The aim was to report operative complications, radiographic and patient-reported outcomes following lateral tibial plateau fracture fixation augmented with calcium phosphate cement (CPC). From 2007–2018, 187 patients (median age 57yrs [range 22–88], 63% female [n=118/187]) with a Schatzker II/III fracture were retrospectively identified. There were 103 (55%) ORIF and 84 (45%) percutaneous fixation procedures. Complications and radiographic outcomes were determined from outpatient records and radiographs. Long-term follow-up was via telephone interview. At a median of 6 months (range 0.1–138) postoperatively, complications included superficial peroneal nerve injury (0.5%, n=1/187), infection (6.4%, n=12/187), prominent metalwork (10.2%, n=19/187) and post-traumatic osteoarthritis (PTOA; 5.3%, n=10/187). The median postoperative medial proximal tibial angle was 89o (range 82–107) and posterior proximal tibial angle 82o (range 45–95). Three patients (1.6%) underwent debridement for infection and 27 (14.4%) required metalwork removal. Seven patients (4.2%) underwent total knee replacement for PTOA. Sixty percent of available patients (n=97/163) completed telephone follow-up at a median of 6yrs (range 1–13). The median Oxford Knee Score was 42 (range 3–48), Knee injury and Osteoarthritis Outcome Score 88 (range 10–100), EuroQol 5-Dimension score 0.812 (range −0.349–1.000) and Visual Analogue Scale 75 (range 10–100). There were no significant differences between ORIF and percutaneous fixation in patient-reported outcome (all p>0.05). Fixation augmented with CPC is safe and effective for lateral tibial plateau fractures, with a low complication rate and good long-term knee function and health-related quality of life. Percutaneous fixation offers a viable alternative to ORIF with no detriment to patient-reported outcome

The objective of this study was to compare differences in alignment following robotic arm-assisted bi-unicompartmental knee arthroplasty (Bi-UKA) and conventional total knee arthroplasty (TKA). This was a prospective, randomised controlled trial of 70 patients. 39 TKAs were implanted manually, as per standard protocol at our institution, and 31 Bi-UKA patients simultaneously received fixed-bearing medial and lateral UKAs, implanted using robotic arm-assistance. Preoperative and 3-month postoperative CT scans were analysed to determine hip knee ankle angle (HKAA), medial distal femoral angle (MDFA), and medial proximal tibial angle (MPTA). Analysis was repeated for 10 patients by a second rater to validate measurement reliability by calculating the intra-class correlation coefficient (ICC). Mean change in HKAA towards neutral was 2.7° in TKA patients and 2.3° in Bi-UKA patients (P=0.6). Mean change in MDFA was 2.5° for TKA and 1.0° for Bi-UKA (P<0.01). Mean change in MPTA was 3.7° for TKA and 0.8° for Bi-UKA (P<0.01). Mean postoperative MDFA and MPTA for TKAs were 89.8° and 89.6° respectively, indicating orientation of femoral and tibial components perpendicular to the mechanical axis. Mean postoperative MDFA and MPTA for Bi-UKAs were 91.0° and 86.9° respectively, indicating a more oblique joint line orientation. Inter-rater agreement was excellent (ICC>0.99). Early functional activities, according to the new Knee Society Scoring System, favoured Bi-UKAs (P<0.05). Robotic arm-assisted, cruciate-sparing Bi-UKA better maintains the natural anatomy of the knee in the coronal plane and may therefore preserve normal joint kinematics, compared to a mechanically aligned TKA. This has been achieved without significantly altering overall HKAA

Anterior knee pain (AKP) is the commonest complication of total knee arthroplasty (TKA). This study aims to assess whether sagittal femoral component position is an independent predictor of AKP after cruciate retaining single radius TKA without primary patellofemoral resurfacing. From a prospective cohort of 297 consecutive TKAs, 73 (25%) patients reported AKP and 89 (30%) reported no pain at 10 years. Patients were assessed pre-operatively and at 1, 5 and 10 years using the short form 12 and Oxford Knee Score (OKS). Variables assessed included demographic data, indication, reoperation, patella resurfacing, and radiographic criteria. Patients with AKP (mean age 67.0 (38–82), 48 (66%) female) had mean Visual Analogue Scale (VAS) Pain scores of 34.3 (range 5–100). VAS scores were 0 in patients with no pain (mean age 66.5 (41–82), 60 (67%) female). Femoral component flexion (FCF), anterior femoral offset ratio, and medial proximal tibial angle all differed significantly between patients with AKP and no pain (p<0.001), p=0.007, p=0.009, respectively). All PROMs were worse in the AKP group at 10 years (p<0.05). OKSs were worse from 1 year (p<0.05). Multivariate analysis confirmed FCF and Insall ratio <0.8 as independent predictors of AKP (R. 2. = 0.263). Extension of ≥0.5° predicted AKP with 87% sensitivity. AKP affects 25% of patients following single radius cruciate retaining TKA, resulting in inferior patient-reported outcome measures at 10 years. Sagittal plane positioning and alignment of the femoral component are important determinants of long-term AKP with femoral component extension being a major risk factor

