Impact of change in coronal plane alignment of knee (CPAK) classification on outcomes of robotic-assisted TKA.

BACKGROUND: Mechanical alignment with total knee arthroplasty (TKA) has been widely used since the implantation of the first prosthetic knee. Multiple studies have reported 80% patient satisfaction with TKA. However, the reported patients' dissatisfaction is believed to be caused by having to convert different knee alignments to neutral alignments. It is postulated that a change in the CPAK classification of knees leads to patient dissatisfaction. Thus, we hypothesized that a change in CPAK classification with robot-assisted TKA with mechanical alignment does not significantly lead to patient dissatisfaction. METHODS: We retrospectively analyzed 134 patients who underwent robot-assisted mechanical alignment total knee arthroplasty (MA-TKA) using cementless implants and classified them into CPAK system pre- and post-operatively. One year after TKA surgery, we recorded binary responses to patients' satisfaction with the outcome of surgery and analyzed if a change in CPAK classification is associated with the outcome of surgery. RESULTS: We found that 125 out of 134 patients (93.28%) were happy with the outcome of surgery. CPAK classification was changed in 116 patients (86.57%) and maintained in 18 patients (13.43%). Our results also showed that 111 (95.7%) out of 116 patients who had a change in CPAK and 14 (77.8%) out of 18 patients who maintained their CPAK post-surgery were happy with the outcome of surgery (OR = 6.3, CI 1.741-25.17, P value = 0.019). CONCLUSION: We concluded that changing the patient's native joint line and CPAK classification does not significantly change the outcome of surgery in terms of satisfaction. The dissatisfaction rate of 20% as published by previous researchers may be confounded by other reasons and not just due to changes in alignment and joint line.

Step-Cut Subtrochanteric Osteotomy Combined with Total Hip Arthroplasty for Neglected Traumatic Hip Dislocations.

Background: Total Hip Arthroplasty remains the standard treatment protocol for patients with neglected traumatic dislocations of the hip with arthritis. A total hip arthroplasty needs to be frequently combined with a subtrochanteric shortening femoral osteotomy to aid in the reduction of the hip joint in such cases. Still long-term stable implant fixation, rigid construct, and favorable functional outcome remain a challenge. In respect to subtrochanteric shortening osteotomy, various techniques have been described in the literature, including the step-cut, double chevron, transverse, and oblique osteotomies. Out of these types, a subtrochanteric step-cut osteotomy provides a better rotational stability and a larger surface of contact to aid in union. As there is a paucity in the literature regarding the step-cut osteotomy for traumatic dislocations of the hip, we designed this study to evaluate the outcomes of this procedure. Methods: We prospectively evaluated 24 patients with neglected traumatic dislocations of the hip, who underwent total hip arthroplasty with a step-cut subtrochanteric shortening osteotomy using a long modular stem within a span of 4 years. The indications were severe pain and difficulty in walking and performing activities of daily living. Patients fulfilling the inclusion criteria were evaluated in terms of Harris Hip Score, leg length discrepancy, neurological status, union of the osteotomy, and implant stability. Results: The mean Harris Hip Score significantly improved from 33.4 preoperatively to 89.2 postoperatively at the latest follow-up. At the final follow-up, all patients showed union at the osteotomy site and there were no cases of implant loosening or instability. No neurological complications were reported. Conclusions: Total hip arthroplasty combined with a step-cut subtrochanteric femoral shortening osteotomy in patients with neglected dislocations of the hip was associated with good functional outcome and higher success rates in terms of stable implant fixation and union at the site of osteotomy.

Lateral Buttress Plate Along with Cancellous Screw Fixation for Hoffa Fracture Using Swashbuckler Approach.

Coronal plane fracture of the posterior femoral condyle, Hoffa fracture is a rare injury pattern. We report a case of a 32-year-old male with closed Lateral Hoffa fracture along with patella and medial condyle of tibia fracture. Patient was treated using 02 cannulated cancellous screws and a lateral recon plate for Hoffa fracture, tension band wiring for patella fracture and 02 cannulated cancellous screws for tibia fracture through modified swashbuckler approach. Twenty-four months postoperatively, the range of movement in the knee was 0°-130°. In this complex case, our technique provided stable fixation of the fragments and a satisfactory final functional outcome.

Osteoblastoma of Talus: A Diagnostic Dilemma.

The critical biomechanical importance of talus and nonspecific clinical features of talus lesion warrants a meticulous diagnostic work-up for specific management, particularly when the talus lesion is associated with concomitant soft tissue and joint abnormalities. We present a rare case of osteoblastoma of talus with concomitant tenosynovitis of tibialis anterior, ankle joint effusion, varicose vein and moderate distal arterial stenosis.

Winging of Scapula: An Uncommon Presentation of a Common Tumor.

Neuromuscular causes of winging of scapula are well known, but winging and snapping of scapula may rarely be caused by space-occupying lesion of the thoracic wall. Although osteochondroma of scapula is rare, it is the most common neoplasm of scapula, and osteochondroma of ventral scapula may lead to pseudo-winging, snapping, and rib erosion on the same side. Owing to its rarity, we report two cases of osteochondroma of ventral scapula with complains of difficult scapulothoracic movement (snapping scapula) and pseudo-winging. After initial clinical and radiological investigations, wide local excision was done and diagnosis confirmed histopathologically. In a two-year follow-up, there is no recurrence, and symptoms of snapping and pseudo-winging disappeared completely. Pertaining to its asymptomatic nature and rare location, diagnosis of osteochondroma may be missed initially searching for some other neuromuscular disorders, and these cases should be reported to increase awareness and to execute proper surgical management.

Adsorption of Emerging Ionizable Contaminants on Carbon Nanotubes: Advancements and Challenges.

The superior adsorption capacity of carbon nanotubes has been well recognized and there is a wealth of information in the literature concerning the adsorption of unionized organic pollutants on carbon nanotubes. Recently, the adsorption of emerging environmental pollutants, most of which are ionizable, has attracted increasing attention due to the heightened concerns about the accumulation of these emerging contaminants in the environment. These recent studies suggest that the adsorption of emerging ionizable contaminants on carbon nanotubes exhibit different characteristics than unionized ones. For example, a new charge-assisted intermolecular force has been proposed for ionizable compounds because some adsorption phenomenon cannot be easily explained by the conventional force theory. The adsorption of ionizable compounds also displayed much stronger dependence on solution pH and ionic strength than unionized compounds. This article aims to present a brief review on the current understanding of the adsorption of emerging ionizable contaminants to carbon nanotubes and discuss further research needs required to advance the mechanistic understanding of the interactions between ionizable contaminants and carbon nanotubes.