Severity and Location of Lumbar Spine Stenosis Affects the Outcome of Total Knee Arthroplasty

BackgroundRecent studies have noted that patients with pre-existing lumbar spinal stenosis (LSS) have lower functional outcomes after total knee arthroplasty (TKA). Given that LSS manifests heterogeneously in location and severity, its influence on knee replacement merits a radiographically targeted analysis. We hypothesize that patients with more severe LSS will have diminished knee mobility following TKA. MethodsThis retrospective study assessed all TKAs performed at our institution for primary osteoarthritis from 2017-2020. Preoperative lumbar magnetic resonance image (MRI) with no prior lumbar spine surgery were necessary for inclusion. Stenosis severity was demonstrated by (1) anterior-posterior (AP) diameter of the dural sac and (2) morphological grade. TKA outcomes in 103 cases (94 patients) were assessed by measuring preoperative and postoperative arc of motion (AOM), postoperative flexion contracture, and need for manipulation under anesthesia. ResultsPatients with mild stenosis did significantly better in terms of postoperative knee AOM. As AP diameter decreased at levels L1-2, L2-3, L3-4, and L4-5, there was a significant reduction in preoperative-AOM (p<0.001 for each), with a 16 degree decrease when using patients’ most stenotic level (p<0.001). The same was noted with respect to increased morphological grade (p<0.001), with a 5 degree decrease for patients’ most stenotic level (p<0.001). ConclusionSevere LSS, which is readily demonstrated by a reduction in the AP diameter of the dural sac or increased morphological grade on MRI, correlated with a significant reduction in preoperative-AOM that was not improved after TKA. Persistent postoperative reductions in AOM may contribute to reduced patient satisfaction and recovery. Level of Evidence: Level 4

The Influence of the Posterior Slope Angle and Posterior Condylar Offset in Posterior-Stabilized Total Knee Arthroplasty Was Analyzed From the Way of Constructing Flexion Gap

IntroductionThe purpose of this study was to compare the effects of two ways of establishing the flexion gap on the flexion angle and flexion-extension motion after posterior-stabilized （PS） prosthesis. A way for the posterior slope angle（PSA）and posterior condylar offset（PCO）were greater than preoperative, another for less than preoperative.Materials and MethodsThey are grouped according to the way flexion gaps are constructed. Data from 28 total knee arthroplasty（TKA）patients treated with propensity score match (PSM) were included. The difference of flexion angle and flexion-extension motion between the two groups was compared, and the influence of PCO and PSA on the flexion angle in the two ways was analyzed.ResultsPostoperative flexion degree of the two groups was 115.50±14.64° and 112.29±10.64° (P =0.553), and there was no statistical significance. Postoperative flexion-extension motion grade data of the decrease group was better than that of the increased group (P =0.031). Postoperative flexion angle was negatively correlated with PCO change in the increase group (r²=0.574 b '=-0.758 p=0.002).ConclusionsIncreasing the PSA and PCO to construct flexion gaps in PS TKA will cause problems with flexion-extension movements. It may be more reasonable to avoid excessive PSA and select appropriate PCO to reconstruct the flexion gap in PS prosthetic.

Scaphoid plating for recalcitrant scaphoid fractures: a systematic review

We conducted a systematic review of scaphoid plating for recalcitrant scaphoid fractures using EMBASE, Pubmed, Cochrane and MEDLINE. Thirteen studies were included. Ninety-three per cent of cases reported were male with a mean age of 27 years. Bony union was reported in eleven studies and achieved in 72% to 100% of cases. Scaphoid plates showed no significant difference in union incidence compared with headless compression screws. Mean removal incidence of plates was 21%. Postoperative flexion–extension arc was 119°. Grip strength improved by 14% postoperatively over that before surgery. There was a general improvement in patient-reported outcome measures. Eighty-six per cent of reported participants returned to their previous work. In these clinical reports, plates frequently required removal more frequently than headless compression screws.

