Purpose. Introduce an Integrated Approach for Orthopedic-Sports Medicine Practice and Patient Care Management that. Is built around effective and efficient surgical techniques, and patient care management processes. Integrates Operations and Service Excellence best practices with patient care management processes. Integrates orthopedic care delivery between outpatient clinic, pre-surgery, surgery, inpatient, (acute care) and post acute care settings. Delivers exceptional clinical, patient satisfaction and financial outcomes as validated by independent national healthcare benchmarking organization. Helps position Ortho-Sports medicine services for strategic growth. Is replicable to develop Ortho-Sports Medicine Centers of Excellence. Presentation illustrates the ‘Ten Elements’ approach to implement the Ortho-Sports Medicine Centers of Excellence and demonstrate the effectiveness of the approach with an outcomes study from over 1000 total knee arthroplasty (TKA) procedures. During the presentation, the speakers would share the key clinical, patient satisfaction, and financial outcomes achieved by the implementation of the best practices defined in our ‘Ten Elements’ approach. All performance data elements are collected, validated and analyzed by an independent third party, national healthcare benchmarking company. During the presentation Dr. Bramlett would elaborate on the surgical protocol, and the key differentiating steps in procedure technique from traditional approach that significantly enhances procedure effectiveness, efficiency and lowers the patient complication rate as demonstrated by benchmarking data. Speakers would further present the key elements of Total Knee Arthoplasty procedure that focus on patient education, patient participation in pre-surgical weight loss and pre-habilitation program, anesthesia approach, avoiding tourniquet use and deep veen thrombosis (DVT) risk reduction, early post operative patient ambulation and weight bearing, and post operative patient management approach. On average the ortho-sports medicine clinical of Alabama TKA patients are disharged from the hospital in 2.6 days, and experience 65 percent less complications than expected for a similar patient population and assume early control of their independent functionality

Introduction

In total knee arthroplasty, the aim is to relieve pain and provide a stable, functional knee. Sagittal stability is crucial in enabling a patient to return to functional activities. Knee implants with a medial pivot (MP) design are thought to more accurately reproduce the mechanics of the native joint, and potentially confer greater antero-posterior stability through the range of flexion than some other implant designs.

Tranexamic Acid (TA) has been shown to reduce transfusion rates in Total Knee Replacement (TKR) without complication. In our unit it was added to our routine enhanced recovery protocol. No other changes were made to the protocol at this time and as such we sought to examine the effects of TA on wound complication and transfusion rate.

All patients undergoing primary TKR over a 12 month period were identified. Notes and online records were reviewed to collate demographics, length of stay, use of TA, thromboprophylaxis, blood transfusion, wound complications and haemoglobin levels. All patients received a Columbus navigated TKR with a tourniquet. Only patients who received 14 days of Dalteparin for thromboprophylaxis were included.

124 patients were included, 72 receiving TA and 52 not. Mean age was 70. Four patients required a blood transfusion all of whom did not receive TA (p = 0.029). Mean change in Hb was 22 without TA and 21 with (p = 0.859). Mean length of stay was 6.83 days without Tranexamic Acid and 5.15 with (p < 0.001). 15% of patients (n=11) of the TA group had a wound complication, with 40% of patients (n=21) in the non TA group (p = 0.003). There was one ultrasound confirmed DVT (non TA group). No patients were diagnosed with pulmonary embolus.

In our unit we have demonstrated a significantly lower transfusion rate, wound complication rate and length of stay, without any significant increase in thromboembolic disease with the use of TA in TKR.

Aims: The purpose of this study was to determine whether patella replacement or RAP of the patella is advantageous in TKA.

Methods: 100 patients were recruited to enter a randomised, prospective, double blind clinical trial to determine the efþcacy of patellar resurfacing during total knee arthroplasty. All patients receive the same posterior cruciatesparing prosthesis, and all operations were performed by, or under the direct supervision of the þrst author. Evaluation consisted of the determination of the HSS-Score, the knee society scores, speciþc questions relating to patellafemoral symptoms, radiographs, measurement of torques and stability of one leg standing. All knees were followed at 3 month and 18 month postoperatively.

Results: There was no signiþcant difference between the two groups with regard to the HSS-Score, and the KS-scores. Excentric and concentric torques were higher in the group with RAP of the patella. One leg standing was more stable in the group with RAP of the patella. In both groups one patient complained of severe anterior knee pain. The patient with RAP of the patellar was treated successfully with secondary patella resurfacing.

