Treatment of 10-mm-Deep or Greater Uncontained Tibial Bone Defects in Primary Total Knee Reconstruction without Metal Augmentation: Autologous Oblique Structural Peg Bone and Cancellous Chip Bone Grafting.

BACKGROUD: In this study, we report satisfactory clinical and radiological outcomes after autologous oblique structural peg bone and cancellous chip bone grafting without metal augmentation, including the use of a metal wedge, block, or additional stem, for patients with ≥ 10-mm-deep uncontained medial proximal tibial bone defects in primary total knee replacement. METHODS: The study group included 40 patients with primary total knee replacement with ≥ 10-mm-deep uncontained tibial bone defects who underwent autologous oblique structural peg bone and cancellous chip bone grafting and were followed-up for at least 1 year. Tibial cutting was performed up to a depth of 10 mm from the articular surface of the lateral tibial condyle, after which the height and area of the remaining bone defect in the medial condyle were measured. The bone defect was treated by making a peg bone and chip bone using excised segments of the tibia and femur. In all cases, the standard tibial stem and full cemented fixation techniques were used without metal augmentation. Preoperative and final follow-up radiologic changes and clinical measures were compared, and prosthesis loosening and bone union were checked radiologically at final follow-up. RESULTS: The mean depth of the bone defects was 10.9 mm, and the mean percentage of the area occupied by bone defects in the axial plane was 18.4%. The mean mechanical femorotibial angle was corrected from 19.5° varus preoperatively to 0.2° varus postoperatively (p < 0.002). There was no prosthesis loosening, and all cases showed bone union at the 1-year postoperative follow-up. CONCLUSIONS: Even in patients with uncontained tibial bone defects ≥ 10-mm deep in primary total knee replacement, if the defect occupies less than 30% of the cut surface, autologous oblique structural peg bone and cancellous chip bone grafting can be used to achieve satisfactory outcomes with a standard tibial stem and no metal augmentation.

COMPARING OUTCOMES OF THE ANKLE ARTHRODESIS BY USING TWO DIFFERENT MATERIALS VIA A TRANSFIBULAR APPROACH.

OBJECTIVE: To compare clinical and radiologic results and complications of patients who underwent arthrodesis using a transfibular approach with either a cannulated screw or an anterior fusion plate. METHODS: Patients who underwent ankle arthrodesis were divided into two groups according to the used materials: 6.5 mm cannulated screw (A) and anterior fusion plate (B). The clinical scores were compared between groups. The radiologic results were then assessed by union time. The results were statistically analyzed using SPSS 20. RESULTS: There was no significant difference between both groups in the American Orthopedic Foot & Ankle Society (AOFAS) score (p = 0.75), and in the visual analog scale (p = 0.42). In group B, two cases included wound infection at the surgical site. In tt A, the mean union time was 10.5 ± 2.3 weeks. In group B, it was 7.8 ± 1.3. There was a statistically significant difference (p = 0.007) between union time in both groups. CONCLUSION: Anterior fusion plate is an effective method for shorter union time, but the surgeon should be careful with the surgical wound at the skin incision site in the lesion of the distal tibia. Level of Evidence III, Retrospective comparative study.

OBJETIVO: Comparar os resultados clínicos e radiológicos assim como as complicações de pacientes sujeitos a artrodese de abordagem transfibular com o uso de parafuso canulado ou placa óssea anterior. MÉTODOS: Pacientes sujeitos a artrodese do tornozelo foram divididos em dois grupos de acordo com os materiais usados: parafuso canulado de 6,5 mm (A) e placa óssea anterior (B). Os escores clínicos de ambos os grupos foram comparados e os resultados radiológicos foram avaliados de acordo com o tempo de união óssea. Os resultados foram analisados estatisticamente usando SPSS 20. RESULTADOS: Não houve diferença significativa entre os grupos quanto ao escore American Orthopedic Foot & Ankle Society (AOFAS) (p = 0,75) e a escala visual analógica (p = 0,42). No grupo B, ocorreu infecção na área da cirurgia em dois casos. No grupo A, a média de tempo de união foi de 10,5 ± 2,3 semanas. No grupo B, este foi de 7,8 ± 1,3. Constatou-se diferença estatisticamente significante (p = 0,007) quanto ao tempo de união em ambos os grupos. CONCLUSÃO: Os autores concluíram que a placa óssea anterior é um método eficiente para tempos de união curtos, porém o cirurgião deve ficar atento à ferida cirúrgica na área de incisão da pele em casos de lesão na tíbia distal. Nível de Evidência III, Estudo retrospectivo comparativo.

