Alignment and Balance Methods in Total Knee Arthroplasty.

Total knee arthroplasty is one of the most commonly performed orthopaedic surgical procedures in the United States. Primary concepts in the surgical technique include restoring limb alignment and soft-tissue balance about the knee. Currently, traditional mechanical alignment concepts that focus on restoring neutral limb alignment have been challenged by the principle of kinematic alignment. In addition to these recent philosophical challenges, new technologies have been introduced to help the surgeon more accurately achieve optimal limb alignment and soft-tissue balance.

Total knee arthroplasty in young patients: Factors predictive of aseptic failure in the 2nd-4th decade.

OBJECTIVE: In a recently published article we reviewed our long term outcomes of TKA in young patients (<55) with end stage OA. The purpose of this study was to identify what additional factors may predict aseptic failure in these young patients. METHODS: A retrospective review of all patients in our young TKA database was performed, and included failure only for mechanical wear and loosening. RESULTS: The IB-II prosthesis, a thin polyethylene (<9 mm), and higher Knee Society functional class at midterm follow-up was associated with higher failure rate. CONCLUSION: This study helps better identify the etiology of failed young patient TKA.

Incidence and predictors of total knee arthroplasty following knee arthroscopy.

OBJECTIVE: The purpose of this study was to determine the effectiveness of knee arthroscopy (KA) in patients with symptomatic meniscal tears or mechanical symptoms and OA, by using conversion to TKA as a final outcome measure. METHODS: Retrospective review of all patients with OA who underwent KA in our practice. RESULTS: 1215 KAs were reviewed; 3.9% underwent conversion to TKA at an average of 3.2 years. CONCLUSION: KA plays a role in delaying TKA in knees with meniscal tears and mechanical symptoms with concurrent OA.

Extension type II pediatric supracondylar humerus fractures: a radiographic outcomes study of closed reduction and cast immobilization.

BACKGROUND: The treatment of Gartland type II pediatric supracondylar humerus fractures remains controversial. Some argue that closed reduction and cast immobilization is sufficient to treat these fractures, whereas others advocate closed reduction and percutaneous pinning. The purpose of this radiographic outcomes study was to determine whether closed reduction and cast immobilization could successfully obtain and maintain acceptable reduction of extension type II supracondylar humerus fractures. METHODS: Prereduction, immediate postreduction, and final radiographs of 155 extension type II fractures that were treated nonoperatively were measured according to the parameters determined earlier to assess the position and alignment of the fracture fragments. These included the anterior humeral line, humerocapitellar angle, Baumann's angle, the Gordon index, and the Griffet index. RESULTS: The average age of the 155 patients at the time of injury was 5.3 years (range: 1 to 13 y). Analysis of the final radiographs, at the final follow-up of 5.3 months, showed that in 80% of patients, the anterior humeral line remained anterior to the mid-third segment of the capitellum (radiographic extension deformity), the mean humerocapitellar angle was 23.77 degrees (range: -11 to 50 degrees), the mean Baumann's angle was 79.40 degrees (range: 62 to 97 degrees), the mean Gordon index was 4.59%, and 44% of patients had a Griffet index between 1 and 3. CONCLUSIONS: From this radiographic review, it was observed that not all fractures treated with closed reduction and cast immobilization achieved anatomic position and alignment at final follow-up; however, the long-term clinical and radiographic significance of these findings remains unknown.