Radiological evaluation of total knee arthroplasty

X-Ray analysis of a subset of TKA performed using a standard posterior cruciate ligament [PCL] retaining cemented technique to study the component malposition, overall post-operative alignment and mechanical loosening with respect to components positioning during follow-up period. This is a prospective study where we radiographically evaluated twenty-six primary TKAs [15 right and 11 left] in 20 patients [six patients received two stage bilateral total knee replacement] performed between July 2004 and December 2005. There were a total of 13 women and 7 men. The mean age at the time of the operation was 68 years and the follow-up period ranged from 18-32 months. The indication for knee replacement in all cases was advanced osteoarthritis. Radiographs were done immediately postoperative, at 6 weeks, at 3 months, at 6 months and then every year after surgery, and each time were compared to the postoperative controls. The overall alignment was acceptable in 19 knees, 3 had excessive valgus and 4 had varus alignment. At the last follow-up which was up to 32 months in some cases, none of the cases developed loosening as evidenced by non appearance of radiolucent zones or shifts in the position of the components. Moreover, the seven cases with joint malalignment didn't show signs of aseptic loosening within the available follow-up period. For the patellar angle, the mean tilt angle was 12° +/- 6°. In 17 knees the patellar prosthesis was displaced superiorly, and in seven cases there was medial displacement of the patellar prosthesis. Evaluation of total joint arthroplasty must be clinical, radiological and with annual intervals, in order to discover early failure signs. Proper alignments are critical for achieving good results thus keeping loosening to a minimum. Concerning the present study, aseptic loosening was not a complication of the toted knee arthroplasty evaluated at a follow-up period of up to almost three years in some cases, including those cases with documented postoperative joint malalignment

Assessment of the range of motion after total knee arthroplasty for osteoarthritic knees

A prospective study was performed to evaluate the range of motion after total knee replacement for osteoarthritis, one year postoperatively, by comparing it to baseline value. Forty-two knees [23 right and 19 left] primary TKAs in 36 patients [six patients received two stage bilateral total knee replacements] were performed between July 2004 to September 2006. There were a total of 22 women and 14 men. The mean age at the time of the operation was 68 years [range 53 - 82 years]. The average duration of follow-up was 18 months [range 14-22 months]. All prostheses were cemented preserving the posterior cruciate ligament Three different models were used namely: P.F.C. SIG-MA[R] Total Knee System from DePuy, AGC[R] Total Knee System from Biomet, and Columbus[R] Total Knee System from Aesculap. The diagnosis of osteoarthritis was established in all cases. The parameters evaluated were age, sex, preoperatlve knee flexion and extension range, preoperative flexion arc, tibiofemoral angle, and implant design. Advanced age, female gender, and good preoperative flexion and flexion arc were related to better postoperative flexion. Preoperative tibiofemoral malalignment had no significant effect on postoperative flexion. Advanced age, female gender, and good preoperative flexion and flexion arc are related to better postoperative range of motion particularly the degree of flexion

Tibial spine fractures: arthroscopic assisted reduction and percutaneous Kirschner wire fixation

The aim of this prospective study is to evaluate our results in the management of avulsion fractures of the anterior tibial spine with the aid of arthroscopy. Twelve patients with displaced tibial spine fractures with an average age of 13.3 years were the material of this study. After through clinical and radiological evaluation an operative arthroscopy for both diagnosis and treatment was done to assess and to guide both reduction and fixation with percutaneous kirschner wires. Eight added surgical techniques had required to treat the associated local knee injuries. The Lysholm scoring system was used for evaluation of the final results. Nine patients were graded as excellent, two patients as good, and one patient was graded as fair outcome. There was statistically significant correlative between the following; fracture type and positivity of anterior drawer test, age of the patients and final Lysholm scoring system, residual postoperative displacement and the final Lysholm knee scoring system, residual postoperative displacement and positive anterior drawer test was found to be statistically significant. There was no statistically significant correlative between the following; positivity of the valgus stress test and the type of the fracture, fracture type and the final Lysholm knee scoring system. Type IV fracture is the worst type regarding the incidence of associated soft tissue and bony injuries and the high rate of post-operative complications. Objective knee laxity does not always mean subjective knee laxity. The number of patients included in this study is very limited to yield a statistically significant relationship. A new comprehensive classification system is urged by this study

Biological plate osteosynthesis for transition zone femoral fractures

Less invasive plate osteosynthesis utilizing the biological sliding plate principle maintain all the soft tissue attachments as well as the length and alignment which allow early bone healing and weight-bearing without the risk of implant failure. The purpouse of this study is to evaluate the results of open reduction and internal fixation of transition zone femoral fractures [subtrochantric and supracondylar with or without intra-articular extension] using less invasive biological sliding plate principle in skeletally mature patients. Ten subtrochantric [ST] and ten supracondylar [SC] were the material for this study. DCS and DM5 were used for subtrochantric fractures and DCS and condylar buttress plate were used for supracondylar fractures. The plate was fixed with 6 to 8 cortices ort each side of the fracture. In some cases an external plate similar to the one inside were used as aiming device to allow insertion of screws closer to fracture site and into the middle fragment of segmental fracture. At the end of the follow-up [>12 months] all patients were evaluated regarding the hip and knee ROM ,time of bone healing, time of weight bearing and any complications. Also Neers .rating point system [1967] were used. for evaluation of the final results. RTA was, the single major cause [17 cases]. The average operative time was 93 minutes for ST and 102 FOT SC Fractures. The average blood losses was 300 ml for STand250 ml for SC fractures. The average period for hospital stay was 15 days, No limitation of hip or knee ROM after ST and SC fractures except one case with SC fracture associated with vascular injury. The aye rage time for radiological union was 17.63 weeks and the average time for full weight-bearing was 19.6 weeks. Shortening 1.2 cm and 15 degrees external rotation deformity were reported in two cases without any functional disability. According to Neer rating system 75% were excellent, 20% were good. Only one case with fair results due to associated vascular injury. In conclusion; less invasive biological plate osteosynthesis proved to be feasible, worthwhile method for transition zone femoral fractures. It is viable option and fragmentary periarticular fractures with many advantages over conventional plating and interlocking nailing with excellent to good results in most of cases