Total Knee Replacement Arthroplasty with Buechel and Pappas Knee: Minimum 2-Year Follow-up

BACKGROUND: Clinical and radiologic evaluation and analyses of the surgeries using Buechel and Pappas (B-P) knee implants. METHODS: The study was conducted on 60 patients who underwent 94 total knee replacement arthroplasty with B-P knee implants from May 2009 to December 2010. The results were compared to the results of 41 patients who underwent 60 knee joint surgeries using NexGen-LPS implants from January 2008 to August 2009. RESULTS: The American Knee Society score of the B-P knee group increased from an average of 66.9 (clinical score) and 65.5 (functional score) to 93.4 and 90.3, respectively; while those for the NexGen-LPS group increased from an average of 68.8 (clinical score) and 62.4 (functional score) to 86.3 and 76, respectively. The average ranges of motion of the B-P knee group and the NexGen-LPS group were 119.1degrees and 114.8degrees, respectively, before surgery and improved to 121.0degrees and 123.0degrees at final follow-up after the surgery. The visual analogue scale scores for the B-P knee group and the NexGen-LPS group improved from 4.7 and 4.6 to 1.4 and 1.8, respectively. The flexion contracture also improved from 5.1degrees and 6.3degrees to 0.64degrees and 1.72degrees. The tibio-femoral angle for the B-P knee group and the NexGen-LPS group also improved greatly after the surgery, from varus 0.34degrees and 0.73degrees each to valgus 6.7degrees and 6.9degrees, respectively. CONCLUSIONS: The evaluation of more than 2 years of total knee replacement arthroplasty using B-P knee implants showed good results. B-P knee implants showed a relatively higher degree of satisfaction in clinical knee score and less intraoperative bone mass removal than NexGen-LPS implants.

Additional Hinged External Fixation in Complex Elbow Injury

PURPOSE: The purpose of this study was to evaluate the use of hinged external fixation in management of complex elbow injury. MATERIALS AND METHODS: We retrospectively reviewed clinical outcomes in 10 patients with elbow dislocation and associated fractures of both the radial head and the coronoid process from January 2007 to December 2013. All ten patients were treated by hinged external fixation after open reduction and internal fixation. The indication for use of a hinged external fixator was persistent instability after fixation of the fractures. Early mobilization was started at 1 week (6.5 days) after surgery. The external fixator was removed at 6 weeks after surgery. Cassebaum classification and Mayo elbow performance score were used for clinical and functional evaluation. The follow-up period was at least 1 year. RESULTS: At the last follow-up, the average further flexion was 127degrees, and the average flexion contracture was 16degrees. The average pronation was 83degrees and the average supination was 78degrees. By the Cassebaum classification after 1 year follow-up, patients were classified as 4 excellent, 4 good, and 2 poor. According to the Mayo elbow performance score, the average score was 87 points (65-100 points) with 3 excellent, 6 good, and 1 fair. Stability was restored in all patients at the last follow-up. There was no case of nonunion and the average union period was 11.5 weeks. CONCLUSION: This study advocated the additional use of a hinged external fixator in the treatment of complex elbow instability, especially when fixation of fractures and repair of soft tissues were not sufficient. Providing adequate stability and allowing early motion, additional external fixation could improve the functional outcome.