ABSTRACT
Background Patellofemoral arthroplasty (PFA) is indicated for isolated patellofemoral arthritis. PFA is a less invasive, bone-preserving procedure with faster recovery when compared to total knee replacement. We aim to present the functional outcome, survival rate, and complications of PFA from our center. Methods A total of 45 consecutive PFA performed (mean age 58.02 ± 9.2 years; 34 females and 11 males; Avon prosthesis) during the study period was included. Prosthesis survivorship was measured using revision as the endpoint, and functional outcome was assessed using Oxford knee scores (OKSs), EQ-5D, and satisfaction scores. Postoperative complications, the number of revisions, and the reasons causing them were collected. Results The mean follow-up was 48.7 (range 16-66) months. As compared to preoperative scores, OKS and Eq5d showed significant improvements (p<0.001). The satisfaction scores indicated that 28 patients (62%) were very satisfied, 10 (26.7%) were satisfied, and seven (15.5%) were dissatisfied. Four patients (8.9%) underwent revision surgery with a total knee replacement. Out of four patients requiring revision, two had progressive arthritis of the medial compartment, one had aseptic loosening of the implants, and one had trauma. Five patients showed persistent anteromedial knee pain (12.2%); one patient had maltracking requiring lateral release; one patient developed stiffness with knee flexion less than 60 degrees requiring manipulation under anesthesia. Conclusion Our results indicated that good or excellent functional outcomes can be expected in >80% of patients with survivorship of 91.1% at mid-term. Careful patient selection and counseling should be done informing of the risk of dissatisfaction/persistent pain and revision surgery in the mid and long term. Long-term outcomes and factors determining good outcomes need to be evaluated in future research.
ABSTRACT
Background: A picture archiving and communication system (PACS) is a means wherein the images are acquired, displayed, transmitted, and stored digitally. Bone Ninja is an application on iPad (Apple Inc.) on the IOS platform, developed as a teaching tool for deformity corrections around the knee. The principal objective of this study is to determine the reliability and consistency of Bone Ninja application in measuring the preoperative and postoperative alignment in patients undergoing a total knee arthroplasty and compare it with the PACS. Methods: This retrospective cross-sectional study was done using preoperative and postoperative leg-length radiographs of 50 consecutive patients (50 knees) who underwent unilateral total knee arthroplasty. Using Bone Ninja application and PACS, preoperative Lateral Distal Femoral Angle (LDFA), Tibiofemoral Angle (TFA), Medial Proximal Tibial Angle (MPTA) and postoperative Tibial alignment angle (TAA), Tibiofemoral angle (TFA), Femoral alignment angle (FAA) were measured independently by three doctors (two orthopedists and one radiologist). The measurements were repeated after an interval to determine intra and interobserver reliability. Results: Both preoperative (TFA, LDFA, MPTA) and postoperative measurements (TFA, TAA, FAA) showed highly correlated intraobserver and interobserver correlation coefficients. Cohen kappa values for all the measurements were greater than 0.80 but the values were higher for PACS compared to Bone Ninja application. Conclusions: PACS remains the gold standard, but bone ninja application is a reliable alternative for preoperative and postoperative alignment measures in total knee arthroplasty where PACS is not available.
ABSTRACT
Cervical canal stenosis, localized to upper cervical spine, is very rare which can be developmental or acquired. Hypertrophic osteoarthritis accompanied by dens hypertrophy, hypertrophy of the osodontoideum, ossification of the transverse atlantal ligament, aplasia or developmental defect of the posterior arches of Atlas, and unilateral lateral mass hypertrophy are some of the rare reported conditions causing cervical myelopathy. Localized upper cervical canal stenosis due to hypertrophied C1 posterior arch and C2 laminae hypertrophy as an isolated cause of cervical myelopathy has not been reported earlier to our knowledge. We report a case of cervical myelopathy in a 52-year-old gentleman due to the hypertrophied posterior arch of atlas and laminae of axis. C2 laminectomy along with removal of the posterior arch of Atlas and decompression is the treatment. No adjuvant radiotherapy or chemotherapy is needed. The knowledge of such an entity will avoid surprises in the diagnosis and facilitates the management.