Conclusions: The clinical outcome and the prevalence of anterior knee pain after TKA with the PFC-∑ knee was not inßuenced by whether or not the patella had been resurfaced. Force and balance are slightly better after TKA with RAP of the patella.

To date, there are no clear guidelines from the National Institute of Clinical Excellence or the British Orthopaedic Association regarding the use of Autologous Blood Transfusion (ABT) drains after elective primary Total Knee Replacement (TKR). There is little evidence to comparing specifically the use of ABT drains versus no drain. The majority of local practice is based on current evidence and personal surgical experience.

We aim to assess whether the use of ABT drains effects the haemoglobin level at day 1 post-operation and thus alter the requirement for allogenic blood transfusion. In addition we aim to establish whether ABT drains reduce post-operative infection risk and length of hospital stay.

Forty-two patients undergoing elective primary TKR in West London between September 2011 and December 2011 were evaluated pre- and post-operatively. Patient records were scrutinised. The patient population was divided into those who received no drain post-operatively and those with an ABT drain where fluid was suctioned out of the knee in a closed system, filtered in a separate compartment and re-transfused into the patient.

Twenty-six patients had ABT drains and 4 (15.4%) required an allogenic blood transfusion post-operatively. Sixteen patients received no drain and 5 (31.3%) required allogenic blood. There was no statistical difference between these two groups (p=0.22). There was no statistical difference (p=0.75) in the average day 1 haemoglobin drop between the ABT drain and no drain groups with haemoglobin drops of 2.80 and 2.91 respectively. There was no statistical difference in the length of hospital stay between the 2 groups (p=0.35). There was no statistical difference (p=0.26) in infection rates between the 2 groups (2 in ABT drains Vs. 0 in no drains). Of the 2 patients who experienced complications one had cellulitis and the other had an infected haematoma, which was subsequently washed out.

The results identify little benefit in using ABT drains to reduce the requirement for allogenic blood transfusion in the post-operative period following TKR. However, due to small patient numbers transfusion rates of 31.3% in the ABT drain group Vs. 15.4% in the no drain group cannot be ignored. Therefore further studies including larger patient numbers with power calculations are required before a true observation can be identified.

Purpose

To compare Radiostereometric Analysis (RSA) and subjective outcomes of Total Knee Arthroplasty (TKA) and Total Ankle Arthroplasty (TAA).

Background and purpose: Development of minimal invasive operation techniques has given unicompartemental knee arthroplasty (UKA) renewed interest. Indications for use of UKA are however debated, and short-term advantages of UKA over total knee arthroplasty (TKA) should be weighed against the higher risk of reoperation. More knowledge on long term results of pain and function after knee arthroplasties is therefore needed and was the purpose of this study.

Methods: Patient-reported pain and function were collected at least two years after the operations in postal questionnaires from 1643 osteoarthritis patients reported to the Norwegian Arthroplasty Register with intact primary TKA (n=1271) or UKA (n=372). The questionnaire contained instruments for calculation of the knee specific Knee Osteoarthritis Outcome Score (KOOS), and for quality of life (EQ-5D, post- and pre-operative). 5 subscales from KOOS were used as outcome. To incorporate an outcome for anterior knee pain an additional subscale based on 7 questions from KOOS, clinically accepted to be related to such discomfort, was calculated. Pain and satisfaction from a visual analogue scale (VAS) were also used as outcomes together with improvement in EQ-5D index score. The outcomes were measured on a scale from 0 (worst) to 100 (best) units with an argued minimal perceptible clinical difference of 8–10 units. Group differences were analysed with multiple linear regression, adjusted for confounding by age, gender, Charnley category, time since operation and preoperative EQ-5D index score.

Results: UKA performed better than TKA for the KOOS subscales Activity in Daily Living (difference in mean outcome score =−3.4,p=0.02) and Sport and Recreation (difference =−4.4,p=0.02) and for Anterior Pain (difference=−4.5,p< 0.01). The difference was also significant for the outcome Pain(VAS) but now in favour of TKA (difference=3.3,p=0.02). Motivated by the discrepancy in the results of the pain related outcomes, Anterior Pain (UKA best), Pain(VAS) (TKA best) and Pain(KOOS) (no difference) further investigation of the questions (0=best to 4=worst) used for calculation of Pain(KOOS) and Anterior Pain were performed. Patients that had undergone UKA had more often pain from the knee (difference=0.26,p< 0.01), while they had less pain when they were bending the knee fully (difference=−0.37,p< 0.01) and less problems when squatting (difference=−0.25,p< 0.01).

