Clinical and radiologic outcomes of total knee arthroplasty using the Advance Medial Pivot prosthesis. A mean 7 years follow-up.

BACKGROUND: Medial Pivot total knee prosthesis has been designed according to studies on normal knee kinematics aiming to replicate physiological knee movement. The purpose of this study was to evaluate clinical and radiologic results of the Advance Medial Pivot Total Knee Arthroplasty, at a mean follow-up of seven years. METHODS: One hundred seventy two Medial Pivot total knee arthroplasties in 160 consecutive patients have been evaluated using the American Knee Society Score and the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Statistical analysis was performed using the Student's t-test and the Wilcoxon matched-pairs signed-rank (Mann-Whitney) test in order to evaluate the significance of differences within the groups of patients. Patients compliance was 93.75% thus only six patients (3.75%) lost to follow-up and four patients (2.5%) died for reasons unrelated to the surgery. RESULTS: The mean Knee Society score and range of motion was improved from 77.6 points and 97.7° to 152.8 points and 112.5° respectively (p<.001). In total 85.8% and 82.4% of the knees had an excellent (≥ 80) or good (70-79) functional and knee scores respectively. Relief of pain was satisfactory in 88.9% of the patients, while 96% of the patients return to age-related daily life activities. Stability and comfort during walking was subjectively judged by the patients as satisfactory in about 90%. Anterior knee pain was observed in eight patients (5.4%). The Kaplan-Meier survivorship analysis showed a cumulative success rate of 98.6%. CONCLUSIONS: The results are encouraging but longer follow-up of this cohort is necessary in the study of this specific design. Level of evidence IV.

Treatment of 103 displaced tibial diaphyseal fractures with a radiolucent unilateral external fixator.

OBJECTIVE: The authors report their experience in the treatment of the diaphyseal tibial fractures, using the unilateral radiolucent External Fixator (EF) XCaliber. DESIGN: A total of 100 patients (average age 35 years, range 16-76) with 103 displaced diaphyseal tibial fractures were treated with the XCaliber. There were 59 type A fractures, 35 type B, and 9 type C (according to the AO classification) and 35 were open fractures. MAIN OUTCOME MEASUREMENTS: During the last assessment, patients were evaluated for level of pain, ability to perform weight-bearing activities, and number of residual deformities. RESULTS: The average follow-up time was 24 months, 3 patients (4 fractures) were excluded for final assessment and 1 patient moved abroad. Of the remaining 98 fractures, 83 (84.7%) healed with a single operation in a mean 21 weeks (SD 3.97; 12-38 weeks), 10 fractures had a delayed union and 5 fractures proceeded to a non-union. There were 13 complications. Among them, a loss of reduction was observed in 3 cases due to overload of the EF, in 3 cases, deep pin track infections were observed and 2 fractures healed with more than 1 cm of shortening. CONCLUSIONS: The results are encouraging, since both complex and open fractures were included in this study. The XCaliber was shown to be a valid unilateral external fixator, combining the advantage of radiolucency during application and radioscopic follow-up with a stable and flexible fracture fixation. This represents the first report in the literature specifically examining treatment of tibial diaphyseal fractures with a radiolucent external fixator.

Evaluation of fissure sealants retention following four different isolation and surface preparation techniques: four years clinical trial.

The purpose of this study was to evaluate the retention of fissure sealants, applied with 4 different combinations of isolation and preparation of occlusal surface. In 95 children aged 7-8 years, having all four first permanent molars fully erupted and caries free, a chemically initiated tinted fissure sealant was placed with the following 4 different methods in every child. 1) Tooth 16: Cotton rolls isolation and cleaning of occlusal surface using a bristle brush and non-fluoridated paste. 2) Tooth 26: Rubber dam isolation and mechanical preparation of pits and fissures using a round bur No. 0 in a slow hand-piece. 3) Tooth 36: Rubber dam isolation and cleaning of occlusal surface using a bristle brush and non-fluoridated paste. 4) Tooth 46: Isolation with cotton rolls and mechanical preparation of pits and fissures using a round bur No. 0 in a slow hand-piece. Eighty children were available for re-examination 4 years later (320 teeth). The 4 methods of application showed the following success rates of full retention: 1) 81% 2) 88% 3) 91% 4) 93%. Although statistical analysis of the results revealed only marginal statistically significant difference among the four different methods of application (p = 0.091), there was statistical significant difference (p = 0.031) between methods 1 and 4. No differences were detected among the remaining methods. The present trial revealed best sealant retention using a combination of cotton rolls isolation and mechanical preparation of the occlusal surface.(ABSTRACT TRUNCATED AT 250 WORDS)