scholarly journals Patients outcome after distal femur- and proximal tibia replacement

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0032
Author(s):  
Tilman Graulich ◽  
Caroline Kranz ◽  
Christoph Korallus ◽  
Marcus Örgel ◽  
Marco Haertle ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Distal Femur ◽  
Proximal Tibia ◽  
Pathologic Fracture ◽  
Postoperative Outcome ◽  
Functional Results ◽  
Contralateral Side ◽  
Primary Surgery ◽  
Traumatic Fracture ◽  
Flexion Force

Aims and Objectives: Mega-knee-arthroplasty are rare and indications are heterogeneous after fracture, tumour and infection. The outcome after distal femur- and/or proximal tibia replacement are unclear. We therefore wanted to analyse the postoperative outcome in case of primary and revision surgery. We hypothesize that I) Implantation of distal femur- and/or proximal tibia replacement are associated with reduced range of motion and function compared to the contralateral side and II) implantation in case of primary surgery is associated with better outcome than in case of revision surgery. Materials and Methods: We retrospectively analysed all patients in our trauma department between 1998 and 2017 who underwent a MUTARS distal femur replacement or proximal tibia replacement (Implantcast GmbH, Buxtehude, Germany). We collected general patients’ data, rang of motion, determined the Toronto extremity selvage score (TESS), musculoskeletal tumour society score (MSTS), knee society score (KSS) and Western Ontario MacMaster questionnaire (WOMAC) Score. Knee extension and flexion force was measured. Results: We included 59 patients with a mean age of 65+/-20 years. Out of these we had 19 (32%) male and 40 (68%) female patients. Mean follow up (f/up) was 36+/-57 month (range: 1-218). Indication for R-TKA was periprosthetic fractures (n=14), tumour (n=16), infection (n=10), traumatic fracture (n=14), aseptic loosening (n=3) and pathologic fracture (n=2). Indication for primary implantation was given in 33 (56%) patients and for implantation in case of revision surgery in 26 (44%) patients. Mean TESS was 66+/-33, mean MSTS was 14+/-7, mean KSS was 49+/-30, mean WOMAC was 36+/-26. Mean flexion on the operated side was 83°+/-24° compared to the healthy side (115°+/-20°) (p<0.001). Mean extension force on the operated side at 60° was 20+/-12 (Nm) compared to 77+/-58 (Nm) on the not operated side (p=0.31). Mean flexion force on the operated side at 60° was 32+/-26 (Nm) compared to 53+/-42 (Nm) on the not operated side (p=0.43). In case of revision surgery significant worse function scores in the TESS and KSS could be overserved (both p<0.05). Conclusion: Implantation of a distal femur- and/or proximal tibia replacement are associated with loss of flexion, a trend to reduced extension and flexion power compared to the contralateral side. In case of primary surgery better functional results in terms of function Scores can be expected than in case of revision surgery.

scholarly journals Comparing Treatment Options for Large Talar Osteochondral Lesions

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Kenneth Chin ◽  
John T. Campbell ◽  
Rebecca Cerrato ◽  
Clifford Jeng ◽  
Tyler Rutherford
Keyword(s):  
Revision Surgery ◽  
Short Form ◽  
Small Sample Size ◽  
Treatment Options ◽  
Return To Sport ◽  
Postoperative Outcome ◽  
Functional Results ◽  
Small Sample ◽  
Osteochondral Lesions ◽  
Physical And Mental Health

