How much improvement can satisfy patients? Exploring patients’ satisfaction 3 years after total knee arthroplasty

Background Despite the innovations in total knee arthroplasty (TKA), there is still a subset of patients who do not acquire significant relief or expected satisfaction after primary TKA. However, this subgroup of patients still gains improvements more or less in terms of objective or quantified assessments after the procedure. The purpose of our study is to explore the factors that correlate with patients’ satisfaction and identify minimal clinically important difference (MCID) and minimum important change (MIC) in clinical parameters. Methods We conducted a retrospective study of 161 patients diagnosed with osteoarthritis who underwent unilateral total knee arthroplasty from January 2017 to December 2017. We collected the following parameters: body mass index (BMI), duration of disease, education level, depression state, preoperative flexion contracture angle of knee, HSS scores, 11-point NRS scores, and radiological parameters (preoperative minimal joint space width and varus angle of knee). The satisfaction was graded by self-reported scores in percentage (0–100). Results We revealed that 80.8% of patients were satisfied 3 years overall after primary TKA. HSS score change, NRS-Walking score change, age, and pre-mJSW showed significant difference between satisfied and dissatisfied group. The varus angle change revealed statistical significance according to the levels of satisfaction. Simple linear regression identified the MCID for HSS score to be 5.41 and for the NRS-Walking to be 1.24. The receiver operating characteristics (ROC) curve identified the MIC for HSS score to be 25.5 and for the NRS-Walking score to be 6.5. Conclusions In summary, we identified several factors that correlated with patients’ satisfaction independently after TKA in a long term. In addition, we revealed the minimal clinically important difference (MCID) and minimum important change (MIC) for HSS and NRS score in these patients.

Post-operative radiographic measures of pelvic limb alignment in dogs with medial patellar luxation after trochlear wedge recession versus trochlear block recession surgery

Background and Aim: Anatomical and mechanical femoral angles are quite different among dog breeds. Most published data are about large dog breeds, however, medial luxation of patella is more common in small breeds. Measures of pelvic limb alignment are important for outcome of patellar luxation surgery. Therefore, the aim of the present study was to compare the values of anatomical and mechanical femoral and tibial angles in dogs before, immediately after, and 1 month after surgery for correction of medial patellar luxation (MPL). Materials and Methods: The study was conducted with 54 dogs (67 stifle joints) from four small breeds that underwent surgery by either trochlear block recession (36 stifle joints) or trochlear wedge recession (31 stifle joints) techniques. Results: In both trochleoplasty techniques, statistically significant differences in the values of the anatomical medial proximal femoral angle (aMPFA), anatomical lateral distal femoral angle (aLDFA), and femoral varus angle (in MPL Grade II) and of aMPFA and Q-angle (in MPL Grade III) were found out. Conclusion: After block recession surgery, more angles were positively influenced and this effect was more pronounced in patients with MPL Grade II.

How Much Improvement Can Satisfy Patients? Exploring Patients’ Satisfaction 3 Years After Total Knee Arthroplasty

Background: Despite the innovations in total knee arthroplasty(TKA), there is still a subset of patients who do not acquire significant relief or expected satisfaction after primary TKA. However, this subgroup of patients still gains improvements more or less in terms of objective or quantified assessments after the procedure. The purpose of our study is to explore the factors that correlate with patients’ satisfaction and identify minimal clinically important difference(MCID) and minimum important change(MIC)in clinical parameters.Methods: We conducted a retrospective study of 161 patients diagnosed with osteoarthritis who underwent unilateral total knee arthroplasty from Jan. 2017-Dec. 2017. We collected the following parameters: body mass index(BMI), duration of disease, education level, depression state, preoperative flexion contracture angle of knee, HSS scores, 11-point NRS scores and radiological parameters(preoperative minimal joint space width and varus angle of knee). The satisfaction was graded by self-reported scores in percentage(0-100). Results: we revealed that 80.8% of patients were satisfied 3 years overall after primary TKA. HSS score change, NRS-Walking score change, age and Pre-mJSW showed significant difference between satisfied and dissatisfied group. The varus angle change revealed statistical significance according to the levels of satisfaction. Simple linear regression identified the MCID for HSS score to be 5.41 and for the NRS-Walking to be 1.24. The receiver operating characteristics (ROC) curve identified the MIC for HSS score to be 25.5 and for the NRS-Walking score to be 6.5. Conclusions: In summary, we identified several factors that correlated with patients’ satisfaction independently after TKA in a long-term. In addition, we revealed the minimal clinically important difference(MCID) and minimum important change(MIC)for HSS and NRS score.

Limited release medial collateral ligament technique

Introduction: To explore the outcome of selective releasing medial collateral ligament in total knee arthroplasty. Hypotheses: Selective releasing technique work for knee balance and clinical results. Methods: Sixty cases of total knee arthroplasty were studied retrospectively from May,2016 to May 2017.The cases traits were as follows:22 male,38 female,age between 55 years and 83 years,the diagnosis totally OA,pre-operative and varus angle was (13.8±2.5)°,preoperative HSS score 36.5±2.9.All the cases were performed with new technique in which anterior parts of MCL was released limitedly ,posterior-lateral was released about one centimeter beneath joint line,and pie-crusting was used when it was still unbalanced.This was different from the conventional one in which a regular medial soft tissue envelope was performed. Results: Post-operation wound was I stage union.The average follou-up was nine months(6-12 months).The resudial varus angle was (0.8±1.5)°,HSS score was (86.0±3.5),which had significant statistically difference compared with the pre-op one. Conclusion: The selectively releasing MCL technique was minimally invasive and easy to learn. Good function was achieved.

