Surgical limb sparing for knee-bearing paediatric bone sarcoma is considered to have a clinically significant influence on postoperative function due to complications and leg-length discrepancies. However, researchers have not fully evaluated the long-term postoperative functional outcomes. Therefore, in this study, we aimed to elucidate the risk factors and long-term functional prognosis associated with paediatric limb-sparing surgery. We reviewed 40 patients aged under 14 years who underwent limb-sparing surgery for knee bone sarcoma (15 cases in the proximal tibia and 25 in the distal femur) between January 2000 and December 2013, and were followed up for a minimum of five years. A total of 35 patients underwent reconstruction using artificial materials, and five underwent biological reconstruction. We evaluated the patients’ postoperative complications, survival rate of reconstruction material, and limb, limb function, and leg-length discrepancy at the final follow-up, as well as the risk factors for each.Aims
Methods
Mobile bearing unicompartmental knee arthroplasty (UKA) is an effective and safe treatment for osteoarthritis of the medial compartment. However, mobile-bearing UKA needs accurate ligament balancing of flexion and extension gaps to prevent dislocation of the mobile meniscal bearing. Instability can lead to dislocation of the insert. The phase 3 instruments of the Oxford UKA use a balancing technique for the flexion gap (90° of flexion) and extension gap (20° of flexion), thereby focusing attention on satisfactory soft tissue balancing. With this technique, spacers are used to balance the flexion and extension gap. However, gap kinematics in another flexion angle of mobile-bearing UKA is unclear. We developed UKA tensor for mobile-bearing UKA and we assessed the accurate gap kinematics of UKA. Between 2012 and 2013, The Phase 3 Oxford Partial Knee UKA (Biomet Inc., Warsaw, IN) were carried out in 48 patients (71 knees) for unicompartmental knee osteoarthritis or spontaneous osteonecrosis of the medial compartment. The mean age of patients at surgery was 71.6 years and the mean follow-up period was 1.7 years. The mean preoperative coronal plane alignment was 7.4° in varus. The indications for UKA included disabling knee pain with medial compartment disease; intact ACL and collateral ligaments; preoperative contracture of less than 15°; and preoperative deformity of <15°. Each surgery was performed by using different spacer block with 1-mm increments and the meniscal bearing lift-off tests according to surgical technique. We developed newly tensor for mobile bearing UKA which designed to permit surgeons to measure multiple range of the joint medial compartment/joint component gap, while applying a constant joint distraction force (Figure 1). We assessed the intra-operative joint gap measurements at 0, 20, 60, 90 and 120 of flexion with 100N, 125N and 150N of joint distraction forces.Objective
Materials and Methods
A Trabecular Metal Modular Acetabular System (Zimmer, Warsaw, Indiana, USA) is a peripheral rim expansion (elliptical) cup, i.e. a non-hemispherical cup. Radiologically a non-hemispherical cup may be deferent from other conventional hemispherical cups. We reviewed radiological findings of a Trabecular Metal Modular Acetabular System chronologically. Twenty six patients with osteoarthritis underwent primary total hip arthroplasty (THA) using a Trabecular Metal Modular Acetabular System from 2011 to April 2013. Twenty five patients (follow-up rate: 96.2%) 31 hips could be followed-up over a year were registered. In common, the diameter of every femoral head was 32 mm. We planned the acetabular cup inclination angle to be 45-degree, the cup coverage with host-bone (cup-CE angle) to be over 10-degree, and high hip center was allowed up to 20mm. In case of the cup-CE angle under 10-degree, an acetabular cup was placed medially using Dorr's medial protrusio technique. We established the medial protrusion angle indicating the degree of medial protrusion of an acetabular cup over the pelvic internal wall. The medial protrusion angle was defined by the center point of THA (C) and the 2 cross-points (X1, X2) which the outline of an acetabular cup crosses the Kohler's line (Figure 1). The cup anteversion angle was measured by the method of Lewinnek, and the cup fixation was evaluated according to the Tompkin's classification.Purpose
Methods
The Flexible Nichidai Knee (FNK) System (Nakashima Medical, Japan) was designed to fit Asian knees. Especially, the posterior stabilized(PS) prosthesis was designed as semi-constrained posterior stabilized system that had a large tibial post and femoral articulation. We hypothesized that the semi-constrained PS implant design would have a positive influence on vivo kinematics after total knee arthroplasty (TKA). A total of 16 patients (21 knees) who had undergone TKA using PS implant were randomly recruited from our database. Of the 16 patients, all patients were women. Fourteen patients had osteoarthritis and 2 patients had rheumatoid arthritis. The average age was 72.3± 9.5 years, and the average postoperative duration was 23.4 ± 19.3 months. The subject performed sequential deep knee bends under WB from 0° to maximum flexion under fluoroscopic monitoring in the sagittal plane. Conversely, under NWB, the patient sat on a chair and was asked to perform active assisted knee flexion. To estimate spatial position and orientation of the artificial knee prosthesis, a 2D to 3D registration technique was used. We evaluated knee range of motion, femoral axial rotation relative to the tibial component, and anteroposterior translation of the femorotibial contact point for both medial and lateral sides. Closest distances between femoral cam and tibial post engagement were measured,Introduction
