Does obesity, duration of symptoms and pre-operative knee movements amend discharge readiness and outcomes following total knee arthroplasty?

<p><strong>Background</strong>: Total knee arthroplasty (TKA) being the definite procedure in degenerative arthritis of the knee is associated with a high cost that includes the cost of implants and in-hospital length of stay (LOS). Incurring such high costs will put a burden on the patients economically, so the goal being the reduction of hospital stay yet improving the functional outcome with better patient satisfaction.</p><p><strong>Methods</strong>: The study design is a retrospective analysis of 1022 patients of primary elective TKA, performed in our institution. The targeted indicators were sex, body mass index (BMI), pre-operative knee range of movements (ROM), knee deformity and duration of symptoms were analyzed.</p><p><strong>Results:</strong> Analyzing these patients, we found the average LOS is 6.4 days, and obesity, pre-op ROM and deformity all play a role to delay the discharge readiness in the patients. Our study showed that LOS after TKA is multifactorial.</p><p><strong>Conclusions:</strong> In acute setting for readiness of discharge the preoperative knee movements, deformity and patients’ functional abilities can be used to segregate patients who may require close monitoring or intensive physiotherapy.</p>

Comparison of Dynamic Balance in Football Players with and without Genu Varum Using Star Excursion Balance Test

Background and Aims: Genu Varum is an angular deformity of the knee that is responsible for the alteration of the forces at the knee so that the line of force shifts farther medially from the knee joint centre intensifying the medial compartment load and creating a medial joint reaction force that is nearly three and a half times that of the lateral compartment. Football is a high intensity sport that places inordinate amounts of load and torque on the knee joint making it more susceptible to growth deformities in the developing age groups. Genu varum is a predisposing factor to lateral instability which affects dynamic balance. This study consists of a comparison in dynamic balance between professional football players, those without a knee deformity and those with genu varum deformity using the Star excursion balance test. Methodology: A comparative study was conducted among 40 elite level football players and they were divided into two groups one of which consisted football players without a knee deformity and the other group which comprised of football players with genu varum. Genu varum was calculated using the intercondylar distance measure. Star excursion balance test was used to assess dynamic balance of each individual and their average distances were calculated for each direction in the test. Results: The Reach Distances in the anterior direction showed no significant difference (P>0.05) between the control and Group Bs whereas significant differences (P<0.05) were obtained in the Posteromedial and Posterolateral directions. Conclusion: There was no significant difference in reach distances in the anterior direction but significant differences in the reach distances were observed in the posteromedial as well as the posterolateral direction suggesting that genu varum deformity does affect the dynamic balance in elite level football players. Key words: Genu Varum, Football Players, Dynamic Balance, Star excursion balance test.

Using Combinations of Both Clinical and Radiographic Parameters to Develop a Diagnostic Prediction Model Demonstrated an Excellent Performance in Early Detection of Patients with Blount’s Disease

Early identification of pathological causes for pediatric genu varum (bowlegs) is crucial for preventing a progressive, irreversible knee deformity of the child. This study aims to develop and validate a diagnostic clinical prediction algorithm for assisting physicians in distinguishing an early stage of Blount’s disease from the physiologic bowlegs to provide an early treatment that could prevent the progressive, irreversible deformity. The diagnostic prediction model for differentiating an early stage of Blount’s disease from the physiologic bowlegs was developed under a retrospective case-control study from 2000 to 2017. Stepwise backward elimination of multivariable logistic regression modeling was used to derive a diagnostic model. A total of 158 limbs from 79 patients were included. Of those, 84 limbs (53.2%) were diagnosed as Blount’s disease. The final model that included age, BMI, MDA, and MMB showed excellent performance (area under the receiver operating characteristic (AuROC) curve: 0.85, 95% confidence interval 0.79 to 0.91) with good calibration. The proposed diagnostic prediction model for discriminating an early stage of Blount’s disease from physiologic bowlegs showed high discriminative ability with minimal optimism.

