Aims

The study aimed to assess the clinical outcomes of arthroscopic debridement and partial excision in patients with traumatic central tears of the triangular fibrocartilage complex (TFCC), and to identify prognostic factors associated with unfavourable clinical outcomes.

Chronic lateral ankle instability (CLAI) is treated operatively, whereas acute ligament injury is usually treated nonoperatively. Such treatments have been widely validated. Apoptosis is known to cause ligament degeneration; however, few reports have focused on the possible role of apoptosis in degeneration of ruptured lateral ankle ligaments. The aim of our study is to elucidate the apoptosis that occurs within anterior talofibular ligament (ATFL) to further validate current CLAI treatments by adducing molecular and cellular evidence.

Between March 2019 and February 2021, 50 patients were prospectively enrolled in this study. Ruptured ATFL tissues were collected from 21 CLAI patients (group C) and 17 acute ankle fracture patients (group A). Apoptotic cells were counted using the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) assay. Western blotting for caspases 3, 7, 8, and 9 and cytochrome c, was performed to explore intrinsic and extrinsic apoptotic pathways. Immunohistochemistry was used to detect caspases 3, 7, 8, and 9 and cytochrome c, in ligament vessel endothelial cells.

More apoptotic cells were observed in group C than group A in TUNEL assay. Western blotting revealed that the apoptotic activities of group C ligaments were significantly higher than those of group A (all p < 0.001). Immunohistochemistry revealed increased expression of caspases 3, 7, 8, and 9, and cytochrome c, in group C compared to group A.

The ATFL apoptotic activities of CLAI patients were significantly higher than those of acute ankle fracture patients, as revealed biochemically and histologically. Our data further validate current CLAI treatments from a molecular and cellular perspective. Efforts should be made to reverse or prevent ATFL apoptosis in CLAI patients.

Introduction

Alumina ceramic-on-highly cross-linked polyethylene bearings (Al-on-X-linked PE) are attractive because of the potential for reduced wear, osteolysis and loosening of the component. The purpose of this study was to evaluate the clinical and radiographic outcomes of cementless total hip arthroplasties (THAs) using an Al-on-X-linked PE bearing and to determine the rates of osteolysis using radiographs and computer tomographic (CT) scans in young patients with osteonecrosis of femoral head.

Background: Although many of the contemporary fixed- and mobile bearing total knee systems have been using extensively world wide, there is limited information available regarding the incidence of osteolysis of the well functioning total knee arthroplasties. We performed this study to evaluate the clinical and radiographic outcomes, the incidence of osteolysis, the revision rates and implant survivorship of the fixed- and mobile-bearing total knee arthroplasties at ten to seventeen years follow-up.

Methods: We compared 488 patients (894 knees) who received a fixed-bearing total knee replacement and 445 patients (816 knees) who received a mobile-bearing total knee replacement. There were 187 men and 301 women (mean age, 58.6 years) in the fixed-bearing group and 167 men and 278 women (mean age, 55.7 years) in the mobile-bearing group. The mean follow-up was 12.6 years (range, ten to seventeen years) in the fixed-bearing group and 14.1 years (range, twelve to seventeen years) in the mobile-bearing group.

Results: The mean postoperative Knee Society knee and functional scores were 92.9 points and 83.5 points, respectively in the fixed-bearing group. The mean postoperative Knee Society knee and functional scores were 90.7 points and 83.8 points, respectively. Incidence of osteolysis was 1.6% (fourteen of 894 knees) in the fixed-bearing group and it was 2.2% (eighteen of 816 knees) in the mobile-bearing group at the final review. Revision rate was 3.7% (thirty-three of 894 knees) in the fixed-bearing group and it was 2.7% (twenty-two of 816 knees) in the mobile-bearing group. Kaplan-Meier survivorship of the fixed-bearing group was 96.3% (95% confidence interval, 0.87–1.0) at 13 years follow-up and it was 97% (95% confidence interval, 0.90–1.0) of the mobile-bearing group at 14 years follow-up.

Conclusions: The present study demonstrates that the clinical and radiographic outcomes, the incidence of osteolysis, the rate of revision and the implant survivorship were similar between the fixed-bearing and mobile-bearing total knee arthroplasties.

Background: Alumina ceramic-on-highly cross-linked polyethylene (Al-on-X-linked PE) is attractive because of the potential for reduced wear, osteolysis and loosening of the component. The purpose of this study was to evaluate the clinical and radiographic outcomes of cement-less total hip arthroplasties (THAs) using Al-on-X-linked PE bearing and to determine the rates of osteolysis using radiographs and computer tomographic (CT) scans in young patients with osteonecrosis of femoral head.

