All types of component malrotation affect the early patient-reported outcome measures after total knee arthroplasty

PURPOSE@#Outcomes following total knee arthroplasty (TKA), whether clinical, radiological or survival analysis, have been well-studied. Still, there are some concerns about patient satisfaction with the outcome of the surgery and factors that might contribute to a suboptimal result. This study aims to determine if there is correlation between primary TKA malalignment and early patient-reported outcome measures (PROMs).@*MATERIALS AND METHODS@#Sixty patients, who had primary TKA and a minimum of 2 years of follow up, were recruited for a detailed clinical and radiological examination. Knee alignment was measured in the coronal, sagittal and axial planes. Normal and the outlier measurements of the patients' knees were defined and the clinical results (PROMs) compared to see if there was a statistically significant difference.@*RESULTS@#Correlation between postoperative limb malalignment in the coronal and the sagittal planes and PROMs was not significant. Conversely, there was significant negative correlation between all types of malrotation and PROMs.@*CONCLUSIONS@#Although malalignment has been linked to inferior outcome and implant survival, our results showed that coronal and sagittal limb malalignment has no significant effect on early PROMs. However, all types of component rotational malalignment significantly worsen early PROMs.

Extra-articular subtalar fusion in children using the technique of locally raised interlocked bone-graft

Fourteen extra-articular suhtalar fusion procedures have been performed in eleven children with hindfoot valgus. Five children were boys and six were girls. Age ranged from 5-9 years with an average age of 6.5 years. The diagnosis was: cerebral palsy in six feet, poliomyelitis in three feet, myelomeningocele in two feet, and neglected congenital convex pes valgus [congenital vertical talus] in three feet. Extra-articular suhtalar fusions were performed using local hone graft technique in all feet. Additional procedures included: peroneus hrevis tendon transfer in five feet, tendoachillis lengthening in six feet, and peroneal tendons lengthening in nine feet. Open reduction of the talonavicular joint and K-wire fixation were performed in 4 feet. Follow-up averaged 34 months. Results were satisfactory in thirteen feet. Failure occurred in one case after nonunion of the graft with subsequent recurrence of the deformity. This was treated by Batchelor's suhtalar fusion. In another case graft resorption occurred after nine months but the hindfoot remained stable with no additional surgery required. Extra-articular suhtalar fusion using local hone graft technique as a part of surgical treatment of valgus deformities in children is a gentle, simple and reliable technique with minimal morbidity avoiding another operation for procuring an autogenous bone graft [iliac, fibular, or tibial]. Moreover, this technique proved to he successful in stabilization of the suhtalar joint in children

Surgical tips and tricks for open reduction and internal fixation of intra-articular calcaneal fractures

Twenty-four intra-articular calcaneal fractures in twenty-three patients have been treated by open reduction and internal fixation. Ten were women and thirteen were men. Age ranged from 18 to 45 years. Fracture classification was based on Sanders computed tomographic classification. There were 5 type II, 15 type III, and 4 type IV fractures. All operations were performed using a standard surgical technique with an extended lateral approach, and the fractures were fixed with plates and screws with bone grafting if needed. Average follow-up was 14 months [range, 10-22 months]. The Creighton-Nebraska assessment score was used for clinical evaluation. Radiological and functional assessments were done for all patients at the latest follow-up. Excellent results were achieved in nine fractures, good in twelve, and fair in three. The average score was 93 for type II, 89.2 for type III, and 73.75 for type IV fractures. There was a clear statistically significant superiority with type II and type III fractures treated with open reduction when compared with type IV fractures [p 0.0001]. Open reduction and internal fixation is recommended for all displaced intra-articular fractures of the calcaneus. It restores hindfoot and subtalar joint anatomy so that sub talar arthritis may be avoided