Short-term results of a novel management of supracondylar fracture with coexisting osteoarthritis with bifold fixation and total knee arthroplasty

Abstract Purpose Presence of supracondylar and periarticular femoral fracture with associated arthritis of knee poses a challenging situation to the orthopaedic surgeon. The results of fixation of fracture in osteoporosis are not very satisfactory and have complications. With fixation alone, they still cannot bear weight on affected leg due to severe disability of osteoarthritis. To make patient walk, conventionally three surgeries in the form of fracture fixation, removal of implant and total knee arthroplasty (TKA) needs to be done in staged manner. We propose a novel management in form of bifold fixation and simultaneous TKA. Methods Eight cases (6 females, 2 males) of supracondylar femoral fractures with severe osteoarthritis of the knee and osteoporosis were primarily fixed with bifold fixation using SIGN nail (www.signfracturecare.org) and locking plate together with simultaneous total knee arthroplasty. There were five cases (2 males and 3 females) of grade 4 (Kellgren-Lawrence grading) osteoarthritis (OA) and three cases (all females) of severe rheumatoid arthritis (RA). Results The mean age was 68 years and average time for full weight bearing was 6 days. Radiographic evidence of fracture union was achieved in 16.25 weeks. The mean Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 26 months was 83.13 and 22.13 respectively. Conclusions Single stage combined bifold osteosynthesis with interlocking nail and locking plate together with total knee arthroplasty helps in one time management of these difficult injuries. It is a cost-effective and economically sound option and gives excellent results with good patient satisfaction.

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FRI0418 SELECTIVE PATELLAR RESURFACING IN TOTAL KNEE ARTHROPLASTY FOR THE OSTEOARTHRITIC KNEE: A PROSPECTIVE STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4074 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 807.3-807

Author(s):

I. Moriyama

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcome ◽

Knee Arthroplasty ◽

Patellofemoral Joint ◽

Osteoarthritis Of The Knee ◽

Patellar Resurfacing ◽

Criterion A ◽

Total Knee ◽

The Mean

Background:No widely accepted view or criteria currently exist concerning whether or not patellar replacement (resurfacing) should accompany total knee arthroplasty for osteoarthritis of the knee.1)2)3)Objectives:We recently devised our own criteria for application of patellar replacement and performed selective patellar replacement in accordance with this set of criteria. The clinical outcome was analyzed.Methods:The study involved 1150 knees on which total knee arthroplasty was performed between 2005 and 2019 because of osteoarthritis of the knee. The mean age at operation was 73, and the mean postoperative follow-up period was 91 months. Our criteria for application of patellar replacement are given below. Criterion A pertains to evaluation of preoperative clinical symptoms related to the patellofemoral joint: (a) interview regarding presence/absence of pain around the patella, (b) cracking or pain heard or felt when standing up from a low chair, (c) pain when going upstairs/downstairs. Because it is difficult for individual patients to identify the origin of pain (patellofemoral joint or femorotibial joint), the examiner advised each patient about the location of the patellofemoral joint when checking for these symptoms. Criterion B pertains to intense narrowing or disappearance of the patellofemoral joint space on preoperative X-ray of the knee. Criterion C pertains to the intraoperatively assessed extent of patellar cartilage degeneration corresponding to class 4 of the Outerbridge classification. Patellar replacement was applied to cases satisfying at least one of these sets of criteria (A-a,-b,-c, B and C). Postoperatively, pain of the patellofemoral joint was evaluated again at the time of the last observation, using Criterion A-a,-b,-c.Results:Patellar replacement was applied to 110 knees in accordance with the criteria mentioned above. There were 82 knees satisfying at least one of the Criterion sets A-a,-b,-c, 39 knees satisfying Criterion B and 70 knees satisfying Criterion C. (Some knees satisfied 2 or 3 of Criteria A, B and C).When the pain originating from patellofemoral joint (Criterion A) was clinically assessed at the time of last observation, pain was not seen in any knee of the replacement group and the non-replacement group.Conclusion:Whether or not patellar replacement is needed should be determined on the basis of the symptoms or findings related to the patellofemoral joint, and we see no necessity of patellar replacement in cases free of such symptoms/findings. When surgery was performed in accordance with the criteria on patellar replacement as devised by us, the clinical outcome of the operated patellofemoral joint was favorable, although the follow-up period was not long. Although further follow-up is needed, the results obtained indicate that selective patellar replacement yields favorable outcome if applied to cases judged indicated with appropriate criteria.References:[1]The Effect of Surgeon Preference for Selective Patellar Resurfacing on Revision Risk in Total Knee Replacement: An Instrumental Variable Analysis of 136,116 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.Vertullo CJ, Graves SE, Cuthbert AR, Lewis PL J Bone Joint Surg Am. 2019 Jul 17;101(14):1261-1270[2]Resurfaced versus Non-Resurfaced Patella in Total Knee Arthroplasty.Allen W1, Eichinger J, Friedman R. Indian J Orthop. 2018 Jul-Aug;52(4):393-398.[3]Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?Maradit-Kremers H, Haque OJ, Kremers WK, Berry DJ, Lewallen DG, Trousdale RT, Sierra RJ. J Arthroplasty. 2017 Apr;32(4):1143-1147.Disclosure of Interests:None declared

