Factors influencing knee valgus alignment in Crowe type IV hip dysplasia after total hip arthroplasty

Background Valgus deformity of the knee remains a complaint after total hip arthroplasty (THA) among some patients with Crowe type IV hip dysplasia. We aimed to identify the knee alignment in these patients before and after surgery, and to explore the factors contributing to postoperative knee valgus alignment. Materials and methods We retrospectively reviewed a series of Crowe type IV patients who received THA between February 2010 and May 2019 in our hospital. The patients’ medical data were collected from the hospital information system. On both preoperative and postoperative full limb length standing radiographs, the following parameters were measured: hip–knee–ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle, anatomical tibiofemoral angle, anatomical lateral distal femoral angle, femoral neck-shaft angle, pelvic obliquity, limb length, height and lateral distance of hip center, and femoral offset. Univariate and multivariate binary logistic regression were used to identify the factors influencing postoperative knee valgus alignment. Results A total of 64 Crowe type IV patients (87 hips) were included in the study. Overall, HKA improved from 176.54 ± 3.52° preoperatively to 179.45 ± 4.31° at the last follow-up. Those hips were subdivided into non-valgus group (≥ 177.0°, n = 65) and valgus group (< 177.0°, n = 22) according to postoperative HKA. Only postoperative mLDFA was a significant factor in the multivariate regression model. Conclusions The postoperative mLDFA is a major factor related to knee valgus alignment after THA, which combines the preoperative anatomy and surgical reconstruction. Other factors previously published were found to have no significance. Level of evidence III.

Gender-specific difference in the recurrence of flexion contracture after total knee arthroplasty

Background Range of motion after total knee arthroplasty (TKA) can impact patients’ daily lives. Nevertheless, flexion contracture (FC) often recurs after TKA, even upon achieving full extension intraoperatively. This study aimed to evaluate the relationship among preoperative, intraoperative, and postoperative knee extension angles, and clarify the risk factor for postoperative FC. Methods One hundred forty-seven knees undergoing TKA using a navigation system were evaluated. We measured the pre- and postoperative (6 months after TKA) extension angles using a goniometer, and intraoperative (before and after TKA) extension angle using a navigation system; the correlation between these angles at each time point was evaluated. Results The mean preoperative, intraoperative (before and after TKA) and postoperative extension angles were -9.9°, -6.8°, -0.1°, and -2.0°. Regarding intraoperative extension angle after TKA, 58 knees showed ≤ 5° hyperextension and six knees showed > 5° hyperextension. At 6 months, no cases showed hyperextension and 105 knees showed full extension. The mean intraoperative extension angle after TKA in the postoperative full extension group was 0.4°. A significant correlation was found among extension angles at each point (p<0.01, respectively). However, the intraoperative extension angle after TKA correlated with the postoperative extension angle only in females. Contrarily, the recurrence rate of FC was significantly higher in males than in females (p<0.01). Conclusion Intraoperative extension angles significantly correlated with pre- and postoperative extension angles in TKA. Moreover, intraoperative mild (≤ 5°) hyperextension is acceptable for postoperative full extension. There was a gender-specific difference in correlation between intra- and postoperative knee extension angles. Level of evidence III.

Occurrence of late postoperative knee and hip arthroplasty postoperative complications / Ocorrência de complicações no pós-operatório tardio de artroplastia de joelho e quadril

Objetivo: avaliar a prevalência de complicações no pós-operatório e sua associação com variáveis sociodemográficas e clínicas. Métodos: Trata-se de um estudo descritivo, de seguimento prospectivo, realizado com 99 pacientes de um hospital de ensino. Os participantes foram selecionados por amostragem intencional (referencia) e seguidos por 30 dias após a alta do hospital. Realizou-se análises descritivas, univariadas e bivariadas Resultados: 32 (32,3%) pacientes desenvolveram ao menos uma complicação, sendo que 10 (10,1%) desenvolveram mais de uma complicação num seguimento de 30 dias. Dor (31; 31,3%) e Infecção (12; 12,1%) foram as complicações mais prevalentes. Identificou-se associação estatística entre o desfecho clinico dos pacientes submetidos a cirurgia de joelho e quadril e a presença de complicações no pós-operatório (p<0,001). Conclusão: A ocorrência de complicações no pós-operatório de artroplastia de joelho e quadril num seguimento de 30 dias foi elevada, com destaque para a dor e infecção local.

