Total knee arthroplasty has become an established operation. Cemented fixation of the components has given satisfactory results and is accepted as the gold standard. Cement failure with aseptic loosening, however, is a possible long term complication. This is particularly important in view of the increasing number of younger patients who can benefit from this procedure. Hence the attraction of using implants fixed by direct osseointegration of bone into the implant, by passing the potential weak link of the cement. The objective of this study was to determine the mid-term clinical, radiological and functional outcomes after navigated cementless and cemented implantation of total knee arthroplasties without patella resurfacing done by a single surgeon.Introduction
Objectives
Recent publications have supported the anatomic placement of anterior cruciate grafts to optimise knee function. However, anatomic placement using the anteromedial portal has been shown to have a higher failure rate than traditional graft placement using the transtibial method. This is possibly due to it being more technically difficult and to the short femoral tunnel compromising fixation methods. It also requires the knee to be in hyper flexion. This position is not feasible during with a tourniquet in situ on the heavily muscled thighs of some athletes. Hypothesis: That navigation can be used to place the femoral tunnel in the anatomic position via a more medial transtibial tunnel. 25 patients underwent Navigated Anterior Cruciate reconstruction with quadruple hamstring grafts. The Orthopilot™ 3.0 ACL (BBraun Aesculap, Tuttlingen) software was used. The femoral and tibial ACL footprints were marked on the bones with a radio frequency probe and registered. The pivot shift test, anterior drawer and internal and external rotation were registered. A navigated tibial guide wire was inserted at 25° to the sagittal plane and 45° to the transverse plane exiting through the centre of the tibial footprint. The guide wire was advanced into the joint to just clear of the surface of the femoral footprint with the knee in 90° flexion. Flexion/extension of the knee was done to determine the closest position of the guide wire tip to the centre of the anatomical femoral footprint. If the tip was within 2mm of the centre of footprint, the position was accepted. If not the tibial guide wire was repositioned and the process repeated. The tibial tunnel was drilled, followed by transtibial drilling of the femoral tunnel. A screen shot was done to allow determination of the shape and area of the tunnel aperture relative to the femoral footprint using ImageJ (National Institute of Health). The graft was fixed proximally with an Arthrex ACL Tightrope® and distally with a Genesys™ interference screw. The pivot shift test, anterior drawer and internal and external rotation were repeated and recorded using the software.Background
Methods
Approximately 20% of patients with ankle fracture sustain syndesmosis injury. This is most common in trans-syndesmotic (type B) and supra-syndesmotic (type C) fibula fractures. Intra-operative assessment of syndesmosis integrity is important because failure to treat these injuries can result in ankle instability and pain. Our aim was to audit the documentation of intra-operative testing of syndesmosis during ankle fracture open reduction and internal fixation (ORIF). All patients who had ankle fracture ORIF between 1/1/2010 and 21/11/2011 were included. Pre-operative radiographs were reviewed and fractures were classified according to AO classification. Operation notes were reviewed for documentation of assessment of syndesmosis integrity. 153 patients, of mean age 50 years (15–93) were included. 60% (n=92) were female. In 78% of cases (n=119), an assessment of syndesmosis integrity was documented in the operation note. Of the patients with no documented syndesmosis assessment (n=35), the majority had type B fractures (n=34). One patient had a type C fracture. We have shown that 22% of patients undergoing ankle ORIF for fracture do not have documented assessment of syndesmosis integrity. We suggest that all patients who have ankle ORIF should have intra-operative assessment and documentation of syndesmosis integrity so these injuries are identified and treated accordingly.
Growing evidence in the literature suggests better clinical and functional outcomes and lower re-rupture rates with repair compared to non-operative treatment of ruptured Achilles tendon. There are however, concerns of wound infection, nerve injury and scar tenderness with the standard open and percutaneous techniques of repair. We aim to evaluate clinical and functional outcomes and complications in patients treated with minimally invasive Achillon device. Prospectively collected clinical data was reviewed of all consecutive patients who underwent repair of the ruptured Achilles tendon using the Achillon device. Patients were contacted using a postal questionnaire for assessment of their functional status using the validated Achilles Tendon Total Rupture Score (ATRS) and compared with their uninjured side. The outcomes were compared to the published results.Introduction
Materials and Methods
