Unicompartmental knee arthroplasty (UKA) is an effective treatment for late knee osteoarthritis (OA). However, its indications remain controversial. Young age (< 60 years) has been associated with worse outcomes. The goal of this systematic review and meta-analysis is to study the effect of age on UKA outcomes. The primary objective was to compare the UKA revision rate in young patients with that of old patients, using the age thresholds of 60 and 55 years. Secondary objectives were patient-reported outcome measures (PROMs) and implant design. PubMed, Ovid, Web of Science, Google Scholar, and Cochrane library were searched in June 2021. This review was conducted in accordance with the PRISMA guidelines (PROSPERO registration number: CRD42021248322).Abstract
Purpose
Methods
Treatment protocols of tibial hemimelia comprised joint reconstruction and amputation or knee disarticulation and prosthetic fitting. However, amputation is not acceptable in our community. Therefore we tried to treat these cases without amputation. From 1993 till 1999, 2 cases of tibial hemimelia type IA, and 4 cases type II were referred to our center. All the cases presented late as the age of patients ranged from 3 _ years to 13 years. For type IA we applied Ilizarov External Fixator on the femur, fibula and foot to centralize the fibula between the femoral candyles and talus using gradual distraction. The second step comprised a Brown procedure. Then, the fixator was reapplied to correct the knee and foot deformities using the bloodless technique. For type II, synostosis of the tibia and fibula was performed followed by differential lengthening. Then we over lengthened the femur. Results: After follow up 2 to 5 _ years all patents were satisfied with good function. The tibial lengthening ranged from 6 to 9 cm and femoral lengthening ranged from 5 to 7.5 cm. Complications:
Pin tract infection in all cases. Cutting through of the calcanean wires in 2 cases. Flexion deformity in 4 cases. Fracture of the lengthened femur in one case. Up to our knowledge this is the first report tfor treatment of complete congenital tibial absence without amputation. Our early results are encouraging, as there are marked functional improvements in these patients.
Post – traumatic nonunion is unusual in children. The presence of more than one site for nonunion in a single bone, infection, shortening, osteoporosis and deformity makes the treatment more complicated. Case Report: A 10-y old boy presented to us with a post-traumatic 12 cm Rt. tibial shortening, unstable knee and a discharging sinus over the upper tibia. Roentgenograms revealed 3 sites of nonunion: in the upper middle and lower 1/3 of the tibia. The deformity of the upper tibia was varus 20° and recurvatum 25° while there was varus of the lower part 15°. The fibular head was over hanging the tibia. Treatment: Ilizarov Ext. fixator was applied concomitant with freshening of the upper site, sinus excision and osteotomy of the fibula. The lower fibula was fixed to the tibia leaving the upper part free. Then, gradual correction of deformities by distraction using properly positioned hinges was applied through the upper and lower sites for nonunion. Compression – Distraction was applied alternatively to stimulate the regenerate till we reached the sum of 12 cm lengthening from the 3 sites. The fixator was removed after 9 months where there was union and consolidation from all sites for non-union. The patient was followed up for 4 years. Complications: Included wire tract infection, mild bowing of the regenerate after fixator removal and refracture. Conclusion: Using the nonunion sites to correct complicated deformities and lengthen the bone is an effective method in children. Up to our knowledge, this is the first time to report the results of trifocal lengthening.
