Artroplastia total de rodilla posterior a osteotomía tibial alta. Estudio retrospectivo comparativo entre osteotomías sustractivas y aditivas

Introducción: El reemplazo total de rodilla luego de una osteotomía tibial alta plantea dificultades técnicas adicionales. El objetivo de este estudio fue analizar los resultados clínicos y radiográficos de la conversión a reemplazo total de rodilla luego de una osteotomía tibial alta y comparar la evolución de los pacientes con una osteotomía de cierre (sustractiva) o de apertura (aditiva) previa.Materiales y Métodos: Se analizó retrospectivamente una serie de 46 artroplastias de rodilla realizadas entre 1997 y 2019, en 39 pacientes con antecedente de osteotomía tibial alta. Se evaluaron los parámetros clínicos y radiográficos antes de la artroplastia y después, determinando el eje femorotibial, la caída tibial posterior, el valor de Insall-Salvati y el Knee Society Score. También se compararon los resultados en pacientes con antecedente de osteotomía tibial sustractiva vs. aditiva. Resultados: El seguimiento promedio fue de 5.72 años (mín. 1, máx. 19). El Knee Society Score de la serie tuvo una mejoría promedio de 42,3 a 79,8. La caída tibial posterior y el índice de Insall-Salvati no sufrieron grandes modificaciones luego de la cirugía. La supervivencia promedio de la osteotomía aditiva hasta la conversión a reemplazo total de rodilla fue de 5.5 años, mientras que la de la sustractiva, de 13.5 años. Conclusiones: Pese a la dificultad técnica que puede plantear, el reemplazo total de rodilla luego de una osteotomía tibial alta valguizante tuvo una buena evolución clínico-radiográfica a corto y mediano plazo, y el tipo de osteotomía no repercutió en los resultados luego de la artroplastia

Gait Characteristics Based on Pain Detect Questionnaire and Pain Catastrophizing Scale in Patients with Knee Osteoarthritis

Background Although patient-reported evaluation of knee osteoarthritis has been more common, little attention has been paid to the relationship between patient-reported questionnaire and gait analysis. The purpose was to investigate the relationship between patient-reported questionnaire and gait parameters. Methods A total of 31 knees in 31 patients (22 females and 9 males) who were diagnosed as end-stage medial compartmental knee osteoarthritis participated in the present study. All the patients were evaluated based on New Knee Society Score, pain detect questionnaire and pain catastrophizing scale. They were divided into two categories based on pain detect questionnaire scores: Group Low (12 ≥ score) and Group High (score > 12). Gait analysis was performed using three-dimensional motion analysis system. Statistical analysis was done using one-tailed Mann-Whitney U-test to compare age, body mass index, Knee Society Score, pain catastrophizing scale, and gait parameters between groups. Results Twenty-six patients were allocated to Group Low, and five patients were to Group High. Subjective pain during walking was significantly worse in Group Low (P = 0.037) and helplessness in pain catastrophizing scale was notably worse in Group High (P = 0.035). Peak vertical ground reaction force (P = 0.018) and knee adduction moment (P < 0.01) were significantly greater in Group Low. Moreover, flexion-extension excursion during mid-stance phase was significantly smaller in Group Low (P = 0.038). Conclusions Patients with likely neuropathic pain had atypical osteoarthritis-related pain as well as atypical gait pattern, compared to patients without neuropathic pain.

Medial closure supracondylar femoral osteotomy: an effective solution for long-term treatment of arthritic valgus knee?

Purpose The aim of this work was to retrospectively analyze the clinical, subjective, and radiological results of medial closing-wedge distal femur osteotomy (MCW-DFO) for the treatment of osteoarthritis (OA) in valgus knee at medium- to long-term follow-up. Materials and methods A total of 57 patients (62 knees) treated with MCW-DFO between 1984 and 2018 were included in the study. Patient age at the time of the surgery ranged between 28 and 61 years (average: 48 years). All patients with a minimum follow-up of 4 years were contacted to request for them to undergo clinical, subjective, and radiological evaluation. Preoperative hip–knee–ankle (HKA) angle (i.e., preoperative valgus malalignment) was 8.6° ± 2°. Patients were evaluated using the following scales: the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Knee Society Score (KSS), the International Knee Documentation Committee (IKDC), the Visual Analog Scale (VAS), and the Numeric Rating Scale 11 (NRS-11). Results Mean follow-up was 11.6 ± 4.9 years, and a total of 17 patients (20 knees) were available for the last examination. At maximum follow-up, 4 patients underwent conversion to a total knee replacement (20%); their survival rate was 100% at 10 years and 66.7% at 15 years, as estimated using the Kaplan–Meier curve. The subjective Knee Society Score improved on average from 37.7 ± 10 to 63.9 ± 15.4. The objective Knee Society Score improved on average from 42.2 ± 11.7 to 75 ± 22.5. The pain detected through the VAS and NRS-11 scales improved from 56.7 ± 12.9 to 42 ± 17.1 and from 5.8 ± 1.1 to 4.4 ± 1.7, respectively. Thirteen patients (70%) required hardware removal at an average time of 19 ± 4 months due to a local nuisance. Conclusions MCW-DFO can improve symptoms in patients with osteoarthritis in a valgus knee at medium- to long-term follow-up, reducing the progression of osteoarthritis in properly selected patients.