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TOTAL KNEE ARTHROPLASTY;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.09.823 ◽

2017 ◽

Vol 24 (09) ◽

pp. 1403-1408

Author(s):

Faisal Abdul Jabbar ◽

Rehana Ali Shah ◽

Muhammad Hashim

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Knee Arthroplasty ◽

Tertiary Care ◽

Osteoarthritis Of The Knee ◽

Care Hospital ◽

Level Of Satisfaction ◽

Significant Difference ◽

Total Knee ◽

The Mean

Objectives: We aim to evaluate the level of satisfaction after total knee arthroplastyprocedure in the patient population at a tertiary care hospital in Karachi, Pakistan, and to assessthe relationship between patient satisfaction and the outcome based on traditional scores.Methods: Study Design: Case series for determination of patient satisfaction. Period: Oneyear duration from April 2015 to May 2016. Setting: Tertiary care centre in Karachi, Pakistan.The inclusion criteria was all the patients with late stage osteoarthritis of the knee joint andunderwent total knee arthroplasty at our institute. Data was analyzed using SPSS version 22.Results: A total of n= 102 patients were included in the study while n= 109 knee surgerieswere done in total (n= 95 patients had unilateral surgery, while n= 7 patients had bilateralsurgeries on both the knee joints) n= 58 patients were females while n= 44 patients weremales, the median age was 60 years, patients had a mean body mass index (BMI) of 27kg/m2. Of the total surgeries performed n= 100 were in the satisfaction group while n= 9 were inthe dissatisfaction group. The majority of the patients reported that they would recommend theprocedure. The co morbid conditions did not affect the patient’s level of satisfaction having ap value of 0.678. In the dissatisfied group, there was no significant difference when it comes togender, the mean age of patients in the dissatisfaction group was higher than the mean age ofpatients in the satisfaction. We found that WOMAC scores for functioning and the final WOMACscores were correlated with patient satisfaction and that was statistically significant, similarlySF-36 form patients were satisfied about the improvement in the physical health while they didnot improve the mental health aspect of their disease. Conclusion: According to our studytotal knee arthroplasty is an effective treatment for osteoarthritis of the knee, patient satisfactionis correlated with post-operative WOMAC function and overall scores, and SF-36 physicalcomponent. It is important to keep patients expectations in check through proper counseling.

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Selfdynamisable internal fixator Mitkovic in treatment of periprosthetic supracondylar femoral fracture after total knee arthroplasty

Acta chirurgica iugoslavica ◽

10.2298/aci1501049s ◽

2015 ◽

Vol 62 (1) ◽

pp. 49-55

Author(s):

Predrag Stojiljkovic ◽

Milorad Mitkovic ◽

Zoran Golubovic ◽

Ivan Micic ◽

Sasa Milenkovic ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Surgical Treatment ◽

