and 11 left femurs were lengthened. Underlying pathology varied amongst the 16 patients. All patients went into a hinged knee brace post operatively. Structural limitations included: pain,
Introduction. The objective of this study was to assess the effect of PCL resection on flexion-extension gaps, mediolateral soft tissue laxity,
Introduction. We propose that Total Hip Replacement with correction of
Total Knee Joint Replacement is mostly commonly performed using a measured resection technique. When the PCL is retained 9mm of bone is resected off the distal femur. If the PCL is excised 11m of bone is resected. Computer assisted total knee joint replacement will guide the surgeon to perform the optimal distal femoral resection to gain neutral alignment and full post operative extension. Three hundred TKJR’s were performed by one surgeon using the De Puy Ci navigation system. A ligament balancing technique is used whereby a neutral tibial resection is performed. A ligament tensor is inserted in extension and flexion. The navigation system then performs an optimization process whereby the distal femoral cut is calculated to give a neutral mechanical axis and 0° of knee extension. Data was collected measuring the distal femoral resection in the PCL retained and resected knees. The distal femoral cut required to achieve full extension for the PCL retaining TKJR ranged from 5 – 15mm. The mean was 11.2mm. The distal femoral cut required to achieve full extension for the PCL sacrificing TKJR ranged from 5 – 15mm. The mean was 10.8mm. There was no difference between the two groups (p=0.07). Both the PCL retaining and sacrificing TKJR distal resections correlated with the preoperative flexion deformity, i.e. patients with a greater
Purpose: Arthrogryposis is a disease of muscular system, which is characterized by fibrous degeneration of muscles that leads to deformed and rigid joints. Aim of this study is to describe the deformities of the lower limbs and their surgical treatment. Material – Methods: Twenty children (12 boys-8 girls) with distal arthrogyposis were treated in our department during the decade 1992–2002. The deformities of lower extremities were referred to hip, knee and foot. Congenital dislocation of hip joint was noticed in 4 patients that were treated by open reduction, while fixed flexion and adduction deformity was appeared in 8 patients that were treated by release of flexors and adductors muscles of hip. The main deformity in knee was
The hip joints are commonly affected in Juvenile Idiopathic Arthritis (JIA) in childhood. Common features are pain, subluxation, femoral anteversion, coxa valga, significant
Introduction. We have previously published limb lengthening using external fixation in pathological bone diseases. We would like to report a case series of femoral lengthening using the PRECICE system in a similar pathological group especially looking at it's feasibility and complications. Materials and Methods. This is a case series of four patients, two patients with osteogenesis imperfecta and two with Ollier's disease, who underwent femoral lengthening via distraction osteogenesis using the PRECICE intramedullary nail system. It was a retrospective study from a prospective database from clinical records and radiographs. Results. The mean age at the time of surgery was 15.5 years, the mean preoperative leg length discrepancy was 30mm, and the mean distraction distance achieved was 28.75mm. Since these patients were of shorter heigh, limb lengthening was considered. All 4 patients had successful insertion of the nail. The outcomes noted from the 4 patients are collated, with several complications occurring including delayed femoral union,
Introduction: Stiffness following total knee arthroplasty is a disabling problem resulting in pain and reduced function. Prevalence is not well defined and although various treatment modalities including manipulation, arthrolysis and revision surgery has been proposed with varying degrees of success for reduced flexion, these Methods: are deemed to be of limited value in
Flexion contractures are a common finding in an end-stage arthritic knee, occurring in up to 60% of patients undergoing total knee arthroplasty.
Flexion contractures are a common finding in an end-stage arthritic knee, occurring in up to 60% of patients undergoing total knee arthroplasty.
