RESUMEN

INTRODUCTION: Nocturnal knee pain and sleep disorders are two common but poorly studied issues contributing to dissatisfaction following knee arthroplasty. This study aims to evaluate the prevalence and associated factors of nocturnal pain and sleep disturbance in a population undergoing knee arthroplasty. METHODS: We included in this prospective observational study 111 patients undergoing knee athroplasty (79 TKA and 32 UKA). Sleep quality, nocturnal knee pain (preoperatively, at day 3, at 3 and 6 weeks, at 3 months and one year after surgery), pain during mobilization and neuropathic pain were evaluated by scores. Painkillers and sleeping pills intake were recorded. Potentially predictive factors for postoperative nocturnal pain evolution were studied. RESULTS: Poor sleeping quality rate was 54% for the pre-operative patients and was still 53% at one year after surgery. The prevalence of nocturnal knee pain was 38,74% before surgery and 2,9% at one year after arthroplasty. This study has been performed at the University Hospital Saint Luc Brussels. Evolution and Characteristics of nocturnal knee pain after knee arthroplasty. Nocturnal pain after knee surgery was significantly associated with higher pain scores at rest during activity and at night. Nocturnal pain was significantly associated with a higher PSQI and DN4 scores and a higher consumption of painkillers or sleeping pills at W6. The multiple variable regression showed a statistically significant correlation between preoperative and postoperative nocturnal pain at D3 and W3. Compared to TKA, UKA patients reported significantly less nocturnal pain at W3 and W6. CONCLUSIONS: Bad sleeping quality is present in 54% of knee arthroplasty patients before and after surgery. Nocturnal pain is present in 39% of knee arthroplasty patients before surgery and this drops to 3% after one year. Nocturnal pain is associated with higher pain intensity, neuropathic symptoms, increased medication consumption and poor sleeping quality. Night pain disappeared faster after UKA than TKA, with a tipping point around 6 weeks postoperatively.

RESUMEN

The extramedullary guides for the tibial resection during medial unicompartmental knee arthroplasty (UKA) are inaccurate, with an error risk in coronal and sagittal planes and cut thickness. It was our hypothesis that the use of anatomical landmarks for the tibial cut can help the surgeon to improve accuracy. The technique described in this paper is based on the use of a simple and reproducible anatomical landmark. This landmark is the line of insertion of the fibers of the deep medial collateral ligament (MCL) around the anterior half of the medial tibial plateau called the "Deep MCL insertion line". The used anatomical landmark determines the orientation (in the coronal and sagittal planes) and the thickness of the tibial cut. This landmark corresponds to the line of insertion of the fibers of the deep MCL around the anterior half of the medial tibial plateau. A consecutive series of patients who underwent primary medial UKA between 2019 and 2021 were retrospectively reviewed. A total of 50 UKA were included. The mean age at the time of surgery was 54.5 ± 6.6 years (44-79). The radiographic measurements showed very good to excellent intra-observer and inter-observer agreements. The limb and implant alignments and the tibial positioning were satisfying, with a low rate of outliers and good restoration of the native anatomy. The landmark of the insertion of deep MCL constitutes a reliable and reproducible reference for the tibial cut axis and thickness during medial UKA, independent of the wear severity.

RESUMEN

The impact of a diaphyseal femoral deformity on knee alignment varies according to its severity and localization. The aims of this study were to determine a method of assessing the impact of diaphyseal femoral deformities on knee alignment for the varus knee, and to evaluate the reliability and the reproducibility of this method in a large cohort of osteoarthritic patients. All patients who underwent a knee arthroplasty from 2019 to 2021 were included. Exclusion criteria were genu valgus, flexion contracture (> 5°), previous femoral osteotomy or fracture, total hip arthroplasty, and femoral rotational disorder. A total of 205 patients met the inclusion criteria. The mean age was 62.2 years (SD 8.4). The mean BMI was 33.1 kg/m2 (SD 5.5). The radiological measurements were performed twice by two independent reviewers, and included hip knee ankle (HKA) angle, mechanical medial distal femoral angle (mMDFA), anatomical medial distal femoral angle (aMDFA), femoral neck shaft angle (NSA), femoral bowing angle (FBow), the distance between the knee centre and the top of the FBow (DK), and the angle representing the FBow impact on the knee (C'KS angle). The FBow impact on the mMDFA can be measured by the C'KS angle. The C'KS angle took the localization (length DK) and the importance (FBow angle) of the FBow into consideration. The mean FBow angle was 4.4° (SD 2.4; 0 to 12.5). The mean C'KS angle was 1.8° (SD 1.1; 0 to 5.8). Overall, 84 knees (41%) had a severe FBow (> 5°). The radiological measurements showed very good to excellent intraobserver and interobserver agreements. The C'KS increased significantly when the length DK decreased and the FBow angle increased (p < 0.001). The impact of the diaphyseal femoral deformity on the mechanical femoral axis is measured by the C'KS angle, a reliable and reproducible measurement.

