Patellar Dislocation Masking a Tibial Post Fracture: An Unusual Complication of Posterior Stabilized Total Knee Arthroplasty.

Posterior stabilized total knee arthroplasty (TKA) has established itself as a highly effective design for total knee arthroplasty, renowned for its longevity and success. However, a subset of cases, approximately 6-12%, faces early failure, necessitating revision procedures. This case report presents a unique and previously undocumented complication involving a tibial post fracture following hyperflexion of the knee, masked by chronic patellar dislocation. This case highlights the importance of considering polyethylene wear-related failure in cases of instability without an apparent history of trauma. The surgical intervention involved polyethylene insert exchange, patellar debulking, lateral retinacular release, and quadriceps tendon double-breasting.

Calcaneal Osteosarcoma: A Rare Instance in Adolescent Patient.

Introduction: Calcaneal osteosarcoma is extremely uncommon, accounting for <1% of all osteosarcomas. They typically exhibit swelling and chronic heel pain and are frequently clinically misdiagnosed as traumatic or inflammatory process. Case Report: We report a case of a 19-year-old girl with calcaneal osteosarcoma who initially complained of heel pain that was refractory to analgesic medications over a period of 4 months. Conclusion: The case highlights the importance of early diagnosis and management of osteosarcoma in patients with chronic heel pain and also highlights the importance of considering osteosarcoma as a differential diagnosis in adolescents who present with chronic heel pain, despite the rarity of the condition.

Erosion and Failure of the Tibial Post after Posterior-stabilized Total Knee Replacement: A Case Report.

Introduction: Posterior-stabilized (PS) total knee arthroplasty (TKA) prostheses are characterized by an articulation between the polyethylene tibial post and the cam of the femoral component. Tibial post-fractures, traumatic and non-traumatic, are uncommon but catastrophic complications. We report a rare and unusual case of complete atraumatic erosion of the tibial post after PS-TKA. Case Report: We present a case of atraumatic tibial post-failure (complete erosion) in a 73-year-old female after primary TKA. The patient presented with chronic pain, effusion, and instability both in the coronal and sagittal plane over a period of 1 year. There were no signs of component loosening on plain radiography, no fractures, and revealed medial extension laxity on valgus stress views. During revision surgery, polyethylene insert retrieval revealed a completely eroded tibial post, without any obvious fracture. There was no fractured tibial post lying freely in the joint cavity. The patient was subsequently revised with a hinged component due to gross bi-planar instability. Conclusion: In a post-TKR (PS knee) patient with chronic pain and instability, one should consider tibial post-complications after ruling out infection. Chronic instability can cause progressive erosion of the tibial post, which can fail without an obvious fracture. Revision surgery with constrained implants may be needed to manage such cases.

Mid-resection Workflow for Robotic-assisted Total Knee Arthroplasty in a Stiff Knee.

Introduction: With the growing prevalence of robotic-assisted total knee arthroplasty (RATKA), the significance of effectively addressing complex deformities using this approach is gaining widespread recognition. This article underscores the importance of a novel mid-resection workflow specifically tailored for RATKA in cases with complex deformities. Case Report: A 58-year-old female patient diagnosed with severe osteoarthritis in both knees and a stiff left knee underwent RATKA utilizing a mid-resection workflow. The surgery resulted in favorable intraoperative stability and achieved a satisfactory range of motion. Follow-up at the 1-year post-operative mark demonstrated a range of movement of 110° and a positive functional outcome for the patient. Conclusion: Severe knee arthritis with flexion deformity represents a common condition encountered in surgical practice. The advent of RATKA has provided us with an opportunity to assess and establish the effectiveness of mid-resection workflow in managing such cases.

Is it worth the risk? Frailty transition and complications following robotic total knee arthroplasty: A retrospective observational study.

