Purpose:

To describe the health status of patients after total knee replacement (TKR) and compare it with the state of health of a comparative Spanish population

Materials and methods: This is an observational analytical study The following variables were assessed: sociodemographic, clinical and HRQofL. Health status was determined by means of generic and specific questionnaires (SF-36 and WOMAC). The age (65–74 years of age) and sex (VPR) values of the comparative population were used. Statistical analysis: mean values and standard deviation were calculated for continuous variables; percentages were determined for categorical variables and Spearman’s correlation analysis was used to determine the correlation of quality of life variables.

Results: There were 82 patients of 72.5 years of age (SD 7.5), 78% were women. There were significant differences between the preoperative and the postoperative WOMAC in pain, stiffness and function (p< 0.001, p=0.035, p< 0.001, respectively). Seventy-nine percent of the patients reported improvement after surgery, and an improvement in general health was also seen (SF-36). However, these values did not reach those of the comparison population in terms of physical function and pain (51.5 vs 61.3 and 50.7 vs 59.0, respectively for women and 60.5 vs 68.9 and 65.0 vs 76.7 for men). The rest of the figures were comparable to those of the comparison population. The correlation between WOMAC function and SF-36 physical function was 87% and that between WOMAC pain and SF-36 body pain, 77%; both were statistically significant (p< 0.001).

Conclusions: Patients reported improvement after TKR both in terms of function and pain and also in their general health status although they did not achieve the values of the comparative population as regards physical function and pain. The correlation between both questionnaires was extremely high, therefore, it is possible to leave aside the specific questionnaire and use the SF-36 since it provides multidimensional information on patients’ HRQofL.

Glenoid replacement is technically challenging. Removal of a cemented glenoid component often results in a large osseous defect which makes the immediate introduction of a revision prosthesis almost impossible. We describe a two-stage revision procedure using a reversed shoulder prosthesis. Freeze-dried allograft with platelet-derived growth factor was used to fill the glenoid defect. Radiological incorporation of the allograft was seen and its consistency allowed the placement of a screwed glenoid component. There were no signs of new mature bone formation on histological examination.

The addition of platelet-derived growth factor to the allograft seems to contribute to an increase in incorporation and hardness, but does not promote the growth of new bone.

Introduction and Objectives: Periprosthetic fractures present some difficult problems: the inability to use intramedullary implants, difficulty in inserting screws (since the cavity is occupied), bone fragility, great mechanical demands, elderly patients, and associated conditions. We have used two osteosynthesis reinforcement techniques in these cases: massive intramedullary cementation and implantation of bone allograph counterplates. Both techniques give a simple solution for complex peri-prosthetic fractures.

Materials and Methods: We used this technique to treat 9 periprosthetic fractures of the femur between 1999 and 2003. In 3 cases, massive intramedullary cementation was used (Johansson type III, distal to the prosthetic stem) and in 6 cases a bone allograft counterplate (Johansson type II, around the prosthesis), associated with the stem replacement in 2 cases. Allografts came from the Tissue Bank of the Institut Clinic de l’Aparell Locomotor (ICAL). There were 7 females and 2 males, with an average age of 76 years (range: 66–83). Average follow-up time was 14 months (range: 6 months to 3.5 years).

Results: In 8 of 9 cases (89%), fracture consolidation was achieved in 3.5 months, with patients regaining the same ability to walk as before the injury. In one case with intramedullary cementation, non-union developed with breakage of the plate at 10 months post-intervention. This case was treated with compression osteosynthesis with a new plate and bone allograft counterplate, and final outcome was satisfactory (consolidation at 4 months) with the patient walking with full weight bearing without crutches.

Discussion and Conclusions: We believe both techniques are useful in the resolution of periprosthetic fractures of the femur over porous bone. However, a very precise surgical technique is necessary, as well as respect for the classical principles of osteosynthesis: fracture fixation with anatomic reduction, interfragmentary compression, and maximum care afforded soft tissue.