Balancing the flexion gap first in total knee arthroplasty leads to better preservation of posterior condylar offset resulting in better knee flexion.

PURPOSE: The purpose of this study is to determine whether the flexion first balancing technique, developed in an attempt to solve the dissatisfaction due to instability in total knee arthroplasties, leads to better restoration of joint line height and medial posterior condylar offset. This might result in better knee flexion, compared to the classic extension first gap balancing technique. The secondary objective is to show non-inferiority of the flexion first balancing technique in terms of clinical outcomes as measured by the Patient Reported Outcome Measurements. METHODS: A cohort of 40 patients (46 knee replacements) operated using the flexion first balancing technique was retrospectively analyzed and compared with a cohort of 51 patients (52 knee replacements) operated using the classic gap balancing technique. Radiographic analysis of the coronal alignment, joint line height and posterior condylar offset was performed. Clinical and functional outcome data were analyzed pre- and postoperatively and compared between both groups. The two sample t test, Mann-Whitney U test, Chi-square test and a linear mixed model were used for performing statistical analyses, after normality analyses were executed. RESULTS: Radiologic evaluation showed a decrease in posterior condylar offset using the classic gap balancing technique (p = 0.040) versus no change using the flexion first balancing technique (p = n.s.). No statistically significant differences were noted for joint line height and coronal alignment. Using the flexion first balancer technique leads to a greater postoperative range of motion with deeper flexion (p = 0.002) and a better Knee injury and Osteoarthritis Outcome Score (KOOS) (p = 0.025). CONCLUSION: The Flexion First Balancing technique is a valid and safe technique for TKA, resulting in better preservation of PCO with consequently greater postoperative flexion and better KOOS scores. LEVEL OF EVIDENCE: III.

Vitamin D, calcium and albumin bloodserum levels in Belgian orthopedic patients - is systematic screening justified?

In the setting of fracture care, orthopedic surgeons are primarily focused on treating the fracture itself, but more and more attention is being paid to prevention of such fractures and identifying risk factors associated with worse postoperative prognoses. In our study we collected postoperative vitamin D, calcium and albumin bloodserum levels from 163 patients who were admitted with a femur fracture and from 233 patients who were admitted for an elective hip arthroplasty during the period of 365 days. Results : 84.21% of the fracture population had a vitamin D deficiency (< 20 ng/mL) as well as 77.30% of the elective hip arthroplasty population. There were no significant seasonal differences in the fracture population. 80.27% of the fracture population had an albumin deficiency (< 29 g/L) compared to 38.75% of the reference population. There were no significant statistical differences in vitamin D and albumin bloodserum levels between the under 75 years old age group and the over 75 years old age group. We can make the tentative assumption that systematic screening for all hip fracture patients and all elective hip arthroplasty patients admitted to our orthopedic ward - independent of their age, season or pathology - is justified and we advise other hospitals to implement this as well.

Functional and radiographic short-term outcome evaluation of the Visionaire system, a patient-matched instrumentation system for total knee arthroplasty.

Patient matched instrumentation is a new operative tool in the field of total knee arthroplasty. Custom made cutting blocks are designed to perform distal femoral and tibial bone cuts according to a pre-operative planning. This study evaluates the Visionaire system of Smith & Nephew. Thirty-one patients, operated with the Visionaire technique, were compared to an equal control group for different clinical and radiographic outcome parameters. Between both groups, no statistical significant difference could be found in post-operative pain, satisfaction, functional outcome, hospital stay, blood loss, radiographic alignment and precision of bone cuts. Only tibial plateau backslope can be created with more precision in the Visionaire group. But there was a statistical significant difference for residual flexion deformity after a mean follow-up time of 200 days.

Osteochondral defect in femoral head: Trufit implantation under fluoroscopic and arthroscopic control.

Under arthroscopic control and guided by fluoroscopy, a Trufit Plug was successfully implanted to repair an osteochondral lesion of the head of the femur. The procedure was evaluated clinically using the HOOS score and Magnetic Resonance Imaging (MRI) of the hip. The short-term (6 months) clinical results are encouraging: the HOOS score improved clearly and the patient was satisfied. Interpretation of MRI images in the early post-operative period is very difficult: in the early months history and clinical examination prevail in the evaluation.

Reconstruction of the medial patellofemoral ligament for patellar instability using an autologous gracilis tendon graft.

Patellofemoral dislocations are common. In cases with recurrence or residual instability, surgical intervention is usually considered. Numerous treatment protocols have been used in the past to treat patellofemoral instability secondary to patella dislocation. Reconstruction of the medial patellofemoral ligament is one of the possible options, since it was acknowledged to have a major medial stabilising role on the patella. We present a technique for reconstruction of the medial patellofemoral ligament using an autologous gracilis tendon graft.