Unicompartmental knee prosthesis (UKP) has been used for 40 years but it is still controversial. Nevertheless, this procedure is positive and it can be a good alternative if it is correctly indicated. From January 2001 we implanted 51 UKP in 47 patients. The diagnoses were: primary arthritis in 45 cases, post-traumatic degeneration in five and arthritis secondary to meniscectomy and ACL reconstruction in one. The mean age was 64.5 (range 49–81), 32 women and 15 men. Mean follow-up was 26 months (range 6–36). Post-operative recovery starts with physical rehabilitation, rarely with kinetics, and full weight-bearing walking the first day. DVT is prevented by treatment with low-molecular-weight heparin for 25 days and elastic stockings. From September 2002 we performed this procedure by minimally invasive surgery with an 8-cm incision and extramedullary intraoperative tools. We did not observe any infections or loosening: we performed just one revision of the femoral component because of a technical error. In four other cases a malpositioning of the femoral component was reported that was pain-free at follow-up. Current studies are starting to show valid and encouraging results at mid- and long-term follow-up, too. The best candidates for UKP are patients over 60 years who are not overweight, with asymptomatic patellar degeneration and no anterior instability and who perform light sport activity. In comparison with high tibial osteotomy (HTO), UKP shows some advantages, such as faster recovery and better mid-term results. In comparison with total knee arthroplasty (TKA), UKP gives better range of motion, faster postoperative recovery and an easier operation in case of infection or loosening. Some features should be evaluated and the surgical technique should employ state-of-the-art hardware. We evaluate the advantages of this procedure with particular emphasis on the minimally invasive technique. In conclusion, although our study is still in progress, correct patient selection, the surgical technique and the updated design of the new prosthesis can give satisfactory results and represent a valid alternative to HTO and TKA. In addition, compared to TKA, UKP shows a real economic advantage.
Patients with osteoarthritis of the knee commonly have degenerative
meniscal tears. Arthroscopic meniscectomy is frequently performed,
although the benefits are debatable. Recent studies have concluded
that there is no role for arthroscopic washout in osteoarthritis
of the knee. Our aim was to perform a systematic review to assess
the evidence for the efficacy of arthroscopic meniscectomy in patients
with meniscal tears and degenerative changes in the knee. A literature search was performed, using the PubMed/MEDLINE database,
for relevant articles published between 1975 and 2015. A total of
six studies, including five randomised controlled trials and one
cross-sectional study of a prospective cohort, met the inclusion
criteria. Relevant information including study design, operations,
the characteristics of the patients, outcomes, adverse events and
further operations were extracted.Aims
Patients and Methods
Abstract. Objective. Meta-analysis of clinical trials highlights that non-operative management of
Introduction. Transtibial osseointegration (TFOI) for amputees has limited but clear literature identifying superior quality of life and mobility versus a socketed prosthesis. Some amputees have knee arthritis that would be relieved by a total knee replacement (TKR). No other group has reported performing a TKR in association with TTOI (TKR+TTOI). We report the outcomes of nine patients who had TKR+TTOI, followed for an average 6.5 years. Materials & Methods. Our osseointegration registry was retrospectively reviewed to identify all patients who had TTOI and who also had TKR, performed at least two years prior. Four patients had TKR first the TTOI, four patients had simultaneous TKR+TTOI, and one patient had 1 OI first then TKR. All constructs were in continuity from hinged TKR to the prosthetic limb. Outcomes were: complications prompting surgical intervention, and changes in daily prosthesis wear hours, Questionnaire for Persons with a Transfemoral Amputation (QTFA), and Short Form 36 (SF36). All patients had clinical follow-up, but two patients did not have complete survey and mobility tests at both time periods. Results. Six (67%) were male, average age 51.2±14.7 years. All primary amputations were performed to manage traumatic injury or its sequelae. No patients died. Five patients (56%) developed infection leading to eventual transfemoral amputation 36.0±15.3 months later, and 1 patient had a single debridement six years after TTOI with no additional surgery in the subsequent two years. All patients who had transfemoral amputation elected for and received transfemoral osseointegration, and no infections occurred, although one patient sustained a periprosthetic fracture which was managed with internal fixation and implant retention and walks independently. The proportion of patients who wore their prosthesis at least 8 hours daily was 5/9=56%, versus 7/9=78% (p=.620). Even after proximal level amputation, the QTFA scores improved versus prior to TKR+TTOI, although not significantly: Global (45.2±20.3 vs 66.7±27.6, p=.179), Problem (39.8±19.8 vs 21.5±16.8, p=.205), Mobility (54.8±28.1 vs 67.7±25.0, p=.356). SF36 changes were also non-significant: Mental (58.6±7.0 vs 46.1±11.0, p=.068), Physical (34.3±6.1 vs 35.2±13.7, p=.904). Conclusions. TKR+TTOI presents a high risk for eventual infection prompting subsequent transfemoral amputation. Although none of these patients died, in general, TKR infection can lead to patient mortality. Given the exceptional benefit to preserving the knee joint to preserve amputee mobility and quality of life, it would be devastating to flatly force transtibial amputees with severe
