Patellofemoral joint replacement - Mean five year follow-up.

BACKGROUND: The Femoro Patella Vialli FPV is a second-generation patellofemoral arthroplasty implant. It is the second most commonly used patellofemoral implant in the National Joint Registry of England and Wales. This is the first published mid-term outcome series for this prosthesis. METHODS: We reviewed the outcomes for all patients who had patellofemoral arthroplasty. Primary outcome was the intention to revise the implant; secondary outcome measures were Oxford and Kujala outcome scores. RESULTS: A total of 43 FPV patellofemoral joint prostheses were implanted in 32 patients at our institution between April 2004 and December 2012. Mean follow-up was 65 (30-119) months. Only one patient was lost to follow-up. At final follow-up the mean flexion was 110° (85°-130°). Five of 43 knees required revision to a total knee replacement because of progressive tibiofemoral osteoarthritis. Revisionswere carried out after amean of 56 months (30-109). There was no radiographic loosening in any case. The most recent functional assessment showed that the mean Oxford Knee score (OKS) has improved from 18 (five to 35) preoperatively to 29 (nine to 45) and the Kujala score from 35 (five to 74) preoperatively to 58 (18-91). CONCLUSIONS: Midterm results with FPV prosthesis demonstrate that moderate outcomes can be achieved. Patellofemoral arthroplasty may be used to delay total knee replacement but judicious patient selection to identify truly isolated patellofemoral osteoarthritis is necessary. Chondral lesion in weight bearing area can lead to early implant failure. The main cause of failure was progressive tibiofemoral osteoarthritis.

Knee Osteochondritis Dissecans Treated by the AO Hook Fixation System: A Four Year Follow-Up of an Alternative Technique.

Surgical fixation is recommended for stable osteochondritis dissecans (OCD) lesions that have failed nonoperative management and for all unstable lesions. In this study we set out to describe and evaluate an alternative method of surgical fixation for such lesions. Five knees with unstable OCD lesions in four male adolescent patients with open physes were treated with the AO Hook Fixation System. The outcome was evaluated both clinically and with three separate outcome systems (IKDC 2000, KOOS, Lysholm) at one and a mean four year follow-up. We demonstrated excellent clinical results in all patients. At four years, all scoring systems demonstrated statistically significant improvement when compared to the preoperative status. Our study suggests that the AO Hook Fixation System is an alternative method of surgical intervention with comparable medium term results with other existing modes of fixation and the added biomechanical advantage of the absence of distracting forces during hardware removal.

Dysfunction of the posterior cruciate ligament in total knee arthroplasty.

PURPOSE: Total knee arthroplasty (TKA) is typically carried out either with retention (CR) of the posterior cruciate ligament (PCL) or with sacrifice of this ligament and implantation of a posterior stabilised (PS) prosthesis. This paper investigates a comparison of PCL function in knees treated for osteoarthritis with TKA where the PCL is preserved to those knees treated with TKA and posterior stabilisation. METHODS: One hundred and sixty-eight patients (232 knees) who had undergone TKA with either a PS or CR implant were included in the study. Clinical assessment included antero-posterior (AP) laxity and posterior sag assessment with an arthrometer. RESULTS: The mean AP laxity at 90° of flexion for CR TKAs was 6.5 mm (±3.1) and was the same [6.5 mm (±2.4)] as in the PS group. However, 56% of the PCL-preserved knees had a posterior sag of over 3 mm compared to 18% of the knees in the PS group. The American Knee Society Scores for either group showed that, although the mean function score was the same, the knee score was superior in the PS group (77 vs. 84). The range of motion was also superior in the PS group (111° vs. 105°). CONCLUSION: The use of the PS prosthesis for TKA provides a more predictable outcome with regard to posterior sag and a better maximum flexion than a CR implant.

The role of anterior cruciate ligament reconstruction in the older patients, 55 years or above.

Anterior cruciate ligament (ACL) deficiency can result in symptomatic functional instability of the knee regardless of the patient's age. We reviewed a single surgeon database of 908 ACL reconstructions carried out in the last 20 years for symptomatic instability. 14 patients were identified who were 55 years or above at surgery (mean: 60 years, range 55-75 years). Patients were evaluated clinically and with clinical outcome scoring and KT-1000 arthrometry assessment. 12 patients (86%) were available to attend for follow-up at a mean 9 years after ACL reconstruction. The median pre-injury Tegner score was 5.5 (range 1-7) and the median pre-operative Lysholm score was 33 (range 15-67). Initially, one patient had a good result but subsequently the patient undergone total knee replacement 5 years after ACL reconstruction. For the remainder, at the most recent review, the median Lysholm score had improved to 79 (range 43-100, P < 0.05) although it had deteriorated from the maximum achieved post-op score of 85.5 (range 53-100, P < 0.05); and the Tegner score had declined to 3 (range 1-5, P < 0.05). KT-1000 testing demonstrated a mean side-to-side difference improvement in laxity from 4.6 +/- 1.3 mm (range 3-7) to 1.5 +/- 1.2 mm (range 0-4, P < 0.05) and >2 mm difference in only one knee (for which it was known that the graft had failed at 11 years after ACL reconstruction). At review, the same knee was the only one that demonstrated a pivot shift. ACL reconstruction with autograft in the above-55 patient with minimal osteoarthritis is a safe procedure that returns stability to the knee and permits a return to a reasonable level of activity.

Replacement arthroplasty of the first metatarsophalangeal joint using a ceramic-coated endoprosthesis for the treatment of hallux rigidus.

We prospectively assessed 40 patients who underwent total first metatarsophalangeal joint replacement arthroplasty using a ceramic implant for the treatment of hallux rigidus. A total of 42 toes in 40 patients were included in the assessment. Preoperatively, the mean American Orthopaedic Foot and Ankle Society (AOFAS) hallux first metatarsal score was 36.00 +/- 10.79 points, and first metatarsophalangeal joint range of motion was 4.9 degrees +/- 5.52 degrees . The mean preoperative AOFAS score increased from 36.00 +/- 10.79 to 82.20 +/- 9.54 at 3 months (P < .001), to 87.00 +/- 10.62 at 12 months, and to 84.20 +/- 10.69 at 24 months. There was no statistically significant change in scores from 3 months onward. Range of motion increased to 70.80 degrees +/- 15.97 degrees in the operating room and reduced to 45.60 degrees +/- 12.28 degrees at 3 months postoperative, decreasing to 40.00 degrees +/- 12.72 degrees at 12 months and 33.30 degrees +/- 17.19 degrees at 24 months postop. We advocate total toe arthroplasty with this all-ceramic press-fit implant as an effective procedure for the treatment of moderate to severe hallux rigidus. This ceramic, total first metatarsophalangeal joint endoprosthesis yields good improvement in foot-related quality-of-life scores, reasonable range of motion, and a low early revision rate.

The Birmingham hip resurfacing procedure: a rare complication.

A case is described of the rare complication of anterior ischemic optic neuropathy following a Birmingham hip resurfacing procedure. Because there is no proven effective treatment, prevention is the key to managing this condition.