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@#Introduction: Proximal tibial plateau fractures are one of the major problems in orthopaedic surgery and are associated with high complication rates. Intra-articular proximal tibia plateau fractures represent approximately 1% of fractures in adults. Various modalities of proximal tibial plateau fracture management have been considered, ranging from simple external fixators in impending compartment syndrome to periarticular proximal tibia plates and inter-locking nails with poller screws. Purpose of this study is to determine clinical outcomes of proximal tibial plateau fractures treated with plate. Materials and methods: We did this study of proximal tibial plateau fracture according to Schatzker’s classification treated with proximal tibial periarticular plates in 53 patients prospectively admitted at the author’s institute from June 2018 to May 2020 with follow-up period of 6 months. Results: In our study, the average knee score was 89.30 (ranging from 79 to 93) and functional knee score was 97.92 (ranging from 75 to 100). Fifty-one (51) patients (96.23%) showed excellent results and 2 patients (3.77%) showed good results according to Knee Society Score, which suggest that internal fixation of proximal tibia plateau fracture with plating provides better results. Out of 53 patients, 9 patients had post-operative complications. Average radiological union was seen at 14 weeks. Conclusion: Locking compression plate in proximal tibia plateau fractures act as a good biological fixation provide stable fixation, articular reduction and limb alignment even in difficult fracture situations. Fixation of proximal tibia plateau fractures with plate gives excellent to good knee society score, with satisfactory functional and radiological outcome.
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Background:Osteoarthritis affects the knee joint more frequently than any other joint. Osteoarthritis is a chronic joint disease that affects the older age group, women more frequently, and is associated in 90% of cases with a varus deformity of the knee. The following study was conducted to evaluate the functional outcome of total knee arthroplasty in osteoarthritis using the knee society score.Methods:The study was conductedin patients treated for osteoarthritis of the knee joint at Jubilee Mission Medical College and Research Institute, Thrissur, Kerala during the period from December 2019 to March 2022. Thirty patients diagnosed with osteoarthritis of the knee joint were taken into the study, all were undergone total knee arthroplasty. Patients were followed up at 4 weeks, 12 weeks, and 24 weeks.Results:The sample consisted of thirty osteoarthritic patients with 8 males and 22 were females. The patients' ages ranged from45-75 years. Among these 30 patients, 14 involved the right side, and 16 involved the left knee joint. The mean pre-operative knee clinical score was 36.93 which was improved to post-operative 84.70 following total knee arthroplasty. The mean pre-operative knee functional score was 16.83 which was improved to post-operative 71.17 following total knee arthroplasty.The outcome was rated as per knee society score. We got excellent results in 25 cases (83%), good in 3(10%), and fair in 2 patients (7%) according to knee clinical score whereas 8 excellent (27%), 16 good (53%), 5 fair (17%) and 1 poor(3%) results were found according to knee functional score.Conclusions:Total knee arthroplasty shows drastic improvement in the functional ability of the patient and the ability of the patient to get back to a pre-disease state, which is mainly because of pain-free joint movements, reflected by the improvement in the post-operative knee clinical score and knee functional score.
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Total knee replacement (TKR) is a surgical procedure with predictable outcomes. This observational study intended to review the outcome of total knee replacements performed in osteoarthritis knee patients and evaluate the postoperative clinical, functional and radiological results in the replaced knees and the preoperative and postoperative lower limb alignment correction achieved and the incidence of early complications. Methods: We selected 20 people (20 knees) from the outdoor clinic who gave their informed consent for the study and satisfied our criteria. They were evaluated using the knee society score (KSS), preoperatively and postoperatively at the 6 months follow up and the data was analysed. Results: In our study we observed that the mean knee society score improved from 27.4 to 81 and the mean functional score improved from 30 to 79.3. The knee flexion range increased from 50* to 125*. Postoperatively all the varus knees were aligned except 3 knees. Complication rate was 5%. We found a significant increase in the knee society score after total knee replacement compared to the preoperative scores. Conclusion: We conclude that total knee replacement is a reliable and safe modality of treatment and can be performed with results comparable to the other global studies.