Background. Computer-assisted navigation systems for total knee arthroplasty (TKA) were introduced to improve implantation accuracy and to optimize ligament balancing. Several comparative studies in the literature confirmed an effect on the component position and other studies could not confirm these results. For ligament balancing most studies found no significant influence on the clinical outcome using a navigation system for TKA. In the literature there were no reports of mid-term results after navigated TKA. With our study we wanted to show if the use of a navigation system for TKA will have an influence on the component's position and on the clinical results at 5-year follow up. Methods. We enrolled 200 patients in a prospective randomized study with a minimum follow up of 5 years. 100 TKA were operated on without using a navigation system (Group A) and 100 surgeries (Group B) were done with computer assistance. Radiological investigation by standard radiographs including a long-leg X-ray was performed with a follow up rate in Group A of 86.2% versus 80.2% in Group B. We measured the mechanical axis of the leg, lateral distal femoral angel (LDFA), medial proximal tibial angle (MPTA), tibial slope and the alpha-angle of the patella. Clinical investigation was performed with a follow up rate in Group A of 85.7% versus 79.8% in Group B including the parameters for the range of motion (ROM), ligament balancing, anterior drawer test, feeling of instability, anterior knee pain, effusion, WOMAC Score, Insall Score and HSS Knee Score. Results. In both groups there was no aseptic loosening or difference in TKA survival rate (Group A 95.4% versus Group B 98.85% 5-year survival rate, p = 0.368). With the navigation technique the mechanical axis of the limb in the frontal plane was improved (p = 0.015; Group B: 1.67 ° ± 1.6° versus 2,44 ° ± 2.2 ° in Group A). 90% of the Group B and 81% of the Group A were within 3 ° varus/valgus deformity of the mechanical axis of the limb (p = 0.157). The accuracy of tibial slope was higher in the Group B (p = 0.001). More patients of the Group B (95% versus 79%) were within a deviation of 3 °, −7 ° tibial slope (p = 0.007). The mean deviation of 90 ° LDFA was higher (p = 0.034) in the Group A (1.89 ° versus 1.36 ° in Group B). Mean deviation of 90 ° MPTA, mean MPTA, mean LDFA and patella alpha angle were similar in both groups (p 0.253). There was no difference in ROM, ligament balancing, anterior drawer test, anterior knee pain or feeling of instability (p 0.058). Insall Knee Score total (181 Group A/191 Group B) and HSS Knee Score total (91 Group A/93 Group B) was higher with the navigated procedure in Group B (p 0.026). WOMAC total and HSS grades were similar in both groups (p 0.070). Conclusions. The accuracy of the mechanical axis of the limb and the tibial slope was higher with the navigated procedure. TKA survival rate and clinical outcomes were similar in both groups at 5-year follow up

We investigated the stability of seven Schatzker type II fractures of the lateral tibial plateau treated by subchondral screws and a buttress plate followed by immediate partial weight-bearing. In order to assess the stability of the fracture, weight-bearing inducible displacements of the fracture fragments and their migration over a one-year period were measured by differentially loaded radiostereometric analysis and standard radiostereometric analysis, respectively. The mean inducible craniocaudal fracture fragment displacements measured −0.30 mm (−0.73 to 0.02) at two weeks and 0.00 mm (−0.12 to 0.15) at 52 weeks. All inducible displacements were elastic in nature under all loads at each examination during follow-up. At one year, the mean craniocaudal migration of the fracture fragments was −0.34 mm (−1.64 to 1.51).

Using radiostereometric methods, this case series has shown that in the Schatzker type II fractures investigated, internal fixation with subchondral screws and a buttress plate provided adequate stability to allow immediate post-operative partial weight-bearing, without harmful consequences.

In this retrospective study we evaluated the method of acute shortening and distraction osteogenesis for the treatment of tibial nonunion with bone loss in 17 patients with a mean age of 36 years (10 to 58). The mean bone loss was 5.6 cm (3 to 10). In infected cases, we performed the treatment in two stages. The mean follow-up time was 43.5 months (24 to 96). The mean time in external fixation was 8.0 months (4 to 13) and the mean external fixator index was 1.4 months/cm (1.1 to 1.8). There was no recurrence of infection. The bone evaluation results were excellent in 16 patients and good in one, while functional results were excellent in 15 and good in two. The complication rate was 1.2 per patient.

We conclude that acute shortening and distraction osteogenesis is a safe, reliable and successful method for the treatment of tibial nonunion with bone loss, with a shorter period of treatment and lower rate of complication.