Comparing outcomes of the ankle arthrodesis by using two different materials via a transfibular approach / Comparação dos resultados da artrodese do tornozelo usando dois diferentes materiais através de uma abordagem transfibular

ABSTRACT Objective: To compare clinical and radiologic results and complications of patients who underwent arthrodesis using a transfibular approach with either a cannulated screw or an anterior fusion plate. Methods: Patients who underwent ankle arthrodesis were divided into two groups according to the used materials: 6.5 mm cannulated screw (A) and anterior fusion plate (B). The clinical scores were compared between groups. The radiologic results were then assessed by union time. The results were statistically analyzed using SPSS 20. Results: There was no significant difference between both groups in the American Orthopedic Foot & Ankle Society (AOFAS) score (p = 0.75), and in the visual analog scale (p = 0.42). In group B, two cases included wound infection at the surgical site. In tt A, the mean union time was 10.5 ± 2.3 weeks. In group B, it was 7.8 ± 1.3. There was a statistically significant difference (p = 0.007) between union time in both groups. Conclusion: Anterior fusion plate is an effective method for shorter union time, but the surgeon should be careful with the surgical wound at the skin incision site in the lesion of the distal tibia. Level of Evidence III, Retrospective comparative study.

RESUMO Objetivo: Comparar os resultados clínicos e radiológicos assim como as complicações de pacientes sujeitos a artrodese de abordagem transfibular com o uso de parafuso canulado ou placa óssea anterior. Métodos: Pacientes sujeitos a artrodese do tornozelo foram divididos em dois grupos de acordo com os materiais usados: parafuso canulado de 6,5 mm (A) e placa óssea anterior (B). Os escores clínicos de ambos os grupos foram comparados e os resultados radiológicos foram avaliados de acordo com o tempo de união óssea. Os resultados foram analisados estatisticamente usando SPSS 20. Resultados: Não houve diferença significativa entre os grupos quanto ao escore American Orthopedic Foot & Ankle Society (AOFAS) (p = 0,75) e a escala visual analógica (p = 0,42). No grupo B, ocorreu infecção na área da cirurgia em dois casos. No grupo A, a média de tempo de união foi de 10,5 ± 2,3 semanas. No grupo B, este foi de 7,8 ± 1,3. Constatou-se diferença estatisticamente significante (p = 0,007) quanto ao tempo de união em ambos os grupos. Conclusão: Os autores concluíram que a placa óssea anterior é um método eficiente para tempos de união curtos, porém o cirurgião deve ficar atento à ferida cirúrgica na área de incisão da pele em casos de lesão na tíbia distal. Nível de Evidência III, Estudo retrospectivo comparativo.

Conversion of Failed Reverse Total Shoulder Arthroplasty to Hemiarthroplasty: Three Cases of Instability and Three Cases of Glenoid Loosening.

BACKGROUND: Glenoid loosening and postoperative instability are common causes of failed reverse total shoulder arthroplasty (RTSA). When soft-tissue problems or large glenoid bone defect interferes with reimplantation in revision RTSA, conversion to hemiarthroplasty can be considered. We present a case series of patients who underwent conversion to hemiarthroplasty due to glenoid loosening and early instability after RTSAs, along with clinical results. METHODS: A total of 72 primary RTSAs using the Aequalis prosthesis were performed at our institution from May 2009 to December 2016. Of these, five patients, including one with humeral neck fracture and absent rotator cuff and four with cuff tear arthropathy, underwent conversion to hemiarthroplasty. Another patient who had RTSA at a local clinic underwent hemiarthroplasty at our institution for unresolved postoperative anterior dislocation. The mean age of the six patients was 71.7 years (range, 62 to 76 years), and the mean follow-up period was 24.4 months (range, 18 to 30 months). Clinical assessments were conducted by using the visual analog scale (VAS), American Shoulder and Elbow Surgery (ASES) score, and University of California at Los Angeles (UCLA) shoulder score at the last follow-up. RESULTS: The conversion to hemiarthroplasty in the six patients dramatically improved the mean VAS score (preoperative, 8.1; postoperative, 2.5), ASES score (preoperative, 22.1; postoperative, 56.5), and UCLA score (preoperative, 12; postoperative, 18.1). However, the range of motion was almost unchanged after surgery. CONCLUSIONS: Conversion to hemiarthroplasty can be a good alternative to revision RTSA in patients with serious complications (such as unresolved instability and glenoid loosening) difficult to treat with revision RTSA.