Introduction: High tibial osteotomy is considered as alternative treatment for the unicompartmental
Background: Osteoarthritis (OA) is a common phenomena in the population. About 80% of the patients more than 55 years of age have reontgenographic signs of OA, while 25% have clinical signs. Eventually OA leads to joint destruction, which may necessitate joint replacement. Aims: Our goal was to evaluate the synovial reaction in 10 patients who suffered from arthritis and thus underwent total knee replacement operation. Methods: Ten patients with
Introduction. The authors performed a short term prospective study of unicompartmental knee replacement (UKR) associated to patella-femoral arthroplasty (PFA) for the treatment of bicompartmental symptomatic knee arthritis. At the latest follow-up all the implants were matched to a similar computer assisted Total Knee Replacements (CAS-TKR) group implanted for the same indications. Hypothesis of the study was that this bicompartimental implants could achieve comparable outcomes to TKR with a more conservative surgery and a higher joint function. Materials and Methods. 19 cases of anteriomedial (12) or anterolateral (7)
One hundred and forty eight meniscus allografts transplanted in one hundred and forty patients between 1988 and 2000 were reviewed. The indication for surgery included disabling knee pain, refractory to conservative treatment, objective symptoms of compartmental crepitus, pain on valgus/varus stress and osteoarthritis documented on arthroscopy following prior total meniscectomy. Knee mal-alignment and instability were also documented. Patients with varus alignment and medial OA, as well as valgus alignment with lateral OA, underwent re-alignment to unload the compartment for allograft transplantation. Patients with anterior cruciate deficiency, underwent ACL reconstruction at the time of allograft transplantation. The purpose of this paper is to show the benefit of meniscus transplantation in osteoarthritis of the knee. At a mean follow-up of six years (range two to fourteen), one hundred and twenty-five out of one hundred and forty-eight knees received good to excellent results. Meniscus allograft transplantation can restore function in patients with arthritis secondary to prior total meniscectomy. The transplantation of a biological load-bearing structure has given reliable long term results, when used in well selected cases. Forty six patients received an isolated meniscus allograft with forty-one receiving good to excellent results. Eleven received a medial or lateral meniscus allograft with an ACL reconstruction and nine obtained good to excellent results. Seventy five knees received a meniscal allograft in combination with an osteotomy to correct for pre-operative deformity, with sixty-four attaining good to excellent results. The remaining twenty-two knees underwent valgus high tibial osteotomy, meniscus allograft and ACL repair, with nineteen achieving good to excellent results. Outcome was assessed subjectively and functionally using a modified Lysholm socre and objectively by clinical examination. The Tegner activity scale was used to compare pre and post- operative function. Second look arthroscopy was performed on the first ten transplanted meniscus to assess healing and graft integrity.
Outcome was assessed subjectively and functionally using a modified Lysholm score and objectively by clinical examination of stress pain and joint crepitus. The Tegner activity scale comparing pre- and post-operative function was applied. Second-look arthroscopy was performed on the first l0 transplanted meniscii to assess healing and integrity of the transplantation graft. The most frequent complication was a traumatic posterior horn tear in l3 knees.