Materials and Methods
We report the case of a 12-year-old boy with flexion loss in the left elbow caused by deficient of the concavity corresponding to the coronoid fossa in the distal humerus. The range of motion (ROM) was 15°/100°, and pain was induced by passive terminal flexion. Plain radiographs revealed complete epiphyseal closure, and computed tomography (CT) revealed a flat anterior surface of the distal humerus; the coronoid fossa was absent. Then, the bony morphometric contour was surgically recreated using a navigation system and a three-dimensional elbow joint model. A three-dimensional model of the elbow joint was made preoperatively and the model comprising the distal humerus was milled so that elbow flexion flexion of more than 140° could be achieved against the proximal ulna and radius. Navigation-assisted surgery (contouring arthroplasty) was performed using CT data from this milled three-dimensional model. Subsequently, an intraoperative passive elbow flexion of 135° was obtained. However, active elbow flexion was still inadequate one year after operation, and a triceps lengthening procedure was performed. At the final follow-up one year after triceps lengthening, a considerable improvement in flexion was observed with a ROM of −12°/125°. Plain radiographs revealed no signs of degenerative change, and CT revealed the formation of the radial and coronoid fossae on the anterior surface of the distal humerus. Navigation-assisted surgery for deformity of the distal humerus based on a contoured three-dimensional model is extremely effective as it facilitates evaluation of the bony morphometry of the distal humerus. It is particularly useful as an indicator for milling the actual bone when a model of the mirror image of the unaffected side cannot be applied to the affected side as observed in our case.
Total knee arthroplasty (TKA) has been proven to be the most effective treatment for patients with severe or “end-stage” joint disease. Although infection is not a frequent complication of total knee arthroplasty, it is certainly one of the most dreaded. The purpose of this study was to identify related factors associated with septic arthritis. 2202 primary total knee arthroplasties were done in 1257 patients between 1995 and 2006. Of these knee arthroplasties, 2022 knees in 1146 patients were available for follow-up. Revision arthroplasty procedures and infected knees were excluded. 252 knees in 147 males, 1770 knees in 999 females were done. Their mean age at the time of primary TKA was 70.6 (range, 26–91) years. The mean follow-up period post primary TKA was 48 (range, 3–145) months. The medical records were reviewed to extract the following information: age, gender, body mass index, preoperative CRP, preoperative ESR, preoperative TP, duration of surgery, operative blood loss, total blood loss, duration of surgical drain, duration of antibiotic prophylaxis, primary diagnoses, smoking, diabetes mellitus, steroid or DMARDs therapy, previous operation around the knee joint, previous arthroscopic surgery, previous except arthroscopic surgery, previous operation of high tibial osteotomy (HTO) or open reduction internal fixation (ORIF), residue of internal fixation material, bone graft, patella replacement, and bone cement. Proportions were compared using the chi-square or two-tailed Fisher’s exact test, as appropriate. Continuous variables were compared by the student’s t-test. Logistic regression analysis (stepwise) of selected variables from univariate analysis was performed to identify factors independently associated with the development of infection following total knee arthroplasty. During the study period, 17 infected knee arthroplasties in 17 patients were identified. The infections occurred in 8 males and 9 females, with a medial age of 69.5 years. The results of univariate analysis indicating those variables statistically associated with infection are : gender (p <
0.0001), smoking (p = 0.02), previous operation around the knee joint (p = 0.001), previous except arthroscopic surgery(p <
0.0001), previous operation of ORIF (p <
0.0001), residue of internal fixation material (p <
0.0001). Logistic regression analysis indicated that the four predictors of infection following total knee arthroplasty were gender (odds ratio [OR], 0.2; 95% confidence interval [CI95], 0.1 to 0.6; P=0.005), previous operation of ORIF (OR, 7.9; CI95, 1.1 to 57.1; P=0.041), residue of internal fixation material (OR, 26.0; CI95, 4.5 to 151.0; P<
0.001), body mass index (OR, 1.2; CI95, 1.0 to 1.3; P=0.007). We conclude that the risk factors of infection after TKA were previous operation of ORIF, gender, residue of internal fixation, and body mass index.
