Long-term outcome of total knee arthroplasty in patients with morbid obesity.

INTRODUCTION: Patients with morbid obesity and advanced painful knee osteoarthritis are considered as poor candidates for total knee replacement. Our aims were to evaluate the outcomes of TKR surgery and the risks for post-operative complications in patients with morbid obesity (BMI > 40 kg/m2) as compared with obese patients (30 < BMI ≤ 40 kg/m2) and non-obese patients, BMI < 30 kg/m2); to evaluate if there are differences between morbid-obese patients (BMI 40-49.99 kg/m2) and extreme morbid obese patients (BMI > 50 kg/m2); and to present some surgical tips which can improve the TKR outcomes in morbid obese patients. MATERIALS AND METHODS: There were successive 333 patients, of them 39 patients (11.7%) were lost for follow-up. So, this series included 292 patients - 82 with bilateral TKR- and 374 TKR. The mean age was 64.3 years old (48-83 years) and the mean follow-up 10.8 years (4-17 years). The KSS and FKSS scores were calculated at the end of the follow-up period and compared to the pre-operative evaluation. Radiographic assessment at the end of follow-up included evaluation of implant position, alignment, and presence of radiolucent lines around the implants and was compared with the immediate post-operative radiographs. Statistical analysis was performed using SPSS v 22.0. RESULTS: Our findings showed marked improvement following TKR of non-obese, obese, and morbid obese patients, regarding the KSS and FKSS. Significant change was observed between the non-obese and obese patients as compared to morbid obese patients. There were no significant differences between morbid obese patients with BMI > 40 versus those with BMI > 50. There was a slight increased risk of early complications following TKR in morbid obese patients such as skin necrosis and infection around the surgical incision. CONCLUSIONS: Marked improvement was observed in the three groups of patients after TKR, although non-obese and obese groups had better mean scores of KSS and FKSS than morbid obese patients. No significant differences were found within the morbid obese patients themselves. Therefore, we believe that morbid obese patients are appropriate candidates and can enjoy the benefits of total knee arthroplasty done with careful use of some surgical tips presented in our study.

Ultrasonographic findings in a large series of patients with knee pain.

BACKGROUND: Musculoskeletal ultrasound (MSKUS) is becoming more and more popular in the evaluation of different musculoskeletal abnormalities. The aim of this retrospective study was to document the prevalence and spectrum of MSKUS findings at the painful knee. MATERIALS AND METHODS: All the studies of MSKUS that were performed for the evaluation of knee pain during the previous 2 years at the Department of Radiology in Nazareth hospital were reviewed. Demographic and clinical parameters including age, gender, side, and MSKUS findings were documented. RESULTS: Two hundred and seventy-six patients were included in the review. In 21 of them, both knees were evaluated at the same setting (total number of knees evaluated was 297). One hundred and forty-four knees were of the left side. Thirty-three pathologies were identified. 34% of the studies were negative. The most common MSKUS findings were medial meniscal tear (MMT) (20%), Baker's cyst (BC) (16%), and osteoarthritis (OA) (11%). Only one knee of all the knees evaluated in our study showed synovitis. Fifty-three knees (18% of all the knees evaluated) had more than one imaging finding, mosty two and while some had three findings. The most common combination of findings was MMT and BC (8 knees), MMT with OA (8 knees), and MMT with fluid (6 knee). In 67% of the patients who had simultaneous bilateral knee evaluation, at least one knee had no abnormal findings and in 43%, both knees were negative. CONCLUSIONS: MSKUS has the potential for revealing huge spectrum of abnormalities. In nearly 90% of the positive studies, degenerative/mechanical abnormalities were reported, with MMT, BC, and osteoarthritic changes being the most common.

Simultaneous bilateral knee injection of methylprednisolone acetate and the hypothalamic-pituitary adrenal axis: a single-blind case-control study.

OBJECTIVE: The objective of this study was to evaluate the effect of simultaneous bilateral intra-articular injection (IAI) of methylprednisolone acetate (MPA) on the hypothalamic-pituitary-adrenal axis in patients with knee osteoarthritis. METHODS: Nonselected patients with symptomatic bilateral knee osteoarthritis had simultaneous IAI of 80 mg MPA at each knee (group 1). Just before the injection and on weeks 1, 2, 4, 6, and 8 after it, patients had 1 µg adrenocorticotropin hormone stimulation test. Age- and sex-matched patients had simultaneous IAI of 60 mg of hyaluronic acid in each knee (group 2) and the same protocol of adrenocorticotropin hormone stimulation tests. Demographic, clinical, and laboratory parameters were documented in all the patients. Secondary adrenal insufficiency (SAI) was defined as poststimulation serum cortisol levels of less than 18 µg/dL. RESULTS: Twenty patients were enrolled in each group. There were 15 women and 5 men in each group. Mean age of the patients in group 1 was 60.3 (SD, 7.6) years. Twelve patients (60%) from group 1 had evidence of SAI versus 3 patients in group 2 (P = 0.003). In all the patients who had SAI in group 1, it was observed in week 1 with decreasing frequency of SAI at the subsequent time points. Yet, 2 patients (10%) from group 1 had evidence of SAI 8 weeks after the IAI. Secondary adrenal insufficiency did not significantly correlate with any demographic, clinical, or laboratory parameter. CONCLUSIONS: Secondary adrenal insufficiency was very common following simultaneous bilateral IAI of 80 mg of MPA. Although it was transient, SAI could still be observed nearly 2 months after the IAI, in 10% of the patients.

[A retrospective statistical analysis of the epidemiology of the congenital lumbar stenosis among the Jewish and Arab populations in Israel].

Congenital spinal lumbar stenosis is defined according to the midsagittal diameter of the lumbar spine. We conducted a retrospective statistical analysis of the results of 998 computer tomography studies of the lumbar spine as they were interpreted by the same author (E.N.). We showed particular interest in the measurement of midsagittal diameters aiming to reach conclusions regarding the difference in the frequency of congenital lumbar stenosis among the various ethnic groups in Israel. The population examined included 517 patients of Arab origin (51.8%) and 481 patients of Jewish origin (48.2%), the combined average age of both examined populations was 44.8 years (range 5.0-83 years), and the distribution according to gender combined for both populations was 55.7% male and 44.3% female. We found a statistically significant higher prevalence of midsagittal (congenital) stenosis at L3 and L5 among the Arab population but that was not confirmed for the other lumbar vertebrae.