The posterior slope of the tibial component in total knee arthroplasty (TKA) has been reported to vary widely even with computer assisted surgery. In the present study, we analyzed the influence of posterior tibial slope on one-year postoperative clinical outcome after posterior-stabilized (PS) -TKA to find out the optimal posterior slope of tibial component. Seventy-three patients with varus type osteoarthritic (OA) knees underwent PS-TKA (Persona PSR) were involved in this study. The mean age was 76.6 years old and preoperative HKA angle was 14.3 degrees in varus. Tibial bone cut was performed using standard extra-medullary guide with 7 degrees of posterior slope. The tibial slopes were radiographically measured by post-operative lateral radiograph with posterior inclination in plus value. The angle between the perpendicular line of the proximal fibular shaft axis and the line drawn along the superior margin of the proximal tibia represented the tibial slope angle. We assessed one-year postoperative clinical outcomes including active range of motion (ROM), patient satisfaction and symptoms scores using 2011 Knee Society Score (2011 KSS). The influences of posterior tibial slope on one-year postoperative parameters were analyzed using simple linear regression analysis (p<0.05).Background
Materials and Method
Patient self-reported outcome scales have recently been used to evaluate total knee arthroplasty (TKA) outcomes. Many follow-up studies have been conducted on patients undergoing TKA; however, they have mostly reported outcomes after unilateral TKA. We believe that a longitudinal study after bilateral TKA will be more useful in evaluating the quality of life (QOL) of such patients. The objective of this study was to longitudinally evaluate QOL using the Japanese Knee Osteoarthritis Measure (JKOM). Objective outcomes were assessed using the Knee Society Score (KSS) and the Timed Up and Go test (TUG) for more than 5 years after bilateral TKA. Furthermore, QOL and objective outcomes were compared between younger (age ≤ 80 years at the final follow-up point) and older (age > 80 years) age groups.Introduction
Objectives
Modified gap technique has been reported to be beneficial for the intraoperative soft tissue balancing in posterior-stabilized (PS) -TKA. We have found intraoperative ligament balance changed depending on joint distraction force, which might be controlled according to surgeons' fells. We have developed a new surgical concept named as “medial preserving gap technique (MPGT)” to preserve medial knee stability and provide quantitative surgical technique according to soft tissue balance measurement using a tensor device. The purpose of this study was to compare 3-years postoperative knee stability after PS-TKA in varus type osteoarthritic (OA) knees between MPGT and measured resection technique (MRT). The subjects were 94 patients underwent primary unilateral PS-TKA for varus type OA knees. The surgical technique was MPGT in 47 patients and MRT in 47 patients. An originally developed off-set type tensor device was used to evaluate intraoperative soft tissue balance. In MPGT, medial release was limited until the spacer block corresponding to the bone thickness from proximal lateral tibial plateau could be easily inserted. Femoral component size and external rotation angle were adjusted depending on the differences of center gaps and varus angles between extension and flexion before posterior femoral condylar resection. The knee stabilities at extension and flexion were assessed by stress radiographies at 1 and 3 years after TKA; varus-valgus stress test at extension and stress epicondylar view at flexion. We measured medial and lateral joint openings (MJO, LJO) at both knee extension and flexion. MJOs and LJOs at 2 time periods were compared in each group using paired t-test. Each joint opening distance was compared between 2 groups using unpaired t-test. The significance level was set as P < 0.05.Introduction
Material & Method
Both measured resection technique and gap balancing technique have been important surgical concepts in total knee arthroplasty (TKA). Modified gap technique has been reported to be beneficial for the intra-operative soft tissue balancing in posterior-stabilizing (PS) -TKA. On the other hand, we have found joint distraction force changed soft tissue balance measurement and medial knee instability would be more likely with aiming at perfect ligament balance at extension in modified gap technique. The medial knee stability after TKA was reported to essential for post-operative clinical result. We have developed a new surgical concept named as “medial preserving gap technique” for varus type osteoarthritic (OA) knees to preserve medial knee stability and provide quantitative surgical technique using tensor device. The purpose of this study was to compare post-operative knee stability between medial preserving gap technique (MPGT) and measured resection technique (MRT) in PS-TKA. The subjects were 140 patients underwent primary unilateral PS-TKA for varus type OA knees. The surgical technique was MPGT in 70 patients and MRT in 70 patients. There were no significant differences between two groups in the pre-operative clinical features including age, sex, ROM and deformity. Originally developed off-set type tensor device was used to evaluate both center gap and varus angle with 40 lbs. of joint distraction force. The extension gap preparation was identical in both group. In MPGT group, femoral component size and external rotation angle were adjusted depending on the differences of center gaps and varus angles between extension and flexion before posterior femoral condylar osteotomy. The knee stabilities at extension and flexion were assessed by stress radiographies; varus-valgus stress test with extension and stress epicondylar view with flexion, at one-month and one-year after TKA. We measured joint opening distance (mm) at medial and lateral compartment at both knee extension and flexion. Joint opening distances were compared between two groups using unpaired t-test, and the difference between medial and lateral compartment in each group was compared using paired t- test (p<0.05).Introduction
Material & Method
pelvic fractures in elderly patients often result in poor prognosis due to immobilization associated complications. Thus, the target of the treatment in this patient group is early mobilization in order to reduce the risk of these complications. We report outcomes of 4 cases of pelvic fracture in elderly patients, who were treated with percutaneous screw fixation. We examined medical records and images of 4 elderly patients between January 2012 and May 2012 in our center. Mean age of the patients was 88.8 years old (range 86–92 years). The causes of injury were motor vehicle accident in 3 patients, and a fall in 1 patient. Fracture types were ao type a in 1 patient, type b in 2 patients and type c in 1 patient. Mean injury severity score was 25 (10–57). We assessed functional status after the follow-up period using majeeds grading score for pelvic fractures.Background
Material and method
Much interest and controversy have arisen regarding treatment and prognosis of unstable pelvic fractures. The choice of treatment should be based to a large extent on the long-term outcome. Residual vertical displacement and sacroiliac joint involvement are often cited as being related to poor outcome. This study attempts to clarify whether residual vertical displacement or location of posterior pelvic ring injury correlate with functional outcomes. 33 patients with unstable pelvic fractures not involving the acetabulum were reviewed with greater than 18 months of follow-up. Iowa pelvic scores and descriptive information about sequelae were administered. Fractures were classified according to Tile as 27 type B, and 6 type C fractures. 9 cases were treated with external fixation and 5 cases were treated open reduction and internal fixation. The amount of residual vertical displacement was measured on plain AP radiographs and graded as 0–4,4–10,10–20, or >
20mm. Location of posterior pelvic ring injury was divided into 3 groups, sacral fractures, sacroiliac fracture dislocations, and transiliac fractures. Residual vertical displacement correlated with the incidence of LBP to some extent, but the difference was not statistically significant. Location of the posterior pelvic injury correlated with the incidence of neurologic injury and gait disturbance. There was high incidence of lower extremity fractures associated with the pelvic fractures. The incidence of gait disturbance and Iowa pelvic score were not valid as functional assessment tool. Residual vertical displacement and location of posterior pelvic injury correlated with the functional outcome to some extent.
