Long-term results of total knee arthroplasty following high tibial osteotomy according to Wagner.

PURPOSE: There is relatively little information available about the long-term results of total knee arthroplasty (TKA) following high tibial osteotomy. The aim of our study was to share our experiences and long-term results of TKA after a previous closing wedge high tibial osteotomy according to Wagner. METHODS: In a retrospective study we identified 48 consecutive patients who had undergone TKA after a previous closing wedge high tibial osteotomy according to Wagner with a follow-up of over ten years. The average duration of follow-up after the TKA was 13.3 years (min 10.0, max 15.5). X-rays were taken in two planes before TKA, one week after TKA and at the latest follow-up. Tibio-femoral alignment was measured on weightbearing long-leg anteroposterior radiographs. Radiolucent lines at the latest follow-up were documented. Functional evaluations were performed preoperatively and postoperatively (at the time of latest follow-up). RESULTS: The mean Knee Society function score increased from 63.1 points preoperatively to 90.0 points postoperatively. The mean overall Knee Society score increased from 93.2 points preoperatively to 160.8 points postoperatively. The mean average femoro-tibial angle was corrected from varus 0.8° (varus 14°-valgus 8.0°) preoperatively to valgus 7.6° (valgus 2-9°) at the last follow-up. CONCLUSIONS: The closing wedge high tibial osteotomy according to Wagner does not compromise subsequent total knee replacement and leads to good clinical and radiological results.

Lipoma Arborescens of both Knees - Case report and Literature Review.

INTRODUCTION: Lipoma arborescens (LA) is a rare, benign intra-articular lesion most commonly found in the knee, characterised by villous proliferation of the synovium. It generally presents as a longstanding, slowly progressive swelling of one or more joints associated which may or may not be associated with pain. MRI is the investigation of choice, with images clearest on fat-supressed or STIR sequences. CASE REPORT: We present a 35 year old male patient, who presented with a three year history of bilateral knee pain and swelling. Magnetic resonance imaging (MRI) scans of his knee showed the characteristic features of lipoma arborescens. A 99technetium bone scan revealed increased uptake in both knees. The patient underwent bilateral arthroscopic synovectomies and made an uneventful recovery. The samples sent for histology were reported as being characteristic of lipoma arborescens. CONCLUSIONS: Lipoma arborescens is a rare, benign intra-articular tumour which may mimic a number of other diagnoses. MRI should be considered to exclude this pathology as well as other uncommon intra-articular pathology. Treatment with synovectomy is frequently curative.

Calcifying Bursitis ischioglutealis: A Case report.

INTRODUCTION: The ischiogluteal bursa is an inconstant anatomical finding located between the ischial tuberosity and the gluteus maximus. Ischiogluteal bursitis is a rare disorder. CASE REPORT: We report the case of a 43-year-old female patient with bilateral calcifying ischiogluteal bursitis. The patient had no relevant medical history of systemic illness or major trauma to the buttock. After aspiration of both ischiogluteal bursitis which delievered calcareous deposits and instillation of a mixture of 1cc betamethasone (6 mg) and 4 cc of 1% lidocaine the patient was out of any complaints. CONCLUSION: Calcifying ischiogluteal bursitis is a rare entity but easily diagnosed on radiographs. Aspiration and local steroid instillation give good relief from symptoms.