Water-Tight Arthrotomy Joint Closure of Modified Intervastus Approach in Total Knee Arthroplasty.

BACKGROUND: The joint closure technique used for total knee arthroplasty cases can have an impact on outcomes, especially when considering accelerated rehabilitation programs that follow surgery. In this study, we describe the details of the technical steps involved in performing the water-tight arthrotomy joint closure technique that we developed and use. METHODS: A total of 536 patients (average age: 62 years, average body mass index: 34 kg/m2) with primary osteoarthritis of the knee underwent total knee arthroplasty using the modified intervastus approach between 2019 and 2021. We used the water-tight arthrotomy joint closure technique to close the knee arthrotomy incision. Any infections and complications, as well as the duration of surgery and cost related to this wound closure technique, are also reported. RESULTS: Few complications were noted with this closure technique. When we first started using it, there was one case of drainage through the proximal capsular repair which required a return to the operating room 5 days postoperatively for an irrigation and debridement. We also had two cases of superficial skin necrosis along a small part of the incision line which were observed on a weekly basis and which healed uneventfully with application of betadine once daily on the necrotic area. The average time for performing wound closure after total knee arthroplasty was 45 min. CONCLUSION: We conclude that the water-tight closure approach can achieve very durable, water-tight capsule repairs and results in a decrease in postoperative wound drainage.

The Kuwait Stitch: A novel surgical technique for surgical wound closures.

There are several stitch techniques used for surgical wound closing. Each stitch has its own benefits and drawbacks that a surgeon must balance before use. In this paper, we highlight some of the more common techniques utilized in operative wound closure and briefly discuss benefits and caveats one must be aware of before using. The rest of our paper will focus on a new technique, the Kuwait Stitch, with instructions on how to perform the technique followed by a discussion on the benefits and indications for use of this stitch.

Medial Tibial Plateau Stress Fracture Following Navigated Total Knee Arthroplasty: Two Case Reports.

BACKGROUND Computer navigation in total knee arthroplasty has been gaining worldwide interest among orthopedic surgeons. While there is controversial data regarding its potential better clinical outcomes compared to conventional total knee arthroplasty, it has been shown to improve component and limb alignment reliability at a potential cost of increased complications. We present 2 case reports of medial tibial stress fracture through navigated tibial cutting block pinhole sites. CASE REPORT Both cases involved morbidly obese patients who underwent a navigated total knee arthroplasty. During surgery, there were no intraoperative concerns. Both knees were well aligned postoperatively and no unusual pain was reported. At 6 months after total knee arthroplasty, a periprosthetic fracture was initiated at a cutting block pinhole site with varus collapse of the tibial component. In both cases, the pinhole site was close to the medial tibial cortex and the primary tibial component collapsed into the varus, requiring revision to a stemmed component with allograft bone. For both patients, the revision arthroplasty continues to perform well. We believe cutting block design in combination with small tibias and elevated body mass index contributed to this complication. CONCLUSIONS Robotic-assisted total knee replacement has been shown to improve precision in component alignment. We caution against placing cutting block pinholes close to the medial tibial cortex, especially in morbidly obese patients with small tibias.

First Reported Series of Outpatient Total Knee Arthroplasty in the Middle East.

BACKGROUND: Outpatient total knee arthroplasty (TKA) is becoming more commonplace in the United States. Alternatively, the current practice in the Middle East involves an inpatient stay of 7-10 days in the hospital after TKA. This study reports the early results of the first reported series of outpatient TKA performed on patients in the Middle East and compares the clinical and functional outcomes with those of patients who underwent inpatient TKA. METHODS: Eighty-eight patients underwent TKA (inpatient: 44 and outpatient: 44) using the modified intervastus approach in 2 hospitals in the Middle East from 2017 to 2019. Clinical and functional outcomes were assessed by recording the Knee Injury and Osteoarthritis Outcome Score, visual analog scale (VAS) for pain, and knee range of motion (ROM) preoperatively, on the day of surgery, and postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months. RESULTS: Two patients undergoing outpatient TKA had complications: one patient suffered a periprosthetic fracture on postoperative day 10 after a fall, and the other patient had drainage on postoperative day 5. No complications occurred in the inpatient TKA cohort. There were no significant differences observed in the VAS scores or knee ROM numbers recorded for inpatient and outpatient TKA groups at any of the follow-up periods. Overall, the Knee Injury and Osteoarthritis Outcome Score, VAS, and ROM significantly improved 6 months after surgery compared with preoperative values for both inpatient and outpatient TKA groups. CONCLUSIONS: Outpatient TKA was safely implemented when compared with inpatient TKA, with satisfactory results. A total of 2 complications were seen in this study, which we believe are unrelated to the patient's discharge status. The concept of outpatient TKA using the modified intervastus approach was very well accepted by the patients in this study and can potentially be applied safely elsewhere in the region.

Rapid magnetic resonance imaging-guided reduction of craniovertebral junction deformities.

The authors demonstrate the utility of an MR imaging-compatible traction board for the rapid reduction of craniovertebral junction (CVJ) deformities. To choose the appropriate surgical management, patients with compressive CVJ deformities often undergo a trial of traction. Conventional traction trials require the treating surgeon to infer from plain radiographs the manner in which traction forces affect neural and ligamentous structures at the CVJ. To avoid overdistraction injury, low increments of weight are added in a gradual fashion, a process that typically requires 48-72 hours. The authors outline the use of an MR imaging-compatible traction board to determine reducibility safely and rapidly in 4 patients with compressive CVJ deformities. Four patients with advanced CVJ deformities underwent a trial of MR imaging-guided traction performed using an MR imaging-compatible spine board. Serial sagittal images were acquired at baseline and following each sequential addition of force. All patients tolerated traction without neurological worsening. The neural elements were seen to be adequately decompressed in all cases during a single MR imaging session. Patients subsequently underwent craniocervical stabilization and fusion. Postoperative imaging showed maintenance of the reduction without neural compression. An MR imaging-guided trial of traction can facilitate the rapid and safe determination of the reducibility of compressive lesions in patients with advanced CVJ deformities. Rapidly acquired sagittal MR images permit the surgeon to evaluate the effects of traction on the soft tissues at the CVJ, thereby expediting the traction trial and avoiding the risks of immobility in this often-fragile patient population.