Introduction. Special high-flexion prosthetic designs show a small increase in postoperative flexion compared to standard designs and some papers show increased
The prevalence of
We performed an advancement and medial transfer of the tibial tuberosity based on Fulkerson's principle to treat intractable
Introduction. A comprehensive met-analysis of
Introduction.
Purpose.
Introduction. The constitutional knee anatomy in the coronal plane includes the distal femoral joint line obliquity (DFJLO) which in most patients is in slight valgus positioning. Despite this native anatomy, the mechanical positioning of the femoral component during primary total knee arthroplasty (TKA) often ignores the native DFJLO opting to place the femur in a set degree of valgus that varies upon the practitioner's practice and experience. Unfortunately, this technique is likely to generate high rate of distal lateral femoral overstuffing. This anatomical mismatch might be a cause of
Background. Hoffa pad in Total knee replacement is a mystery. Very few studies have been carried out and no obvious results have been achieved. Aim. Our aim was to compare the clinical value of the Hoffa pad including blood loss, range of motion,
Introduction. Total knee replacement (TKR) is an established and effective surgical procedure in case of advanced osteoarthritis. However, the rate of satisfied patients amounts only to about 75 %. One common cause for unsatisfied patients is the
To determine in skeletally mature patients with a traumatic, first-time, patellar dislocation, the effect of early MPFL reconstruction versus rehabilitation on the rate of recurrent patellar dislocations and functional outcomes. Three online databases MEDLINE, EMBASE and PubMed were searched from database inception (1946, 1974, 1966 respectively), to August 20th, 2021, for literature addressing the management of patients sustaining acute first-time patellar dislocations. Data on redislocation rates, functional outcomes using the Kujala score, and complication rates were recorded. A meta-analysis was used to pool the mean postoperative kujala score as well as calculate the proportion of patients sustaining redislocation episodes using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS and Detsky scores. Overall, there were a total of 22 studies and 1705 patients included in this review. The pooled mean redislocation rate in 18 studies comprising 1409 patients in the rehabilitation group was 31% (95% CI 25%-36%, I2 = 65%). Moreover, the pooled mean redislocation rate in five studies comprising 318 patients undergoing early MPFL reconstruction was 7% (95% CI 2%-17%, I2 = 70%). The pooled mean postoperative Kujala
Resurfacing the patella is performed the majority of the time in the United States and in many regions it is considered standard practice. In many countries, however, the patella is left un-resurfaced an equal amount of the time or even rarely ever resurfaced. Patella resurfacing is not a simple or benign procedure. There are numerous negative sequelae of resurfacing including loosening, fragmentation, avascular necrosis, lateral facet pain, stress fracture, acute fracture, late fracture, and restricted motion. In a study by Berend, Ritter, et al, failures of the patella component were reported 4.2% of the time at an average of only 2.6 years. A study was undertaken at Washington University in recent years to determine rather more clinical problems were observed following total knee replacement with or without patella resurfacing. Records were maintained on all problem total knees cases with well localised
The decision to resurface the patella has been well studied. While regional differences exist, the overwhelming choice by most Surgeons in the United States is to resurface the patella. Data supports that this is the correct choice. Articular cartilage on metal has not been shown to be a good long term bearing surface. Cushner et al. has also shown that cartilage in the arthritic knee has significant pathologic abnormalities. Patella surfacing has excellent long-term results with a low complication rate.
