Lymphadenopathy after GORE-TEX anterior cruciate ligament reconstruction.

The GORE-TEX (W. L. Gore & Associates, Flagstaff, Arizona) graft was used in humans for about 10 years starting in 1982. During that time thousands of these ligaments were inserted. In our hospital, 162 GORE-TEX cruciate reconstructions were performed between 1986 and 1993 using a standard over-the-top technique. Two of these patients developed inguinal lymphadenopathy secondary to GORE-TEX particulate materials from the ipsilateral knee joint. To our knowledge, this is the first paper describing the above-mentioned complication, which was established by histologic examination, including electron microscopy.

Is the KT1000 knee ligament arthrometer reliable?

We set up a trial to test whether the KT1000 arthrometer would give consistent measurements of anteroposterior laxity when used by the same and different examiners on the knees of the same subjects on the same day. The results showed substantial inter- and intra-examiner variation in the measurements both of absolute displacement in single knees and of side-to-side differences between pairs of knees. This casts doubt on the reliability of the instrument when used to compare the results of different techniques for reconstructing injured cruciate ligaments.

Effect of total knee arthroplasty on maximal flexion.

The advantage of potential flexion offered by total knee arthroplasty (TKA) is limited. In this review of 724 replaced knees, only one-third flexed to 105 degrees, while nearly one-half did not flex beyond 90 degrees. Postoperative flexion depended partly on preoperative flexion and partly on the prosthesis used, but these factors could not be the only determinants of results, for flexion in individual knees could increase, decrease, or remain unchanged whatever the preoperative measurement and whatever the design of prosthesis. Little difference in flexion before or after TKA was found between rheumatoid and osteoarthritic knees. Success or failure of the implant, according to the crude definition used, was not associated with degree of flexion. Patients with the lowest levels of function tended to have TKA with the least flexion and vice versa. Nevertheless, the degree of flexion is only one of the factors influencing mobility.

Effect of knee replacement on flexion deformity.

One of the objectives of knee replacement is to correct flexion deformity, the frequent consequence of rheumatoid arthritis and osteoarthritis. A review of 697 primary and revision replacements carried out between 1969 and 1985 and followed up from 1 to 16 years found that such deformity was present in 61% of knees before the primary operation. Replacement reduced this to 17% and the improvement was usually maintained. The deformity was present in only 21% of the replacements which required revision and the second operation reduced this to 8%. Flexion contractures affected rheumatoid knees more often and more seriously than osteoarthritic knees, but arthroplasty was more successful in correcting the deformity in the former. All of the 11 types of prosthesis used achieved some degree of correction, but the Walldius hinge and the variants of the Freeman condylar design were the most successful. Surprisingly, the best outcome, in terms of pain and reduced need for revision, was found in the rheumatoid knees most seriously deformed before operation, but this association was absent in the osteoarthritic knees. Postoperative deformity in knees without pain or extreme weakness did not appear to influence the patients' ability to walk or to use stairs or a chair, as measured by unexacting tests in the clinic.

Comparing the results of different types of knee replacement. A method proposed and applied.

Many knee replacement prostheses, embodying various principles of design, are now available and there is need for a method by which valid comparisons of results can be made. An important criterion of success is durability, so the length of time the prostheses have been in situ must be taken into account. Such a method is proposed here and is applied to the results of 673 knee replacements, of nine different types, implanted at the same hospital between 1970 and 1983. A prosthesis was considered to have failed if it had been removed or persistently caused severe pain. Two types of prosthesis were found to be significantly less successful than the other seven, between which none consistently showed significant superiority. Results for the seven types were similar despite the facts that they had been used for knees with different degrees of damage, some as secondary implants, and that they were of different design and at different stages of technical development. The more recently introduced types of prosthesis, designed to have theoretical advantages, were found in practice to be no more successful than the models they superseded.

Image intensifier as an aid to insertion of the Zickel nail apparatus for proximal femoral fractures.

Technical problems have been encountered when using the usual method of implanting the Zickel nail. We have attempted to overcome them by placing the patient on an orthopaedic table and screening the femur using an image intensifier. The results, and the particular ways in which this technique has helped, are described.

Induction of tendon and ligament formation by carbon implants.

Experiments have been performed on rabbits and sheep which demonstrate that pure carbon, in a flexible and filamentous form of great strength, can be used successfully to induce the formation of new tendons. A concept fundamentally different from that underlying the use of other artificial tendon replacements is involved, in which rapidly developing tendon-like tissue is induced to form around the implant. This gradually takes over the function of the implant. The early results in rabbits and the late results in sheep suggest that filamentous carbon may have a place in the replacement of the calcaneal tendon and the collateral ligaments of the knee.