Comparison of Robotic and Conventional Unicompartmental Knee Arthroplasty Outcomes in Patients with Osteoarthritis: A Retrospective Cohort Study

Robotic-arm-assisted unicompartmental knee arthroplasty (RUKA) was developed to increase the accuracy of bone alignment and implant positioning. This retrospective study explored whether RUKA has more favorable overall outcomes than conventional unicompartmental knee arthroplasty (CUKA). A total of 158 patients with medial compartment osteoarthritis were recruited, of which 85 had undergone RUKA with the Mako system and 73 had undergone CUKA. The accuracy of component positioning and bone anatomical alignment was compared using preoperative and postoperative radiograph. Clinical outcomes were evaluated using questionnaires, which the patients completed preoperatively and then postoperatively at six months, one year, and two years. In total, 52 patients from the RUKA group and 61 from the CUKA group were eligible for analysis. The preoperative health scores and Kellgren–Lawrence scores were higher in the RUKA group. RUKA exhibited higher implant positioning accuracy, thus providing a superior femoral implant angle, properly aligned implant placement, and a low rate of overhang. RUKA also achieved higher accuracy in bone anatomical alignment (tibial axis angle and anatomical axis angle) than CUKA, but surgical time was longer, and blood loss was greater. No significant differences were observed in the clinical outcomes of the two procedures.

Subtrochanteric femur fractures: current review of management

Subtrochanteric (ST) femur fractures are proximal femur fractures, which are often difficult to manage effectively because of their deforming anatomical forces. Operative management of ST fractures is the mainstay of treatment, with the two primary surgical implant options being intramedullary (IM) nails and extramedullary plates. Of these, IM nails have a biologic and biomechanical superiority, and have become the gold standard for ST femur fractures. The orthopaedic surgeon should become familiar and facile with several reduction techniques to create anatomical alignment in all unique ST fracture patterns. This article presents a comprehensive and current review of the epidemiology, anatomy, biomechanics, clinical presentation, diagnosis, and management of subtrochanteric femur fractures. Cite this article: EFORT Open Rev 2021;6:145-151. DOI: 10.1302/2058-5241.6.200048

Which Specific Angle Measurement Criteria Should be Used to Define Forward Head and Rounded Shoulder Posture: An Evidence-Based Commentary

Postural distortions in the upper limb are prevalent and change the anatomical alignment, which alters force couples and the biomechanics of the body. Forward head posture (FHP) and rounded shoulder posture (RSP) are the two that are most prevalent. Measurement techniques using the craniovertebral angle for FHP and forward shoulder angle for RSP have been used both clinically and in the literature. However, what is not known is what specific criteria can be consistently used to define FHP and RSP as reference angles lack vigorous validity and there is a shortage of quantity, quality, and consistency of the evidence. Thus, there is much to be learned about postural classifications and the effect on the kinetic chain, supporting the need for further research in this area. As it is important to classify those who may need exercise and therapeutic intervention, following evidence-informed practice to inform decision-making clinicians should continue to evaluate posture, as well as examine scapular kinematics and muscle activity and the effects of interventions to improve posture. Therefore, determining whether FHP and RSP are present is paramount for the treatment to be successful.

Thoracolumbar Junction (TLJ) Fracture: Principle of Management

The thoracolumbar junction (TLJ) is the most common site of traumatic spinal injury. Its management is a highly controversial area. There are no specific guidelines for management of these injuries. The primary goal of treatment of TLJ fractures involves protecting the spinal cord from further neural damage, obtaining the stability by reconstructing anatomical alignment of spinal column, and returning patients to workplace through early mobilization and rehabilitation. There is a great variation in evaluation of stability of these fractures, which is one of the crucial factors in deciding the treatment. Controversy also exists regarding conservative versus operative treatment, timing of intervention, anterior versus posterior approach, short versus long segment fixation, and bracing versus no bracing. This article had reviewed the conflicting results and recommendations for management of TLJ fractures of previously published reports in PubMed, PubMed Central, and Medline databases. We analyzed these related articles which addresses issues regarding evaluation of stability, indications for operative and conservative treatment, timing of surgery, surgical approach, and fusion length.

Long-Term Follow-up of Functional and Radiographic Outcome After Revision Surgery for Fibula Malunion

Background. Ankle fractures are some of the most common injuries seen in the emergency department. Malunited ankle fractures are uncommon. Patients with malunion frequently present with multiple complaints. Radiographs often show abnormalities in anatomical alignment. Aim. To evaluate the anatomical alignment on radiographic imaging in patients with malunited ankle fractures. Secondary aims were to evaluate patient satisfaction after reconstruction and to investigate the relationships between radiological alignment and functional outcome. Methods. All consecutive patients (n = 25) treated for a fibula malunion between January 1, 2002, and September 1, 2017, were included. The primary outcome was anatomical alignment of the ankle mortise. The talocrural angle (TCA), talar tilt (TT), and medial clear space (MCS) were used to investigate to what extent revision surgery had improved alignment. The patient-related outcome measure consisted of the Olerud and Molander Ankle Score (OMAS). To assess quality of life (QoL) the EQ-5D-5L was used. Results. The median TCA was 78.4° before revision and 79.25° after revision; P = .297. The median TT was 2.95° before revision and 0.70° after; P < .001. The MCS before revision was 5.2 mm and 3.17 mm after; P < .000). The OMAS had a median of 67.5 points. Analysis of the QoL questionnaires yielded a score of 0.84 points. Conclusion. Anatomical alignment improves significantly after revision surgery of malunited ankles. Measurements of the TCA appeared less useful in determining the anatomical alignment. In our series, 60% of patients reported good to excellent results. The QoL scores of our patient were comparable to those in the healthy population in the Netherlands. Levels of Evidence: Level IV: Case series