Not all
Today several therapeutic options exist for the management of early degenerative lesions in the knee. These include marrow stimulation techniques (abrasion arthroplasty, sub-chondral drilling, microfracturing), periosteal and perichondral graft interposition, the implantation of synthetic matrices (collagen, carbon fibres, or glycosaminoglycan gel), autologous chondrocyte transplantation, osteochondral mosaic autografts or allografts, or simple arthroscopic lavage and debridement. It appears that some of these techniques are moderately successful in the short-term, especially in younger patients with relatively recent localised chondral lesions or erosion, and in joints with normal stability and alignment. In these optimal conditions, it is possible to achieve repair in 70% of the diseased area. However, the cartilage remains substandard, with a one-third decrease in stiffness and increased tissue permeability. In the early
Objectives: Partial meniscectomy is the current standard of care for torn menisci not suitable for repair. Arthroscopic partial meniscectomy is the most commonly performed orthopaedic surgical procedure. The purpose of this study was to determine what specific factors influence longevity of improvements in function and activity levels following arthroscopic partial meniscectomy. Methods: Six hundred forty (640) knees which had undergone isolated partial meniscectomy were identified from a clinical database. One hundred ninety-three (193) knees had partial lateral meniscectomy, 342 had partial medial meniscectomy, and 105 had partial medial and lateral meniscectomy. Average age was 52 years (range, 15 to 79) with 207 females and 433 males. Patients were excluded if they had concurrent ACL reconstructions or microfracture for chondral defects. Lysholm function and Tegner activity scores were collected for a minimum of 8 years after the index partial meniscectomy. Results: For all knees, Lysholm scores improved significantly from preoperative (54) to 1 year postoperative (76) (p<
0.001). Lysholm scores did not change from year 1 to year 5. At year 6, average Lysholm score decreased to 69, and by year 8, the score decreased further to 63. When comparing
The French word debridement means the removal of the foreign matter or devitalised tissue from a lesion until surrounding healthy tissue is exposed. Arthroscopic techniques facilitated the removal of the intra-articular torn menisci, loose bodies, degenerated articular cartilage, and osteophytes. However, debridement procedure itself cannot induce tissue regeneration thus, the basic goal of the procedure is relief of pain. If pain can be relieved by non-surgical means very few patients can be considered for arthroscopic management. Debridement of early osteoarthritic knees can be carried out with a minimally invasive procedure with extremely low risk of infection and morbidity. However, it should be understood that this procedure is basically indicated for early
The purpose of this study was to compare the clinical outcomes, mortalities, implant survival rates, and complications of total knee arthroplasty (TKA) in patients with or without hepatitis B virus (HBV) infection over at least ten years of follow-up. From January 2008 to December 2010, 266 TKAs were performed in 169 patients with HBV (HBV group). A total of 169 propensity score–matched patients without HBV were chosen for the control group in a one-to-one ratio. Then, the clinical outcomes, mortalities, implant survival rates, and complications of TKA in the two groups were compared. The mean follow-up periods were 11.7 years (10.5 to 13.4) in the HBV group and 11.8 years (11.5 to 12.4) in the control group.Aims
Methods
Background. Total knee arthroplasty (TKA) is a cost-effective surgical procedure for
The aim of this study was to determine the long-term mortality rate, and to identify factors associated with this, following primary and revision knee arthroplasty (KA). Data from the Scottish Arthroplasty Project (1998 to 2019) were retrospectively analyzed. Patient mortality data were linked from the National Records of Scotland. Analyses were performed separately for the primary and revised KA cohorts. The standardized mortality ratio (SMR) with 95% confidence intervals (CIs) was calculated for the population at risk. Multivariable Cox proportional hazards were used to identify predictors and estimate relative mortality risks.Aims
Methods
Patients with skeletal dysplasia are prone to developing advanced
Purpose: To see if the symptoms of mild to moderate
Purpose of the study: The purpose of rotating the femoral piece, using an indepenent cut strategy, is to «correct» for epiphyseal torsion of the distal femur and thus obtain a biepicondylar axis parallel to the posterior bicondylar axis. It is known however that epiphyseal torsion of the distal femur is highly variable from one individual to another. Intraoperative identification of the biepicondylar line enables appropriate rotation, as long as the data collected are reliable. The purpose of this study was to determine the reliability of intraoperative biepicondylar axis measurements made with navigation systems and to compare the results with the preoperative scan taken as the gold standard. Material and methods: This prospective study included 60
Aims: To investigate the clinical and radiological (MRI) effectiveness of Nuclear Magnetic Resonance Therapy (NMRT) on mild to moderate
Purpose of the study: Total knee arthroplasty (TKA) is considered to be an effective treatment for
Introduction: Microfracture is found to be effective for isolated chondral defect of knee in young adults however controversy exists over the relevance of microfracture treatment in