Introduction. Snapping hip syndrome is a common condition affecting 10% of the population. It is due to the advance of the iliotibial band (ITB) over the greater trochanter during lower limb movements and often associated with hip overuse, such as in athletic activities. Management is commonly conservative with physiotherapy or can be surgical to release the ITB. Here we carry out a systematic review into published surgical management and present a case report on an overlooked cause of paediatric snapping hip syndrome. Materials & Methods. A systematic review looking at published surgical management of snapping hip was performed according to PRISMA guidelines. PubMed, MEDLINE, EMBASE, CINAHL and the Cochrane Library databases were searched for “((Snapping hip OR Iliotibial band syndrome OR ITB syndrome) AND (Management OR treatment))”. Adult and paediatric published studies were included as few results were found on paediatric snapping hip alone. Results. 1548 studies were screened by 2 independent reviewers. 8 studies were included with a total of 134 cases, with an age range of 14–71 years. Surgical management ranged from arthroscopic, open or ultrasound guided release of the ITB, as well as gluteal muscle releases. Common outcome measures showed statistically significant improvement pre- and post-operatively in visual analogue pain score (VAPS) and the Harris Hip Score (HHS). VAPS improved from an average of 6.77 to 0.3 (t-test p value <0.0001) and the HHS improved from an average of 62.6 to 89.4 (t-test p value <0.0001). Conclusions. Although good surgical outcomes have been reported, no study has reported on the effect of rotational profile of the lower limbs and snapping hip syndrome. We present the case of a 13-year-old female with snapping hip syndrome and trochanteric pain. Ultrasound confirmed external snapping hip with normal soft tissue morphology and radiographs confirmed no structural abnormalities. Following extensive physiotherapy and little improvement, she presented again aged 17 with concurrent
The decision to resurface the patella has been well studied. While regional differences exist, the overwhelming choice by most surgeons in the United States is to resurface the patella. Data supports that this is the correct choice. Articular cartilage on metal has not been shown to be a good long term bearing surface. Cushner et al has also shown that cartilage in the arthritic knee has significant pathologic abnormalities. Patella surfacing has excellent long-term results with a low complication rate.
Patellar resurfacing in total knee arthroplasty remains controversial. We report the medium term results of patients who had Scorpio total knee replacement for osteoarthritis between January 2002 and September 2004. A retrospective review of 118 patients was undertaken. All patients during the first half of this time period had no resurfacing of the patella, and all patients in the later half of this period underwent resurfacing of the patella. The mean follow-up in the non-resurfaced group was 30 months and the mean follow-up in the resurfaced group was 17 months. The two groups were similar in age, gender and the grade of the surgeon. Knee society clinical rating score, patient satisfaction,
Resurfacing the patella is performed the majority of the time in the US and in many regions it is considered standard practice. In many countries, however, the patella is left unresurfaced an equal amount of the time or even rarely ever resurfaced. Patella resurfacing is not a simple or benign procedure. There are numerous negative sequelae of resurfacing including loosening, fragmentation, avascular necrosis, lateral facet pain, stress fracture, acute fracture, late fracture, and restricted motion. In a study by Berend, Ritter, et al, failures of the patella component were reported 4.2% of the time at an average of only 2.6 years. A study was undertaken at Washington University in recent years to determine whether more clinical problems were observed following total knee replacement with or without patella resurfacing. Records were maintained on all problem total knees cases with well localised
Abstract. Background. Conventional TKR aims for neutral mechanical alignment which may result in a smaller lateral distal femoral condyle resection than the implant thickness. We aim to explore the mismatch between implant thickness and bone resection using 3D planning software used for Patient Specific Instrumentation (PSI) TKR. Methods. This is a retrospective anatomical study from pre-operative MRI 3D models for PSI TKR. Cartilage mapping allowed us to recreate the native anatomy, enabling us to quantify the mismatch between the distal lateral femoral condyle resection and the implant thickness. Results. We modelled 292 knees from PSI TKR performed between 2012 and 2015. There were 225 varus knees and 67 valgus knees, with mean supine hip-knee-angle of 5.6±3.1 degrees and 3.6±4.6 degrees, respectively. In varus knees, the mean cartilage loss from medial and lateral femoral condyle was 2.3±0.7mm and 1.1±0.8mm respectively; the mean overstuffing of the lateral condyle 1.9±2.2mm. In valgus knees, the mean cartilage loss from medial and lateral condyle was 1.4±0.8mm and 1.5±0.9mm respectively; the mean overstuffing of the lateral condyle was 4.1±1.9mm. Conclusions. Neutral alignment TKR often results in overstuffing of the lateral condyle. This may increase the patello-femoral pressure at the lateral facet in flexion.
To resurface or not to resurface the patella… that is the question. It all comes down to where you practice. It is controversial in that there is a risk of possible complications from resurfacing versus the potential for simply having complaints of pain which may supposedly arise from the anterior knee stemming from the unresurfaced patella. The evolution of more favorable anatomic femoral component designs which are very friendly to the patellofemoral articulation have resulted in lower patella resurfacing complications. The insertion of appropriately externally rotated tibial and femoral components, if not reducing
Total knee arthroplasty (TKA) is recognised as an effective treatment for end-staged knee osteoarthritis. Up to 20% of these patients is unfortunately unsatisfied due to