Methods: Consecutive primary cementless THAs using Al-on-X-linked PE bearing were performed in 71 patients (73 hips) who were younger than 50 years of age with osteonecrosis of the femoral head. There were 48 men (51 hips) and 23 women (23 hips). The average age at the time of the index arthroplasty was 45.5 years (range, 20 to 50 years). Osteolysis was evaluated using radiographs and CT scanning. The average follow-up was 10.5 years (range, 10 to 13 years).

Results: The mean preoperative Harris hip score was 50.6 points (range, 27 to 55 points), which was improved to 96 points (range, 85 to 100 points) at the final follow-up. Preoperative functional activity was improved significantly (p=0.001) at the latest follow-up. All acetabular and femoral components were fixed by bone ingrown. The mean polyethylene linear penetration was 0.05±0.02 mm per year (range, 0.02 mm to 0.08 mm per year). Radiographic and CT scans demonstrated that no acetabular or femoral osteolysis was detected in any hip at the latest follow-up.

Conclusions: The current generation of anatomic tapered cementless femoral component with Al-on-X-linked PE bearing is functioning well with no osteolysis at a 10-year minimum and average of 10.5-year follow-up in this series of young patients with osteonecrosis of the femoral head.

Background: Whether total knee arthroplasty using computer-assisted surgical navigation can improve the limb and component alignment is a matter of debate. We hypothesized that total knee arthroplasty using computer-assisted surgical navigation is superior to the conventional total knee arthroplasty with regard to the precision of implant positioning.

Methods: Sequential simultaneous bilateral total knee arthroplasties were carried out in 160 patients (320 knees). One knee was replaced using a computer-assisted surgical navigation system and the other conventionally without using computer-assisted surgical navigation. The two methods were compared for accuracy of orientation and alignment of the components determined by radiographs and computed tomographs. The mean follow-up was 3.4 years.

Results: The mean preoperative Knee Society score was 26 points in the computer-assisted total knee arthroplasty group, which was improved to 92 points postoperatively and it was 25 points, which improved to 93 points post-opertively in the conventional total knee arthroplasty group. Ranges of motion of the knees were similar in both groups. The operating and tourniquet times were significantly longer in the computer-assisted total knee arthroplasty group than in the conventional total knee arthroplasty group (P< 0.001). Accuracy and the number of outliers of component position between the two groups were not significantly different (P> 0.05).

Conclusions: Our data demonstrated that total knee arthroplasty using computer-assisted surgical navigation did not result in more accurate implant positioning than that achieved in conventional total knee arthroplasty, determined by both radiographs and computed tomographs.

Background: The main goals of total knee arthroplasty are pain relief and improvement of function and range of motion. To ascertain whether posterior cruciate-retaining-flex total knee prosthesis would improve pain, function and range of motion, we asked whether knee and pain scores, ranges of motion, WOMAC score, patient satisfaction, and radiographic results would be better in the knees with a high-flexion posterior cruciate-retaining prosthesis than in the knees with a standard posterior cruciate-retaining prosthesis.

Methods: Fifty-four patients (mean age, 69.7 years) received a standard posterior cruciate-retaining knee prosthesis in one knee and a high-flexion posterior cruciate-retaining knee prosthesis in the contralateral knee. Five patients were men, and forty-nine were women. The minimum follow-up was three years (mean 3.1 years). At each follow-up, the WOMAC score and range of knee motion were evaluated and patients were assessed clinically and radiographically with use of the knee-rating systems of the Knee Society and The Hospital for Special Surgery.

Results: The mean postoperative Knee Society and Hospital for Special Surgery knee scores were 93.7 and 89 points, respectively in the knees with a standard posterior cruciate-retaining prosthesis and those were 93.9 and 90 points, respectively in the knees with a high-flexion posterior cruciate-retaining prosthesis. The mean postoperative WOMAC score was 22 points. Postoperatively, the mean non-weight and weight bearing ranges of motion were 131° (range, 90° to 150°) and 115° (range, 75 to 145°), respectively in the knees with a standard prosthesis and those were 133° (range, 90° to 150°) and 118° (range, 75 to 145°), respectively in the knees with a highflexion prosthesis. Patients satisfaction and radiographic results were similar in both groups. No knee had aseptic loosening, revision, or osteolysis.

Conclusions: After a minimum follow-up of three years, we found no significant differences between the two groups with regard to range of knee motion or clinical and radiographic results.

We undertook a study in which 138 female patients with a mean age of 71.2 years (51 to 82) received a standard NexGen CR-flex prosthesis in one knee and a gender-specific NexGen CR-flex prosthesis in the other. The mean follow-up period was 3.25 years (3.1 to 3.5). The aspect ratios of the standard and gender-specific prostheses were compared with that of the distal femur.

