RESUMEN
BACKGROUND: Achieving neutral limb alignment during total knee arthroplasty (TKA) has been considered an important determinant in the long-term prosthesis survival. The purpose of this study was to evaluate the association between the immediate postoperative mechanical alignment of the lower limb and the rate of revision TKA by comparing an acceptable mechanical axis group (within ± 3° from neutral alignment) and an outlier group (> 3° deviation from neutral alignment). METHODS: Between 2000 and 2006, clinical and radiographic data of 334 primary TKAs were retrospectively reviewed to determine the 10-year Kaplan-Meier survival rate. Patients were divided into acceptable and outlier groups according to the mechanical axis checked postoperatively within a month. Clinical outcomes were assessed using Hospital for Special Surgery, Knee Society Score, and Western Ontario and McMaster Universities Osteoarthritis Index score preoperatively and at the final follow-up. Postoperative complications and revision rates were also evaluated. RESULTS: The mean change in mechanical axis between the immediate postoperative examination and the last follow-up was greater in the outlier group (1.6 ± 2.7) than in the acceptable group (0.8 ± 2.4). The revision rates were significantly different between the two groups (p = 0.04). At the last follow-up, clinical scores were all improved in both groups compared to each preoperative condition. There were no significant differences in clinical scores between the two groups at the last follow-up. The 10-year Kaplan-Meier survival analysis showed a tendency towards better survival with restoration of neutral mechanical axis. However, the difference was not statistically significant (p = 0.25). CONCLUSIONS: Restoration of neutral limb alignment is a factor that can result in a lower revision rate and higher longevity in TKA. However, there were no significant differences in clinical outcomes between the two groups.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Anciano , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/mortalidad , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Complicaciones Posoperatorias , Falla de Prótesis , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
PURPOSE: The purpose of the present study was to compare functional outcomes of medial unicompartmental knee arthroplasty (UKA) in patients with patellofemoral osteoarthritis (PF OA) and those without PF OA and to evaluate the effect of PF OA on functional outcomes after UKA. METHODS: The outcomes of 48 knees in patients without PF OA who underwent medial UKA (non-PF OA group) were compared to the outcomes of 57 knees in patients with PF OA [Kellgren-Lawrence (K-L) grade ≤ 2] who underwent medial UKA (PF OA group) with a median follow-up of 5.4 years (range 3.1-10.2 years). Clinical outcomes including anterior knee pain, HSS scores, radiological parameters, and the progression of patellofemoral osteoarthritis were compared, and their effects on functional outcomes were evaluated at the final follow-up visits. RESULTS: At final follow-up visits, no significant inter-group difference was found in terms of anterior knee pain (1.9 vs. 1.9 in non-PF OA and PF OA groups, respectively), HSS score, or range of motion. Preoperative anterior knee pain and patellofemoral joint degeneration were found to be unrelated to poor outcome in patients that underwent medial UKA. Furthermore, no correlation was found between any functional outcome variable and chondral lesion pattern. CONCLUSIONS: The result of UKA for medial unicompartmental knee osteoarthritis was excellent regardless of PF OA (K-L grade ≤ 2). Hence, the patients with medial unicompartmental OA combined with a moderate degree of anterior knee pain or patellofemoral arthritis should be viewed as appropriate candidates for medial UKA. LEVEL OF EVIDENCE: III.
Asunto(s)
Artralgia/etiología , Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla/cirugía , Articulación Patelofemoral , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Prótesis de la Rodilla , Masculino , Persona de Mediana Edad , Recuperación de la Función , Resultado del TratamientoRESUMEN
BACKGROUND: Heterotopic ossification following lower-limb joint arthroplasty is a challenging clinical problem. No comprehensive study has been conducted on heterotopic ossification after total ankle arthroplasty, to our knowledge. The purpose of this study was to evaluate the prevalence and location of heterotopic ossification after primary total ankle arthroplasty, predisposing factors, and effects on clinical outcomes, and to develop a method of classification. METHODS: Eighty ankles in eighty patients with a primary total ankle arthroplasty were followed for a mean (and standard deviation) of 31.9 ± 11.3 months (range, twenty-four to sixty-five months). The prevalence and location of heterotopic ossification, predisposing factors, and outcomes were analyzed, and a method of classification was developed. RESULTS: Twenty (25%) of the eighty ankles demonstrated postoperative heterotopic ossification, with the majority of the cases in the posterior aspect of the ankle. The heterotopic ossification was Class I in four cases (20%); Class II, in five (25%); Class III, in four (20%); and Class IV, in seven (35%). Symptomatic heterotopic ossification was reported in eight patients (10%), and two required surgical resection because of intractable pain. Ankles that developed heterotopic ossification had significantly longer operative times, less postoperative motion, and lower American Orthopaedic Foot & Ankle Society ankle-hindfoot scores at the six, twelve, and twenty-four-month follow-up examinations (p < 0.05 for all). CONCLUSIONS: This study demonstrates that the prevalence of heterotopic ossification following primary total ankle arthroplasty is considerable, and that heterotopic ossification is associated with reduced ankle motion and a poor clinical outcome at a mean of two years postoperatively. Care is needed to attempt to reduce the occurrence of heterotopic ossification.