Comparación de los espaciadores articulados vs. fijos en la revisión de la infección periprotésica de rodilla

Introducción: Los espaciadores de cemento con antibiótico pueden ser fijos o articulados y se logra un resultado similar con ambos para erradicar una infección. Nuestro objetivo fue comparar el rango de movilidad articular y los resultados funcionales después del reimplante. Materiales y Métodos: Estudio de cohorte retrospectiva de pacientes sometidos a una revisión de la prótesis de rodilla por infección, en dos tiempos quirúrgicos. Se analizó la funcionalidad según el Knee Society Score (KSS) al año de la cirugía y se registró el rango de movilidad a los 45 días. Se registraron el grado de defecto óseo, dolor, satisfacción, las complicaciones y la recidiva de la infección. Resultados: Se incluyeron 103 pacientes (40 con espaciador articulado, 63 con espaciador fijo). El grupo con espaciador articulado tuvo una mediana 2,5° mayor en la movilidad final (102,5; RIC 95-110 vs. 100;RIC 90-105, p 0,01). Según el KSS funcional y el KSS de rodilla, no hubo diferencias entre ambos grupos. No hubo diferencias en el grado de satisfacción, dolor y el tiempo hasta el reimplante. Las complicaciones fueron similares en ambos grupos, con una tasa de reinfección sin diferencias estadísticamente significativas. Conclusión: Los espaciadores articulados proporcionaron un beneficio en el rango de movilidad después del reimplante de la prótesis.

Correlation of knee society score and oxford knee score in patients with moderate to severe osteoarthritis of the knee

Osteoarthritis (OA) of the knee is a degenerative, non-inflammatory joint condition marked by articular cartilage disintegration and the growth of new bone (osteophytes) at the joint surfaces and borders. It impairs one's ability to function and makes one disabled. It is the most common rheumatic disease. Because the Knee is a weight-bearing joint and a crutch joint, it is the most usually afflicted joint by Osteoarthritis.A Correlational study was conducted to find out the correlation between Knee Society Score (KSS) and Oxford Knee Score (OKS) on 142 Osteoarthritis Knees. Purposive sampling was used to collect data from the Orthopaedics OPD at AIIMS Jodhpur from October to December 2018.On evaluation, the mean age of the patients was 60.19±1.01. Bilateral Knee Osteoarthritis affected about 42% of the patients. Approximately half of the patients were obese. Only 34% of patients had compliance in physiotherapy. Analgesics and massage treatment are used by about 76% of the patients to relieve knee pain. In the Knee Society Score, the majority of the patients (82.4%) had a bad knee condition, with a mean score of 49.07±1.06. In OKS, about half of the patients (46.5%) had Moderate to Severe Knee Osteoarthritis, with a mean score of 22.69±7.09. The correlation coefficient between the Knee Society Score and the Oxford Knee Score is 0.660. As a consequence of the analysis, both scales have almost the same outcome, indicating that they are moderately associated. The Knee Society Score is highly associated with occupation and physiotherapy, whereas the Oxford Knee Score is significantly related to the patients' age alone. According to the study, there is a moderate correlation between the Knee Society Score (KSS) and the Oxford Knee Score (OKS). These scores should be included during the diagnosis of Knee Osteoarthritis for improved patient care.

