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Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_20 | Pages 42 - 42
1 Dec 2017
Steimer D Suero E Luecke U Stuebig T Krettek C Liodakis E
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INTRODUCTION

To test whether there are differences in postoperative mechanical and component alignment, and in functional results, between conventional, navigated and patient-specific total knee arthroplasties in a low-volume centre?

MATERIAL AND METHODS

Retrospective cohort study of 391 patients who received conventional, navigated or patient- specific primary cemented TKA in a low-volume hospital.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_20 | Pages 65 - 65
1 Dec 2017
Macke C Westphal R Citak M Hawi N Liodakis E Krettek C Stuebig T Suero EM
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Introduction

High tibial osteotomy (HTO) is a commonly used surgical technique for treating moderate osteoarthritis (OA) of the medial compartment of the knee by shifting the center of force towards the lateral compartment. The amount of alignment correction to be performed is usually calculated prior to surgery and it's based on the patient's lower limb alignment using long-leg radiographs. While the procedure is generally effective at relieving symptoms, an accurate estimation of change in intraarticular contact pressures and contact surface area has not been developed. Using electromyography (EMG), Meyer et al. attempted to predict intraarticular contact pressures during gait patterns in a patient who had received a cruciate retaining force-measuring tibial prosthesis. Lundberg et al. used data from the Third Grand Challenge Competition to improve contact force predictions in total knee replacement. Mina et al. performed high tibial osteotomy on eight human cadaveric knees with osteochondral defects in the medial compartment. They determined that complete unloading of the medial compartment occurred at between 6° and 10° of valgus, and that contact pressure was similarly distributed between the medial and lateral compartments at alignments of 0° to 4° of valgus. In the current study, we hypothesised that it would be possible to predict the change in intra-articular pressures based on extra-articular data acquisition.

Methods

Seven cadavers underwent an HTO procedure with sequential 5º valgus realignment of the leg up to 15º of correction. A previously developed stainless-steel device with integrated load cell was used to axially load the leg. Pressure-sensitive sensors were used to measure intra-articular contact pressures. Intraoperative changes in alignment were monitored in real time using computer navigation. An axial loading force was applied to the leg in the caudal-craneal direction and gradually ramped up from 0 to 550 N. Intra-articular contact pressure (kg) and contact area (mm2) data were collected. Generalised linear models were constructed to estimate the change in contact pressure based on extra-articular force and alignment data.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IV | Pages 67 - 67
1 Mar 2012
Pape H Rixen D Morley J Ellingson C Dumont C Garving C Vaske B Mueller M Krettek C Giannoudis P
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Purpose

The timing of definitive fixation for major fractures in polytrauma patients is controversial. To clarify this aspect of trauma management, we randomised patients with blunt multiple injuries to either initial definitive stabilisation of the femur shaft with an intramedullary nail or an external fixator which was converted to an intramedullary nail at a secondary procedure and documented the post-operative clinical condition.

Methods

Multiply injured patients with femoral shaft fractures were randomised to either initial (<24 hours) intramedullary femoral nailing or to initial external fixation and conversion to an intramedullary nail at a later phase. Inclusion criteria: New Injury Severity Score >16 points, or 3 fractures and Abbreviated Injury Scale score >2 points and another injury (Abbreviated Injury Scale score >2 points), and age 18 to 65 years. Exclusion criteria: unstable or patients in extremis. Patients were graded as stable or borderline (increased risk of systemic complications). OUTCOMES: Incidence of acute lung injuries.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_II | Pages 92 - 92
1 Feb 2012
Giannoudis P Allami M Harwood P Macdonald D Dimitriou R Pape H Krettek C
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We aimed to investigate the treatment and outcome of patients over 65 years of age with tibial Pilon fracture. Patients were treated by primary open reduction and internal fixation or external fixation (EF) as determined by local soft tissue conditions. Patient course, incidence of radiological osteoarthritis and functional outcome using the SF-36 questionnaire were recorded. All patients were evaluated serially until discharge from final follow-up. The mean follow-up time was 28 months (12-45). Statistical analysis was performed using Analyse-it(tm) software for Excel.

In total 25 patients were studied. Two patients died before completion of treatment and were excluded from the final analysis. Therefore, 23 patients (10 male) were included with a mean age of 70.9 years (range 66-89) and a mean ISS of 10.25 (range 9-22). There were 4 grade IIIb open injuries.

Three patients suffered superficial tibial wound infection. Two patients underwent early secondary amputation due to deep bone sepsis within 8 weeks of injury. One patient in the ORIF group underwent primary arthrodesis, which was subsequently revised due to non-union. 3 patients underwent secondary bone grafting to enhance healing, performed at 2, 6 and 9 weeks. 2 patients with metal work failure underwent subsequent revision of ORIF and progressed to union; the mean time to union was 33.8 weeks. At final follow-up 7 (28%) patients had radiological features of osteoarthritis but none had symptoms severe enough to warrant ankle arthrodesis. There were significant differences from the USA norm in physical function score, role physical score, and physical component score, (p< 0.01).

Conclusion/Significance

In older patients local complications are relatively common and clinical vigilance must be maintained in order to allow appropriate intervention during their post-operative course. Despite the incidence of radiological post-traumatic arthrosis, none of the patients progressed to ankle fusion.