The Tibia Plafond Horizontal Orientation Angle for Frontal Alignment Evaluation of the Distal Lower Extremity.

PURPOSE OF THE STUDY Osteotomies around the knee are an established technique for treating knee osteoarthritis and other knee conditions by redistributing the body's weight and force within and around the knee joint. The aim of this study was to determine if the Tibia Plafond Horizontal Orientation Angle (TPHA) is a reliable measure for describing ankle alignment of the distal tibia in the coronal plane. MATERIALS AND METHODS This retrospective study included patients who underwent supracondylar rotational osteotomies for correction of femoral torsion. All patients had standing radiographs taken preoperatively and postoperatively with both knees pointed forward. Five variables, including Mechanical Lateral Distal Tibia Angle (mLDTA), Mechanical Malleolar Angle (mMA), Malleolar Horizontal Orientation Angle (MHA), Tibia Plafond Horizontal Orientation Angle (TPHA), and Tibio Talar Tilt Angle (TTTA), were collected. The preoperative and postoperative measurements were compared to each other using the Wilcoxon signed rank test. RESULTS A total of 146 patients were included in the study, with a mean age of 51.47 ± 11.87 years. There were 92 (63.0%) males and 54 (37.0%) females. MHA decreased from 14.0° ± 5.32° preoperatively to 10.59° ± 3.93° (p < 0.001) postoperatively, and TPHA decreased from 4.88° ± 4.07° preoperatively to 3.82 ± 3.10° (p = 0.013) postoperatively. The change in TPHA was significantly correlated with the change in MHA (r = 0.185, CI 0.023 - 0.337; p = 0.025). No differences were found between the measurements of mLDTA, mMA, and mMA pre- and postoperatively. DISCUSSION The orientation of the ankle should be taken into consideration during preoperative planning of osteotomies and should be measured in cases of postoperative ankle pain. CONCLUSIONS The TPHA is a reliable measure for describing ankle alignment of the distal tibia in the frontal plane. Key words: osteotomy, ankle, realignment, coronal alignment, preoperative planning.

Single-stage total hip arthroplasty after failed fixation of proximal femoral fractures: an increased risk for periprosthetic joint infections?

BACKGROUND: Higher complication rates have been reported for total hip arthroplasty (THA) after osteosynthesis of proximal femur fractures (PFF). This study evaluated the infection risk for conversion of internal fixation of PFF to THA by a single-staged procedure in the absence of clear infection signs. METHODS: Patients undergoing a one-staged conversion to THA (2013-2018) after prior internal fixation of the proximal femur were included. Preoperative diagnostics with laboratory results, hip aspirations as well as intraoperative microbiology and sonication were assessed. Postoperative complications were recorded as well as patient demographics, duration between initial and conversion to THA, explanted osteosynthesis and implanted THA. RESULTS: Fifty-eight patients (24 male/34 female, 62.8 ± 14.5 years) were included with a mean time of 3.8 ± 7.5 years between internal fixation and conversion to THA (45 cementless, 3 cemented, 3 hybrid and 7 hybrid inverse THAs). Preoperative mean blood level CRP was 8.36 ± 14 mg/l (reference value < 5 mg/l) and leukocyte count was 7.11 ± 1.84^3/µl (4.5-10.000^3/µl). Fifty patients had intraoperative microbiological diagnostics, with either swabs in 86.2% and/or sonication in 29.3%. Positive microbiological results were recorded in 10% (5 of 50 patients), with pathogens identified being mainly Staphylococcus. Complications after conversion occurred in 9.6% including a postoperative low-grade infection rate of 5.8% after a mean of 2.5 years. CONCLUSION: This study found a positive microbiological test result in 10% of a one-stage conversion of PFF fixation to THA. Moreover, we found a high infection rate (5.8%) for early postoperative periprosthetic joint infection. Interestingly, CRP has not been proven to be an adequate parameter for low-grade infections or occult colonized implants. Therefore, we recommend a comprehensive pre- and intraoperative diagnostic including hip aspiration, swabs and sonication when considering one-staged revision.

Sporting activity is reduced following medial reefing performed for patellar dislocation : A retrospective case series of 144 patients with a minimum follow-up of 24 months.

