RESUMO
This study aimed to establish the effect of severe varus deformity on soft tissue balance in total knee arthroplasty (TKA), which is not yet well established. We retrospectively enrolled 205 patients (270 knees) who underwent primary TKA using the measured resection technique. Four intraoperatively measured TKA gaps and gap differences were compared between the severe varus deformity group (Hip-knee-ankle [HKA] varus angle ≥ 10°) and the mild varus deformity group (HKA varus angle < 10°). Pearson's correlation analysis and multiple linear regression analysis were used to investigate the factors affecting flexion and extension gap differences (FGD and EGD). A receiver operating characteristic curve was applied to assess the cut-off value of the HKA varus angle to discriminate the rectangular gap. The FGD (1.42 ± 1.35 mm vs. 1.05 ± 1.16 mm, p = 0.019) and the EGD (1.45 ± 1.32 mm vs. 0.97 ± 1.53 mm, p = 0.006) were significantly larger in severe varus deformity group than in mild varus deformity group. The HKA varus angle was positively correlated with both FGD (r = 0.264, p < 0.001) and EGD (r = 0.319, p < 0.001) and was an influencing factor for FGD (ß = 0.232, p = 0.040) and EGD (ß = 0.229, p = 0.037). A preoperative HKA angle of 12.4° was selected as the cutoff value to discriminate between rectangular and trapezoidal gaps. Thus, the severity of varus deformity (HKA varus angle) was found to be a significant factor affecting the mediolateral gap difference in TKA. When performing TKA in a knee with an HKA varus angle ≥ 12.4°, a trapezoidal gap is more likely to be expected. Level of evidence III, case−control study.
RESUMO
AIMS: Procalcitonin (PCT) has been recently accepted as a marker for diagnosing infection. The aim of the present study was to determine whether PCT levels are associated with infection severity of diabetic foot ulcers and whether PCT levels would be helpful to differentiate infected diabetic foot ulcer (IDFU) from IDFU associated with other infectious diseases (IDFU+O). METHODS: We prospectively included 123 diabetic patients hospitalized for IDFU. Infection severity of diabetic foot ulcers was graded according to the Infectious Diseases Society of America-International Working Group on the Diabetic Foot clinical classification of diabetic foot infection. Chest radiograph, urinalysis, urine microscopy, urine culture, and blood cultures (if fever was present) were performed for all patients to diagnose other infectious diseases. Laboratory parameters were measured from blood venous samples. RESULTS: PCT (Spearman's ρ=0.338, P<0.001) and C-reactive protein (Spearman's ρ=0.477, P<0.001) levels were significantly associated with infection severity of diabetic foot ulcers. However, only PCT levels could differentiate patients with associated infectious diseases from patients with no concomitant infection (area under the receiver-operator characteristic curve 0.869, P<0.0001; cut-off value 0.59; sensitivity 94.7; specificity 88.5). CONCLUSION: PCT and CRP levels positively correlated with infection severity of diabetic foot ulcers and PCT levels>0.59ng/mL in patients with IDFU may be associated with other systemic bacterial infection.
