To explore the relationship in terms of time scale between pre-operative expectations and postoperative outcomes and satisfaction after Hallux valgus surgery. A patient derived questionnaire was developed and 30 patients aged 19 to 67 were included undergoing primary hallux valgus correction with a first metatarsal osteotomy and distal soft tissue release. Patients were asked pre-operatively to quantify their expected time scale for improvement in pain, ability to walk unaided, ability to drive, routine foot wear and foot feeling normal at 6 weeks, 3 and 6 months following surgery, and to indicate their confidence in achieving this result. Patients recorded postoperative outcomes achieved at number of weeks. Ordinal logistic regression multivariate modelling was used to examine predictors of postoperative satisfaction.Purpose
Methods
Olecranon plates used for the internal fixation of complex olecranon fractures are applied directly over the triceps tendon on the posterior aspect of the olecranon. The aim of the study is to describe the relationship of the plates and screws to the triceps tendon at the level of the olecranon. Eight cadaveric elbows were used. Dimensions of the triceps tendon at the insertion and 1cm proximal were measured. A long or a short olecranon plate was then applied over the olecranon and the most proximal screw applied. The length of the plate impinging on the tendon and the level of the screw tract on the tendon and bone were measured. The mean olecranon height was 24.3cm (22.4-26.9cm) with a tip-to-tendon distance of 14.5cm (11.9-16.2cm). The triceps tendon footprint averaged 13.3cm (11.7-14.9cm) and 8.8cm (7.6-10.2cm) in width and length, respectively. The mean width of the central tendon 1 cm proximal to the footprint was 6.8 cm. The long olecranon plate overlay over more movable tendon length than did the short plate and consequently the superior screw pierced the triceps tendon more proximally with the long plate. Using the Mann-Whitney U test, the differences were significant. The long olecranon plates encroach on more triceps tendon than short plates. This may be an important consideration for olecranon fractures with regards implant loosening or triceps tendon injury.
Most surgeons that have performed kinematically aligned TKA have noticed an overall better clinical outcome, better motion, better patient satisfaction, and a quicker recovery than their patients treated with mechanically aligned TKA. We prospectively followed all 128 knees who underwent primary total knee arthroplasty. The Lysholm knee Introduction
Materials and Methods
The purpose of this study was to demonstrate postoperative improvement and high satisfaction rates after a surgical approach that includes arthroscopic labral repair only, in patients with borderline dysplasia, without instability. Between September 2009 and December 2011, patients less than 50 years old who underwent hip arthroscopy for symptomatic intra-articular hip disorders, with a lateral center-edge (CE) angle between 20 and 25, were included in this study. Patients with Tönnis grade 2 or greater, hip joint space narrowing, severe hip dysplasia, hip joint instability and Legg-Calve-Perthes disease were excluded. Patient-reported outcome scores, including the modified Harris Hip Score (mHHS), Western Ontario and McMaster Universities Arthritis index (WOMAC), and visual analog scale (VAS) for pain were obtained in all patients preoperatively and at 1, 2, and 3 years postoperatively.Purpose
Methods
The goal of total knee arthroplasty (TKA) is to relieve pain and restore the function of the knee joint. Recently the number of TKA cases in Korea has increased considerably with increase in elderly population and change in life style. Accordingly, demand for TKA design that is capable of better accommodating anatomical dimensions and life styles of Koreans is also on the rise. During the prototype design process for the Korean-TKA, different stem and keel designs of the tibial base plate have been attempted to improve fixation and longevity of the implant. In this study, we conducted a biomechanical analysis of the tibial base plate using finite element analysis (FEA). Specifically, biomechanical effects of insert positioning in the tibia were assessed to investigate the likelihood of tibial fracture and implant loosening due to mal-positioning of the implant. A 3-D finite element(FE) models of the left femur, patella, and tibia were developed from computed tomography (CT) scan data (a normal Korean male, 27 years of age, 70 kg). 2-D truss elements were chosen to represent ligamentous structures such as lateral &
medial collateral ligament, posterior cruciate ligament, patella tendon and patella ligament. Nonlinear elastic materal properties for the soft-tissue structures were also adopted from literatures. The surgical model was then constructed after inserting Korean-TKA prototype in the intact model. Here, the implant was the posterior cruciate ligament retaining type (CR) with the fixed bearing system. To simulate loading on the knee joint in heel strike and toe off positions, 15° and 45° flexions of the femur orientation were simulated under the compressive load of 3.8 and 5.7 times of body weight (BW= 700N), respectively, in a uniform pressure at the horizontal section of the femur. The tibia was assumed to be completely constrained. The surgical position of the tibial insert was varied from the center either to the medial or to the lateral direction by 3-mm. The peak von mises stresses (PVMS) at the stem and the keel regions of the tibial insert were assessed. With respect to the central positioning the lateral shift of the tibial plate resulted in higher PVMS than the medial. Particularly, increases of 24.5 %, 29.8%, and 28.4% were observed at the stem, the lateral keel, and the medial keel, respectively, due to lateral mal-positioning of the implant. With the medial shift, on the other hand, PVMS increase remained at around 6% level at the stem and the lateral keel. A decrease of 4.5 % was noted at the medial keel region. In this study, a computational approach was used to evaluate biomechanical effect of tibial plate positioning on the stress distribution within the implant. The lateral mal-positioning showed more stress concentration than the medial. This may be due to the fact that body weight is transmitted more to the lateral portion of the tibia (5.5:4.5) that is smaller and thinner than its counterpart. These results suggest that the lateral deviation of the implant can be more likely cause TKR loosening and tibial fracture.