BACKGROUND: Patellar dislocation is common in young and active patients. The purpose of this study was to determine sporting activity following the medial reefing of patellar dislocation. METHODS: One hundred forty-four patients with objective patellar dislocation were treated between 2004 and 2013. Three groups were analyzed retrospectively with a minimum follow-up of 24 months: (1) primary dislocation that was treated with medial reefing without a recurrent dislocation until the day of follow-up (n = 74), (2) primary dislocation that was initially treated with medial reefing but with a recurrent dislocation until the day of follow-up (n = 44), and (3) medial reefing after failed conservative treatment (n = 26). Sporting activity was assessed using a widely-used sporting activity questionnaire and the Tegner score prior to the injury and at the follow-up (58.7 ± 22.6 months after the injury). Clinical outcomes were assessed using IKDC and Kujala score. RESULTS: The Kujala score was 94.7 ± 9.3 for Group 1, 84.1 ± 16.6 for Group 2 and 93.4 ± 9.7 for Group 3. IKDC at the time of follow-up was 97.2 ± 9.3 for Group 1, 86.1 ± 14.6 for Group 2 and 95.1 ± 11.1 for Group 3. 91.9% of Group 1 and 92.3% of Group 3 were active in sports prior to their injuries and at the time of the follow-up. In Group 2, sporting activity reduced from 81.8 to 75.0%. In all groups, a shift from high performance to recreational sports was found. CONCLUSIONS: Despite good clinical results, sporting activity was reduced following patellar dislocation treated with medial reefing. Also, a shift from engagement in high- to low-impact sports among the participants was noted.

[Combined posterior and anterior cruciate ligament reconstruction : Arthroscopic treatment with the GraftLink® system]. / Kombinierte Rekonstruktion des hinteren und vorderen Kreuzbandes : Arthroskopische Versorgung mit dem GraftLink®-System.

OBJECTIVE: Simultaneous arthroscopic reconstruction of the anterior and/or posterior cruciate ligament (ACL/PCL) using the GraftLink® system (Arthrex) to obtain stable treatment and good functional results. The transplant is protected by the safety belt like biomechanical GraftLink® principle, which is used to secure the intraoperatively obtained stability in the long term. INDICATIONS: ACL, PCL, or combined cruciate ligament rupture, especially multiligament injuries. Revision ACL and PCL reconstruction. CONTRAINDICATIONS: Preoperative fixed posterior tibial subluxation. Reduced range of motion (ROM) with an extension lag (extension/flexion 0­0-120° preoperatively required). Complex regional pain syndrome. High-grade atrophy of the quadriceps femoris muscle and osseous deformities. SURGICAL TECHNIQUE: Supine position with mobile leg and possible flexion of at least 120° allowing antegrade femoral bone tunnel replacement. Retrograde tunnel placement (e. g. using a retrocutter) is recommended in case of less than 120° knee flexion. Thigh tourniquet. Staging arthroscopy. Cruciate ligament reconstruction is realized by anatomic tunnel placement for the ACL/PCL using the GraftLink®. Recommended sequence of reconstruction: 1. tibial PCL tunnel, 2. femoral ACL tunnel, 3. femoral PCL tunnel, 4. tibial ACL tunnel. Hybrid fixation is recommended. Portals: High anteromedial, high anterolateral, posteromedial, posterolateral, small subvastus incision. POSTOPERATIVE MANAGEMENT: Combined cruciate ligament replacement: Gradual load and ROM increase in the PCL track. After postoperative week 5, increasing load up to full weight bearing, with extension/flexion 0­0-90° after week 7. Down training of the PCL track after week 13. Contact and competitive sports after 1 year. RESULTS: The GraftLink® system allows restoration of knee joint stability with good functional results. The procedure is especially suitable for complex situations like after knee dislocation with ACL and PCL reconstruction in 1 or 2 steps.

Obesity causes poorer clinical results and higher re-tear rates in rotator cuff repair.

BACKGROUND: The purpose of this retrospective study was to report on the functional outcome after both open and arthroscopic rotator cuff (RC) repair in normal weight, pre-obese and obese patients. It was hypothesized that obesity is a negative prognostic factor for clinical outcome and failure for the RC repair. METHODS: One hundred and forty-six patients who underwent either open or arthroscopic rotator cuff repair between 2006 and 2010 were included in this study. Seventy-five patients (56.7 ± 10.1 years of age) after open RC repair and 71 patients (59.0 ± 9.1 years of age) treated arthroscopically were available for evaluation. In both groups a double-row reconstruction was performed. Patients were divided in three groups according to their body-mass index. The mean follow-up was at 43 ± 16 (minimum 24) months. At follow-up, the clinical outcome was assessed by the DASH and Constant score. An ultrasound of both shoulders was performed in all patients. RESULTS: The mean BMI was 28.3 ± 5.3 in the arthroscopic group and 27.7 ± 4.3 in the open group. Overall, in both groups similar clinical results were noted [Constant-Murley score 78.3 ± 18.2 arthroscopic vs. 77.0 ± 21.8 for open surgery; DASH 12.7 ± 18.2 arthroscopic vs. 15.6 ± 21.6 for open surgery (p = 0.81)]. Both the failure rate and the clinical outcome were significantly worse for obese patients (BMI > 30, p = 0.007). The failure rate was 15.8% for the normal-weight patients, 8.2% in the pre-obese group and in the obese group 28.6%. The RC repair failure occurred in 11 cases in both groups after arthroscopic or open treatment (15.0%). CONCLUSIONS: Both the arthroscopic and the open approach showed equivalent clinical results and failure rates. Obesity (BMI > 30) causes less favorable results in the Constant and DASH scores and showed higher re-tear rates.