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: The surgical treatment of large or revision osteochondral (OCD) lesions of the talus remain challenging. Currently, there are several treatment options for these patients, including: osteochondral autograft (OATS), allograft cartilage extracellular matrix (Arthrex BioCartilage), and particulated juvenile articular cartilage allograft (Zimmer DeNovo). Due to the relative rarity of these procedures, the literature comparing these three modalities is scarce. The aim of this study was to assess midterm clinical outcomes after these surgical treatments for large or revision talar OCD lesions. Methods: Hospital IRB approval was obtained. We reviewed surgical case logs and identified 78 total patients between 2003- 2015 for inclusion in this retrospective study. Thirty-three patients were excluded due to incomplete preoperative or postoperative outcome scoring data, and 23 patients are pending followup, leaving a cohort of N = 22 patients (5 OATS, 5 DeNovo, 12 BioCartilage). Functional outcomes preoperatively and postoperatively were evaluated using Short Form 12-item Physical and Mental Health Survey (SF12 M and SF12P) and Foot Function Index (FFI) scores, ability to return to sport or work, and the need to return to the OR for revision surgery. Data were compared using paired student’s t-test and a one way ANOVA. Results: Mean age was 38y with mean followup of 4.3y (range 1.1-12.5). Of 22 patients, three were revisions. Mean lesion size was (12.6x9.1x6.5 mm). All groups showed significant improvements in FFI (p < 0.05) compared to preoperative baseline. Only the BioCartilage group showed significant improvement in SF12P (37.6 vs 47.8, p<0.05). The OATS and DeNovo groups did not show a significant increase in SF12P, and none of the groups demonstrated significant improvement in SF12 M. All patients returned to work, and 8/11 (73%) athletes returned to sport. There were no significant differences between groups when comparing SF12, FFI, and return to sport/work. Revision surgery was necessary in 6/22 (28%) patients. Post-hoc power analysis revealed limited power (0.23), and effect size (f=0.32) may be due to small sample size. Conclusion: All three treatment methods resulted in good medium-term functional results for the treatment of large or revision talar OCD lesions. However, we were unable to distinguish significant differences between OATS, Biocartilage, and Denovo, likely due to small cohort numbers and low power. Further study is warranted with increased patient numbers to improve power and differentiate among the three treatment options, as well as provide longer clinical and radiographic follow-up.

Extended Routine Follow-up of Primary Uncomplicated Hip and Knee Arthroplasty is not Necessary

2019 ◽  
Vol 13 (1) ◽  
pp. 266-271
Author(s):  
Georgina Kakra Wartemberg ◽  
Thomas Goff ◽  
Simon Jones ◽  
James Newman
Keyword(s):  
Aseptic Loosening ◽  
Revision Surgery ◽  
Revision Arthroplasty ◽  
Cost Effective ◽  
Face To Face ◽  
Primary Surgery ◽  
Effective System ◽  
Knee Revision Surgery ◽  
Knee Revision

Aims: To create a more effective system to identify patients in need of revision surgery. Background: There are over 160,000 total hip and knee replacements performed per year in England and Wales. Currently, most trusts review patients for up to 10 years or more. When we consider the cost of prolonged reviews, we cannot justify the expenditure within a limited budget. Study Design & Methods: We reviewed all patients' notes that underwent primary hip and knee revision surgery at our institution, noting age, gender, symptoms at presentation, referral source, details of the surgery, reason for revision and follow up history from primary surgery. Results: There were 145 revision arthroplasties (60 THR and 85 TKR) that met our inclusion criteria. Within the hip arthroplasty group, indications for revision included aseptic loosening (37), dislocation (10), and infection (3), periprosthetic fracture, acetabular liner wear and implant failure. All thirty-seven patients with aseptic loosening presented with pain. Twenty-five were referred from general practice with new symptoms. The remaining were clinic follow-ups. The most common reason for knee revision was aseptic loosening (37), followed by infection (21) and then progressive osteoarthritis (8). Most were referred from GP as a new referral or were clinic follow-ups. All patients were symptomatic. Conclusion: All the patients that underwent revision arthroplasty were symptomatic. Rather than yearly follow up, we recommend a cost-effective system. We are implementing a 'non face-to-face' system. Patients would be directly sent a questionnaire and x-ray form. The radiographs and forms will be reviewed by an experienced arthroplasty surgeon. The concerning cases will be seen urgently in a face-to-face clinic.

Hisotological and radiographic determination of the age of physeal closure of the distal femur, proximal tibia, and proximal fibula of the New Zealand white rabbit

1994 ◽  
Vol 12 (5) ◽  
pp. 747-749 ◽  
Author(s):  
Moises Kaweblum ◽  
Maria Del Carmen Aguilar ◽  
Eduardo Blancas ◽  
Jaime Kaweblum ◽  
Wallace B. Lehman ◽  
...  
Keyword(s):  
New Zealand ◽  
Distal Femur ◽  
Proximal Tibia ◽  
Zealand White Rabbit ◽  
Proximal Fibula ◽  
New Zealand White Rabbit ◽  
Physeal Closure

A volar approach to on-top plasty for correction of radial polydactyly: a case series of 21 patients

