RESUMO
CONTEXT: Paralysis of quadriceps muscle leads to severe disability as the knee is unstable and cannot be fully extended and locked in extension, which results in giving way of the knee joint. Because of this, the patient tries to get stability of the knee by various means like hand to knee gait, extreme internal or external rotation of the affected limb to stabilize knee by support of medial or lateral collateral ligament, respectively, or by tilting pelvis. When there is concomitant weakness of gluteus maximus quadriceps and hamstrings (MRC muscle power less than grade III), patient may develop compensatory hyperlordosis of spine. Hamstring (H) transfer is a well-accepted procedure for patients with quadriceps (Q) weakness. For hamstring transfer, we have used a modified technique of anchoring of biceps femoris and semitendinosus tendon to patella. Instead of cutting the periosteum over the patella in an I-shaped manner, an osteoperisoteal flap was raised after two parallel incisions over the patella and both tendons were sutured under the flap with each other. We conducted a retrospective evaluation of the results of modified hamstring transfer in 267 patients of post polio residual paralysis with residual quadriceps paralysis. MATERIALS AND METHODS: Two hundred and fifty young patients (100 male and 150 female patients) who had quadriceps paralysis due to polio were managed by hamstring transfer at a single center between 1984 and 1996 and were followed for a mean of 5 years (range 4-12 years). Age of patients ranged from 7 to 18 years in 238 patients and 12 patients were above the age of 18 years. All cases were followed periodically, and assessment of knee extension, extension lag, knee flexion, elimination of calliper, and avoidance of hand to knee gait was done. RESULTS: One hundred and sixty two patients (65%) showed excellent results, 38 patients (15%) had good results, and 50 patients (20%) showed poor results. Ninety three patients had major complications like genu recurvatum, restricted knee flexion, and extension lag. Ten patients had minor complications like superficial infection and epidermal edge necrosis. CONCLUSIONS: H to Q transfer in the presence of quadriceps paralysis with good power in hamstring is a better alternative than supracondylar osteotomy because it is a dynamic correction and it produces some degree of recurvatum with increasing stability of knee in extension while walking. While inserting hamstring over patella the periosteum is not cut in an I-shaped fashion to create a flap which gives additional strength to new insertion and also patella act as a fulcrum during the extension of knee by producing the bowstring effect.
RESUMO
BACKGROUND: Standard treatment of chronic infected total knee arthroplasty (TKA) is a two-stage revision, the first step being placement of an antibiotic-impregnated cement spacer. Here we describe the results of a new technique (modification of the Goldstien's technique) for intraoperative manufacture of a customized articulating spacer at minimal cost and with relatively good conformity and longevity. MATERIALS AND METHODS: Thirty-six infected knees underwent this procedure from June 2002 to May 2007. The technique consists of using the freshened femur and tibia interface as molds wrapped in a tin foil for manufacturing the two components of the spacer with antibiotic-impregnated methyl methycrylate cement. We used the spacer and the femoral component of the trial set of a TKA system to mold them to perfect articulation. We also reinforced the spacer with a K-wire scaffold to prevent fracture of the cement mantle in the last 21 cases. RESULTS: All 36 knees showed excellent results in terms of infection control, mobility, and stability. There was significant improvement in the WOMAC and Knee Society Scores (20 and 39 points respectively). There were two fractures of the spacers in the initial 15 cases that did not have K-wire scaffolding but none in the last 21 that had reinforcement. CONCLUSION: This technique provides a more conforming spacer, with good range of motion and stability. The reinforcement helps in preventing the fracture of the cement mantle and is cost effective.
