Ligament balancing aims to equalize lateral and medial gaps or tensions for optimal functional outcomes. Balancing can now be measured as lateral and medial contact forces during flexion (Roche 2014). Several studies found improved functional outcomes with balancing (Unitt 2008; Gustke 2014a; Gustke 2014b) although another study found only weak correlations (Meneghini 2016). Questions remain on study design, optimal lateral-medial force ratio, and remodeling over time. Our goals were to determine the functional outcomes between pre-op and 6 months post-op, and determine if there was a range of balancing parameters which gave the highest scores. This IRB study involved a single surgeon and the same CR implant (Triathlon). Fifty patients were enrolled age 50–90 years. A navigation system was used for alignments. Balancing aimed for equal lateral and medial contact forces throughout flexion, using various soft tissue releases (Meneghini 2013; Mihalko 2015). The patients completed a Knee Society evaluation pre-op, 4 weeks, 3 months and 6 months. The total (medial+lateral) force, and the medial/(medial+lateral) force ratio was calculated for 4 flexion angles and averaged. These were plotted against Pain, Satisfaction, Delta Function (postop – preop), and Delta Flexion Angle. The data was divided into 2 groups. 1. By balancing parameters. T-Test for differences in outcomes between the 2 groups. 2. By outcome parameters. T-Test for differences in Balancing Parameters between the two groups.INTRODUCTION
METHODS
By next summer the number of patients in the tranexamic acid group will be much higher, probably around 50–60. Tranexamic acid has been extensively studied in single total knee and total hip replacement patients. It has been found to reduce blood loss and transfusion rates, with no increase in the rate of venous thromboembolism. This study was undertaken to determine whether tranexamic acid reduces blood loss and the rate of blood transfusion after bilateral total knee replacement, which has a much higher transfusion rate.Abstract
Purpose
Ten patients, who were unsuitable for limb lengthening over an intramedullary nail, underwent lengthening with a submuscular locking plate. Their mean age at operation was 18.5 years (11 to 40). After fixing a locking plate submuscularly on the proximal segment, an external fixator was applied to lengthen the bone after corticotomy. Lengthening was at 1 mm/day and on reaching the target length, three or four screws were placed in the plate in the distal segment and the external fixator was removed. All patients achieved the pre-operative target length at a mean of 4.0 cm (3.2 to 5.5). The mean duration of external fixation was 61.6 days (45 to 113) and the mean external fixation index was 15.1 days/cm (13.2 to 20.5), which was less than one-third of the mean healing index (48 days/cm (41.3 to 55). There were only minor complications. Lengthening with a submuscular locking plate can successfully permit early removal of the fixator with fewer complications and is a useful alternative in children or when nailing is difficult.