2021 ◽  
pp. 175319342098185
Author(s):  
Xia Fang ◽  
Ping-tak Chan ◽  
Shengbo Zhou ◽  
Xinyi Dai ◽  
Ruiji Guo ◽  
...  
Keyword(s):  
Case Series ◽  
Functional Results ◽  
Metacarpophalangeal Joint ◽  
Contralateral Side ◽  
Average Score ◽  
Pinch Strength ◽  
Level Of Evidence ◽  
Volar Approach ◽  
Flexion Extension ◽  
Aesthetic Results

Correction of unequal radial polydactyly in which neither thumb duplicates possess both well-developed proximal and distal components, remains challenging. Current techniques using on-top plasty techniques require circumferential incisions, often resulting in postoperative swelling and dorsal scars. We described our experience using a volar approach to achieve better aesthetic and functional results. Twenty-one patients underwent this surgery between 2008 and 2018, with a mean follow-up of 5.1 years. The mean flexion–extension arc for the metacarpophalangeal joint was 75° and that of the interphalangeal joint was 43°. Mean percentage of key, tripod and tip pinch strength were 77%, 79% and 77%, respectively, when compared with the contralateral side. The Vancouver Scar Scale showed an average score of 1.2. We conclude from our study that the volar approach to on-top plasty is a good technique for the correction of unequal radial polydactyly, with good functional and aesthetic results. Level of evidence: IV

Analysis of an Early Intervention Tibial Component for Medial Osteoarthritis

2014 ◽  
Vol 136 (6) ◽  
Author(s):  
M. E. Chaudhary ◽  
P. S. Walker
Keyword(s):  
Early Intervention ◽  
Tibial Component ◽  
Strain Energy ◽  
Distal Femur ◽  
Proximal Tibia ◽  
Metal Plate ◽  
Thin Metal ◽  
Bone Resection ◽  
Component Loosening ◽  
Thin Metal Plate

Tibial component loosening is an important failure mode in unicompartmental knee arthroplasty (UKA) which may be due to the 6–8 mm of bone resection required. To address component loosening and fixation, a new early intervention (EI) design is proposed which reverses the traditional material scheme between femoral and tibial components. The EI design consists of a plastic inlay for the distal femur and a thin metal plate for the proximal tibia. With this reversed materials scheme, the EI design requires minimal tibial bone resection compared with traditional UKA. This study investigated, by means of finite element (FE) simulations, the advantages of a thin metal tibial component compared with traditional UKA tibial components, such as an all-plastic inlay or a metal-backed onlay. We hypothesized that an EI tibial component would produce comparable stress, strain, and strain energy density (SED) characteristics to an intact knee and more favorable values than UKA components, due primarily to the preservation of dense cancellous bone near the surface. Indeed, FE results showed that stresses in the supporting bone for an EI design were close to intact, while stresses, strains, and strain energy densities were reduced compared with an all-plastic UKA component. Analyzed parameters were similar for an EI and a metal-backed onlay, but the EI component had the advantage of minimal resection of the stiffest bone.

scholarly journals GCT of knee treated with modular prosthesis-case presentation

2019 ◽  
Vol 2 (1) ◽  
pp. 18-22
Author(s):  
Alexandru Papuc ◽  
Ioan Mihai Japie ◽  
Traian Ciobanu ◽  
Octavian Nutiu ◽  
Dragos Radulescu ◽  
...  
Keyword(s):  
Bone Tumors ◽  
Benign Tumor ◽  
Distal Femur ◽  
Proximal Tibia ◽  
Metastatic Potential ◽  
Left Knee ◽  
Case Presentation ◽  
Previous Medical History ◽  
Malignancy Potential

AbstractThe GCT is an aggressive benign tumor with metastatic potential, most often within the lungs in 2-3% of the patients. It makes about 5% of total bone tumors and about 15% of total benign bone tumors.The maximum incidence occurs between 30 and 40 years old, most frequently affecting the long bones epiphysis (distal femur, proximal tibia, and distal radius).We report the case of a 50-year-old female, with no previous medical history, admitted in the emergency department (ED) for significant pain and functional impairment of the left knee. Clinical examination and imaging tests established the diagnosis of distal femoral tumor.The patient underwent surgical segmental resection of the tumor within oncological limits and subsequent arthroplasty with cemented modular tumoral prosthesis was performed.Even if the GCT is a benign tumor, it has an aggressive behavior and malignancy potential with an important impact on quality of life. Due to localization, this type of tumor can quickly manifest clinically, which allows an early diagnosis and a less invasive surgical technique.

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