Interpretation: Estimated differences did not reach the level of minimal perceptible clinical difference. There are however indication of differences in the way the two treatment groups experience knee related discomfort. Even though UKA offers a lower level of pain and less problems in activities involving bending of the knee, these patients seem to experience pain from the knee more often.

Orthopaedic surgeons and their patients continue to seek better functional outcomes after total knee replacement, but TKA designs claim characteristic kinematic performance that is rarely assessed in patients.

The objectives of this investigation is to determine the in vivo kinematics in knees with Cruciate Retaining TKA using Patient Specific Technology during activities of daily living and to compare the findings with previous studies of kinematics of other CR TKA designs.

Four knees were operated by Triathlon CR TKA using Patient Specific Technology and a fluoroscopic measurement technique has been used to provide detailed three-dimensional kinematic assessment of knee arthroplasty function during three motor tasks. 3D fluoroscopic analysis was performed at 4-month follow-up.

The range of flexion was 90°(range 5°–95°) during chair-rising, 80°(range 0°–80°) during step up and 100° (range 0°–100°) during leg extension. The corresponding average external rotation of the femur on the tibial base-plate was 7.6° (range +4.3°; +11.9°), 9.5° (+4.0°; 13.5°) and 11.6° (+4.5°; +16.1°). The mean antero-posterior translations between femoral and tibial components during the three motor tasks were +4.7 (−3.7; +1.0), +6.4 (−3.8; +2.6) and +8,4 (−4.9; +3.5) mm on the medial compartment, and −2.5 (−7.1; −9.6), −3.6 (−6.1; −9.7), −2.6 (−7.7; −10.3) mm on the lateral compartment, respectively, with the medial condyle moving progressively anterior with flexion, and the medial condyle moving progressively posterior with flexion.

We compared Triathlon CR PSI TKA results from this study with Genesis II CR TKA, with Duracon CR TKA, with Triathlon CR TKA and with the healthy knee kinematics. The results of this study showed no screw home mechanism. The internal rotation of the tibia with knee flexion is close to normal, better than Genesis II, Duracon and Triathlon CR TKA operated with standard surgery.

The medial condyle is characterized by the same pattern of the other implants, with a paradoxical anterior translation of 5 mm.

The lateral condyle shows a posterior rollback better than Triathlon CR operated with standard surgery.

For the first time is demonstrated that the surgical technique can modify the tibio-femoral kinematics.

Background

Post operative analgesia is an important part of Total Knee Arthroplasty (TKA) to facilitate early mobilisation and patient satisfaction. We investigated the effect of periarticular infiltration of the joint with chirocaine local anaesthetic (LA) on the requirement of analgesic in the first 24 hrs period post op.

Introduction: This observational study assessed the influence of obesity on operating time and duration of hospital admission following Total Knee Arthroplasty (TKA).

Materials and Methods: 263 patients who underwent 276 TKAs between 1st January and December 31st 2005 at the Glenfield General Hospital were identified from the Trent (and Wales) Arthoplasty Audit Group. Patients were grouped into three weight categories based upon BMI. We examined hospital records for 265 of the 276 procedures and compared operating time, length of hospital admission and complication rates between the three BMI groups. Patient perceived outcomes including patient satisfaction, post-operative pain and frequency of walking were compared at 1-year post TKA.

Results: Obesity did not adversely influence operating time and duration of hospital stay. The mean operating time was 82 minutes in patients with a BMI ≤ 25.0, 84 min in those with a BMI 25.1–30.0 and 88 minutes for those with a BMI> 30.0 (p=0.2). The mean hospital stay was 7.7 days in patients with a BMI ≤ 25.0, 7.2 days in the BMI 25.1–30.0 group, and 6.7 days in those with a BMI > 30.0 (p=0.8).