Asunto(s)
Articulación del Tobillo/cirugía , Artroplastia de Reemplazo de Tobillo/métodos , Prótesis Articulares , Osificación Heterotópica/epidemiología , Osteoartritis/cirugía , Complicaciones Posoperatorias/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osificación Heterotópica/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Prevalencia , Radiografía , Estudios Retrospectivos , Factores de RiesgoRESUMEN
PURPOSE: The purpose of this study was to compare in vivo kinematics, range of motion, and functional outcomes in patients that received either a high-flexion cruciate retaining or a high-flexion cruciate substituting knee. METHODS: Forty-eight high-flexion cruciate retaining (CR) and 47 high-flexion cruciate substituting (PS) knees were included in this study and followed for an average of 27 months (24-33). Weight-bearing and non-weight-bearing maximal flexions and functional scores were compared between two groups. For kinematics evaluations, amount of posterior femoral roll-back and internal tibial rotation from 0° to maximal flexion using lateral radiographs under weight-bearing conditions were also compared. RESULTS: Average weight-bearing maximal flexion was 126.3° in the PS group, which was significantly higher than the 115.0° in the CR group. Average functional scores showed no significant difference between the two groups. In terms of kinematics, the average amount of posterior femoral roll-back during full flexion was 9.6 mm in the PS group and 6.1 mm in the CR group, which was a significant difference. However, internal tibial rotation during full flexion was not significantly different in the two groups. CONCLUSION: PS high-flexion TKA provided greater weight-bearing maximal flexion and posterior femoral roll-back than CR high-flexion TKA, although no difference in clinical outcomes was observed between the two prosthesis designs.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Rango del Movimiento Articular/fisiología , Anciano , Anciano de 80 o más Años , Ligamento Cruzado Anterior/fisiopatología , Ligamento Cruzado Anterior/cirugía , Fenómenos Biomecánicos , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ligamento Cruzado Posterior/fisiopatología , Ligamento Cruzado Posterior/cirugía , Estudios Prospectivos , Recuperación de la Función , Estadísticas no Paramétricas , Resultado del Tratamiento , Soporte de PesoRESUMEN
The authors evaluated the relationships between preoperative and postoperative kinematics in 50 osteoarthritic knees scheduled for cruciate retaining total knee arthroplasty with regards to posterior femoral roll back and external femoral rotation using a navigation system from 10° to 120° of knee flexion. Although posterior femoral roll back was maintained, external femoral rotation was significantly decreased compared to those of the preoperative knee after total knee arthroplasty. However, the amount of posterior roll back and external femoral rotation after total knee arthroplasty were found to be significantly positively related to those measured preoperatively (r = 0.62 and 0.57, respectively). These significant kinematic correlations may explain why preoperative range of knee motion influences range of motion after total knee arthroplasty.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla , Ligamento Cruzado Posterior/cirugía , Anciano , Artroplastia de Reemplazo de Rodilla/rehabilitación , Fenómenos Biomecánicos , Femenino , Humanos , Articulación de la Rodilla/fisiopatología , Masculino , Osteoartritis de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/cirugía , Complicaciones Posoperatorias , Periodo Preoperatorio , Diseño de Prótesis , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
This study evaluated and compared the intraoperative stabilities using the low and high femoral tunnel techniques in ACL reconstruction. Seventy patients who underwent ACL reconstruction were equally allocated to low or high femoral tunnel groups (35 in the low femoral tunnel group and 35 in the high femoral tunnel group) for this study. The authors compared intraoperative anterior, internal rotational, and external rotational stabilities at 0°, 30°, 60°, and 90° of knee flexion using a navigation system after reconstruction. The low femoral tunnel group showed significantly better intraoperative internal rotational stability at 0° and 30° of flexion than the high tunnel group; however, no significant intergroup differences were found for anterior and external rotational stabilities at any flexion angle. These findings suggested that the low femoral tunnel group showed better internal rotational stability at time zero condition during ACL reconstruction than the high femoral tunnel group, but anterior and external rotational stabilities were similar. However, to determine whether these results may affect clinical results, further studies based on more accurate measurement of rotational stability in clinical settings are needed.