Joint line reestablishment in revision total knee arthroplasty

Background In this study, the traditional “Anatomical Landmark-Distance Method (AL-DM)” in the formation of joint line (JL) was compared with “Adductor Tubercle-Ratios method” (AT-RM), and the effect of reestablishment of JL on clinical and functional outcomes were evaluated. Materials and methods 16 revision total knee arthroplasties (rTKAs) were performed by using “AT-RM” (group 1) and 16 rTKA by using “AL-DM” (group 2) in our clinic between 2015 and 2018. The data were prospectively collected and a total of 32 knees of 31 patients were analyzed. At the final follow-up, knee functions were evaluated by using Knee Society Score (KSS) knee and function, Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, Short Form-36 (SF-36) questionnaires and physical examinations. Results Postoperative flexion arc was higher in Group 1. KSS knee and function scores were better in group 1. In group1, JL was reestablished successfully in all revision rTKAs in terms of ATJL and the tibial tubercle TT-JL ratios. The improvement in KSS knee and function scores and WOMAC scores were also better in group 1. Measurements showed that the improvement in KSS scores increased as AT-JL and TT-JL distances approached the calculated values. Conclusion “AT-RM” was shown to be superior to the traditional distance method in terms of JL reestablishment. Functional results and patient satisfaction increased when JL was reestablished.

Comparative study between open and arthroscopic techniques for scaphoid excision and four-corner arthrodesis

This study presents our technique of arthroscopic scaphoid excision and four-corner arthrodesis and compares the clinical and radiological outcomes with those achieved with the open method. Twenty-seven patients (14 in arthroscopy group and 13 in open group) were included. Bone union was achieved in 13 of 14 patients in the arthroscopy group and in all 13 patients in the open group. In the open group, severe stiffness (flexion–extension arc was 10°) occurred in one patient after surgery. The mean postoperative flexion–extension arc was 75° and 51° in the arthroscopy group and open group, respectively. The pain, clinical scores, and radiological indices were improved in both arthroscopy and open groups. Arthroscopic and open scaphoid excision and four-corner arthrodesis did not show significant differences in clinical outcomes and bone union rates. The arthroscopic method provided a superior range of motion. Level of evidence: III

IDENTIFICATION OF PREDISPOSING FACTORS FOR RECOVERY OF RANGE OF MOTION OF KNEE AFTER TOTAL KNEE ARTHROPLASTY

BACKGROUND: Knee joint arthroplasty is the standard treatment for severe dysfunction of the knee aiming to make the knee pain free as well as to stabilise it with an appropriate range of motion. Aims and objectives: To assess whether the postoperative functional recovery of range of motion of total knee arthroplasty depends on objective and subjective parameters. MATERIAL AND METHODS: A prospective study comprising of twenty six cases who underwent total knee arthroplasty had been carried out from November 2013 to October 2015, in the in the Orthopaedics Department of IPGMER and SSKM Hospital, Kolkata, West Bengal, India. RESULTS: The mean age group in our study is 35.3 years and 69.2% were females. Left side surgeries were more common (57.7%). Mean fixed flexion deformity decreased significantly from 10.8396 to 0.7692 postoperative 1 year. Mean preoperative extension lag was 2.3077 degrees and postoperative extension lag was 4.0385 degrees. CONCLUSIONS: Total knee arthroplasty is the standard treatment for severe destructive arthritis of the knee with an aim to provide stable, painless and mobile joint. Based on the findings of this study, preoperative arc of flexion, mediolateral laxity and preoperative tibiofemoral varus/valgus angle have a significant influence on the postoperative flexion, which means they are important factors for predicting the outcome range of motion of the knee after a total knee arthroplasty. Keywords: Total Knee Arthroplasty (TKA).

The role of the femoral anterior offset index on the degree of flexion in total knee arthroplasty

<p class="abstract"><strong>Background:</strong> Anterior projection of the femoral condyles is often disregarded as an issue in knee arthroplasty. Overstuffing the patellofemoral joint may limit knee flexion and be a source of patellofemoral complications, thus having an impact in satisfaction rates after total knee arthroplasty (TKA). Our hypothesis is that excessive anterior projection of the femoral condyles as a negative effect in flexion range after TKA, introducing a new concept, the anterior offset index (AOI).</p><p class="abstract"><strong>Methods:</strong> From a group of 99 consecutive patients who underwent TKA using patient specific instrumentation (PSI), we selected the patients with good pre-operative flexion range (above 90º) and a 6-minute walk test (6 MWT) ≥ 0 meters, evaluating the correlation between the AOI and the flexion range. A total of 23 patients were included in the study.<strong></strong></p><p class="abstract"><strong>Results:</strong> A moderate and positive correlation (r=0.488; p=0.018) between AOI and flexion range was found.</p><p class="abstract"><strong>Conclusions:</strong> Our results seem to indicate that the AOI influences postoperative flexion in TKA, in patients with a good pre-operative flexion and good functional outcome. AOI is an important concept to retain when optimizing knee flexion and minimizing patellofemoral complications. However, more studies need to be done in order to clarify the role of all the factors influencing post op flexion after TKA.</p>