ABSTRACT
The range of motion after a total knee arthroplasty is an important clinical outcome affecting the life of the patient. The aim of this study was to determine the most important factors influencing the postoperative knee flexion in Tehran, Iran. Between July 2007 and January 2009, on 95 cases of total knee joint replacement [89 patients], who were followed for 1 year postoperatively, the risk factors were assessed. Patient demographics [sex, age, body mass index, previous surgery, preoperative Knee Society System score, and preoperative range of motion] as well as radiographic measurement for preoperative tibiofemoral angle were statistically analyzed and the probable predictors entered into a linear regression model. Univariate analysis showed that age, preoperative flexion angle, preoperative flexion arc and preoperative tibiofemoral angle had significant correlation with the postoperative flexion angle. The linear regression model on the other hand revealed that preoperative flexion angle and preoperative tibiofemoral angle were the true predictors of the postoperative flexion angle with coefficients of 0.64 and -0.21, respectively. Better range of motion before the surgery with a lower tibiofemoral varus/valgus angle were more likely to result in a better range of motion after the surgery, suggesting that an appropriate timing for the surgery when the knee joint is still in a better function can lead to a better outcome
Subject(s)
Humans , Male , Female , Range of Motion, Articular , Treatment Outcome , Knee Joint/surgery , Knee/surgeryABSTRACT
High tibial osteotomy is an accepted procedure to reduce the progress of osteoarthritis of medial compartment of the knee and also to decline the patient's complaints such as pain or limitation of physical activities. The aim of this study was to compare two methods of lateral closed wedge and medial open wedge in osteoarthritis of medial compartment of the knee. This study was a prospective clinical trial, performed on 59 patients [37 females and 22 males] at Rasul-e-Akram Hospital in Tehran during 2006 and 2008. The mean follow-up time of the patients after surgery was 27 +/- 6 months. Femorotibial angle, pain, joint's function as well as limitation of motion, total score of Lysholm criteria, and stability of the medial collateral ligament were assessed and recorded before and after surgery. Data were analyzed statistically using Chi-square test, t-test, and Mann-Whitney test. The angles of correction were 9.8 and 9.6 in closed and open wedge, respectively. Seven cases [24.1%] of post-surgery complications were seen in closed wedge and 8 cases [21.1%] in open one among those 4 cases in closed and only 1 case in open wedge needed reoperation. The mean times of the healing process were 3.1 +/- 1.7 and 2.8 +/- 1.2 months after closed and open wedge osteotomy, respectively. There was no significant difference between two methods. Both methods resulted in remarkable decrease in pain along with increased function and Lysholm score after surgery yet no significant distinction was demonstrated between two techniques. In addition, while the stability of medial collateral ligament considerably increased in open wedge method, it slightly decreased in closed wedge technique following surgery. Considering the increased stability of medial collateral ligament by open wedge method and slight instability after closed wedge method, it seems that the instability of the medial collateral ligament before surgery to be one of the most noteworthy indications of medial open wedge osteotomy
Subject(s)
Humans , Male , Female , Osteoarthritis, Knee/surgery , Treatment Outcome , Prospective StudiesABSTRACT
Background: since anterior cruciate ligament [ACL] reconstruction become more frequently carried out, expectation of less morbidity and earlier return to activities become higher; for this reason defining influencing factors on outcome for selecting patients is valuable. The aim of this study is to investigate demographic factors influencing outcome of ACL reconstruction
Materials and Methods: we evaluate the clinical results of 187 patients who underwent patellar and hamstring techniques for ACL reconstruction, considering height, weight, BMI, gender, and age as assessed by history, instability tests, KT 1000 knee arthrometer, Lysholm and IKDC score, and MRI and compare them. Majority of patients were followed and evaluated 6 months [92%] and 3 years [84%] after arthroscopic reconstruction
Results: there were no differences between the study groups considering these two surgical techniques and demographic factors preoperatively. Our comparison has shown less satisfaction in the results while BMI was increased, but there were no differences between male and female in the outcome. However, results of reconstruction in the patients over 40 years old were favorable, but there were more complications in the patellar tendon group
Conclusion: obesity was a factor resulted in more complications and unsatisfactory. Gender was not a reason for making any difference between patients, and outcomes of both male and female were the same. Results of patients over 40 years old were a good reason for performing reconstruction at these ages, but since complications of patellar technique were noticeable, it is a good reason for surgeons to prefer hamstring technique in elderly
ABSTRACT
Background: since anterior cruciate ligament [ACL] reconstruction become more frequently carried out, expectation of less morbidity and earlier return to activities become higher; for this reason graft selection become more important. The purpose of this randomized clinical study is to compare the outcomes of ACL arthroscopic reconstruction when using either patellar tendon [PT] and tendons of medial hamstring muscle [HS]
Materials and Methods: we evaluate the clinical results of 187 patients who underwent these techniques, as assessed by history, instability tests, KT 1000 knee arthrometer, Lysholm and IKDC score, and MRI and compare them. Majority of patients were followed and evaluated 6 months [92%] and 3 years [84%] after arthroscopic reconstruction
Results: there were no differences between the study groups preoperatively. Our comparison has shown significant kneeling pain and anterior knee pain in the PT with respect to HS technique. Although, extension deficits were significantly greater in the PT group, Flexion deficits were not significantly different between the groups. Clinical results according to the Lysholm scale and IKDC score between these techniques were the same, except Lysholm score was worse in PT group than HS group at 3 year follow up. About radiologic evaluation, the tibial tunnel enlargement was significantly higher in HS technique in comparison with PT technique
Conclusion: the use of both grafts had a good and equal outcome and the only difference is their long-term complications. Anterior knee pain, kneeling pain, and more extension deficit could be good reasons for a surgeon to prefer tendons of medial hamstring muscle as graft for performing ACL reconstruction