For the past four decades controversy surrounds the decision to retain or sacrifice the posterior cruciate ligament during a total knee arthroplasty. To our knowledge no study has been done to describe the effect of releasing the PCL on the range of motion of the knee. Case seriesBackground:
Study design:
We sought to validate a method of measuring the
To assess long and short term kinematic gait outcomes after rectus femoris transfers (RFT) in ambulatory children with cerebral palsy (CP). A retrospective review was conducted of ambulatory children with spastic diplegic CP, who had RFT plus motion analysis preoperatively and 1 year post-operatively. Those with 5 and 10 year post-operative motion analysis were also included. The primary variables were: peak
Variations in the pivot shift test have been proposed by many authors, though, a test comprised of rotatory and valgus tibial forces with accompanied
Introduction. Increasingly young and active patients are concerned about revision arthroplasty forcing the manufacturers to think about revision prostheses that fit to this population while meeting the indications and fitting with bone losses and ligament deficiencies. One of those industrials claims that its system allows the surgeon to rise the constraint from a posterior stabilized (PS) prostheses to a semi-constraint total stabilized (TS) prostheses without modifying the gait pattern thanks to a similar single radius design. The aim of the study was to compare gait parameters in patients receiving either PS or TS knee prostheses. Methods. Nineteen patients in each groups were prospectively collected for this study and compared between each other. All subjects were assessed with a 3D knee kinematics analysis, performed with an optoelectronic knee assessment device (KneeKG®). Were measured for each
MPFL reconstruction has demonstrated a very high success rate with improved patella stability, physical function, and patient-reported outcomes. However technical error and a lack of consideration of anatomic risk factors have been shown to contribute to failure after MPFL reconstruction. Previous research has also reported a complication rate of 26% following surgery. The purposes of this study were to determine the re-dislocation rate, type and number of complications, and most common additional surgical procedures following MPFL reconstruction. Patients with symptomatic recurrent patellofemoral instability underwent an MPFL reconstruction (n = 268) and were assessed with a mean follow-up of 31.5 months (minimally 24-months). Concomitant procedures were performed in addition to the MPFL reconstruction in order to address significant anatomic or biomechanical characteristics. Failure of the patellofemoral stabilization procedure was defined as post-operative re-dislocation of the patella. Rates of complications and re-procedures were assessed for all patients. The re-dislocation rate following MPFL reconstruction was 5.6% (15/268). There were no patella fractures. A total of 49/268 patients (18.3%) returned to the operating room for additional procedures following surgery. The most common reason for additonal surgery was removal of symptomatic tibial tubercle osteotomy hardware in 24/268 patients (8.9%). A further 9.3% of patients underwent addtional surgery including revision MPFL reconstruction: with trochleoplasty 8/268 (3.0%), with tibial tubercule osteotomy 4/286 (1.5%) and with femoral derotation osteotomy 3/268 (1.1%); manipulation under anaesthesia for reduced
In total knee arthroplasty (TKA), both intravenous (IV) and/or intra-articular (IA) administration of tranexamic acid (TXA) were showed to reduce blood loss. Moreover, research suggesting TXA decreases postoperative knee swelling, but it is unknown whether this results in improved postoperative rehabilitation outcome. Thus, the aim of this study was to evaluate whether combined IV and IA administration of TXA would associate with improved early rehabilitation outcomes. In this institutional review board approved randomized controlled trial, 179 patients scheduled for unilateral TKA were randomized to one of three regimens: (1) IA administration of 1gm TXA at end of procedure only, (2) additional preoperative IV dose of 15 mg/kg 30min before tourniquet inflation, and (3) additional postoperative dose 4hrs after preoperative dose. Primary outcomes included
Previous studies have identified the anterolateral complex (ALC) as having an important role in controlling anterolateral rotatory laxity following anterior cruciate ligament injury and subsequent reconstruction. In particular, injury to the iliotibial band (ITB) and its component deep (dITB) and capsulo-osseous (coITB) layers, have been shown to significantly correlate with different grades of the pivot-shift test in patients with acute ACL injuries. However, the kinematic properties of the capsulo-osseous layer of the ITB, throughout