Minimally Invasive ◽

Knee Arthroplasty ◽

Weight Bearing ◽

Internal Fixator ◽

Full Weight Bearing ◽

Invasive Technique ◽

Femur Fractures ◽

Total Knee

Supracondylar periprosthetic femoral fractures after total knee arthroplasty are very rare, but very difficult to treat. They occur most often as a result of low energy trauma (slips and fall) in older patients with present osteoporosis and periprosthetic osteolysis. The treatment of these fractures is very difficult due to reduced biological capacity for healing in most cases. Surgical treatment of these fractures is accompanied by severe complications (prolonged healing, nonunion and disintegration osteosintets material) in 25 to 70% of the cases. The aim of this paper is to present the treatment of supracondylar femur fractures after total knee arthroplasty in men aged 72 with selfdynamisable internal fixator Mitkovic. Surgical treatment of fracture performed on the six day after the injury with minimally invasive surgical technique through two incisions. Verticalization and walking with crutches with non-weight-bearing started the first postoperative day. Patient discharged from hospital fifth postoperative day. Full weight-bearing on the operated leg is allowed after 6 weeks. The patient started a stationary physical therapy 6 weeks after surgery. Postoperative follow-up was 10 months. The fractures healed with an excellent functional result. Application of selfdynamisable internal fixator Mitkovic with minimally invasive technique in the treatment of these complex fractures provides excellent biomechanical conditions for healing.

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Neutral or Natural? Functional Impact of the Coronal Alignment in Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0038-1669788 ◽

2018 ◽

Vol 32 (08) ◽

pp. 820-824 ◽

Cited By ~ 2

Author(s):

Erik Schiffner ◽

Michael Wild ◽

Bertram Regenbrecht ◽

Alberto Schek ◽

Mohssen Hakimi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Weight Bearing ◽

Oxford Knee Score ◽

Clinical Results ◽

Full Weight Bearing ◽

Knee Score ◽

Varus Alignment ◽

Neutral Group ◽

Total Knee

AbstractTotal knee arthroplasty (TKA) is a very successful procedure. The alignment in TKA has been identified as being of importance to prevent early implant failure and patient dissatisfaction. Our hypothesis was that patients with a preoperative varus deformation remaining in a slight varus alignment as their natural alignment after TKA will have superior clinical results compared with patients who are restored in neutral alignment. A total of 115 patients were corrected from varus to neutral (varus–neutral) and in 33 patients a preoperative varus alignment was kept in varus (varus). Standardized preoperative and postoperative full-length hip–knee–ankle radiographs under full weight-bearing conditions were performed in all patients. The patients' knees were categorized preoperatively and postoperatively based on the angle between mechanical femoral axis and mechanical tibial axis. Knees with alignment between ± 3 degrees were categorized as neutrally aligned, whereas alignment within ≤ –3 degrees was categorized as varus. The Knee Injury Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score were determined retrospectively. The varus group scored significantly better in total KOOS (p < 0.05) compared with the varus–neutral group. Also, a trend was visible in the Oxford Knee Score but this was not significant (p > 0.05). This trend was even more evident in varus knees which were slightly undercorrected. The results support the assumption that leaving a residual varus alignment after TKA leads to better functional outcomes in TKA for patients with preoperative varus osteoarthritis.

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Primary Total knee Arthroplasty: A Viable Surgical Option for Complex Tibial Plateau Fractures in Elderly

The Journal of Knee Surgery ◽

10.1055/s-0039-1679921 ◽

2019 ◽

Vol 33 (05) ◽

pp. 496-503 ◽

Cited By ~ 1

Author(s):

Ahmed Abdelbadie ◽

Ayman El-Hennawy ◽

Asser Sallam

Keyword(s):

Total Knee Arthroplasty ◽

Elderly Patients ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Weight Bearing ◽

Primary Total Knee Arthroplasty ◽

Tibial Plateau Fractures ◽

Full Weight Bearing ◽

Total Knee ◽

Primary Total Knee

AbstractThe optimal treatment of complex tibial plateau fractures in elderly is still controversial. The aim of the study was to retrospectively analyze the clinical and radiological outcomes of primary total knee arthroplasty (TKA) versus open reduction and internal fixation (ORIF) in elderly patients presenting with acute complex tibial plateau fractures. Between June 2011 and December 2015, we have analyzed the clinical outcomes of 22 primary total knee replacements and 21 ORIFs. The mean follow-up was 27 months. The intra- and postoperative complications, as well as the knee society score (KSS), were our outcome measures. The knee range of motion and the KSS knee and function scores were significantly better in the TKA patients compared with ORIF patients. Early postoperative full weight-bearing was allowed in the TKA patients with lower complications rate. In conclusion, primary TKA utilizing a stemmed tibial component is an effective treatment option for elderly patients with a complex acute fracture of the tibial plateau. This is a Type III therapeutic study.

