ABSTRACT
PURPOSE: This study was performed to compare the postoperative maximal flexion angle (MFA) of standard PCL-substituting (PS) prosthesis with that of high-flexion PS prosthesis after total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 81 patients (133 knees) were enrolled in this study. Sixty-eight primary bilateral TKAs were performed in 34 consecutive patients. The bilateral TKAs were performed in a staged sequential manner, with a standard PS prosthesis in one knee and a high-flexion PS prosthesis in the contralateral knee. We also analyzed the results of another 47 patients as several control groups, and this consisted of standard or high-flexion PS total knee prostheses in the bilateral TKAs, and standard or high-flexion PS total knee prostheses in the unilateral TKAs. The patients were clinically assessed with the Knee Society scoring system and the MFA was measured with a goniometer. RESULTS: At the last follow up, the mean postoperative MFA of the 34 patients operated with the combination of different prostheses was 131.6+/-10.4degrees for high-flexion prosthesis side and 131.6+/-9.5degrees for standard prosthesis side respectively. There was no statistically significant difference. On comparing with the results of the 47 patients in the control group, no statistically significant difference in the mean postoperative MFA was found between the groups. CONCLUSION: We found no significant differences between the high-flexion PS prosthesis and the standard PS prosthesis in the postoperative MFA.
Subject(s)
Humans , Arthroplasty , Follow-Up Studies , Knee , Knee Prosthesis , Prostheses and ImplantsABSTRACT
PURPOSE: This study was performed to determine new criteria for performing lateral retinacular release (LRR) without having a detrimental effect on patellar tracking. MATERIALS AND METHODS: For 17 patients who underwent bilateral TKAs, LRR was not performed at one side (A) due to improvement of patellar tracking after deflation of tourniquet although maltracking existed with the inflation of tourniquet. At the other side (B), LRR was not performed either because patellar tracking improved with one stich method although maltracking existed regardless of tourniquet status. We measured the lateral patellar tilt angle (LPTA) of each side inthose 17 patients after 1 year after TKAs and compared them. We also surveyed the incidence of LRR in 225 primary TKAs with the staged method of patellar tracking evaluation during the same period. RESULTS: The average LPTA was 3.4degrees at side (A) and 4.6degrees at side (B) respectively. There was no significant difference in LPTA between side (A) and side (B) (p=0.337). From the survey for incidence of LRR in 225 primary TKAs during the same period, LRR was not required in 19% of patients showing good patellar tracking with inflation of tourniquet, 58% of patients showing improved patellar tracking after deflation of tourniquet and 21% of patients showing improved patellar tracking by one stitch method regardless of tourniquet status. Consequently, only 2% of patients required LRR in primary TKA. CONCLUSION: One stitch method under the deflation of tourniquet in evaluating process of patellar tracking during primary TKAs is supposed to be very effective and to reduce the incidence of LRR to only 2% without influencing the LPTA.
Subject(s)
Humans , Incidence , Inflation, Economic , Knee , Thumb , Tourniquets , Track and FieldABSTRACT
PURPOSE: To study the availability of the radiological classification for incongruent hallux valgus deformities, which has been used as the key to the algorithm for selecting surgical options. MATERIALS AND METHODS: To determine radiological severity, 257 cases of incongruent hallux valgus deformities were studied. The hallux valgus angle (HVA) and the 1/2 intermetatarsal angle (IMA) were measured in each case. Following Mann's radiological classification system, the HVA and IMA were compared to determine any similarity in severity. The distal metatarsal articular angle (DMAA) was also measured to observe the extent of its effect on the incongruent deformity. RESULTS: The HVA was 36.1degrees on average (range, 16-60degrees) and the 1/2 IMA was 15.8degrees on average (range, 5-30degrees). In 126 cases (49.1%), the severity between the 1/2 IMA and HVA coincided with the index classification, whereas. 131 cases (50.9%) did not correspond. Overall, the severity of approximately half the cases, could not be graded. The DMAA was 15.6degrees on average (range, 0-40degrees) and 133 cases (51.8%) demonstrated a value above normal value (>15degrees). CONCLUSION: The radiological classification system used as a guide for surgical decision-making needs to be revised, due to the overt limits of correspondence between the severity of the 1/2 IMA and HVA. Because the HVA would be influenced by both the lateral subluxation and bony deformity around the first metatarsophalangeal joint, it is reasonable to consider these factors on the HVA as elements to be corrected individually, instead of the HVA alone.