Objective: To emphasize the need to provide a controlled method of intra-operative reduction to correct
Introduction. Total knee arthroplasty is the standard treatment for advanced knee osteoarthritis. Patient-specific instrument (PSI)has been reported by several authors using different techniques produced by implant companies. The implant manufacturers produce PSI exclusively for their own knee implants and for easy straightforward cases. However, the PSI has become very expensive and unusable as a universal or an open platform. In addition, planning the implant is done by technicians and not by surgeons and needs long waiting time before surgery (6 weeks). Methods. We proposed a new technique which is a device and method for preparing a knee joint in a patient undergoing TKA surgery of any knee implant (prosthesis). The device is patient specific, based on a method comprised of image-based 3D preoperative planning (CT, MRI or computed X-ray) to design the templates (PSI) that are used to perform the knee surgery by converting them to physical templates using computer-aided manufacturing such as computer numerical control (CNC) or additive-manufacturing technologies. The device and method are used for preparing a knee joint in a universal and open-platform fashion for any currently available knee implant. Results. All patient-specific implants and any knee implant could be produced. The technique was applied on NExGen implant (Zimmer)on 21 patients, PFC implant (Depuy, J & J) on 5 patients, Scorpio NRG implant (Stryker) on 24 patients and SLK Evo implant (Implant International) on 81 patients. The >15 degrees varus gave a mean of 10.44 degrees in 56.67% of cases and the <15 degrees varus gave a mean of 24.04 degrees in 43.33% of cases. The total varus of 5–30 degrees gave a mean of 16.33 degrees in 90.9% of cases and the total valgus of 20–40 gave a mean of 25 degrees in 9.1% of cases. The
This study was performed at Assiut University, Assiut, Egypt. Anterior distal femoral hemiepiphysiodesis (ADFH) using intra-articular plates for the correction of paediatric
Saggital plane deformities are difficult to treat and pose major challenge to orthopaedic surgeons and we are presenting short series of patients who have undergone the deformity correction with ring fixator. Sixteen deformities in 15 patients were corrected during 1996 to 2004. The aetiology was congenital pterigium five cases, post traumatic seven cases, one each of polio, septic knee and post osteomyelitic sequelae. Nine patients had
Introduction: Majority of children with cerebral palsy patients suffer from fixed flexion contractures of their knees. Procedures commonly used to correct knee flexion deformities include hamstring release, anterior femoral hemiepiphyseodesis and femoral extension osteotomies. The latter procedure can cause neurovascular complications. Femoral stapling procedures are not very popular because of a theoretical risk of permanent physeal closure. We present our initial experience in correction of knee flexion deformity by using the 8-plate technique. This uses guided growth in the distal femoral physis to achieve gradual correction of the knee flexion deformity. Materials and Methods: We reviewed a consecutive series of 25 children with
Radial head fractures with fragment displacement should be reduced and fixed, when classified as Mason II type injuries. We describe a method of arthroscopic fixation which is performed as a day case trauma surgery, and compare the results with a more traditional fixation approach, in a case controlled manner. We prospectively reviewed six Mason II radial head fractures which were treated using an arthroscopic reduction and fixation technique. The technique allows the fracture to be mobilised, reduced, and anatomically fixed using headless screws. All arthroscopic surgeries were conducted as day-cases. We retrospectively collected age and sex matched cases of open reduction and fixation of Mason II fractures using headless screws. The arthroscopic cases required less analgesia, shorter hospital admissions, and had fewer complications. The averaged final range of follow-up, at 1 year post-operation was 15 to 140 degrees in the arthroscopic group and 35 to 120 degrees in the open group. The Mayo Elbow Performance Score was 95/100 and 90/100 respectively. No acute complications were noted in the arthroscopic group, and a radial nerve neuropraxia [n=1], superficial wound infection [n=1], and loose screw [n=1]. Two patients of the arthroscopic group required secondary motion gaining operations [n=1 arthroscopic anterior capsulectomy for a fixed flexion contracture of 35 degrees, and n=1 loss of supination requiring and arthroscopic radial scar excision]. Three patients in the open group required secondary surgery [n=2 arthroscopic anterior capsulectomy for
Introduction: Avulsion fractures of the anterior tibial spine are not so common. The best form of treatment for displaced fractures is still debatable. Aims: We aimed to analyze the results of different forms of internal fixation for avulsion fractures of the anterior tibial spine. Material and Methods: Twenty-five patients with avulsion fractures of the anterior tibial spine had open reduction and internal fixation with different implants (AO screw, Herbert screw, stainless steel wire loop and absorbable stitch) and techniques. The mean follow up period was 3.66 years. They were evaluated clinically and radiologically, using KT 1000 arthrometer for ACL laxity and goniometer for range of movements. The outcome was measured using Lysholm Knee Score. Results: Significant residual anterior laxity despite adequate fracture union was a common finding. Maximum ACL laxity was seen in adults in whom absorbable stitches had been used and they had a corresponding lower Lysholm score. Significant migration of the Herbert screws was noted in two of five patients in which it was used. Five of the eight patients with higher Lysholm score had AO screw fixation. Three patients with steel wire loop for stabilization of the fracture also had better results comparatively. Three individuals who had their knee immobilised in 25°–50° of flexion developed