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Functional results of total-knee arthroplasty versus medial unicompartmental arthroplasty: two-year results of a randomised, assessor-blinded multicentre trial

BMJ Open ◽

10.1136/bmjopen-2020-046731 ◽

2021 ◽

Vol 11 (6) ◽

pp. e046731

Author(s):

Jani Knifsund ◽

Tuukka Niinimaki ◽

Heikki Nurmi ◽

Alar Toom ◽

Hannes Keemu ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Primary Outcome ◽

Mean Difference ◽

Osteoarthritis Of The Knee ◽

Unicompartmental Arthroplasty ◽

Medial Osteoarthritis ◽

Total Knee ◽

The Mean

ObjectiveThe primary objective of the trial was to assess the clinical effectiveness of medial unicompartmental knee arthroplasty versus total knee arthroplasty in patients with isolated medial osteoarthritis of the knee.DesignProspective, randomised, 2 years, assessor-blind, multicentre, superiority trial.SettingThe patients were enrolled between December 2015 and May 2018 from the outpatient clinics of three public high-volume arthroplasty hospitals (Finland).ParticipantsWe recruited 143 patients with symptomatic-isolated medial osteoarthritis of the knee needing an arthroplasty procedure. All the patients were suitable for both unicompartmental and total knee arthroplasties. Population was selected as the end-stage-isolated medial osteoarthritis.InterventionsAll patients, randomized 1:1, received a medial unicompartmental arthroplasty or a total knee arthroplasty through a similar midline skin incision. Patients were blinded to the type of arthroplasty for the whole 2 years of follow-up.Main outcome measuresPrimary outcome measure was between-group differences in the Oxford Knee Score (OKS) and secondary outcome Knee injury and Osteoarthritis Score (KOOS) at 2 years postoperatively. The changes within and between the groups were analysed with analysis of variance for repeated measurements.ResultsThe primary outcome was comparable for medial unicompartmental arthroplasty and total knee arthroplasty at 2 years. The mean difference in the OKS between the groups was 1.6 points (95% CI −0.7 to 3.9). In the KOOS subscales, the mean difference between the groups was 0.1 points (95% CI −4.8 to 5.0) for pain, 7.8 points (95% CI 1.5 to 14.0) for symptoms, 4.3 points (95% CI −0.6 to 9.2) for function in daily living, 4.3 points (95% CI −3.0 to 11.6) for function in sports, and 2.1 points (95% CI −4.8 to 9.1) for knee-related quality of life.ConclusionsThe recovery after unicompartmental knee arthroplasty was faster compared with total knee arthroplasty, but unicompartmental arthroplasty did not provide a better patient-reported outcome at 2 years.Trial registration numberNCT02481427.

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Early full weight bearing on cementless total knee arthroplasty.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.51.208 ◽

2002 ◽

Vol 51 (1) ◽

pp. 208-212 ◽

Cited By ~ 1

Author(s):

Tetsuya Fukumoto ◽

Kazutoshi Nomura ◽

Mako Hirano ◽

Noburo Hashimoto ◽

Kenji I ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Weight Bearing ◽

Full Weight Bearing ◽

Total Knee

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Revision Total Knee Arthroplasty Using a Constrained Condylar Knee Prosthesis Combined with a Posterior Stabilized Articular Surface

The Journal of Knee Surgery ◽

10.1055/s-0037-1603337 ◽

2017 ◽

Vol 31 (02) ◽

pp. 197-201

Author(s):

Shang-Wen Tsai ◽

Cheng-Fong Chen ◽

Po-Kuei Wu ◽

Chao-Ming Chen ◽

Wei-Ming Chen

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Prosthesis ◽

Articular Surface ◽

Womac Score ◽

Revision Total Knee Arthroplasty ◽

Functional Score ◽

Posterior Stabilized ◽

Total Knee ◽

The Mean

AbstractIntraoperative assessment of valgus–varus stability is crucial for choosing articular surfaces with different levels of constraint. Legacy constrained condylar knee (CCK) prostheses are readily available to assemble and use with a CCK articular surface or a posterior stabilized (PS) articular surface in revision knee arthroplasty surgeries. We wanted to validate outcomes of revision total knee arthroplasty (TKA) using legacy CCK prostheses combined with a PS articular surface. Thirty-seven patients were enrolled and followed up for more than 2 years. Range of motion (ROM), the Knee Society score (KSS), the Knee Society functional score (KSS-F), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used to evaluate outcomes. Follow-up was a mean of 86.5 months (range: 28–152 months). The mean age of the participants was 69.8 years (range: 31–86 years). The mean ROM was 110.5 degrees, the KSS was 86.2 points, the KSS-F was 68.3 points, and the WOMAC score was 22.6 points. Seven participants had implant failures: five because of delayed infections and two because of posterior dislocations. In conclusion, revision TKA using a CCK prosthesis combined with a PS articular surface might provide satisfactory mid-term outcomes. Delayed infection was the most common cause of implant failure. Dislocation might occur in middle-old or older patients despite careful intraoperative examination of valgus–varus stability, extension–flexion gap balancing, and signs of recurvatum.

