Aims

In the last decade, perioperative advancements have expanded the use of outpatient primary total knee arthroplasty (TKA). Despite this, there remains limited data on expedited discharge after revision TKA. This study compared 30-day readmissions and reoperations in patients undergoing revision TKA with a hospital stay greater or less than 24 hours. The authors hypothesized that expedited discharge in select patients would not be associated with increased 30-day readmissions and reoperations.

We checked intraoperative patellar tracking with both ‘towel clip technique’ and the ‘no thumb technique’ on 354 patients (571 knees) who underwent primary total knee arthroplasty to decide whether to do or not to do lateral retinacular release.

All surgical procedures consisted of medial parapatellar arthrotomy and patellar resurfacing. Patellar tracking was assessed under pneumatic tourniquette with the no thumb technique first and reevaluated with the towel clip technique. The tracking was graded as total contact, good contact, lateral contact, and subluxation. The knees graded as total or good contact with the no thumb technique were classified into group A; those graded lateral contact or subluxation by the no thumb technique but total or good contact by the towel clip technique were classified into group B; and those graded lateral contact or subluxation by both techniques were classified into group C, in which lateral releases were performed. We classified 371, 148, and 52 knees into groups A, B, and C respectively. Patellar lateral tilting in the Merchant view was reviewed preoperatively and 2 weeks, 6 weeks, 6 months, and 1 year postoperatively.

There were no statistical differences on postoperative patellar tilting among the groups. Assessment of the patellar tracking using only the no thumb technique may overestimate the need for lateral retinacular release. The use of the no thumb technique as a screening test, and reevaluation with the towel clip technique, may reduce unnecessary lateral retinacular release.

As a result of lateral skin numbness that quite commonly occurs after knee joint operation, injury of the Infrapatellar branch of Saphenous nerve is often underestimated and regarded as a trivial complications. However, there are many complaints and worries from the patients in relation to the injury of this nerve never seems to stop.

The authors wanted to report the results of preserving this nerve during the unicompartmental knee arthroplasty for preventing lateral skin numbness.

The targets of this study were 100 cases of the unicompartmental knee arthroplasty by a single surgeon. All of the cases were medial compartmental osteoarthritis and in which a minimally invasive technique was used, with the average follow up of two years and eight months (range 24 to 42 months). The results were recorded in terms of classification of the nerve by location, preservation after surgery, sensory changes of the lateral skin flap, and complications. The classification by the location of this nerve was observed as either Mochida Type I with 76 people (76%), Type II with 16 people (16%), and unclassified types with eight people(8%). In Type I, this nerve was saved in 62 cases (82%). However in Type II, it could not be preserved in any cases because of the surgical procedure. The results of our study showed that while most of the nerve (76%) on average had a distance of 9.13mm (range 2 to 19mm) from the medial joint line to the nerve and passed inferiorly. This results allowed us to predict ahead of the location of this nerve and careful incision during the operation can preserve this nerve.

The authors discovered that in cases of unicompartmental knee arthroplasty, the nerve can be easily preserved, as 62 people(82%) of type I had this nerve completely preserved. Even if five extra minutes is necessary in order to preserve this nerve, when we think of the patient’s satisfaction it is thought of as a meaningful procedure.

The purpose of this study was to review the total ankle arthroplasties performed in consecutive series of 78 ankles and to determine the short-term results in cases with over 12 months follow-up. Preoperative diagnoses were post-traumatic osteoarthritis in 40 ankles (51.3%), primary osteoarthritis in 32 ankles (41.0%), and systemic arthritis in six ankles (7.7%). HINTEGRA^® (Newdeal SA, Lyon, France) total ankle system was used in all cases

Fifty-five total ankle arthroplasties including four revision cases, followed up for over 12 months (range, 13~49 months) were included in this study. Ankles were divided into three groups according to the coronal plane deformity in preoperative standing ankle AP radiograph; Varus (≥10°; 20 ankles (39.2%)), neutral (< 10° varus or valgus; 25 ankles (49%)), and valgus (≥10° valgus; 6 ankles (11.8%)). Various additional surgeries were performed simultaneously with the arthroplasty to correct the deformities; deltoid ligament release (25 cases), posterior tibialis tendon lengthening (2 cases), peroneus longus tendon transfer to brevis (5 cases), lateral ankle reconstruction with modified Broström procedure (4 cases), lateral closed-wedge calcaneal osteotomy (3 cases), percutaneous heel cord lengthening (19 cases), and gastrocnemius recession (1 case). In one patient with severe valgus deformity, staged total ankle arthroplasty was conducted after primary triple arthrodesis.

Preoperative and postoperative visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, range of motion (ROM), as well as patient’s satisfaction and willingness to receive the operation again were evaluated The results were compared among the three groups. Serial radiographs were reviewed for any radiological changes.

AOFAS score has improved from 54.3 ± 11.4 pre-operatively to 79.2 ± 11.4 at last follow-up. VAS has decreased from 6.8 ± 1.6 to 3.2 ± 1.6. Mean improvement in ROM was 15.6 ± 16.2 degrees. Forty-eight cases (873%) were satisfied with excellent or good results and 49 cases (89.1 %) were willing to receive the operation again. No significant differences in the postoperative VAS (p=0.14), AOFAS score (p=0.79), and ROM (p=0.06) were found among the three groups. Hetero-topic ossifications were observed in 12 cases (23.5%) and periosteal reactions proximal to medial malleolus occurred in four cases (7.8%).

Perioperative complications include one intraoperative medial malleolus fracture which was successfully managed with two cannulated-screws, and one medial malleolar stress fracture at six weeks after surgery which has healed spontaneously. One case with osteolysis around tibial screws was managed with bone graft. One case with deep fungal infection was converted to arthrodesis after infection control. Four ankles had to be revised including three cases of polyethylene bearing change due to dislocation, and one case of tibial component and bearing change due to loosening. The patient with revised tibial component was converted to arthrodesis due to recurred loosening. The Kaplan-Meier cumulative survival rate was 90.9% at 12 months and 87.8% at 49 months postoperatively.

The short term clinical results of HINTEGRA ankles showed favorable results. No significant differences were observed among different groups of coronal plane deformities when adequate additional surgeries were performed simultaneously. Long term follow-up study is required.