Outcome of Midvastus versus Subvastus Approach in Single Stage Bilateral Total Knee Arthroplasty

Objective: To compare midvastus and subvastus approach regarding operative parameters(lateral retinacular release, operative time, neurovascular injury) and outcome (Knee Society Score, Straight Leg Raise) at 12 weeks in single stage bilateral total knee arthroplasty. Study Design: Randomized clinical trial study Place and Duration of Study: Institute of Orthopaedic Surgery and South City Hospital Karachi from 1st January 2016 to 31st December 2018. Methodology: Fifty two patients of both genders ofmore than 50 years with osteoarthritis grade III or IV and bony changes confirmed by AP and lateral radiographs of knee were included. Patients with previous knee surgeries including high tibial osteotomy, deformities >20°(on mechanical axis), any neuromuscular problem and BMI ≥30 were excluded. Final assessment was done at 12 weeks. Isometric quadriceps strength was assessed by holding of contraction in seconds during the lifting (10cm above the plinth) phase of SLR (patient lying supine).Knee score (preoperative and final follow-up) was performed by Knee Society Score. Results: Thirty five were females and 21 males with mean age 65.3 years (50-78 years). Mean body mass index was 27.8 Kg/m2 (26.4-29.9). In midvastus TKR, the mean operative time was 61.7 minutes (range 52-70) whereas the same was 68.3 minutes (range 58-74) in subvastus TKR with p value 0.002. Rate of lateral retinacular release (LLR) was significantly (p=0.011) different between the midvastus TKR 5 (8.9%) and subvastus TKR 11 (19.6%). Neither group had neurovascular injury or early infection of the knee. Active SLR in subvastus group was achieved in shorter time (mean 3.1 days) as compared to midvastus group (mean 4.7 days). There was no difference (p=0.173) in isometric quadriceps strength at 12 weeks between subvastus TKR (mean 18 seconds) and midvastus TKR (mean 17 seconds). Knee society pain and functional scores were comparable between the two approaches at final follow up. Conclusion: Subvastus exposure has advantage of achieving active straight leg raise earlier while midvastus has lower frequency of lateral retinacular release. No difference in hospital stay and postoperative pain scores. Both subvastus and midvastus approaches are safe and offer comparable Knee Society Score outcomes. Keywords: Midvastus, Subvastus, Total knee arthroplasty, Knee Society Score, Straight leg raise

Does patellar tilt affect the outcome of total knee arthroplasty? a retrospective study

<p><strong>Background</strong>: Patellofemoral joint management during total knee replacement remains a controversial topic among knee surgeons. The purpose of this study is to evaluate the influence of resurfaced patellar component tilt on the functional outcome of total knee arthroplasty.</p><p><strong>Methods</strong>: This is a retrospective study reviewing all the patients who underwent total knee arthroplasty in our institution, operated by a single surgeon using a single implant design.</p><p><strong>Results:</strong> A total of 48 patients and 82 knees were enrolled into this study. Patients were evaluated by Oxford knee score, knee society score, Melbourne patellar score, anteroposterior, lateral, and Merchant’s view radiographs. The patellar tilt was divided into three grades according the measurement obtained from knee radiographs.</p><p><strong>Conclusions: </strong>A higher degree of patella tilt (more than 10 degree) is associated with poor outcome following total knee arthroplasty. Melbourne patella score is more sensitive than knee society score and Oxford score in assessing the effect of patella tilt on the outcome of total knee arthroplasty.</p>

Outcome after total knee arthroplasty with or without patellar resurfacing

<p><strong>Background: </strong>Patellar resurfacing in total knee arthroplasty has had its defenders and detractors. There seems to be a great difference in patellar resurfacing between countries and patellar resurfacing is still controversial. Some surgeons resurface the patella routinely, others not at all, and a third group prefers selective resurfacing. Therefore, in this prospective and randomised study, we compared the outcome after total knee arthroplasty with or without patellar resurfacing.</p><p><strong>Methods: </strong>In this study 50 cases (100 knees) were selected and each case was followed up for 2 years. In each case, one knee was operated by TKA with patellar resurfacing and the other by TKA with patellar non-resurfacing. Patients were followed-up for a period of 2 years and clinical and functional outcome of both knees was measured and compared by the help of knee society score (KSS) and VAS score.</p><p><strong>Results: </strong>There was statistically significant difference between the patellar resurfacing and non-resurfacing group with regard to knee society score, pain score and visual analogue score (VAS), with the patellar resurfacing having better scores. There was no significant difference in the functional scores between the 2 groups. Range of motion was complication rate was comparable in both the groups. However, there was no case of reoperation nor was there any complication related to the patellar implant. </p><p><strong>Conclusions:</strong> Patellar resurfacing in TKA leads to less post-operative persisting knee pain, and also leads to better outcome in terms of walking without pain, using stairs without pain and rest pain as compared to TKA without patellar resurfacing.</p>