Hypersensitive Reaction of Oxidized Regenerated Cellulose Powder in Total Knee Arthroplasty.

The powdered form of oxidized regenerated cellulose (ORC powder) is a widely used biodegradable hemostatic material in the field of surgery. There are several reports of its effectiveness and safety; however, excessive foreign body reactions remain a concern for surgeons in total knee arthroplasty (TKA). A 70-year-old woman who underwent unilateral TKA using ORC powder to control perioperative blood loss exhibited a skin rash around her operated knee at six days postoperatively. These reactions were potentially hypersensitive to ORC powder. After receiving antiallergic medication for 18 days, the skin rash disappeared. Although there are several reports on the safety of ORC powder, inadequate intraoperative lavage of the product may induce hypersensitive reactions such as skin rash.

Modern cementless posterior stabilized mobile-bearing total knee arthroplasty shows comparable clinical and radiographical results to its cemented predecessor at 1-year follow-up.

PURPOSE: The purpose of this study was to evaluate perioperative and short-term clinical and radiographical results of a modern PS mobile-bearing cementless TKA system. METHODS: A retrospective review of a consecutive series of TKAs was performed by a single surgeon using a cementless or cemented TKA of the same design (Attune, DePuy Synthes, Massachusetts, USA). The 2011 Knee Society Score, Forgotten Joint Score-12, Hip-Knee-Ankle angle, and the presence of radiolucent lines (RLLs) were reviewed 1-year postoperatively with 1:1 matching performed for age, gender, body mass index, and preoperative UCLA score. Fisher's exact test or independent Student's t-test were used for statistical analyses. RESULTS: Forty-five cementless and 45 cemented TKAs were reviewed after 1:1 matching. The mean operative time was 8.8 min shorter (P < .01), and the mean amount of drainage was 40.0 ml greater (P = .04) in the cementless cohort. At 1-year postoperatively, there were no significant differences in both cohorts in 2011 Knee Scores and Forgotten Joint Scores-12, with no patients requiring revision surgery (NS). The incidence of RLLs was significantly higher in cementless TKAs (51%) than that in cemented TKAs (22%, P < .01). However, the mean width of RLLs in the cementless TKAs (0.2 mm) was significantly smaller (P < .01) than that in the cemented TKAs (0.8 mm) at 1-year postoperatively with no progression. CONCLUSION: A recently introduced cementless PS mobile-bearing TKA design demonstrated comparable postoperative and radiographical results to its cemented predecessor at 1-year follow-up. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.

Does mobile-bearing knee arthroplasty motion change with activity?

BACKGROUND: The purpose of this study was to evaluate the effect of mobile-bearing implant design and activity on knee arthroplasty kinematics during three activities of daily living. METHODS: In vivo kinematics were analyzed using 3D model registration from fluoroscopic images of non-weightbearing knee flexion-extension, weight-bearing squatting and stair activities in 20 knees in 10 patients with bilateral total knee arthroplasty. Each patient had one rotating-platform and one meniscal-bearing variant of the same prosthesis design. RESULTS: Anteroposterior translations in meniscal-bearing knees were larger than those in rotating-platform knees for the different dynamic conditions. Meniscal-bearing knees showed more posterior femoral locations with activities that increased demand on the quadriceps. Condylar translations changed little in rotating-platform knees with different activities. CONCLUSIONS: Activity dynamics can have a significant influence on knee kinematics, and have a greater effect on the kinematics of unconstrained meniscal-bearing prostheses than rotating-platform knee prostheses. LEVEL OF EVIDENCE: Level II.

Efficacy of acupuncture during post-acute phase of rehabilitation after total knee arthroplasty.

OBJECTIVE: The purpose of this study was to determine whether acupuncture is effective in reducing pain and swelling around the knee and improving range of motion (ROM) during the post-acute phase of rehabilitation after total knee arthroplasty (TKA). METHODS: Following TKA, 80 knees in 80 patients were randomly assigned to either an acupuncture treatment group (Group A) or a control group (Group C). In Group A, the complementary treatment of acupuncture was performed three times/week from postoperative day 7 until postoperative day 21. Outcome measures were: i) pain as assessed by a visual analog scale; ii) reduction of swelling around the knee as indicated by its circumference at the center of the patella; and iii) ROM of the affected knee. RESULTS: Group A patients had significantly reduced pain and swelling around the knees and earlier recovery of ROM than did those in Group C. CONCLUSION: Acupuncture provides effective treatment during the post-acute phase of rehabilitation after TKA with respect to pain relief, reduction of swelling around the knee, and early recovery of ROM.

