Is Mediolateral Translation of Femur Caused by Total Knee Arthroplasty Being Ignored?

Purpose: This study aims to show the change in overall congruency due to mediolateral translation after total knee arthroplasty compared with normal knee anatomy. Methods: This study was performed in two parts. In part 1, the relationship between femur and tibia was defined by new parameters on the antero-posterior radiographs of 84 patients. In part 2, this relationship was evaluated on the postoperative radiographs of 136 total knee arthroplasty patients. Two parallel lines to the tibial anatomical axis were drawn tangent to the most lateral and most medial parts of the tibial plateau. After creating medial and lateral tangential lines, the distance between the most lateral point of the lateral femoral epicondyle and lateral tangential line and the most medial point of the medial femoral epicondyle and medial tangential line was measured. Another new parameter described in the study is epicondylar distance ratio. The ratios between the shortest distance between tibial anatomical axis and lateral femoral epicondyle and the distance between tibial anatomical axis and medial femoral epicondyle were defined. Results: It was found that the lateral tangent was not superposed in any measurement to the femoral lateral condyle, the closest tangent was passed, and the mean lateral space distance was 1.8 mm (SD 1.5, 95% CI 0-5.3 mm). The medial tangent was passed from the lateral to the femoral medial epicondyle, and the medial crossing distance was 8.5 mm (SD 5.7, 95% CI 5-14 mm). Epicondylar distance ratio used as the second measurement was 0.8 (0.5-0.9). After total knee arthroplasty measurements showed that the line passing through the lateral tibia crossed the lateral epicondyle of the femur and intersected at an average distance of 4.3 mm (SD 4.1, 95% CI 1-11.2 mm). Conclusions: There is a coronal plane congruence between tibia and femur in the healthy knees, which get changed after total knee arthroplasty.

Efficiency of autologous blood donation in combination with a cell saver in bilateral total knee arthroplasty.

The increased blood loss and resulting need for allogenic blood has been a major concern of one-stage bilateral total knee arthroplasty (TKA). One hundred eighteen consecutive patients donating either 2 units (87 patients) or 3 units (31 patients) of autologous blood prior to one-stage bilateral TKA were retrospectively evaluated to determine: (1) how many patients received allogenic transfusion; (2) what percentage of autologous blood was wasted; and (3) whether donating 2 or 3 units of autologous blood before surgery is more cost-effective. Fifteen patients in the 2-units donation group (17.2%) and one patient in the 3-units donation group (3.2%) required allogenic blood transfusions. In the 2-units group, 37.9% of the patients wasted 21.8% of predonated autologous blood, and in the 3-units group, 64.5% of the patients wasted 32.3% of predonated autologous blood. The estimated cost for patients donating 2 or 3 units of blood was $1,814.17 and $1,996.10, respectively. Donating 2 units of autologous blood is more cost-effective; however, patients donating 3 units of blood required less allogenic blood.

[Dorsal closing-wedge osteotomy in the treatment of Freiberg's disease]. / Freiberg hastaliginda dorsal kapali kama osteotomisi.

OBJECTIVES: We evaluated the midterm results of debridement, synovectomy, and dorsal closing-wedge osteotomy in the treatment of metatarsal head osteochondrosis (Freiberg's disease). METHODS: Nineteen patients (17 females, 2 males; mean age 26 years; range 13 to 49 years) were treated with debridement, synovectomy, and dorsal closing-wedge osteotomy for metatarsal head osteochondrosis. The main presenting symptom was pain on walking or sports activities. The second metatarsal head was affected in 16 patients, the third in two patients, and both heads in one patient. Four patients had a history of trauma, while the remaining patients had a history of standing for long hours. According to the Smillie's classification, four patients had type 5, 12 patients had type 4, and three patients had type 3 osteonecrosis. After osteotomy, the smooth and healthy plantar surface of the metatarsal head faced the phalangeal cartilage. The mean follow-up period was 41 months (range 15 to 88 months). The results were assessed by the Lesser Metatarsophalangeal-Interphalangeal Scale by Kitaoka et al. RESULTS: The results were excellent in seven patients (36.8%), good in nine patients (47.4%), and poor in three patients (15.8%). Poor results were seen in two patients with type 5, and one patient with type 4 osteonecrosis, all of whom developed aseptic necrosis in the metatarsal head and shortening of about 4 mm. One patient underwent resection arthroplasty. The mean flexion and extension losses were 15 degrees (range 0 degrees to 30 degrees ) and 10 degrees (range 0 degrees to 20 degrees ), respectively. The mean shortening in the metatarsal length was 1.6 mm (range 1 to 4 mm), postoperatively. No instances of infection, nonunion, or arthrosis were encountered. CONCLUSION: Treatment with debridement, synovectomy, and dorsal closing-wedge osteotomy yields successful results in Freiberg's disease.

[Coccygectomy in patients with coccydynia]. / Koksidinili hastalarda koksiks eksizyonu.

OBJECTIVES: The results of coccygectomy were evaluated in patients with coccydynia unresponsive to conservative treatment. METHODS: Twenty-four patients (23 females, 1 male; mean age 33 years; range 21 to 60 years) underwent coccygectomy for coccydynia unresponsive to conservative treatment of at least a year. The mean symptom duration was 30 months (range 14 to 144 months), and the mean length of conservative treatment was 18 months (range 12 to 32 months). Eighteen patients had a history of trauma and six patients were considered idiopathic. According to the radiographic classification of Postacchini and Massobrio, four patients (16.7%) were type 1, 16 patients (66.7%) were type 2, three patients (12.5%) were type 3, and one patient (4.2%) was type 4. Coccygectomy was performed according to the technique described by Key and complete excision was confirmed by radiologic examination. All the patients received postoperative dual antibiotic therapy for 72 hours. The mean follow-up was 28 months (range 12 to 70 months). Functional evaluations included the extent of relief in the painful area, improvement in quality of life, the severity of pain in the sitting position, and pain score during daily activities. RESULTS: None of the patients required reoperation for incomplete excision. The results were excellent in 13 patients (54.2%), good in seven patients (29.2%), moderate in two patients (8.3%), and poor in two patients. Excellent and good results amounted to 83.3%. The only postoperative complication was infection in two patients, which was treated with antibiotics and appropriate wound care. None of the patients had rectal rupture or prolapse. CONCLUSION: Coccygectomy is a successful treatment option in patients unresponsive to conservative treatment for coccydynia.