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Sequential changes in lower extremity function after total knee arthroplasty

Journal of Orthopaedic Surgery ◽

10.1177/2309499020965645 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902096564

Author(s):

Masanori Tsubosaka ◽

Hirotsugu Muratsu ◽

Naoki Nakano ◽

Tomoyuki Kamenaga ◽

Yuichi Kuroda ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Lower Limb ◽

Repeated Measures ◽

Osteoarthritis Of The Knee ◽

Balance Function ◽

Functional Changes ◽

Total Knee ◽

The Mean ◽

Balance Functions

Purpose: The effectiveness of total knee arthroplasty (TKA) for recovering ambulation and balance functions has not been investigated in detail. The present study aimed to measure functional changes in the lower limb before and after TKA by measuring ambulation function with the 3 m Timed Up and Go (TUG) test and balance function using one-leg standing time (ST). Methods: The study included 137 patients (116 women and 21 men) with osteoarthritis of the knee who underwent primary TKA. The mean age of the patients was 74.4 years. The mean postoperative hospital stay for rehabilitation was 23.9 days. The TUG test and ST were performed preoperatively, 2 weeks postoperatively, at discharge, and 3, 6, and 12 months postoperatively. These results from these six measurements were also compared using one-way repeated measures analysis of variance. Results: The TUG test and ST were significantly improved at 3 months after surgery. However, both the TUG test and ST did not improve further from 3 months to 6 months postoperatively or from 6 months to 1 year postoperatively. Conclusion: TKA is useful for restoring lower limb function, as both ambulation and balance functions were significantly improved 3 months after surgery. However, no further improvement in ambulation or balance function was recognized beyond 3 months.

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Tibial bowing and tibial component placement in primary total knee arthroplasty in valgus knees: Are we overlooking?

Journal of Orthopaedic Surgery ◽

10.1177/2309499019867006 ◽

2019 ◽

Vol 27 (3) ◽

pp. 230949901986700

Author(s):

Dhanasekararaja Palanisami ◽

Melvin J George ◽

Arif Mohammed Hussain ◽

Chunchesh MD ◽

Rajkumar Natesan ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Weight Bearing ◽

Valgus Deformity ◽

Strong Positive Correlation ◽

Component Placement ◽

Positive Correlation ◽

Total Knee ◽

The Mean

Purpose: Tibial bowing in valgus knees with arthritis can lead to component malplacement during total knee arthroplasty (TKA). Incidence of valgus knees with medial tibial bowing, its effect on tibial component placement during primary TKA and methods to improve accuracy of the component placement were studied. Methods: Full-length weight-bearing alignment radiograph was taken in 117 patients (149 knees) with valgus deformity undergoing TKA. In these cases, the proximal tibial reference for extramedullary jig placement was planned preoperatively with reference to the tibial spines and classified as four zones. Results: The mean preoperative hip–knee–ankle (HKA) angle was 192.9° (180.3–234.5°). Bowing >3° was considered significant ( p < 0.001) and at this level of bowing, the proximal tibial reference was shifted from centre to medial. Tibial bowing <3° was considered straight and >3° as tibia valga. Tibia was bowed in 70 knees (46.97%). Severity of valgus deformity had strong positive correlation with the tibia valga ( p < 0.001). The post-operative medial proximal tibial angle (MPTA) and HKA angle were 91.63° (87.9–95.7°) and 182.6° (178.1–189.7°), respectively. The mean MPTA and post-operative HKA angle in bowed and straight tibiae were 90.35° versus 89.78° ( p = 0.547) and 181.5° versus 180.7° ( p = 0.5716), respectively, and the difference was not statistically significant. Conclusion: Medial tibial bowing is very common in valgus knees. Tibia valga has a strong positive correlation with the severity of valgus deformity. Accurate tibial component placement can be achieved with a medialized reference point for extramedullary tibial cutting jig in knees with significant tibia valga. The study has been registered in clinical trials registry – India (CTRI/2018/03/012283).

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