RESUMEN

PURPOSE: To report the early clinical and radiographic outcomes of custom total knee arthroplasty (TKA) in knees that had prior osteotomies and/or extra-articular fracture sequelae. METHODS: The authors retrospectively analysed a consecutive series of 444 knees that received custom TKA between 2016 and 2019 and identified 41 knees that had prior extra-articular events (osteotomies or fracture sequelae). Patients responded to pre- and post-operative (> 12 months) questionnaires, including Knee Society Score (KSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS) and Knee injury and Osteoarthritis Outcome Score (KOOS). Net improvements were calculated by subtracting pre- from post-operative scores. In addition to a preoperative CT scan, pre- and post-operative long-leg weight-bearing radiographs were obtained, on which the hip-knee-ankle (HKA) angle, femoral mechanical angle (FMA, between femoral mechanical axis and joint line) and tibial mechanical angle (TMA, between tibial mechanical axis and joint line) angles were measured, and alignment was planned within a 'target zone' of FMA and TMA within 85°-95° and HKA angle within 175°-183°. Agreements between preoperative, planned and post-operative angles were calculated using intra-class correlation coefficients (ICC). RESULTS: From the initial 41 knees, 3 had incomplete post-operative data and 1 was revised for painful stiffness due to uncorrected rotational malunion, leaving 37 knees for analysis. Twenty had prior osteotomies (tibia, n = 18, femur, n = 2), 8 had isolated fractures (tibial, n = 3; femoral, n = 5), and 9 had both osteotomies and fractures. Postoperative coronal alignments were 90.4° ± 2.4° for FMA, 89.3° ± 2.6° for TMA and 179.9° ± 3.0° for HKA angle. Agreements between planned and achieved alignments were fair to excellent, and 29 (78%) knees were within the 'target zone'. At a mean follow-up of 15 ± 5 months, all clinical scores had improved significantly (p < 0.001). CONCLUSIONS: Custom TKA granted satisfactory clinical outcomes and a low complication rate in knees that had prior osteotomies and/or extra-articular fracture sequelae. Using custom implants and strategies for coronal alignment, 29 (78%) of the 37 knees were successfully aligned within the 'target zone', and 35 (95%) of the 41 knees did not require ligament release. LEVEL OF EVIDENCE: IV.

Asunto(s)

RESUMEN

PURPOSE: The purpose of this systematic review and meta-analysis was to investigate the variability in tibial geometric ratios among knees of different sexes and races to determine whether commercially-available tibial baseplates accommodate the morphologic diversity. The hypothesis was that anthropometric studies report considerable variability of tibial geometric ratios among sexes and races. METHODS: This systematic review and meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on 28 January 2021 for clinical studies reporting on tibial geometric ratios. Tibial geometric ratios, as reported by the clinical studies, were represented by plotting their means and two standard deviations for comparison to two symmetric and two asymmetric commercially-available tibial baseplates. RESULTS: A total of 27 articles that reported on a combined total of 20,944 knees were eligible for data extraction. Variation in tibial aspect ratios was equal among sexes. The greatest variation in aspect ratio was observed among East Asians, followed by Caucasians, African-Americans, Indian and Middle Easterns. The variation in tibial asymmetry ratio was larger among men compared to women. The greatest variation in asymmetry ratio was observed among African-Americans, followed by Caucasians, East Asians, Indian and Middle Easterns. Bone-implant mismatch of > 3 mm overhang or > 4 mm under-coverage with four commercially-available tibial baseplates occurred in large proportions of knees due to variations in aspect ratio (in 17-100% of knees) and asymmetry ratio (in 7-100% of knees). CONCLUSION: Anthropometric studies reported considerable inter-individual variability of tibial geometric ratios, which exceeded effects of sexual dimorphism and racial diversity. Bone-implant mismatch may be unavoidable in a large proportion of knees, when considering that a surgeon generally only uses one or a few TKA brands. These findings support the drive towards patient-specific implants to potentially achieve accurate bone-implant fit by implant customisation. LEVEL OF EVIDENCE: IV.

Asunto(s)

RESUMEN

We present a surgical technique to reconstruct the deep portion of the medial collateral ligament (MCL) when associated with an injury of the anterior cruciate ligament (ACL). Patients could benefit from this procedure in cases of ACL reconstruction and persistent laxity at 20° of flexion of the MCL without any laxity in extension. This surgery uses the gracilis to reconstruct the deep portion of the MCL in the same manner described for the anterolateral ligament on the other side of the knee. The procedure is performed percutaneously, graft and tunnels are independent from the ACL, a screw is used on the femoral side, and a cortical device is used on the tibial side.