There were no significant differences between the three BMI groups and post-operative complications (p = 0.7), patient satisfaction (p=0.1) or pain levels (p=0.7) at 1-year post-TKA. As has been demonstrated previously, increasing BMI negatively influenced post operative walking frequency (p=0.02)

Conclusion: BMI did not influence operating time, length of stay, complication rates, post operative pain and patient satisfaction post Total Knee Arthroplasty, but was associated with decreased post operative mobility.

Aim. We aim to compare revision rates and functional outcome scores in between two contemporary total knee arthoplasty systems. Methods. A search was carried out of a prospectively maintained outcomes database to identify all patients receiving total knee replacement (TKR) in the department between 2005 and 2006, when evaluation of different knee arthroplasty systems was being undertaken. Data on the first 93 consecutive patients receiving a Scorpio (Stryker, Allendale, NJ) implant and the first 93 consecutively receiving a PFC (DePuy, Warsaw, IN) implant were reviewed. Four year revision rates and functional scores were recorded. Results. Patient demographics were similar in both groups. Six of ninety three Scorpio implants were listed for revision over the four year period (6%). Five of these were for aseptic loosening. Three further patients are currently being investigated for pain and have radiological evidence of loosening with no clinical evidence of infection. No PFC implants required revision in the four year period (p = 0.013). There was no difference in Oxford Scores pre-operatively, or at 3 months, 1 year and 2 years post-operatively. Discussion. There is a significant difference in revision rates between the two prostheses, and the revision rate of the Scorpio prosthesis is far higher than would be expected. The majority of these have been revised for aseptic loosening. Those prostheses surviving to four years had similar clinical outcomes. The reasons for this higher than expected revision rate in the Scorpio group require further exploration

Purpose. Traditional total knee arthoplasty techniques have involved implantation of diaphyseal stems to aid in fixation expecially when using constrained polyethylene inserts. While the debate over cemented vs uncemented stems continues, the actual use of stems is considered routine. The authors' experience with cemented stemmed knee revisions in older patients with osteoporotic bone has been favorable. Our younger patients with press-fit stems from varying manufacturers have been plagued with a relatively high incidence of component loosening and stem tip pain in the tibia and occasionally thigh. We report the early results of the first 20 total knee revisions using press-fit metaphyseal filling sleeved stemless implants with constrained bearings. Methods. Twenty three patients with failed primary or revision total knees were assigned to receive stemless sleeved revision knee designs using the DePuy MBT/TC3 system. Reasons for revision included loosening, implant fracture, stiffness, instability, and stem pain. Twenty patients (ages ranging from 42–73) were successfully reconstructed without stems. Six knees with significant uncontained cavitary defects were included. Three patients with unexpectedly osteoporotic metaphyseal bone were revised with cemented stemmed implants and excluded. All cases used cement for initial fixation on the cut bone surface and fully constrained mobile bearing inserts. Results. Follow up ranged from six months to three years. All patients had radiographic evidence of well fixed stable implants on most recent examination. All four cases of revision for “end of stem pain” had complete resolution of symptoms within two weeks of revision surgery. Long leg anterior posterior mechanical alignment x-rays measured within two degrees of neutral in all cases. Knee Society Scores improved an average of 34 points. Clinical results for revision for stiffness had the lowest final scores post operatively. Conclusion. Stemmed total knee arthroplasty revision implants with or without cement are considered the standard for most revision reconstructions. Recently, primary total hip replacements using newer short metaphyseal stems have shown promising early clinical results. This case series of twenty total knee revisions using stemless press-fit metaphyseal sleeves shows similarly favorable outcomes. The complications of stemmed implants such as stem tip pain and difficulty of cemented stem removal can be avoided successfully in non-osteporotic bone reconstructions. With stable bony ingrowth visible on early post-operatyive radiographs, long term stable fixation even with constrained bearings is expected. Longer follow up will be needed to validate this technique for routine use