BACKGROUND: Frailty is an underutilized prognostic parameter in the geriatric population. Our study aimed to analyse the frailty incidence, its transition over 1 year and its influence on complication rate in patients undergoing elective robotic-assisted total knee arthroplasty (TKA). METHODS: This was a retrospective study wherein an accumulation of deficits model was used to evaluate frailty of 435 consecutive patients undergoing primary unilateral Mako-assisted cemented TKA between January 2020 and July 2021. Based upon the preoperative values, participants were divided into three groups; non-frail (FI < 0.11), vulnerable (0.11-0.20) and frail (FI > 0.20) states and were followed up for 1 year for change in frailty class, complications, re-admissions and mortality. RESULTS: A total of 435 patients were divided into three groups, non-frail (178), vulnerable (208) and frail (49). Improvement in mean frailty scores was seen in all three groups (P < 0.0001); 21.63% of the vulnerable and 48.97% of the frail participants improved by one frailty class. Multivariate analysis showed the co-relation of change in frailty index (ΔFI) with preoperative FI (r = 0.083) and Knee Society Score (KSS) (r = 0.742). The frail group had a significantly higher re-admission rate over 1 year. When compared with the vulnerable group, the frail group had a higher hazard ratio for readmission (3.12 vs. 0.96) and complications (1.62 vs. 1.26). CONCLUSION: Although frail individuals are at a higher risk for readmissions and perioperative complications, TKA significantly improves the mobility and frailty status of elderly individuals. With explained higher risk of complications, surgeons should not refrain from offering TKA to elderly frail individuals disabled with knee pain.

Influence of vitamin D levels on outcomes and nosocomial COVID-19 infection in patients undergoing total knee arthroplasty- a cohort study.

Purpose: This study aimed to audit the effects of vitamin D3 on the early functional outcomes, the incidence of nosocomial COVID-19 infection and complications in patients undergoing elective Total Knee Arthroplasty (TKA). Methods: This was a retrospective study involving patients undergoing primary unilateral TKA between January 2020 to May 2021 operated by a single surgeon using a single implant. Participants were divided into two cohorts, Deficient-vitamin D3 level <20 ng/ml and Sufficient-vitamin D3 level ≥20 ng/ml. Assessment for Knee Society Score and Oxford Knee Score (OKS) was done preoperatively and one year after TKA. Nosocomial COVID-19 infection rate, 30-day re-admissions and complications were noted during the study. Results: 235 patients were divided into 2 cohorts matched by age, gender and ASA grades. 74 patients belonged to the deficient group and 161 belonged to the sufficient group. The mean preoperative scores in the sufficient group were higher than the deficient group (OKS = 15.74 vs 12.95; KSS = 88.91vs 85.62). Similarly, the one-year postoperative scores in the sufficient group were significantly higher (OKS = 36.54 vs 35.16; KSS = 164.01 vs 161.22). A linear correlation was present between preoperative score (r = 0.273) & post-operative scores (r = 0.141) with serum vitamin D3 levels. Vitamin D3 deficient individuals had higher nosocomial COVID-19 infection rate (10.81% vs 4.96%,p = 0.16). The incidence of complications like DVT, embolism, stroke, infection and fracture were not statistically different in the two groups. Conclusion: Vitamin D positively influences the outcomes of TKA and protects against nosocomial COVID-19 infection in patients undergoing elective TKA.

Two-Staged Total Knee Arthroplasty in Juvenile Rheumatoid Arthritis with Severe Flexion Deformity: A Case Report.

CASE: Juvenile rheumatoid arthritis (JRA) is associated with severe flexion contracture of the knees disabling a patient's ability to walk. Although various treatment modalities are available in the literature, we report a 2-stage procedure in a case of a 22-year-old female JRA patient with bilateral severe flexion deformity of the knee: stage 1-correction of the flexion contracture deformity by ring fixators and stage 2-total knee arthroplasty (TKA) for arthritis. To the best of our knowledge, no such approach has been reported previously. CONCLUSIONS: An Ilizarov ring fixator is a safe technique for gradual correction of a severe flexion deformity. Subsequent TKA can be performed as a standard procedure.