ABSTRACT
BACKGROUND: Total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) are already proven good for end-stage arthritis in the older populations but it is challenging in young teenage patients. The primary aim was to assess Hip Disability and Osteoarthritis Outcome Score (HOSS), Harris Hip Score (HHS) and secondary aim for implant survival rate. MATERIALS AND METHODS: The details of 33 teenage patients (forty hips) who underwent HRA (21) and THA (19) at our institution (January 2002 to December 2013) with a mean follow-up period of 11.00 years (range 7.00-18.40) were included. The study group had 25 males and eight females. RESULTS: The overall median HOOSs with interquartile range were 89.00 (87.63-0.00). The median HOOSs at follow-up were as follows: 95.00 (90.00-95.00) for symptoms, 92.00 (90.00-95.00) pain, 87.00 (85.00-90.00) for functions, 81.00 (75.00-85.00) for sports and 94.00 (88.00-95.00) for QOL. HHS improved significantly from 36.88 ± 6.14 to 90.12 ± 6.56 (p < 0.001). The HHS of HRA group improved from 36.29 ± 5.83 to 89.38 ± 5.23 and THA group improved from 37.26 ± 6.22 to 90.94 ± 7.84. The 5-year radiological follow-up X-rays did not show any radiolucent line wider than 2 mm in all three zones of the acetabulum and no progressive subsidence or migration of > 1 mm and divergent radiopaque line in femur. The Implant survival rate for HRA was 100% at 5 years, 100% at 10 years, 92% at 15 years and THA group was 100% at 5 years and 90% at 10 years. CONCLUSION: Our study showed a disability rate of zero with improved HOSS and HHS. The overall implant survival rate was good with 100% at 5 years, 97% at 10 years and 89.9% at 15 years in contrast to the previous studies with the use of modern implants and newer standard surgical techniques. LEVEL OF EVIDENCE: A Level II study http://www.spine.org/Documents/LevelsofEvidenceFinal.pdf.
ABSTRACT
BACKGROUND: Lateral tibial bowing leads to varus placement of the tibial component during total knee replacement in varus knees. Lateralised tibial jig placement can improve the accuracy of the tibial cut. METHODS: A total of 227 patients (300 knees) undergoing total knee replacements were randomised into two groups. In the study group, the point of intersection of the distal tibial diaphyseal line at the tibial plateau drawn on long films was represented by zones. Knees with femoral bowing >5° (28%) were excluded. Tibial jig placement on the proximal tibia was lateralised according to the zones. In the control group, the mid-point of the tibial plateau was taken as a reference. Femoral and tibial bowing, postoperative limb alignment and component placement were assessed. RESULTS: Of the 216 knees that were studied, 106 were in the study group and 110 in the control group. Bowing ≥3° had a significant positive correlation with lateralisation of the proximal tibial reference (pâ¯<â¯0.001). The Incidence of tibial bowing ≥3° was 57.33%. The mean postoperative hip-knee-ankle (HKA) angle was 178.31⯱â¯2.88° and 176.53⯱â¯2.88° (pâ¯<â¯0.001), whereas the mean medial proximal tibial angle (MPTA) was 89.91⯱â¯1.42° and 88.79⯱â¯1.72° (pâ¯<â¯0.001) in the study and control groups, respectively. Considering bowed tibiae alone, HKA angle and MPTA in the study group were 178.08⯱â¯2.81° and 89.72⯱â¯1.39° compared with 175.88⯱â¯2.87° and 88.38⯱â¯1.38° in the control group (pâ¯<â¯0.001). CONCLUSION: There is a high incidence of tibial bowing in varus knees. Lateralised tibial jig placement improved tibial component placement and postoperative limb alignment in total knee arthroplasty in varus knees with tibial bowing.