Total knee arthoplasty (TKA) remains a standard treatment for advanced knee arthritis. The aim of the procedure is to restore function and relieve pain ideally for the rest of patient's life. Patient matched templating (PMT) or patient specific instrumentation (PSI) is a recent development for alignment of TKA components that uses disposable guides. The users of PSI claim it to be the optimum balance of new technology and conventional technique by reducing the complexity of conventional alignment and sizing tools. To assess the clinical and radiological outcome of Primary TKA done with PSI. More than 200 cases of TKA have been done in our unit using PSI and we analysed the radiographic outcome of these cases postoperatively. We also reviewed the clinical outcome of 103 patients with 1 year and 43 patients with 2 year follow-up. Data was collected prospectively: pre-operatively and at 1 year and 2 years post-operatively including Oxford knee score (OKS), WOMAC and American knee society score (AKS). Standard AP and lateral films were done pre-operatively and post-operatively. Mean age was 66 years. There were 56 female and 47 male patients. Mean post-operative angles on standard films were: Alpha = 95.6, Beta = 88.4, Saggittal femur = 3.4 and Saggittal tibia = 90.8. Of the 103 cases with 1 year follow-up, there was significant improvement in all clinical outcome scores. Mean OKS improved from 18 to 39 at 1 year and remained the same at 2 years, WOMAC improved from 40 to 18 in both 1 and 2 years post-op. AKS Total improved from 79 to 173 at 1 year and 170 at 2 years. Performing TKA using PSI is safe and provides good radiological alignment in the coronal and sagittal plane. Significant improvement in outcome scores were seen at one and two year follow up and reached levels that compared favourably with other reported series of TKA outcome from our unit

Ligament balancing can be difficult to perfect in total knee arthoplasty (TKA), where current surgical practice is subjective and highly dependent on the individual surgeon. Proper ligament balancing contributes to postoperative stability, prosthetic alignment, and proprioception. Conversely, imbalance is linked to increased wear rates of the polyethylene component within the implant and, in turn, early surgical revision. With the end goal of quantification of joint compartmental pressures, pressure sensor arrays have been designed to quantify contact stresses within the knee during TKA. Flexible, capacitive pressure sensors are designed as simple parallel plates, enabling a robust solid state design. Modification of cleanroom microfabrication processes enable realization of these arrays on polyimide (common in microdevices), and polyethylene (common in joint replacements). Readout circuitry implements an Analog Devices capacitance to digital chip and output is compared to direct LCR meter data. Testing verifies the highly linear response of the sensors with applied normal loads corresponding to pressure magnitudes present in passive (intraoperative) knee flexion. Spatial resolution of the arrays is 0.5 mm, with a critical dimension of 25 micrometers, allowing the magnitude and location of forces to be accurately recorded. The MEMS pressure sensors are mounted on a tibial trial, with the body of the trial housing all circuitry. The sensors are read sequentially, and the data undergoes analog to digital conversion prior to wireless data transmission at 2.4 GHz. An Instron machine is used for compressive loading for laboratory calibration and testing. This paper outlines device fabrication, readout circuit implementation, and preliminary results

Orthopedic surgery is one of the most blood-consuming surgeries. Currently there has been a radical change in transfusion policies, developing a series of therapeutic measures essentially created to minimize the use of allogeneic blood. On the one hand, the safety of our patients must be even more our main objective. On the other hand, our economic resources are more restricted and therefore we must evaluate our surgical techniques and proceedings in order to be safer and more cost-effective. The aim of this study is to report our results of the blood lost, the percentage of blood loss, the necessity of transfussions and how many blood pakages are needed. From a sample of 2400 total knee arthroplasties proceedings, we analyze some surgical proceedings such as lligament balance, patelar traking, artrotomy, ischemia, femoro-tibial axis and type of arthroplasty. We also examine the total blood lost and the percentage of total blood loss after 4 hours, after 24hours and after 48 hour of the total knee arthoplasty surgery. We made a statistical analysis with t-test or anova test when it was necesassary. The outcome of our investigation show that the blood loss when the ischemia is less than 50 minutes is 1470 cc and 1603 cc when is more than 50 minuntes (p<0.05). If we use the medial arthrotomy, the total bleeding is 1563cc, but with subvastus arthrotomy is 1294cc (p<0.05). If we use a primary rotational total knee arthroplasty the bleeding is 953cc, but if we use a PS or PCR the bleeding is 874cc (p<0.05). As a conclusion we should know that our patients have more blood loss when the ischemia is more than fifty minutes, the bleeding is higher when we make a medial arthrotomy and when we use a rotational knee primary arthroplasty

