Early results of total knee arthroplasty with a low contact stress anteroposterior glide.

PURPOSE: To present early results of 400 consecutive low contact stress (LCS) anteroposterior (AP) glide total knee arthroplasties (TKAs) performed by a single surgeon. METHODS: 304 consecutive patients aged 30 to 96 (mean, 66) years underwent 400 TKAs using LCS AP glides performed by a single surgeon. Only patients with an intact posterior cruciate ligament, a fixed flexion deformity of <15 degrees, and a valgus deformity of <15 degrees were included. Patients were assessed pre- and post-operatively using the American Knee Society (AKS) and Hospital for Special Surgery (HSS) scores. Range of motion was measured using a goniometer. AP and lateral radiographs were assessed for radiolucencies and osteolysis. RESULTS: The mean follow-up period was 4.2 (range, 1-8) years. The mean fixed flexion improved to 1 from 11 degrees and the mean active flexion improved to 120 from 111 degrees. Both AKS and HSS scores improved significantly. There were 28 anterior soft tissue impingements; 9 of them were in the first year of the study. Thereafter, the anterior lip of the bearing was modified and any offending osteophytes, soft tissue, or fat pads were excised. Of 39 (10%) knees that underwent re-operation (16 were due to anterior soft tissue impingement), 20 (5%) did not require change of the AP glide bearing and the remaining 19 were converted to a rotating platform bearing. No patellar baja was noted after fat pad excision. No patient had catastrophic wear or failure of the polyethylene bearing. The survival rate of the AP glide bearing was 95%. CONCLUSION: The early-to-mid-term outcomes of the LCS AP glide TKA are promising.

A retrospective comparative study of bilateral total knee replacement staged at a one-week interval.

The clinical results of bilateral total knee replacement staged at a one-week interval during a single hospital admission were compared with bilateral total knee replacements performed under the same anaesthetic and with bilateral total knee replacements performed during two separate admissions. The data were retrospectively reviewed. All operations had been performed by the same surgeon using the same design of prosthesis at a single institution. The operative time and length of stay for the one-week staged group were comparable with those of the separate admission group but longer than for the patients treated under one anaesthetic. There was a low rate of complications and good clinical outcome in all groups at a mean follow-up of four years (1 to 7.2). The group staged at a one-week interval had the least blood loss (p = 0.004). With appropriate patient selection, bilateral total knee replacement performed under a single anaesthetic, or staged at a one-week interval, is a safe and effective method to treat bilateral arthritis of the knee.

Cervical lymphadenitis in children: the role of Mycobacterium avium-intracellulare.

Non-tuberculous mycobacteria are the most frequent cause of mycobacterial cervical lymphadenitis in children. Although uncommon, the incidence in recent years has shown a marked increase. Its early differentiation from tuberculous mycobacterial lymphadenitis is essential as the treatment of choice is early surgical excision rather than antituberculous chemotherapy. Three such cases are reported with emphasis on the differential diagnosis and management.

Aspergillosis of the paranasal sinuses. A case report and radiographic review.

Aspergillosis of the paranasal sinuses is uncommon; however, its incidence in recent years has shown a marked increase, and it is believed that it may account for a number of cases of nonspecific sinusitis. It may present in one of four forms, one of which is the noninvasive Aspergillus mycetoma. One such case affecting the maxillary sinus is reported, and reference is made to its possible sequelae and management. The significance of its presentation as a radiodense focus within the antrum on plain radiographs and computed tomography is discussed, as is the use of magnetic resonance imaging for excluding aspergillosis from the differential diagnosis.