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For medial compartment knee OA, which is usually seen in the age group 40-50 years, total knee replacement is not recommended ideally. Hence, for these patients, there is need of a new procedure which would be safe, effective & affordable. Objective: The aim of this study is to evaluate the early benefits of proximal fibular osteotomy (PFO) in medial compartment knee OA. Methods: Total 50 patients (70 knees) with medial compartment OA included in this study from march 2017 to august 2017. All patients were managed by PFO and followed-up prospectively for minimum upto 12 months. Visual analogue scale to assess knee pain, American knee society score (AKSS) to evaluate knee functions and medial/lateral joint space ratio were used for radiological assessment. Statistical analysis done by using SPSS 20.0 software.. Results: All patients observed significant relief in knee pain after PFO. AKSS and medial/lateral joint space ratio improved significantly postoperatively. Most of the patients showed increased walking distance post-operatively. Conclusion: This study concludes that PFO is a safe & effective method for the management of medial compartment knee OA. It relieves knee pain significantly and improves knee joint function
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Introduction: Osteoarthritis is thought to be the most prevalent chronic joint disease. Total Knee Arthroplasty (TKA) is now a reliable treatment for severe arthritis and is now commonly done for end stage arthritis of knee. The results of TKA are predictable in majority of cases, but with geriatric population, arthritis is often associated with other co-morbid condition along with age, which makes the results of TKA less predictable. So, the present study was conducted to evaluate the clinical and functional outcome of TKA in this subset of population. Materials and methods: This prospective study was done at a tertiary care center of Mumbai. A total of 30 consecutive patients who consented and underwent TKA were assessed clinically, functionally and radiologically using the Knee Society Score at an interval of 6 weeks and 6 months. All the data was entered in Microsoft Excel sheet 2013 and analyzed using appropriate statistical tests using SPSS software ver. 21 Results: The average pre-op Knee Clinical Score (KCS) was 28.13 which improved to an average post-op score of 95.38. At 6 month follow up, 26 patients (87%) had Excellent, 3 patients (10%) had Good, and 1 patient (3%) poor results as per KCS. The average pre-op Knee Functional Score (KFS) was 41.53, which improved to a post-op score of 88.49. At 6 month follow up, 16 patients (53%) had Excellent, 11 patients (37%) had Good, 2 patients (7%) had Fair and 1 patient (3%) had poor results as per KFS. Chandran R, Shetty SK, Shetty A, Balan B, Lawrence J Mathias LJ. A study of functional outcome after Primary Total Knee Arthroplasty in elderly patients. IAIM, 2016; 3(7): 297-301. Page 298 Conclusion: Primary Total Knee Arthroplasty improves the functional ability of the old patient above 70 years and the ability of the patient to get back to pre-disease state, which is to have a pain free mobile joint, as reflected by the improvement in the post-op Knee Clinical Score and Knee Functional Score.
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This study aimed to examine the clinical and radiographic outcomes of primary total knee arthroplasy (TKA) with use of NexGen® Legacy® Constrained Condylar Knee (CCK) prosthesis for severe knee deformity. Clinical data of 46 patients (48 knees in total, aged 61 years on average) with severe knee deformity who underwent TKA with NexGen® Legacy® CCK prosthesis between December 2007 and February 2012 were retrospectively analyzed. There were 34 knees with severe valgus with incompetent medial collateral ligament, 11 knees with severe flexion contracture with inability to achieve knee balancing in flexion and extension by posterior soft tissue release, 2 knees with Charcot arthritis with severe varus and bone loss, and 1 with traumatic osteoarthritis with severe varus and ligamentous instability. The mean duration of follow-up was 71 months (range 40-90 months). The New Knee Society scoring (NKSS) system and the Hospital for Special Surgery (HSS) score were used to evaluate the functional and clinical outcomes. Visual Analogue Scale (VAS) was used for pain measurement and Knee Society criteria for evaluation of radiological images. The results showed that, in the total 48 knees, 1 case of loosening due to short-stem tibial component at 3 months post-operatively underwent revision. The 6-year prosthesis survival rate in this cohort was 97.9%. There was no component infection occurring within 6 years. Significant post-operative improvements were found in NKSS and HSS scores. Patient satisfaction was significantly increased. Pain score was decreased significantly. Total functional score was improved from 31.46±11.43 to 86.42±8.87, range of motion (ROM) from 42.42°±23.57° to 95.31°±23.45° and the flexion contracture from 5.31°±7.87° to 0.92°±1.80°. Preoperative radiographic study showed excessive valgus (≥7°) in 37 knees, and varus deformity in 3 knees. Post-operative femorotibial alignment was valgus 3.88°±1.76° in 48 knees. Antero/posterior (A/P) view of X-ray films showed 4 radiolucent lines (RLL) in 48 tibial components. It was concluded that TKA with CCK is effective for the treatment of the severe unstable knee that cannot be balanced by soft tissue.