Introduction. Robotics have been applied to total knee arthroplasty (TKA) to improve surgical precision in components’ placement, providing a physiologic ligament tensioning throughout
Introduction. Gait analysis systems have enjoyed increasing usage and have been validated to provide highly accurate assessments for range of motion. Size, cost, need for marker placement and need for complex data processing have remained limiting factors in uptake outside of what remains predominantly large research institutions. Progress and advances in deep neural networks, trained on millions of clinically labelled datasets, have allowed the development of a computer vision system which enables assessment using a handheld smartphone with no markers and accurate
The moderator will lead a structured panel discussion that explores how to manage challenges commonly found in the multiply revised knee. Topics covered will include: (1) Exposure in the multiply operated knee (when to use quad snip, tibial tubercle osteotomy, other techniques); (2) Implant removal: Tips for removing stemmed implants; (3) Management of bone loss in multiply operated knees (metal cones/sleeves vs. structural allograft vs. particulate graft); (4) Level of constraint (when to use posterior stabilised, constrained condylar, and hinge) and management of instability in multiply operated knees; (5) Preferred management of infection in the multiply operated knee; (6) The extensor mechanism: Preferred deficient patellar bone management; Preferred extensor mechanism deficiency management; (7) When is it time to convert to a salvage procedure (i.e. fusion, resection arthroplasty, amputation)?; (8) Post-operative management: wound management;
Background. Total knee arthroplasty (TKA) is offered to patients who have end-stage knee osteoarthritis to reduce pain and improve functional performance. Knee edema and pain deteriorate the patients' outcomes after TKA at early period. By quantifying the patients' early outcome deficits and their potential relationships to edema and pain may assist in the design of in-patient rehabilitation programs. Objectives. The aim of this study was to investigate of the effect of knee swelling on early patients' outcomes after primary TKA. Design and Methods. The study group consisted of 61 patients (10 males, 51 females), who underwent primary TKR because of knee arthrosis were included in the study with mean age 65.2±9 years. Patients were evaluated regarding knee circumference (10 cm superior of midpoint of patella, midpoint of patella, 10 cm distal of midpoint of patella), pain (Numeric Pain Rating Scale (NPRS)),
Introduction. A decrease of 15% in femoral off-set (FO) was reported to generate a weakness of the abductor muscle after THA, which may increase the risk of limping and dislocation. However, this value was defined under experimental conditions using a CYBEX machine, which does not correspond to daily life activities. To our best knowledge, there is no reported study about the effect of the FO alteration on the gait, following THA. Materials and Methods. To assess the functional consequences of an alteration in the FO, a prospective comparative study was carried out and it included patients who underwent THA for primary osteoarthritis. In order to select only patients with an isolated FO alteration, the three-dimensional hip anatomy was analysed preoperatively and post-operatively with CT-scans using HipPlan Software. Three groups were defined according to the FO alteration: 15% decrease, restored and 15% increase. The exclusion criteria were: the presence of an arthroplasty or of an associated pathology on the contra-lateral or the same limb, a spine disease and a non-restoration of the other hip parameters (center of rotation, limb length). 26 patients were included: 12 restored, 9 decreased FO and 5 increased FO. The patients were composed of 20 women and 6 men with an average age of 67.7 ± 9 years. All the patients were assessed clinically, pre-operatively and 1 year after surgery with 4 scores: the Poste Merle d'Aubigné score, the Harris score, the womac score and the quality of life score SF12. A gait analysis was performed at 1 year follow-up using an ambulatory device (Physilog (3)) under normal walking conditions. The patients were asked to walk at their usual normal speed for 30 metres in a standardized corridor: Each limb was compared to the contra-lateral healthy limb. Results. Contrarily to the restored and the increased groups, there was in the decreased group a significant asymmetry between the operated limb and the healthy side with a decreased