Purpose. The patella provides a mechanical advantage to the knee extensor mechanism. Patellectomy, performed for trauma or patellofemoral arthrosis, does not preclude the development of tibiofemoral arthrosis. Total knee arthroplasty is the mainstay of treatment for tibiofemoral arthrosis. The purpose of this study was to evaluate the outcomes of total knee arthoplasty in patients who previously underwent patellectomy. Method. A retrospective analysis was completed on a prospectively collected database to identify all patients who underwent total knee arthroplasty following a previous patellectomy. Sixty-one total knee arthroplasties in 57 patients were identified. Patient demographics as well as functional outcome scores, including WOMAC and Knee Society Scores, were evaluated. Results. Thirty-six females (63.2%) and 21 males (36.8%) underwent a Total knee arthroplasty between July 1984 and April 2010. Mean follow up was 6.0 years (3 months–20 years). Mean Age and BMI was 59.8 8.6 and 30.5 5.8 respectively. Patellectomy was performed for trauma (56) and patellofemoral arthosis (five). All polyethylene inserts were cruciate substituting. There were five deaths and 10 knees (16.4%) required revision surgery. Causes for failure included aseptic loosening (2), polyethylene wear (3), component fracture (2), infection (2) and stiffness (1). WOMAC scores improved from 38.0 14.1 pre-operatively to 58.5 22.1 at latest review. Knee Society scores improved from 81.5 31.2 to 136.0 41.0. Range of motion and extensor lag changed preoperatively from 105.7 15.9 and 4.3 15.5 degrees to 110.7 12.1 and 6.3 7.1 degrees postoperatively. Conclusion. Despite the mechanical disadvantage to the knee extensor mechanism rendered by patellectomy, total knee arthroplasty is an effective treatment option for tibiofemoral arthrosis in these patients

Aim: The purpose of the study is to determine the opioid Ð sparing effect of Rofecoxibe and Lornoxicam in comparison to placebo in total knee arthoplasty. Method: This was a prospective, randomized, double-blind study. 82 patients with mean age of 70 years old (±3.5) and weight 82 (±4) were included. The operation was done under spinal anaesthesia. All patients after the operation were transferred to the Orthopaedic High Dependency unit where PCA morphine with a bolus of 1 mgr and lock-out interval of 8 min was started. There were randomized to receive 50 mgr of Rofecoxibe orally the morning of the operation or 8 mg of Lornoxicam I.V. twice a day. The third group did not receive any additional analgesic. After 24 hours the consumption of morphine and the evaluation of pain according to VAS scale were recorded. The evaluation of pain was done by the same doctor. Results: There was no statistically signiþcant differences between the three groups either in the consumption of morphine or the pain intensity (Wilcoxon test)Conclusions: Our study showed that the administration of Rofecoxibe 50 mg per os, Lornoxicam 8 mg I.V/b.d. or placebo makes no difference either in the consumption of morphine or the pain intensity during the þrst 24 hours

Inflammatory changes in synovial tissues occur commonly in knee osteoarthritis (OA) and are termed “inflammatory OA”. The pathogenic significance of this inflammatory OA is uncertain. It is also not known whether inflammatory changes in the synovial membrane are reflected in the synovial fluid (SF) and whether the SF contains a similar inflammatory cell infiltrate. This study examined 34 cases of knee joint OA and cytologically and immunohistochemically characterised inflammatory cells in the synovial membrane and SF. Specimens of SF and synovial membrane were taken at the time of knee arthroplasty. All cases of inflammatory OA synovium contained (CD68+) macrophages; several cases also contained a scattered, focally heavy (CD3+) lymphocytic infiltrate and occasional lymphoid aggregates. Inflammatory changes in OA SF reflected this cell composition with numerous CD68+ macrophages and CD3+ lymphocytes being noted in inflammatory OA cases. The SF volume was greater (> 5ml) in cases of inflammatory OA. Non-inflammatory OA knee joints contained very few inflammatory cells, which were mainly macrophages, in both the synovial membrane and SF. Our findings indicate that inflammatory changes in the synovial membrane of OA knee joints are reflected in the SF and that the volume of SF is commonly increased in cases of inflammatory OA. Both macrophages and lymphocytes in the inflammatory infiltrate of knee joint SF may contribute to joint destruction in OA by providing mononuclear phagocyte osteoclast precursors and the production of inflammatory cytokines and growth factors that promote osteoclastogenesis. In conclusion, the cytology of SF and synovitic membrane are similar in inflammatory OA. With knee effusions of greater than 5mls and inflammatory synovitic membrane consideration of total knee arthoplasty in the presence of single compartment disease should be considered because of the risk of further joint destruction

