The coronal angulation of the femur in Thai osteoarthritic knee patients with varus deformity.

Objective: To determine the angulation of the distal femoral axis - femoral mechanical axis and the coronal femoral bowing in varus OA knees. This information is necessar, because the routine distal femoral valgus cut can potentially lead to error in post-operative alignment. Methods: Hip to ankle standing radiographs were ordered in 160 varus OA patients (200 limbs). The mean age of the patients was 63.8 years. In addition, 50 limbs of young volunteers with an average age of 28.8 years, were also studied for comparison. The distal femoral axis-femoral mechanical axis angle, femoral bow, and other angles were determined and compared between two groups. Results: Mean distal femoral axis-mechanical axis angle was 7.0˚+ 1.5˚ and mean femoral bow was 2.4˚+ 2.6˚ in patients compared to 5.7˚ + 0.5˚ and 0.3˚+ 0.5˚ respectively, in controls. The varus deformity significantly correlated with femoral bowing. Thirty-five (17.5 percent) of OA limbs showed a distal femoral axis-mechanical axis angle of more than 9˚ and there were 42 OA limbs (21%) that had significant (> 3˚) femoral bowing. Conclusion: These findings have implications in deciding the optimum valgus angle at which to perform distal femoral resection during TKA in varus OA knee.

Disability evaluation in posttramatic chronic joint pain patients.

A 37-year-old single female, working as a laboratory technician at a rural public hospital, was presented at Siriraj Hospital with the complaint of chronic knee joint pain for about a year and a half. She had a history of injury by falling down on both knees in her bathroom and suffered significant aggravation to her knee joint. Her pain was constant regardless of her activities except that it was worse with knee bending. Seeking several medical doctors\' treatments did not cure the pain at all. Upon a through physical examination and investigation, the objective data did not seem to correlate the severe subjective complaint or any definite diseases. After being treated with several methods, including medication, surgery, and rehabilitation for 6 months, she quite her job and personally asked for a permanent disability certificate. The formal request was submitted to the hospital\'s director fpr a disability evaluation and the issuing the certificate 6 months later. She was then scheduled for a disability assessment and consideration of legal fitness.