Introduction. Femoral shaft fractures in children is a serious injury that needs hospitalization, with a high prevalence in the age group 6–8 years old. Various treatment options are available and with a comparable weight of evidence. Submuscular plating provides a dependable solution, especially in length-unstable fractures and heavier kids. We present a novel technique to facilitate and control the reduction intraoperatively, which would allow for easier submuscular plate application. Materials and Methods. We have retrospectively reviewed four boys and three girls; all were operated in one centre. Polyaxial clamps and rods were applied to the sagittally-oriented bone screws, the reduction was done manually, and the clamps were tightened after achieving the proper alignment in the anteroposterior and lateral fluoroscopy views. The submuscular plate was applied as described, then clamps and bone screws were removed. Results. The mean age at surgery was 13 years (range, 9–14). The mean body weight was 43.3 kg (range, 30–66). There were five mid-shaft fractures, one proximal third and one distal third. There were Four type A fractures, two type B and one type C. Four patients had road traffic accidents while three had direct trauma. The mean preoperative haemoglobin concentration 12.5 g/dl (range 11.3–13 g/dl). No blood transfusion was needed intraoperatively or postoperatively. The operative time averaged 122 minutes, and the mean hospital stay was one (range 1–4 days). The patients reported no pain at a mean of 1.5 weeks (range, one-three weeks). All fractures united at a mean of 8.7 weeks (range 6–12 weeks). No wound healing problems nor deep infections happened. The
The moderator will lead a structured panel discussion that explores how to manage challenges commonly found in the multiply revised knee. Topics covered will include: (1) Exposure in the multiply operated knee (when to use quad snip, tibial tubercle osteotomy, other techniques); (2) Implant removal: Tips for removing stemmed implants; (3) Management of bone loss in multiply operated knees (metal cones/sleeves vs. structural allograft vs. particulate graft); (4) Level of constraint (when to use posterior stabilised, constrained condylar, and hinge) and management of instability in multiply operated knees; (3) Management of bone loss in multiply operated knees (metal cones/sleeves vs. structural allograft vs. particulate graft); (5) Preferred management of infection in the multiply operated knee; (6) The extensor mechanism: Preferred deficient patellar bone management; Preferred extensor mechanism deficiency management; (7) When is it time to convert to a salvage procedure (i.e. fusion, resection arthroplasty, amputation)?; (8) Post-operative management: wound management;
There is enough evidence to show that navigation improves precision of component placement and consistent and accurate restoration of limb alignment, allowing the surgeon to achieve the desired neutral or kinematic alignment. Computer-assisted TKA provides excellent information regarding gap equality and symmetry throughout the
Purpose. The aim of this study was to compare the accuracy of limb alignment and component positioning after total knee arthroplasty(TKA) performed using fixed or individual distal femoral valgus correction angle(VCA)in valgus knees. Materials and Methods. One hundred and twenty-four patients were randomised to undergo TKA with either of the clinical baseline, radiological outcomes and subsequent outcome such as knee HSS scores,
A 51 years old female who experienced difficulty in gait ambulation due to secondary osteoarthritis of knee showed knee instability caused by paralysis associated with poliomyelitis and scoliosis. At the first medical examination, right
Interest in minimal-incision total knee arthroplasty (TKA) has increased in recent years. The advantages of minimally invasive techniques (MIS) used for TKA are faster functional recovery, shorter hospital stay and better early
Background. Proper femoral component placement plays a key role in the success of a total knee replacement (TKR). Controversy exists on which technique should be used to ensure proper femoral component placement. This two-part study compares gap balancing (GB) and measured resection (MR) techniques used in TKR, investigating femoral component position and early clinical outcomes. Methods. Femoral component position was analyzed in 95 consecutive knees that underwent primary TKR. Both GB and MR cutting blocks from the same knee system were sequentially placed on the operative knee, marking the pin sits. A standardized photograph (Figure) was taken prior to making final femoral cuts. Relative rotation was determined based on measurements made from a commercially available software. Clinical comparison was made using 50 consecutive GB patients and 50 consecutive MR patients. Clinical outcome measures were Knee Society Scores (KSS),