Arthritic knees, for the purpose of surgical correction during arthroplasty, are generally thought to be either varus knees or valgus knees and soft tissue releases are done in accordance with the same concept. This view is dependent on the clinical deformity in extended knee and the plain AP radiograph of the extended knee. This concept is now challenged by the observations from our study of the arthritic knee kinematics using computer aided navigation when performing total knee replacement arthroplasty. We performed 283 total knee replacements with computer aided navigation. Imageless navigation was used with Stryker and Orthopilot systems. Bone trackers were fixed to the bones and through real time infrared communication the data was collected. The knee kinematics were recorded before and at the end of surgery. This included measurement of biomechanical axis with the knee extended and then gradually flexed. The effect of flexion on the coronal alignment was recorded real time on the computer. The results were then analysed and compared with plain radiographic deformity on long leg films. Majority of the knees did not behave in a true varus or valgus fashion. We classified the deformity into different groups depending on the behavior of the knee in coronal plane as it moves from extension to flexion. 2 degree was taken as minimum deviation to signify change, as the knee bends from full extension to flexion. The classification system is as follows
Deformity - Varus/Valgus to start with in extension
Deformity remains the same as the knee flexes Increasing deformity as the knee flexes
Decreasing deformity but does not reach neutral in flexion Decreasing deformity reaches neutral in flexion
Decreasing deformity and crosses to opposite (Varus to valgus or valgus to varus) deformity in flexion
Deformity first increases and then decreases but does not reach neutral Deformity first increases and then decreases to neutral Deformity first increases and then decreases to cross over to opposite deformity in flexion Traditional releases of medial or lateral structures without realising the true picture of what happens when the knee is flexed, may not be correct. From our study it is clear that not all arthritic varus or valgus knees behave in the same way. Some of the releases we perform conventionally may not be required or need to be modified depending on the knee kinematics.
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
Introduction and Objective. Malunion after trauma can lead to coronal plane malalignment in the lower limb. The mechanical hypothesis suggests that this alters the load distribution in the knee joint and that that this increased load may predispose to compartmental arthritis. This is generally accepted in the orthopaedic community and serves as the basis guiding deformity correction after malunion as well as congenital or insidious onset malalignment. Much of the literature surrounding the contribution of lower limb alignment to arthritis comes from cohort studies of incident osteoarthritis. There has been a causation dilemma perpetuated in a number of studies - suggesting malalignment does not contribute to, but is instead a consequence of, compartmental arthritis. In this investigation the relationship between compartmental (medial or lateral) arthritis and coronal plane malalignment (varus or valgus) in patients with post traumatic unilateral limb deformity was examined. This represents a specific niche cohort of patients in which worsened compartmental knee arthritis after extra-articular injury must rationally be attributed to malalignment. Materials and Methods. The picture archiving system was searched to identify all 1160 long leg x ray films available at a major metropolitan trauma center over a 12-year period. Images were screened for inclusion and exclusion criteria, namely patients >10 years after traumatic long bone fracture without contralateral injury or arthroplasty to give 39 cases. Alignment was measured according to established surgical standards on long leg films by 3 independent reviewers, and arthritis scores Osteoarthritis Research Society International (OARSI) and Kellegren-Lawrence (KL) were recorded independently for each compartment of both knees. Malalignment was defined conservatively as mechanical axis deviation outside of 0–20 mm medial from centre of the knee, to give 27 patients. Comparison of mean compartmental arthritis score was performed for patients with varus and valgus malalignment, using Analysis of Variance and linear regression. Results. In knees with varus malalignment there was a greater mean arthritis score in the medial compartment compared to the contralateral knee, with OARSI scores 5.69 vs 3.86 (0.32, 3.35 95% CI; p<0.05) and KL 2.92 vs 1.92 (0.38, 1.62; p<0.005). There was a similar trend in valgus knees for the lateral compartment OARSI 2.98 vs 1.84 (CI −0.16, 2.42; p=0.1) and KL 1.76 vs 1.31 (CI −0.12, 1.01; p=0.17), but the evidence was not conclusive. OARSI arthritis score was significantly associated with absolute MAD (0.7/10mm MAD, p<0.0005) and Time (0.6/decade, p=0.01) in a linear regression model. Conclusions. Malalignment in the coronal plane is correlated with worsened arthritis scores in the medial compartment for varus deformity and may similarly result in worsened lateral compartment
MOXIMED KineSpring® Knee Implant System is an Orthopaedic device designed for younger or highly active patients with osteoarthritis. The device is placed under the skin, is attached to the tibia and femur, and contains springs which help limit some of the forces that are transmitted through the knee during activities such as walking or running and thereby relieve pain that may be experienced by patients with early
Introduction. Our purpose is to analyze the true costs associated with preoperative CT scans performed for robotic assisted TKA planning and also to determine the value of a formal radiologist reading of these studies. Methods. We reviewed 194 CT scans of 176 sequential patients who underwent primary RTKA by a single surgeon at a suburban teaching hospital. CT radiology reports were reviewed for the presence of incidental findings that might result in change of care to the patient. Actual payments for technical and professional components of the CT scans were retrieved for 170 of the 176 patients. Any patient payments for the CT scan were also recorded. Results. In no CT scan report was there any findings other than
Introduction. Total knee arthroplasty (TKA) is an effective surgical intervention, which alleviates pain and improves function and health-related quality of life in patients with end-stage
Introduction. Although total knee replacement became a widespread procedure for the purpose of knee reconstruction, osteotomies around the knee were regularly performed. Total knee arthroplasty should be performed for advanced
Introduction. Stryker computer navigation system has been used for total knee arthroplasty (TKA) procedures since October 2008 at the Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics. Material and methods. There have been 126 computer assisted TKA that accounted for 11.5 % of primary TKA within this period (1096 procedures).
