Background

Multiple randomised controlled trials have demonstrated that arthroscopy provides little benefit in patients with knee osteoarthritis. In 2008, NICE released guidelines to reflect this evidence. Implementation has been sporadic, and arthroscopy for knee osteoarthritis is commonly performed with an annual incidence of 9.9 per 10,000 in England. Our aim was to establish whether previous arthroscopy affects Patient Reported Outcome Measures (PROMs) in Total Knee Replacement (TKR) patients.

Several emerging reports suggest an important involvement of the hindfoot alignment in the outcome of knee osteotomy. At present, studies lack a comprehensive overview. Therefore, we aimed to systematically review all biomechanical and clinical studies investigating the role of the hindfoot alignment in the setting of osteotomies around the knee. A systematic literature search was conducted on multiple databases combining “knee osteotomy” and “hindfoot/ankle alignment” search terms. Articles were screened and included according to the PRISMA guidelines. A quality assessment was conducted using the Quality Appraisal for Cadaveric Studies (QUACS) - and modified methodologic index for non-randomized studies (MINORS) scales. Three cadaveric, fourteen retrospective cohort and two case-control studies were eligible for review. Biomechanical hindfoot characteristics were positively affected (n=4), except in rigid subtalar joint (n=1) or talar tilt (n=1) deformity. Patient symptoms and/or radiographic alignment at the level of the hindfoot did also improve after knee osteotomy (n=13), except in case of a small pre-operative lateral distal tibia- and hip knee ankle (HKA) angulation or in case of a large HKA correction (>14.5°). Additionally, a pre-existent hindfoot deformity (>15.9°) was associated with undercorrection of lower limb alignment following knee osteotomy. The mean QUACS score was 61.3% (range: 46–69%) and mean MINORS score was 9.2 out of 16 (range 6–12) for non-comparative and 16.5 out of 24 (range 15–18) for comparative studies. Osteotomies performed to correct knee deformity have also an impact on biomechanical and clinical outcomes of the hindfoot. In general, these are reported to be beneficial, but several parameters were identified that are associated with newly onset – or deterioration of hindfoot symptoms following knee osteotomy. Further prospective studies are warranted to assess how diagnostic and therapeutic algorithms based on the identified criteria could be implemented to optimize the overall outcome of knee osteotomy. Remark: Aline Van Oevelen and Arne Burssens contributed equally to this work

Fixed flexion contracture (FFC) following total knee arthroplasty (TKA) is a source of morbidity for patients. This retrospective review of pre- and post-operative data for 811 total knee replacements with two year follow up aimed to identify pre-operative risk factors for developing FFC and quantify the effect of FFC on outcomes. The incidence of FFC two years post-operation was 3.6%. Advanced age was associated with increased rate of FFC (p=0.02) Males were 2.6 times more likely than females to have FFC at two years (p=0.012). Patients with pre-implant FFC were 2.95 times more likely than those without to have FFC (p=0.028). BMI was not a risk factor (p=0.968). Patients with FFC had poorer outcomes (Oxford Knee Score p=0.003, patient satisfaction p=0.036). The results of this study support the existing literature and clarify a previously contentious point by excluding BMI as a risk factor