ABSTRACT
Background: In severe arthritis cases, goal of total knee arthroplasty (TKA) management is to attain pain-free joint and restore the overall limb alignment. There are limited short-term studies published from Indian hospitals that investigated the importance of neutral mechanical component alignment in TKA patients. Methods: Retrospective and prospective study was conducted at the Department of orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune from June 2020 to September 2022. Enrolled patients were assessed preoperatively and postoperatively using clinical examination, radiological assessment and functional outcomes through the Oxford knee score, Knee society score and VAS score. Results: 204 patients enrolled, and 267 knees were evaluated for the study. Osteoarthritis was the commonest diagnosis (254 knees, 95.13%). Pre-operatively, 92.13% knees were varus, 4.87% valgus and 3% neutral while post-operatively, 51.69% were varus, 16.1% were valgus, and 32.32% were with neutral axis. Majority of patients with a pre-operative neutral axis converted to varus axis (62.5%), while most valgus axis cases preoperatively converted to a neutral axis (53.84%). For pre-operative varus subgroup, the majority patients with < 10° pre-operative axis converted to neutral (41.28%). Majority patients with 10°-20° pre-operative axis remained varus (60.53%) and with > 20° pre-operative axis remained varus (78.26%). Functional outcome parameters were significantly improved at follow-up (P < 0.05). Conclusion: Short-term postoperative functional scores were significantly improved in postoperative cases, with the postoperative alignment of 0° ± 3° relative to the mechanical axis was achieved. Thus, postoperative neutral mechanical alignment of 0° ± 3° can be the standard of care for patients undergoing TKA.
ABSTRACT
PURPOSE: Sprengel's deformity is a congenital failure of the descent of the scapula with main concerns regarding cosmetic deformity and restricted function of the affected shoulder. The purpose of this study was to present the results of Modified Woodward procedure in 28 patients with Sprengel's shoulder. METHODS: Twenty-eight patients (9 males, 19 females) of Sprengel's shoulder treated with modified Woodward procedure from 2010 to 2016 were retrospectively studied. Clinical assessment was done using Cavendish grading and Rigault's classification for radiographic evaluation. RESULTS: Mean age at the time of surgery was six years and three months. Mean follow-up was 20 months. We found a mean increase in abduction of 34.2° (15-50) and flexion of 20.6° (10-25), mean scapular lowering of 2.3 cm (0.5-4.5 cm), and a Cavendish grade I in 18 (65%), grade II in 10 (35%). Thus, we had 65% satisfactory results in terms of cosmesis and 85% with the function of the affected limb. Rigault grading improved by one grade in 16 children and by two grades in 12 children. Subjectively, all parents were satisfied with the cosmetic appearance of the achieved scapular lowering. We had one case of delayed superficial wound healing which resolved spontaneously. CONCLUSION: Modified Woodward procedure for Sprengel's shoulder deformity gives good cosmetic correction and improvement in shoulder function with minimal complications. This procedure is good for selective cases of Cavendish grade II with cosmetic concerns and all cases of Cavendish grade III and IV.