Nowdays bicompartmental
The aims were to assess whether joint-specific outcome after total knee arthroplasty (TKA) was influenced by implant design over a 12-year follow-up period, and whether patient-related factors were associated with loss to follow-up and mortality risk. Long-term follow-up of a randomized controlled trial was undertaken. A total of 212 patients were allocated a Triathlon or a Kinemax TKA. Patients were assessed preoperatively, and one, three, eight, and 12 years postoperatively using the Oxford Knee Score (OKS). Reasons for patient lost to follow-up, mortality, and revision were recorded.Aims
Methods
Introduction: Nowadays bicompartimental
To perform an incremental cost-utility analysis and assess the impact of differential costs and case volume on the cost-effectiveness of robotic arm-assisted unicompartmental knee arthroplasty (rUKA) compared to manual (mUKA). This was a five-year follow-up study of patients who were randomized to rUKA (n = 64) or mUKA (n = 65). Patients completed the EuroQol five-dimension questionnaire (EQ-5D) preoperatively, and at three months and one, two, and five years postoperatively, which was used to calculate quality-adjusted life years (QALYs) gained. Costs for the primary and additional surgery and healthcare costs were calculated.Aims
Methods
Nowadays unicompartimental knee replacement (UKR) is a valuable solution for the treatment of knee osteoarthritis. Likewise in selected cases bicompartimental
To explore the efficacy of extracorporeal shockwave therapy (ESWT) in the treatment of osteochondral defect (OCD), and its effects on the levels of transforming growth factor (TGF)-β, bone morphogenetic protein (BMP)-2, -3, -4, -5, and -7 in terms of cartilage and bone regeneration. The OCD lesion was created on the trochlear groove of left articular cartilage of femur per rat (40 rats in total). The experimental groups were Sham, OCD, and ESWT (0.25 mJ/mm2, 800 impulses, 4 Hz). The animals were euthanized at 2, 4, 8, and 12 weeks post-treatment, and histopathological analysis, micro-CT scanning, and immunohistochemical staining were performed for the specimens.Aims
Methods
This study aimed to define the histopathology of degenerated humeral head cartilage and synovial inflammation of the glenohumeral joint in patients with omarthrosis (OmA) and cuff tear arthropathy (CTA). Additionally, the potential of immunohistochemical tissue biomarkers in reflecting the degeneration status of humeral head cartilage was evaluated. Specimens of the humeral head and synovial tissue from 12 patients with OmA, seven patients with CTA, and four body donors were processed histologically for examination using different histopathological scores. Osteochondral sections were immunohistochemically stained for collagen type I, collagen type II, collagen neoepitope C1,2C, collagen type X, and osteocalcin, prior to semiquantitative analysis. Matrix metalloproteinase (MMP)-1, MMP-3, and MMP-13 levels were analyzed in synovial fluid using enzyme-linked immunosorbent assay (ELISA).Aims
Methods