Introduction. Patellofemoral complications remain a very common post-operative problem in association with total knee arthoplasty (TKA). As malrotation of the femoral component is often considered crucial for the outcome, we analyzed absolute rotational femoral alignment in relation to patellar tracking pre- and postoperatively and matched the results with the two year functional outcome. Methods. Femoral rotation and component rotation was assessed by axial radiography using condylar twist angle (CTA). The lateral patellar displacement, patellar tilt and Insall-Salvati index were measured on conventional radiographs. All assessments were done pre-operatively and at 2-year follow up. The series included 48 consecutive TKA (21 men, 27 women) performed at a single high-volume joint-replacement-center in 2008. All operations were performed using a tibia first-ligament balancing technique without patella resurfacing. The implant used was a condylar unconstrained ultracongruent rotating platform design. Outcome was assessed using the international knee society score (KSS) and the Kujala Score for anterior knee pain. Results. Preoperative CTA showed 6.4±2. 5° (X±SD) of internal femoral rotation (IR) (range, 1° of external rotation (ER) to 12° of IR) compared to postoperative CTA of 3.9°±2.98° (X±SD) of IR (range, 9.5° IR to 3.8°of ER) Preoperative patella lateral displacement showed a mean of 1.1mm (−2mm, 6mm), compared to postoperative patella lateral displacement with a mean of 1.7mm (−3mm, 6mm). Postoperative mean patella tilt was 6.65° (1.8°, 11.7°) postoperatively compared to 8.55° (4.3°,11.5°) preoperatively. No correlation was found between CTA post surgery and patella positioning (r=0.034, 95% CI). IR of the femoral component >3°did not show increased patella lateral displacement/tilt compared to 0° or ER. No correlation was found between the Kujala score and internal rotation of the component (r=0.082, p=0.05). At 2 year post OP KSS reached > 185 of max. 200 points in over 82% of patients. Conclusion. The influence of IR of the femoral component on patellofemoral kinematics remains controversial. As demonstrated, IR does not imperatively lead to patella maltracking and/or patellofemoral symptoms. Functional outcome in this series shows that relative rotation of the femoral component in accordance with natural variations as seen in the pre-operative assessment allows for good and excellent results

One hundred and ninety patients requiring total knee arthroplasty were randomized to one of two treatments: retaining or sacrificing the posterior cruciate ligament during surgery. Both groups received a Genesis II implant (Smith and Nephew Richards) appropriate to the treatment. Patients were seen preoperatively, at three months, one year, and two years. The end-of-study date is at five years postoperatively. Outcome measures include range of motion, the KSCRS, SF-12, and WOMAC. At two years both groups have shown improvement in pain, function, and stiffness. There is no apparent difference between groups with regard to any outcome measures or complications. The purpose of this study was to compare retaining vs. sacrificing the posterior cruciate ligament (PCL) in total knee arthroplasty in the patients who satisfy the criteria for a cruciate retaining knee. Two years after total knee replacement, both groups have improved knee function, less pain, and less knee stiffness. There is no apparent difference between the groups with regards to range of motion, function, or other outcome measures. Designs of total knee arthoplasty implants, as well as surgical techniques continue to evolve. The role of the PCL in primary total knee arthroplasty remains controversial. Current prosthetic designs have the flexibility to either substitute for a resected PCL or allow preservation of the ligament. One hundred and ninety patients requiring total knee arthroplasty upon satisfying the criteria for a cruciate retaing arthroplasty were randomized to receive either a posterior cruciate retaining implant or a posterior cruciate sacrificing implant. Surgery was performed following standard procedure with the only difference between groups being the sacrificing or retaining of the PCL. Patients were followed at three months, one year, and two years postoperatively. Outcome measures included range of motion, the Knee Society Clinical Rating Score (KSCRS), SF-12, and Western Ontario and McMaster Osteoarthritis Index (WOMAC). Early results indicate that both groups are doing equally well with no statistical difference in outcomes at two years. There is a trend toward increased range of motion at six and twelve months in the PCL sacrificing group. A six- degree gain was noted in the sacrificed group as compared to a two degree gain in the intact group. Funding: Smith and Nephew