RESUMEN

PURPOSE: The purpose of this study was to report Knee Society Scores (KSS) at 12-month follow-up in a series of 266 knees that received custom TKA. The hypothesis was that custom TKA combined with personalised alignment would yield improvements greater than substantial clinical benefits (SCB) of KSS Knee and Function. METHODS: From a consecutive series of 905 patients (918 knees) that received primary TKAs, 261 (29%) patients (266 knees) received computed tomography (CT)-based posterior-stabilised cemented custom TKA. Knees were aligned aiming to preserve or restore constitutional alignment within predetermined limits of 85°-95° for femoral mechanical angle (FMA) and tibial mechanical angle (TMA), and 175°-183° for hip knee ankle (HKA) angle. The KSS Knee and Function were collected preoperatively and 12 months postoperatively, to determine if patients achieved SCB. Uni- and multivariable analyses were performed to determine associations between KSS scores (Knee and Function) and patient demographics as well as pre- and postoperative radiographic alignments. RESULTS: Of the initial cohort of 261 patients, 4 (1.8%) were reoperated for patellar resurfacing, 1 (0.4%) for lavage to treat infection, and 1 (0.4%) had arthroscopy to treat a stiff knee with < 90° range of motion. Complete clinical records were available for 227 patients (232 knees, 87%) that comprised 102 men (5 bilateral) and 125 women. At 12-month follow-up, mean improvements in KSS Knee and Function scores were, respectively, 61.0 ± 13.0 and 42.7 ± 16.7, which exceeded the SCB of KSS. Comparison of knees inside versus outside the target zone revealed no differences in KSS Knee (94.1 ± 9.1 versus 94.3 ± 9.0, n.s.) and Function (96.1 ± 9.2 versus 96.3 ± 8.9, n.s.). Multivariable analysis revealed worse KSS Knee in knees with preoperative FMA > 95° (ß = - 6.21; p = 0.023), but no association between KSS Function and patient demographics or pre- and postoperative radiographic alignments. CONCLUSIONS: Custom TKA combined with personalised alignment yielded improvements that exceeded substantial clinical benefits of KSS Knee and Function scores. These findings demonstrate the feasibility of custom TKA with 'personalised alignment' and encourage further investigations using comparative studies at longer follow-up. LEVEL OF EVIDENCE: IV, case series.

Asunto(s)

RESUMEN

PURPOSE: The purpose of this systematic review and meta-analysis was to investigate the variability in femoral geometric ratios among knees of different sexes and races, and to appreciate whether the observed variability is accommodated by commonly implanted total knee arthroplasty (TKA) components. The hypothesis was that the anthropometric studies report considerable variability of femoral geometric ratios among sexes and races. METHODS: This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on 6 July 2020 for clinical studies reporting on femoral geometric ratios among sexes and races. Femoral geometric ratios were graphically represented as means and 2 standard deviations, and compared to those of 13 commonly implanted femoral components. RESULTS: A total of 15 studies were identified that reported on a combined total of 2627 knees; all reported the aspect ratio, and 2 also reported the asymmetry ratio and trapezoidicity ratio. Men had wider knees than women, and compared to Caucasian knees, Arabian and Indian knees were wider, while East Asian were narrower. There were no differences in asymmetry ratio between men and women, nor among Caucasian and East Asian knees. Men had more trapezoidal knees than women, and East Asian knees were more trapezoidal than Caucasian knees. The commonly implanted femoral components accommodated less than a quarter of the geometric variability observed among sexes and races. CONCLUSION: Anthropometric studies reported considerable sexual dimorphism and racial diversity of femoral geometric ratios. Since a surgeon generally only uses one or a few TKA brands, bone-implant mismatch remains unavoidable in a large proportion of knees. These findings support the drive towards personalized medicine, and accurate bone-implant fit may only be achievable through customisation of implants, though the clinical benefits of custom TKA remain to be confirmed. LEVEL OF EVIDENCE: IV.

Asunto(s)

RESUMEN

BACKGROUND: Methicillin-Resistant Staphylococcus Aureus (MRSA) has been widely recognized as a serious problem in hospital settings. The purpose of this study is to evaluate the predictive value of MRSA colonization factors in the detection of MRSA carriers in an orthopedic ward. METHODS AND MATERIALS: A systematic MRSA detection strategy was set up to assess the predictive value of MRSA colonization factors among 554 patients undergoing elective knee arthroplasty. RESULTS: In total 116 patients were found positive for Staphylococcus Aureus; among those 110/116 patients were found positive for Methicillin-Sensitive Staphylococcus Aureus (MSSA) and 6/116 for MRSA. Only one patient out of six presented two risk factors according to MRSA risk factors. In this study, no correlation was found between the remaining conventional risk factors, according to Belgian guidelines, defined to target high-risk populations and to identify MRSA carriers. CONCLUSIONS: Established criteria for selective MRSA screening do not allow detecting MRSA carriers. The objective of detecting MRSA carriers is not correctly met by the actual applied criteria (Belgian consensus) for a selective screening policy. Future studies should aim at identifying the right risk factors, depending of the country's prevalence of MRSA, to improve the ability to predict the risk of MRSA carriage at hospital admission.

Asunto(s)