Introduction

In the case of bipolar hemiarthroplasty, surgeons are often faced with only migration of outer head and severe osteolysis in acetabulum without loosening of femoral component. There has been much debate regarding the merits of removing or retaining stable femoral components in such cases. The purpose of this study was to determine whether revision of an isolated acetabular component without the removal of a well-fixed femoral component [Fig. 1] could be successfully performed.

Restoration of joint line in total knee arthroplasty (TKA) is important for kinematics of knee and ligamentous balance. Especially in revision TKA, it may be difficult to identify the joint line. The aim of this study is to define the relationship between epicondyles and articular surface using CT based three-dimensional digital templating sofware $“Athena” (Soft Cube, Osaka, Japan).

137 knees with osteoarthritis, all caces were grade 2 or lower in Kellgren-Lawrence index, were investigated. Perpendicular lines were dropped from the prominences of the medial and lateral femoral epicondyles to the most distal points of articular surfaces and distances of the lines were measured on the axial and coronal planes. The femoral width was measured as the distance between medial and lateral epicondyles. Each of the distance described above was converted to a ratio by dividing by the femoral width.

On the axial plane, the average distance from epicondyles to the posterior articular surfaces were 29.4±2.2mm on the medial side and 21.2±2.3mm on the lateral side. The average of the femoral width was 75.2±4.1mm. On coronal plane, the average distance from epicondyles to the distal articular surfaces were 25.2±2.8mm on the medial side and 21.4±2.5mm on the lateral side.

The ratio for the distance from epicondyles to the distal and posterior joint line compared to femoral width was 0.39±0.02, 0.28±0.03, 0.33±0.03 and 0.28±0.03. The distance from epicondyles to the distal and posterior joint line correlates with the femoral width of the distal femur. This information can be useful in determining appropriate joint line.

Introduction: Appropriate femoral component alignment is important for long-term survival of total knee arthroplasty (TKA). Valgus angle of femoral component is recommended as the angle between mechanical axis and anatomical axis of the femur. Intramedullary guide system is widely used for determining the valgus positioning of femoral component. Entry point of intramedullary guide is one of the key factors for determining valgus angle of femoral component. Some investigators have shown appropriate entry points of intramedullary guide, however, it is still unclear. In this study, appropriate entry point of intramedullary guide system was calculated using three-dimensional digital templating software “Athena” (Soft Cube, Osaka, Japan).

Method: Forty-one knees in 34 osteoarthritis patients except valgus deformity (30 females and 4 males, mean age 75.1 years) received TKA and were simulated using “Athena” from January 2009 to March 2009. All cases were grade III or IV in Kellgren-Lawrence index. Radiograph and CT scan image were used for determination of appropriate entry point of femur using “Athena”. The anatomical axis of femur was defined as a line connecting the midpoints of femoral AP and lateral diameter, at 60 mm and 110 mm proximal to the center of intercondylar notch. Two coordinate systems were configured as representation of entry points. One was at the center of intercondylar notch defined as the point of origin in axial view of CT image and the line parallel to the clinical epicondylar axis (cTEA) defined as X-axis. Another coordinate system was the same point of origin but parallel to the line between trochlear groove and the center of intercondylar notch (AP line) defined as Y-axis.

Result: In the coordinate system that defined the cTEA as the X-axis, the average of entry point was 0.3± 0.30 mm medial (range, −4.8~ 4.7mm) and 11.6 ± 0.52mm anterior (range, 3.1~ 16.5mm) to the center of intecondylar notch. In the other coordinate system that defined AP line as the Y-axis, the average of entry point was 2.6± 0.29 mm medial (range, −1.5~ 6.3mm) and 11.2±0.52 mm anterior (range, 2.8~ 16.0mm) to the center of intercondylar notch.

Discussion: In this study, the appropriate entry point of intramdullary guide was slightly medial and about 11mm anterior to the center of intercondylar notch on average. However, individual entry point varied considerably in distance. These data indicates that it is important to simulate the appropriate entry point of intramedullary guide in preoperative planning.

Venous thromboembolism (VTE) is a frequent, life-threatening postoperative complication of orthopaedic surgery. Preoperative autologous blood donation has been advocated to reduce the risk of transfusion reactions and to limit potential infectious risk associated with donor blood. Experimental data suggest that autologous leukocytes might lead to immunomodulation similar to the effect attributed to allogenic leukocytes, but autologous whole blood (WB) is often still being used in Japan. We investigated the incidence rate of VTE and plasma D-dimer levels of the autologous WB transfusion and compared the findings with autologous red cell concentrates (RCC) and fresh frozen plasma (FFP) with regard to the cases of lower extremity arthroplasty.

The subjects of this study were 138 patients with lower extremity arthroplasty who were scheduled to receive surgery. The operations included 72 total hip arthroplasties (THA) and 66 total knee arthroplasties (TKA). Postoperatively, plasma D-dimer levels were measured latex agglutination turbidimetric immunoassay. Ultrasonography and contrast-enhanced helical computed tomography was used for diagnosing VTE.

There was no statistically significant difference in the post-surgery incidence rate of VTE between the autologous WB group (THA:20.0%, TKA: 27.9%) and autologous RCC/FFP group (THA: 11.9%, TKA: 30.4%). On the first post-surgery day, the plasma D-dimer levels were significantly higher in autologous WB group (THA: 8.1±9.5 μg/ml, TKA: 12.1±15.9 μg/ml) compared to the autologous RCC/FFP group (THA: 4.2±2.9 μg/ml, TKA:8.0±6.6 μg/ml). However, the plasma D-dimer levels were almost the same in both groups on the 14th day from the surgery. The results of this study suggest that donation and transfusion of autologous WB do not negatively influence the post operative VTE compared with autologous RCC/FFP. However, we must cautiously assess the plasma D-dimer levels of the autologous WB group on the first post-surgery day because of the high propensity of showing false positive rate compared to the RCC/FFP group.