The mean post-operative Knee Society knee scores were 94 (70 to 100) and 93 (70 to 100) points and the function scores were 83 (60 to 100) and 84 (60 to 100) points for the standard implants and the gender-specific designs, respectively. The mean post-operative Western Ontario and McMaster Universities score was 26.4 points (0 to 76). Patient satisfaction, the radiological results and the complication rates were similar in the two groups. In those with a standard prosthesis, the femoral component was closely matched in 80 knees (58.0%), overhung in 14 (10.1%) and undercovered the bone in 44 (31.9%). In those with a gender-specific prosthesis, it was closely matched in 15 knees (10.9%) and undercovered the bone in 123 (89.1%).

Since we found no significant differences between the two groups with regard to the clinical and radiological results, patient satisfaction or complication rate, the goal of the design of the gender-specific CR-flex prosthesis to improve the outcome was not achieved in our patients.

The purpose of this study was to compare the clinical and radiological results of the PFC flex mobile bearing design with those of the LPS flex fixed bearing design in high-flex total knee arthroplasty.

Between January 2005 and November 2006, forty-six patients who received PFC flex mobile bearing prosthesis in one knee and LPS flex fixed bearing prosthesis in the contralateral knee followed up for a minimum 2 years were evaluated. Clinical results were assessed using the ROM, HSS score, the Knee rating systems of the knee society, WOMAC score and SF-36. Radiological results were evaluated tibio-femoral angle and loosening or osteolysis of components. We subdivided preoperative less 90 degree and more 90 degree in each group.

Mean ROM range of last follow up was increased to 131.1 degree in LPS group and 130.1 degree in PFC group. But there was no significant difference between the two groups. HSS score, knee pain and function score, WOMAC score, SF-36 score didn’t differ significantly between two groups. But descending stairs, rising from sitting, bending to the floor more improved significantly in LPS group. T-F angle was changed from preoperative 8.2 degree varus to a postoperative 4.8 degree valgus. No knee had aseptic loosening or osteolysis.

Postoperative ROM was increase significantly in both groups. We found no significant differences between the two groups with regard to clinical and radiological parameters excepts descending stairs, rising from sitting, bending to the floor in WOMAC score. There was no aseptic loosening or osteolysis but needed long term observation about these concerns.

We wished to determine whether simultaneous bilateral sequential total knee replacement (TKR) carried increased rates of mortality and complications compared with unilateral TKR in low- and high-risk patients.

Our study included 2385 patients who had undergone bilateral sequential TKR under one anaesthetic and 719 who had unilateral TKR. There were no significant pre-operative differences between the groups in terms of age, gender, height, weight, body mass index, diagnosis, comorbidity and duration of follow-up, which was a mean of 10.2 years (5 to 14) in the bilateral and 10.4 years (5 to 14) in the unilateral group.

The peri-operative mortality rate (eight patients, 0.3%) of patients who had bilateral sequential TKR was similar to that (five patients, 0.7%) of those undergoing unilateral TKR. In bilateral cases the peri-operative mortality rate (three patients, 0.4%) of patients at high risk was similar to that (five patients, 0.3%) of patients at low risk as it was also in unilateral cases (two patients, 1.0% vs three patients, 0.6%). There was no significant difference (p = 0.735) in either the overall number of major complications between bilateral and unilateral cases or between low- (p = 0.57) and high-risk (p = 0.61) patients. Also, the overall number of minor complications was not significantly different between the bilateral and unilateral group (p = 0.143).

Simultaneous bilateral sequential TKR can be offered to patients at low and high risk and has an expected rate of complications similar to that of unilateral TKR.

There is still some controversy about the treatment of nonunion of the lateral humeral condyle in children. Twelve patients with symptomatic long standing nonunion of the lateral humeral condyle were treated by internal fixation with iliac bone graft. The age range of the patients 8 years to 25 years. There were 10 males and 2 females. The time from the original fracture to nonunion ranged from 2 years 6 months to 13 years averaging 6 years 3 months.

The indication for surgery was pain and deformity and weakness in elbow. Follow up ranged from 16 months to 6 years averaging 32 months. Bony union was achieved in all cases. Strength of the elbow were restored in all cases. All patients were painfree in the elbow strenuous activities. Postoperative elbow motion was decreased in four patients with an average loss of 10.5 degree of the motion present before surgery. The valgus deformity was improved. Surgical osteosynthesis for long standing nonunion of the lateral humeral condyle is recommendable method.