Pre-operative templating for knee arthroplasty shows low accuracy with standard X-rays.

OBJECTIVES: The purpose of this study was to evaluate the accuracy and reliability of pre-operative templating in predicting the size of femoral and tibial components and the effect of coronal deformity on templating accuracy. METHODS: This was a retrospective study of 39 pre-operative templates prepared by three different surgeons with different levels of training. The accuracy and reliability measures were evaluated by alpha and kappa coefficients of agreement. The analysis of the effect of coronal deformity on the accuracy of the template was measured by the Spearman's correlation test. RESULTS: Templating was accurate for the femoral component in 28.21% of anterposterior (AP) radiographs and 35.90% of lateral radiographs. Kappa coefficients were respectively 0.111 (95% confidence interval [95%CI]: -0.19 to 0.241) and 0.200 (95%CI: -0.010 to 0.401), indicating poor agreement. Templating accuracy for the tibial component were, respectively, 37.61% and 47.01% for AP and lateral views. Kappa coefficients were 0.186 (95%CI: -0.070 to 0.379) for the AP view and 0.315 (95%CI: -0.199 to 0.431) for the lateral view, showing poor and slight agreement respectively. Considering a margin of error of ±1 sizes, the agreement level improved for all components, particularly for tibia, where agreement levels become very good. The inter-observer agreement was fair for all components, except for the lateral view of the femoral component, whose agreement was good. The Spearman correlation test showed no correlation between accuracy of templating and coronal deformity. CONCLUSION: Pre-operative templating is an unreliable and inaccurate tool. There is no relation between coronal deformity and accuracy of templating.

Viscosupplementation in patients with severe osteoarthritis of the knee: six month follow-up of a randomized, double-blind clinical trial.

PURPOSE: To analyze the early outcomes of viscosupplementation in patients with severe knee osteoarthritis. METHOD: A randomized, double-blind clinical trial of 143 knees divided into three groups: Group 1 - intra-articular injection of triamcinolone; Group 2 - hylan GF20; and Group 3 - triamcinolone + hylan GF20. Outcomes were evaluated using Lysholm and KSS scores before treatment and after one, three and six months. RESULTS: Within-group comparisons revealed improvements in Lysholm scores in all groups in the one month evaluation relative to pre-treatment levels (p < 0.01). This improvement was maintained in the third month after treatment (p > 0.05). Scores at six months were significantly lower than those observed in the previous follow-up assessments (p < 0.05), but still higher than pre-treatment levels (p < 0.05). KSS scores also improved after one month relative to pre-treatment levels (p < 0.01). This improvement was still present at three and six months after treatment in the corticosteroid group (p > 0.05). Patients treated with hylan GF20 showed lower scores in the last evaluation relative to month one (p < 0.05). No significant differences were observed between the treatment groups (p > 0.05). CONCLUSIONS: Viscosupplementation increased functional scores in patients with severe osteoarthritis of the knee, especially within three months of injection. However, it was not superior to the use of triamcinolone.