Early Failure of Total Ankle Arthroplasty in a Patient with Ipsilateral Varus Knee Deformity

Multiple risk factors such as age, body mass index (BMI), preoperative diagnosis, smoking, diabetes mellitus, malalignment of an implant, and presence of ipsilateral hindfoot fusion have been shown to contribute to failure of total ankle arthroplasty (TAA). However, the exact causes of TAA failure remain uncertain, and various causes can lead to a need for revision surgery. We report a case of early aseptic loosening of the implant following TAA in a patient with severe varus deformity of the ipsilateral knee.

Overcoming the Technical Challenges of Total Knee Arthroplasty in Patients Affected by Hereditary Multiple Exostoses: Our Experience Managing the Bone Deformities

Introduction: Hereditary multiple exostoses (MHE), also known as familiar osteochondromatosis or diaphyseal aclasis, is an autosomal dominant inherited genetic pathology that is characterized by the presence of multiple benign osteochondromas (exostoses). Knee deformity is common in patients with HME, with nearly a third of patients developing genu valgus. Total knee arthroplasty (TKA) has been used to correct valgus deformities with advanced knee osteoarthritis (OA). However concomitant limb deformities and altered anatomy of the knee make this surgery particularly challenging.Case presentation: We present the case of a 50 years old Caucasian woman, affected by multiple hereditary exostoses, who came to our attention for progressive pain in the right knee. Upon further examination the knee had a prominent valgus alignment, concomitant valgus instability and flexion contraction. The patient was treated with one stage total knee arthroplasty using a semi-constrained design. The patient was re-evaluated at 24 months follow-up and there were no signs of implant loosening, the knee function improved significantly and the patient was very satisfiedConclusions: We also present a mini-review of the literature on this topic. Given the recurring technical difficulties of such procedure in these patients, we describe our experience as well as the need for preoperative planning, the use of appropriate constrain when required, the high frequency of ligament instability, bony defects, and patellar maltracking. TKA must be considered when necessary, in these patients, as good to excellent clinical results can be achieved and maintained, allowing for significant improvements in quality of life.

Total knee arthroplasty in valgus knee deformity: is it still a challenge in 2021?

Total knee arthroplasty in valgus knee deformities continues to be a challenge for a surgeon. Approximately 10% of patients who undergo total knee arthroplasty have a valgus deformity. While performing total knee arthroplasty in a severe valgus knee, one should aware with the technical aspects of surgical exposure, bone cuts of the distal femur and proximal tibia, medial and lateral ligament balancing, flexion and extension gap balancing, creating an appropriate tibiofemoral joint line, balancing the patellofemoral joint, preserving peroneal nerve function, and selection of the implant regarding constraint. Restoration of neutral mechanical axis and correct ligament balance are important factors for stability and longevity of the prosthesis and for good functional outcome. Thus, our review aims to provide step by step comprehensive knowledge about different surgical techniques for the correction of severe valgus deformity in total knee arthroplasty.

Genetic Association and Role of Surgery for the Treatment of Lower Limb Deformities in Diastrophic Dysplasia: A Case Report

Introduction: Diastrophic dysplasia (DTD) results from SCN26A2 gene mutation, with autosomal recessive inheritance and widely variable phenotype. The gene has been mapped to chromosome 5q32-q33.1. Case Report: We present a case of a 4-year-old female with short stature, bilateral feet and knee deformity, and dysplastic facies. SCN26A2 mutations were seen in patient as well as parents. She underwent multiple orthopedic procedures involving metatarsals, gastrosoleus, and distal femur. Based on typical clinical features, DTD was suspected. Genetic studies of patient and parents provided the exact diagnosis in this case. Conclusion: Genetic diagnosis and family counseling are important caveat of management. Key features like ear abnormalities help to suspect diagnosis which requires a high index of suspicion. Associated bony and soft-tissue abnormalities of lower limb may require surgical intervention for improvement of gait, functions, and cosmesis. Keywords: Diastrophic dysplasia, Skeletal dysplasia, Ear abnormalities, SCN26A2, Osteotomy.