Recurrent Hemarthrosis following Resections of Benign Bone Tumors: A Case Report of Two Pediatric Cases

Introduction/Cases. Two pediatric patients presenting with benign bone tumors of the distal femur at the level of the suprapatellar fat pad developed late onset recurrent knee hemarthrosis following surgical treatment of the lesions. A sinus tract from the intramedullary bone to the knee capsule was discovered in both patients during surgical exploration. Resection of the sinus tract and full closure of the knee capsule resulted in no further recurrence. Conclusion. Postoperative knee effusions in patients following resection near the distal femur could represent hemarthrosis that require additional workup and treatment. Resection of the sinus tract successfully treats the hemarthrosis.

Predictive Factors in Selecting Patients with Knee Osteoarthritis for Knee Replacement: A Single Center Experience

Total knee arthroplasty (TKA) is gaining acceptance among patients worldwide, knowing who benefits from surgery and who does not is detrimental. Comorbid conditions are detrimental for joint replacement surgery, and patient medical optimization is critical and sometimes challenging. TKA surgery was first performed in 1968. Since then, improvement in many aspects of the procedure is reported. This study aimed to retrospectively evaluate the predictive factors for outcome in TKA done at Aseer central hospital. Retrospective study of TKA cases done at a tertiary care hospital in the Abha region, Saudi Arabia from January 2006 to January 2012 were included in the study. We evaluated Knee function using Knee Society scoring system, and the percentage of each comorbidity in our patient study group was recorded. Female were more than males (83.33% vs. 16.67% males). comorbidities in the study group and their frequencies were: psychosocial factors (28.4%); severe joint disease (67%); additional joint disease (other knee, 59.4%; hips, 35.4%; spine, 34.2%); depression and anxiety (49.8%); hypertension (25%); asthma (14%); sleep apnea (8.4%); diabetes: HbA1c &lt; 7 (82%); HbA1c &gt; 7 (18%); obesity BMI &lt; 30 (96.6%); BMI &gt; 30 (3.4%); peripheral vascular disease (0.20%); and comparative pre- and postoperative knee scores with observed correlation showed significant improvement. Isolating the predictive factors of unfavored outcome may help total knee results.

Total Knee Arthroplasty in Octogenarians: Should We Still Be so Restrictive?

Demand for total knee arthroplasty (TKA) in octogenarians will increase in subsequent years as society ages. We conducted a retrospective observational study in octogenarians operated on with TKA between 2015 and 2019, comparing preoperative and postoperative Knee Society Score (KSS), Knee Society Function Score (KSFS), extension and flexion balance, and radiologic alignment using a paired Student t-test. A chi-squared test was used to correlate mortality with Charlson comorbidities index score and with ASA scale. Kaplan–Meier analysis was performed to calculate patient survival. In this period 36 patients ≥80 years underwent TKA, with a mean age of 81.6 years. Of these, 24 patients (66.7%) were classified as ASA II and 12 (33.3%) as ASA III. Sixteen patients (44.4%) were Charlson 0, 14 (38.9%) Charlson 1, two (5.6%) Charlson 2, and four (11.1%) Charlson 3. KSS, KSFS, flexion and extension range, and radiologic alignment were statistically significant (p < 0.001) when comparing preoperatory and post-operatory data. No correlation (p > 0.05) was found between mortality and ASA or Charlson score. Seven patients (19.4%) suffered a medical complication and two patients experienced surgical complications. Four patient died (11.1%) during follow-up. The mean patient survival was 67.4 months. Patients ≥80 years achieve clinical improvement after TKA. Comorbidities, not age, are the burden for surgery in older patients.