Neglected spontaneous rupture of the Achilles tendon in elderly patients with rheumatoid arthritis.

Spontaneous Achilles tendon rupture associated with rheumatoid arthritis (RA) is a very rare complication. In this report, we have experienced neglected spontaneous rupture of the Achilles tendon in 5 elderly RA patients, and report its clinical features and management. These patients had taken corticosteroids for a long time for RA control. Moreover, they did not show any signs, such as click or impact on the rear foot at the moment of the rupture, and had few complaints or obvious symptoms around their ankles or the rear of the foot after the rupture. This suggests that the lack of severe symptoms prevented the early diagnosis of the Achilles tendon rupture, and that this injury had been neglected during treatment for RA. Therefore, careful diagnosis of the Achilles tendon rupture is needed in elderly patients with RA, even if they have little or no history of trauma.

Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella.

Complications and results of medial patellofemoral ligament (MPFL) reconstruction, performed between 2000 and 2003, were studied retrospectively in 24 randomised patients (24 knees). All procedures were performed for recurrent dislocation or subluxation of the patella, using an autogenous semitendinosus tendon. Two different methods of anchoring of the transplant were compared. After a 2-year follow-up, patellar stability was found to be similar, when the transplant was sutured to the fibrous tissue and periosteum overlying the patella or when it was fixed in a bone tunnel through the patella. The majority of the patients who had undergone MPFL reconstruction have returned to their previous level of sports activities. We had two cases of patella fracture and one case of persisting patella apprehension after surgery. Further studies must determine which measures are necessary to prevent these complications.

The pathology and evaluation of surgical treatment in a ruptured giant popliteal/crural cyst associated with rheumatoid arthritis.

Abstract Popliteal cysts are often observed in patients with rheumatoid arthritis (RA), and giant cysts that extend from the popliteal to the crural region (popliteal/crural cysts) are occasionally encountered. We studied the background of popliteal/crural cysts and therapeutic results, and evaluated its etiologic factors and the effectiveness of surgical treatment. Nine knees of eight patients with popliteal/crural cyst secondary to RA, which was treated surgically because it resisted conservative treatment, and was followed up for 1 year or longer after surgery, were evaluated. The patients were five men and three women, with a mean age at surgery of 59.1 years and a mean duration of RA disease of 4.5 years. Only one male patient suffered pain in the bilateral joints. The mean level of erythrocyte sedimentation rate was 61.3 mm/h (range 3.9-100.2), the mean level of C-reactive protein was 3.6 (0.1-8.2) mg/dl, and the mean Lansbury index was 36.4 (12-61) at surgery. The cyst disappeared completely after surgery, and the postoperative course was uneventful in eight knees, but recurrence was observed in just one knee of the bilateral case. However, in this patient the cyst that recurred was not as large as the one before surgery, and it was eventually brought under control by subsequent outpatient medical management. Inflammatory reactions were suppressed, if temporarily, in all patients. The patients evaluated in this study showed the following characteristics: the male-female ratio of the patients was biased to males compared with that of RA patients in general; although knee joint damage was radiographically mild, marked symptoms of arthritis were observed in not only the knees but also other joints in all patients; and the disease could not be controlled effectively by medication. However, after surgical resection of the cysts, general as well as local signs of inflammation were mitigated, and surgery was considered to be very effective for the treatment of ruptured giant popliteal/crural cyst associated with RA.

Medial patellofemoral ligament reconstruction for recurrent patellar instability.

The purpose of this study was to determine the value of reconstruction of the medial patellofemoral ligament (MPFL) in the treatment of recurrent patellar dislocation and subluxation. We retrospectively reviewed 40 randomised patients with recurrent patellar dislocation or subluxation, who had undergone realignment surgery from July 1999 to December 2001. Group E consisted of 20 patients who had undergone an Elmslie-Trillat procedure. In Group M, also consisting of 20 patients, the Elmslie-Trillat procedure was combined with reconstruction of the MPFL. Pre and postoperative data were collected and compared. At follow-up after 2 years, the apprehension sign remained positive in 6 knees of Group E, but in none of Group M. On a stress skyline radiograph, stability was significantly better in Group M than in Group E. Based on these findings, it appears that reconstruction of the MPFL is a useful addition to the treatment of recurrent patellar dislocation and subluxation.