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirugía , Fémur/cirugía , Inestabilidad de la Articulación/prevención & control , Traumatismos de la Rodilla/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto , Ligamento Cruzado Anterior/diagnóstico por imagen , Artroscopía , Femenino , Humanos , Inestabilidad de la Articulación/etiología , Traumatismos de la Rodilla/complicaciones , Masculino , Meniscos Tibiales/cirugía , Persona de Mediana Edad , Radiografía , Cirugía Asistida por Computador/métodos , Lesiones de Menisco Tibial , Adulto JovenRESUMEN
BACKGROUND: Painful plantar callosities under lesser metatarsal heads are commonly associated with hallux valgus. The purpose of the present study was to evaluate the prognosis of painful plantar callosities after hallux valgus correction without lesser metatarsal osteotomy in hallux valgus deformity. MATERIALS AND METHODS: Between September 2004 and June 2007, 31 patients (40 feet) underwent proximal chevron first metatarsal osteotomy with a distal soft tissue procedure, with preoperatively painful plantar callosities under lesser metatarsal heads. Clinical results were evaluated using a visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal interphalangeal scales, and a modified 70-point clinical scale. Radiographic evaluations included hallux valgus angle and intermetatarsal angle. RESULTS: Thirty-two (80%) of the 40 feet had no pain and callosity and 5 (12.5%) had no pain but residual plantar callosities, and 3 (7.5%) were not improved at final evaluation. The mean VAS and AOFAS scores were improved from 7.8 +/- 1.6 to 1.9 +/- 1.5 points and from 53.8 +/- 14.2 to 92.6 +/- 15.3 points, respectively. In terms of the 70-point clinical scale, overall clinical results were good in 34 feet and fair in 6. The mean hallux valgus and intermetatarsal angles were improved from 36.6 +/- 6.2 to 12.5 +/- 5.9 degrees and from 17.5 +/- 3.9 to 8.6 +/- 3.5 degrees, respectively. CONCLUSION: Painful plantar callosities under the lesser metatarsals in patients with hallux valgus deformity can be improved by hallux valgus correction alone without lesser metatarsal osteotomy.
Asunto(s)
Callosidades/epidemiología , Hallux Valgus/epidemiología , Hallux Valgus/cirugía , Huesos Metatarsianos/cirugía , Osteotomía/métodos , Adulto , Comorbilidad , Femenino , Hallux Valgus/diagnóstico por imagen , Humanos , Masculino , Huesos Metatarsianos/diagnóstico por imagen , Persona de Mediana Edad , Dimensión del Dolor , Pronóstico , RadiografíaRESUMEN
This study was done to evaluate the change of medial-lateral gap in flexion and extension after posterior cruciate ligament (PCL) release in severely deformed knees and to determine how PCL release affects bone resection, rotation, and size of the femoral component and polyethylene thickness in converting to a PCL-sacrificed design. Thirty primary osteoarthritis patients with severe varus deformity or flexion contracture were enrolled. After releasing the PCL, the medial gap in extension increased by 1.2 mm, the lateral gap in extension increased by 0.3 mm, the medial gap in flexion increased by 4.5 mm, and the lateral gap in flexion increased by 3.4 mm. Compared with PCL-retained prostheses, the mean external rotation of the femoral component decreased by 1.6 degrees in the PCL-sacrificed type. Polyethylene thickness increased by 1.2 mm. In 12 cases, a larger femoral component was needed. In 8 knees, the size of the femoral component and the thickness of polyethylene did not change; however, posterior femoral resection could be decreased. In 8 knees, thicker polyethylene was planned with slightly increased distal femoral resection. After PCL cutting, flexion gap increased significantly compared with extension gap; however, correction of varus deformity was not significant. Conversion to PCL-sacrificed design resulted in a decrease in external rotation of the femoral component and increased the size of the femoral component or the thickness of the polyethylene insert.