The effect of sacrificing the posterior cruciate ligament on total knee arthroplasty with cruciate retaining highly congruent rotating platform prosthesis.

OBJECTIVE: To analyze the effect of sacrificing the posterior cruciate ligament (PCL) on the early postoperative outcome of cruciate retaining (CR) highly congruent rotating platform TKA. METHODS: From May 2018 to September 2019, 105 cases of total knee arthroplasty (TKA) with CR highly congruent rotating platform prosthesis were retrospectively analyzed. According to the tension of posterior cruciate ligament, they were divided into sacrifice group (29 cases, 27.6%) and retention group (76 cases, 72.4%). Preoperative and postoperative The Hospital for Special Surgery (HSS) score, range of motion (ROM) were compared between the two groups. In addition, postoperative infection, prosthesis loosening, bearing dislocation, and other complications were also compared. RESULTS: All patients were followed up for 11~24 months (mean 18.14 ± 3.52) months. There was no significant difference in general data, preoperative HSS score, and ROM between the two groups (P > 0.05). At the last follow-up, HSS score and ROM of the two groups were better than those before operation (P < 0.05). However, there was no significant difference between the two groups (P > 0.05). Moreover, there were no complications such as infection, loosening of prosthesis, and bearing dislocation in all cases. CONCLUSION: In CR, highly congruent rotating platform TKA with or without tension of the PCL can achieve satisfactory outcomes. Tension-free PCL do not cause joint instability.

Microscopic Minimally Invasive Keyhole Technique for Surgical Resection of Spinal Dumbbell Tumors.

BACKGROUND: Multiple surgical modalities have been developedl and applied for surgical excision of spinal dumbbell tumors. The microscopic minimally invasive keyhole technique has not yet been well characterized for this purpose. We report our experience with 1-stage surgical resection of both intraforaminal and extraforaminal/paraspinal components of spinal dumbbell tumors using the microsurgical keyhole technique. METHODS: We retrospectively reviewed 12 cases of spinal dumbbell tumors treated via 1-stage surgical resection by the same senior spinal surgeon from January 2013 to April 2017. All patients were treated surgically using the microsurgical keyhole technique through a tubular retractor. Demographic data, perioperative variables, and associated complications were recorded. The clinical outcomes were evaluated at the last follow-up using a visual analog scale and the American Spinal Injury Association scale. RESULTS: Mean duration of surgical resection was 184.58 minutes, and mean estimated total blood loss was 208.33 mL. The mean hospitalization time was 9.17 days. Postoperatively, 11 patients (91.67%) who originally presented with pain had a significantly lower visual analog scale score, indicating a reduction in their pain intensity. All patients demonstrated neurologic stability or improvement by 1-3 grades: 16.67% remained stable, 41.67% improved by 1 grade, 33.33% improved by 2 grades, and 8.33% improved by 3 grades. CONCLUSIONS: The microscopic minimally invasive keyhole technique can be used successfully for resection of spinal dumbbell tumors. Further comparative studies are warranted to demonstrate the benefits of the microsurgical keyhole technique compared with traditional open procedures for surgical resection of spinal dumbbell tumors.