Predicting Functional Coronal Knee Laxity in Pre-Operative TKA Patients Using Morphological Measurements

Currently, pre-operative analysis of soft-tissue balance is limited to measures of passive laxity rather than active laxity. By including active laxity data, a more comprehensive surgical plan can be delivered, however there are no measures for active laxity currently in routine use. Therefore, the validation of a proxy measure based on routine collected imaging is valuable. This study aimed to determine whether coronal knee laxity can be predicted from pre-operative alignment and bony morphology of the knee. Fifty-eight patients with pre-operative CT and stressed x-ray imaging for activity laxity were analysed to identify anatomical landmarks and determine varus-valgus laxity ranges for a range of flexion angles with the joint subjected to lateral forces. Correlations between anatomical and alignment parameters, vs laxity ranges and midpoints were determined using pairwise complete Pearson linear correlation analyses. Of the 17 anatomical/alignment measurements studied, 8 correlated significantly with the knee laxity range’s midpoint at 20 ̊ flexion, with the strongest correlation being with supine coronal alignment (r = 0.95, p &lt; 0.001); the findings were similar at 45-90 ̊. Compared to knee laxity midpoint, knee laxity range was not as strongly correlated with anatomical and alignment parameters, with only 3 anatomical parameters correlated significantly with laxity range at 20 ̊ flexion and none at 45-90 ̊ flexion. These results suggest morphological measurements and anatomical characteristics may help define functional coronal laxity range of the knee.

Development and validation of a prediction model for knee joint line orientation after high tibial osteotomy

Background Maintenance of optimal knee joint line orientation (KJLO) is important after high tibial osteotomy (HTO). No tools, however, are currently available that could predict the value of postoperative KJLO before surgery. First, this study sought to determine the effects of various preoperative anatomical alignment parameters to postoperative KJLO. Based upon these analyses, we aimed to devise an equation that predicts the value of postoperative KJLO. Methods A total of 14 radiographic parameters were measured in preoperative and postoperative full-limb standing anteroposterior radiographs on 50 patients who underwent open-wedge HTO. The parameters were analysed using multivariable linear regression to predict KJLO after HTO. External validation of the equation was done with 20 patients who underwent HTO at another institution. Results After HTO, KJLO increased from − 0.8° to 2.9° (P < 0.001). Based on the multivariable linear regression analysis, an equation was derived that can estimate postoperative KJLO after HTO; postoperative KJLO(°) = 1.029 + 0.560 × preoperative KJLO(°) + 0.310 × preoperative tibia plateau inclination(°) + 0.463 × aimed correction angle(°). The adjusted coefficients of determination value for this equation was 0.721. The equation also showed good calibration and predictability in external validation with predicted squared correlation coefficient of 0.867. Conclusions This study analysed the effects of preoperative anatomical alignment parameters on the postoperative KJLO. An equation which predicts postoperative KJLO with preoperative anatomical alignment factors was devised and validated. This equation would help in selecting optimal patients for HTO and in selecting the optimal target correction angle in HTO.

A comparative study of the relationship between the recovery of movement and the anatomical alignment in fractures around the elbow

<p class="abstract"><strong>Background:</strong> The injury around the elbow joint is a common condition in any age group, especially in children as a result of fall, during the course of a child's normal play. The aim of the present study was to study the relationship between the recovery of movements and the anatomical alignment in fractures around the elbow.</p><p class="abstract"><strong>Methods:</strong> In the present study, 110 cases of fractures around elbow were included. The treatment with conservative or operative procedure depends on the surgeon concerned and his priorities. Sixty-six cases were treated conservatively, and 56 cases required operative intervention. At the time of follow up examination, cases were assessed as to the anatomical and functional point of view according to Flynn's criteria. We evaluated the reduction as per alignment in anteroposterior axis, lateral axis, and angulation. The patients were followed up for over 24 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> Patients who had good anatomical alignment (grade A) showed 96.87% satisfactory result as compared to the patient who had fair anatomical alignment (91.66%) and poor anatomical alignment (54.54%). Thus in grade A where alignment was up to 76 points, we had satisfactory result in 96.87% patients, where as in grade C where alignment was less than 50 points, the result in 45.5% of patients was poor.</p><p class="abstract"><strong>Conclusions:</strong> Patients who had good anatomical alignment achieved, showed higher recovery of movement compared to the patient who had fair anatomical alignment and poor anatomical alignment.</p>