LONG-TERM OUTCOMES OF USING VARIOUS GRAIN ALLOGRAFT SIZES IN PAPROSKY TYPE 3.

Introduction: Severe acetabular bone defects can pose challenges in revision total hip replacement. The use of structural allografts and various sizes of grain allografts has been proposed as an alternative surgical technique for treating Paprosky type 3 acetabular defects. This study aimed to evaluate the long-term outcomes and potential complications associated with this approach. Methods: A retrospective review was performed on 102 hip reconstructions in patients with major acetabular bone loss, including 81 cases of type 3A and 21 cases of type 3B according to Paprosky's classification. Surgical procedures involved the use of structural allografts and various sizes of grain allografts in both reinforcement ring group and cementless cups group. Results: At a mean follow-up of 82.75 months, 76% of hips had no complications, while The others experienced pain changes in the cup position, post-operative dislocations, and infections. The mean pre-operative Modified Harris Hip Score improved in both groups at the last follow-up. Conclusion: The use of structural allografts and various sizes of grain allografts for treating type 3 acetabular defects in revision total hip replacement showed promising long-term outcomes and a low rate of complications. Level of Evidence IV; Retrospective Case Series.

Introdução: Defeitos ósseos acetabulares graves podem representar desafios na revisão da artroplastia total do quadril. O uso de aloenxertos estruturais e aloenxertos de grãos de vários tamanhos foram propostos como uma técnica cirúrgica alternativa para o tratamento de defeitos acetabulares Paprosky tipo 3. O objetivo deste estudo foi avaliar os resultados de longo prazo e as possíveis complicações associadas a essa abordagem. Métodos: Foi realizada uma revisão retrospectiva de 102 reconstruções de quadril em pacientes com grande perda óssea acetabular, incluindo 81 casos do tipo 3A e 21 casos do tipo 3B de acordo com a classificação de Paprosky. Os procedimentos cirúrgicos envolveram o uso de aloenxertos estruturais e aloenxertos de grãos de vários tamanhos, tanto no grupo do anel de reforço quanto no grupo das próteses sem cimento. Resultados: Em um acompanhamento médio de 82,75 meses, 76% dos quadris não apresentaram complicações, enquanto os demais apresentaram dor, alterações na posição da prótese, luxações pós-operatórias e infecções. A pontuação média pré-operatória do escore de quadril modificado de Harris melhorou em ambos os grupos no último acompanhamento. Conclusão: O uso de aloenxertos estruturais e aloenxertos de grãos de vários tamanhos para o tratamento de defeitos acetabulares do tipo 3 na substituição total do quadril de revisão mostrou resultados promissores em longo prazo e uma baixa taxa de complicações. Nível de Evidência IV; Série de Casos Retrospectivos.

Efficacy of a Combined Periarticular and Intraosseous Multimodal Analgesic Injection Technique in Simultaneous Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial.

Introduction Early postoperative pain poses a challenge for surgeons to manage after total knee arthroplasty (TKA). Various techniques have been employed to optimize pain reduction, including Periarticular Multimodal Analgesia (PMA), recognized as a safe and effective method. Our study aims to enhance PMA through a combined intraosseous injection (PMA-I) and compare it with standard PMA. Methods Forty patients undergoing simultaneous bilateral TKA surgery were enrolled. Patients were randomized to receive PMA-I on one side of the knee, while the contralateral knee received standard PMA. Pain scores, bleeding, and range of motion (ROM) were assessed in both groups. Results The PMA-I group demonstrated statistically significant lower visual analog scale (VAS) scores at all postoperative time points, except at 48 hours, where the difference was not statistically significant. Postoperative bleeding and ROM did not significantly differ between groups. Conclusion PMA-I demonstrated both statistically and clinically significant reduction in early post-TKA pain, without additional costs, providing a technique that can be used to optimize postoperative pain control in TKA.

Computer-Assisted Total Knee Arthroplasty vs. Conventional Total Knee Arthroplasty: Post-Operative Ankle Radiographic Findings and Ankle Clinical Assessment.

BACKGROUND: A number of previous studies have shown that conventional total knee arthroplasty (TKA) can affect talar tilt (TT) in the ankle of the operated leg. We aimed to prevent this problem by utilizing computer-assisted Total Knee Arthroplasty (CAS-TKA). OBJECTIVE: To compare pre- and post-operative talar tilt and ankle clinical assessment after computer-assisted total knee arthroplasty (CAS-TKA) and conventional total knee arthroplasty (TKA) in the 56 knees of 28 patients who underwent bilateral TKA. MATERIAL AND METHOD: We studied the 56 knees of 28 patients who underwent computer-assisted total knee arthroplasty (CAS-TKA) in one knee and conventional total knee arthroplasty (TKA) in the other A combination of the Gap Balancing and Measured Resection techniques was used, and the operations were performed by a single surgeon. At follow-up 12 months post-operatively, we examined ankle radiographic findings for tibio-talar angle (TTA), tibial articular surface angle (TAS), and talar tilt (TT) which was taken as the difference between TAS and TTA. Ankle clinical assessment was performed using the foot functional index (FF) in both groups pre- and post-operatively. The study also compared the results of computer-assisted total knee arthroplasty with those of conventional total knee arthroplasty pre- and post-operatively. RESULTS: We studied the 56 knees of 28 patients whose mean age was 67.79 years and who underwent bilateral total knee arthroplasty. Comparison of pre-operative and postoperative TT in the Conventional group showed a significant difference (p = 0.016), while there was no significant difference in the CAS group (p = 0.657). Ankle clinical assessment using foot functional index (FFI) revealed that there was no significant difference in the pre-operative FFI in the Conventional group = 1.85 (0.81, 6.88) and that of the CAS group = 1.91 (0.24, 66.5) (p = 0.577). The post-operative FFI in the Conventional group was 1.68 (0.24, 7.0) and in the CAS group it was 1.65 (0.24, 6.76), and these results were statistically significant (p = 0.047). In the Conventional group, the postoperative FFI was not significantly different from pre-operative FFI (p = 0.269), but in the CAS group there was a significant difference (p = 0.047). CONCLUSION: This study showed that conventional total knee arthroplasty affected postoperative talar tilt while computer-assisted total knee arthroplasty had a lesser effect and did not significantly change the axis of rotation of the ankle joint. More research needs to be carried out on larger numbers of patients with longer follow-up periods.