Management of bone loss and instability in revision knee arthroplasty

Eighteen cases of TKA were revised due to different causes of failure that included septic and aseptic loosening, implant failure comprising metal breakage and polyethylene wear, major ligamentous instability, and peri-prosthetic fractures. One stage revision was performed in all but two of the septic loosening cases where the responsible organism could not be isolated on repeated cultures. Bone loss was compensated for by using thicker plastic inserts on the tibial side and augmentation metal on both tibial and femoral components with accurate consideration of the joint line level. Whenever the stability of the prosthetic components was in question, long stem components were used. Soft tissue balance was achieved by proper tensioning of the collaterals through sequential releases, augmentation of a failed ligament and the use of a more constrained implant. Complications included patellar subluxation, two medial instability and recurrence of infection at nine months postoperatively. This study has shown that the short-term outcome of revision surgery for failed knee arthroplasty has satisfactory functional and radiological results despite the osseous and ligamentous deficits present at revision surgery

Meniscal repair using biodegradable arrows

The authors treated 39 patients with torn meniscal injuries by arthroscopic direct fixation using Bionx Meniscal Arrows[MT] [Bionx/Biofix, Bioscience, Tampere, Finland], with follow up between 6 and 26 months [mean 23]. There were 25 males and 14 females injuring 32 medial and 7 lateral menisci, an associated ACL injury was present in 7 cases. Patients' age ranged between 9 and 46 years [mean 27]. The clinical status of the tibio-femoral articulation was the main stay of follow up assessment, while 13 patients were followed up by post operative MRI, and 6 patients by 2[nd] look arthroscopy for criteria of complete, partial and non healing. In 3 patients ACL reconstruction was done, 2 in the same sessions as the arrows, and one after 6 weeks. Postoperative hinge bracing at 20°-70° was used in 22 patients, POP cylinder in 17 patients. Thirty-five patients were clinically asymptomatic in the tibio-femoral articulation [89.7%]. 15 patients [83%] returned to their athletic activity [there were 18 athletes], while the complications were 5 posterior knee pain, 4 effusion and one re-tear, the effusion and pain seemed to be related to long arrows, causing paramenisal synoviocapsular irritation, they subsided spontaneously over 6 months. Complete or partial healing, as judged by second look arthroscopy and MRI, did not correlate well with the functional outcome