Proper femoral component placement plays a key role in the success of a total knee replacement (TKR). Controversy exists on which technique should be used to ensure proper femoral component placement. This two-part study compares gap balancing (GB) and measured resection (MR) techniques used in TKR, investigating femoral component position and early clinical outcomes. Femoral component position was analyzed in 95 consecutive knees that underwent primary TKR. Both GB and MR cutting blocks from the same knee system were sequentially placed on the operative knee, marking the pin sits. A standardized photograph (Figure) was taken prior to making final femoral cuts. Relative rotation was determined based on measurements made from a commercially available software. Clinical comparison was made using 50 consecutive GB patients and 50 consecutive MR patients. Clinical outcome measures were Knee Society Scores (KSS), knee range of motion (ROM), functional ROM (FROM), tourniquet time, and patients having manipulations under anesthesia (MUA).Background
Methods
Displaced fractures of the neck of femur are routinely treated in the elderly by either cemented hemiarthoplasty, in the fit, or uncemented hemiarthroplasty, in the less fit. In Scotland the Scottish Intercollegiate Guidelines Network (SIGN) guidelines are followed to identify which patients should have a cemented prosthesis. This is based on cardiovascular status, and the age and fragility of the patient. An uncemented prosthesis should be a final operation. A peri-prosthetic fracture is considered a failure of treatment as the patient then has to undergo an operation with a far greater surgical insult. We looked at all neck of femur fractures over a period of Jan 2007 to June 2010. The number of the peri-prosthetic fractures for uncemented hip hemiarthroplasties was established and a case note review was carried out. There was 1397 neck of femur fractures. 546 hemiarthroplasties were carried out, of which 183 were cemented, and 363 uncemented. 14 patients (4% of uncemented hemiarthoplasties) had peri-prosthetic fractures. The case notes of these patients were analysed. We found there was a common link of significant cardiovascular risk, lack of falls assessment (only 14% of patients had a completed falls assessment and 35% sustained their fracture during an admission to hospital) and confusion (43% had a degree of dementia that caused significant confusion). Cemented implants should be considered in those who have failed falls assessment, or are confused; even if the cardiovascular risk is significant. This decision should be made in conjunction with a senior anaesthetist. This is being implemented in our unit and a prospective audit is being carried out over the same time period (July 2010 to Dec 2013) to assess the benefit.