Does Patella Position Influence Soft Tissue Balance and Clinical Outcome in Minimally Invasive Total Knee Arthroplasty?

Purpose: We hypothesized that patellar positioning during minimally invasive total knee arthroplasty (MIS-TKA) would affect soft tissue balance and postoperative outcome.Methods: From December 2018 to February 2019, 55 patients receiving primary MIS-TKA were enrolled. The gap-balance technique was used, with patients randomly assigned to undergo osteotomy and balance of soft tissue with the patella reduced (group A; n = 27) or with the patella subluxated (group B; n = 28). The soft tissue balance achieved with the patella reduced and subluxated were compared. Femoral prosthesis rotation, mechanical femoral axis–to–tibial axis angle, Knee Society Score (KSS), pain score, and range of flexion were compared between the groups. Follow-up was for 6 months.Results: The flexion gap and the varus angle were significantly greater after patella reduction than before reduction, but the extension joint gap and varus angle were comparable before and after patella reduction. The femoral prosthesis tended to be internally rotated in group B. Range of flexion was better in the group A than in group B at 1 month after surgery, but the differences were not significant at 3 and 6 months. KSS and pain score were comparable between the groups after surgery.Conclusion: During MIS-TKA, as far as possible, soft tissue balance should be achieved with the patella reduced; otherwise, the femoral prosthesis may be installed more internally and, after patella reduction, the flexion gap and varus would increase.

Preoperative Clinical Correctability and Prediction of the Prosthesis Type in Total Knee Arthroplasty for ‌Severe Osteoarthritic Varus Deformity

Background: The preoperative identification of patients who might need constrained condylar knee (CCK) prosthesis in total knee arthroplasty (TKA), is essential to ensure the availability of equipment and to address the patients’ expectations accurately. Objectives: In this study, we aimed at investigating if the preoperative features of the patients can provide this data. Methods: A total of 30 patients who underwent primary TKA for severe osteoarthritic genu varum deformity (varus angle ≥20º) were evaluated in this retrospective study. Prosthesis selection was based on preoperative and intraoperative information. Demographic data, preoperative correctability of the deformity, and intraoperative information, including the reduction osteotomy, soft-tissue release, and pie-crust technique, were retrospectively collected. Soft-tissue release was performed in a sequential manner in 3 steps. Results: The study population included 4 males and 26 females with a mean±SD age of 64.6±8.7 years. A CCK prosthesis was used in 11 (36.7%) cases. A significant association was found between the preoperative correctability and the type of prosthesis. In other words, all CCK prostheses were used in patients who were preoperatively non-correctable (P<0.001). Also, the step of release was significantly associated with the type of prosthesis, and CCK prosthesis was used in all patients with step 3 release (P<0.001). Preoperative correctability was significantly related to the step of release, as well. It means that all deformities with step 3 release were preoperatively non-correctable (P=0.008). Conclusion: The preoperative clinical evaluation of correctability could be used in the identification of patients who might need a CCK prosthesis.

Primary Results of Medial Epicondylar Osteotomy in Patients with Severe Bilateral Varus Knee Candidate for Total Knee Replacement

Background Total knee arthroplasty is a challenging task in patients with severe varus deformity. In most of these patients, an extensive medial release is needed that may lead to instability. Medial epicondylar osteotomy may be a better substitute for complete medial collateral release. Materials and Methods Fourteen patients with bilateral knee osteoarthritis and severe varus deformity were enrolled in this study. In one side, the patients underwent medial epicondylar osteotomy for mediolateral imbalance if the only option was superficial medial collateral ligament (MCL) release. In contralateral side, the extensive medial release was performed and MCL was released either by pie-crusting technique or by subperiosteally release. The results of the two sides were compared. Patients were followed up for 12 months after the operation. Physical examination, clinical questionnaires, and radiography findings were recorded. Union of the osteotomies fragment and complications was evaluated. Results The mean varus angle before surgery was 21.6 ± 4.7 degrees, which was corrected to 8.6 ± 2.9 degrees after operation with an extensive medial release. The mean varus angle of contralateral side was 22.6 ± 1.7 degrees, which was corrected to 7.5 ± 2.3 degrees following medial femoral epicondyle osteotomy. There was no significant difference in varus correction (p = 0.1). Medial joint line opening in valgus stress test was 2.7 ± 0.4 mm in the osteotomized side and 3.5 ± 0.9 mm in contralateral side. Mean range of motion for the osteotomized side was 97.8 ± 4.3 degrees and 100.7 ± 2.7 degrees for contralateral side (p = 0.6). Nonunion occurred in a case in the osteotomized side and no medial instability was observed in medial release or osteotomies sides. No statistical difference was recorded based on clinical questionnaires (Oxford and WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index] scores). Conclusion Medial epicondylar osteotomy is a safe technique with the well-controlled medial extensive release in the patients with severe varus deformity during total knee arthroplasty.