The personalized Berger method is usable to solve the problem of tibial rotation.

PURPOSE: The revision of any total knee replacement is carried out in a significant number of cases, due to the excessive internal rotation of the tibial component. The goal was to develop a personalized method, using only the geometric parameters of the tibia, without the femoral guidelines, to calculate the postoperative rotational position of tibial component malrotation within a tolerable error threshold in every case. METHODS: Preoperative CT scans of eighty-five osteoarthritic knees were examined by three independent medical doctors twice over 7 weeks. The geometric centre of the tibia was produced by the ellipse annotation drawn 8 mm below the tibial plateau, the sagittal and frontal axes of the ellipse were transposed to the slice of the tibial tuberosity. With the usage of several guide lines, a right triangle was drawn within which the personalized Berger angle was calculated. RESULTS: A very good intra-observer (0.89-0.925) and inter-observer (0.874) intra-class correlation coefficient (ICC) was achieved. Even if the average of the personalized Berger values were similar to the original 18° (18.32° in our case), only 70.6% of the patients are between the clinically tolerable thresholds (12.2° and 23.8°). CONCLUSION: The method, measured on the preoperative CT scans, is capable of calculating the required correction during the planning of revision arthroplasties which are necessary due to the tibial component malrotation. The personalized Berger angle isn't altered during arthroplasty, this way it determines which one of the anterior reference points of the tibia (medial 1/3 or the tip of the tibial tuberosity, medial border or 1/6 or 1/3 or the centre of the patellar tendon) can be used during the positioning of the tibial component. LEVEL OF EVIDENCE: Level II, Diagnostic Study (Methodological Study).

An unusual case of hip pain after total hip arthroplasty: A case report.

Our goal is to draw attention to the inflammation of the iliopectineal bursa being a rare condition, which can cause lower limb swelling and anterior pain of the hip even years after total hip arthroplasty. A 67-year-old woman was admitted seven years after hip arthroplasty (cemented total endoprosthesis [TEP]) with swelling and feeling of excessive fullness of the lower extremity and with tolerable anterior hip pain. The physical examination and blood tests were non-specific for septic condition. Ultrasound showed a cystic mass in the inguinal region with a direct contact to the common femoral vein. Deep vein thrombosis was excluded. The single-photon emission computed tomography-computed tomography (SPECT-CT) was administered to decide the surgical plan, either making a bursa extirpation or making revision hip arthroplasty. The SPECT-CT excluded the possibility of aseptic loosening. Methylene blue was injected into the bursa intraoperatively which did not enter the strong pseudo-capsule of the joint and, therefore, we did not administer revision of the TEP, and the bursa was extirpated. Two weeks after the operation, the patient had no pain, was able to walk, and the swelling decreased. Four months after surgery, the pain and feeling of fullness disappeared, with minimal lower limb swelling. In conclusion, in case of increasing complaints of patients who left years behind without any problem following total hip arthroplasty, the pathogenic role of the iliopectineal bursa should be taken into account, after excluding more frequent causes such as aseptic loosening or periprosthetic joint infection. As long as we consider about a rare disease, we can find a solution to the patient's complaint sooner.

[Hip arthroscopy: short-term outcomes]. / Csípoarthroscopia: rövid távú eredményeink.

Introduction: As a minimally invasive procedure, hip arthroscopy plays an increasingly significant role in the diagnostics and management of hip joint diseases. In this study, we present our initial experience with hip arthroscopy established at our department. Aim: Our aim was to integrate the hip arthroscopy procedure into the surgical protocol of our department, since after reviewing the relevant literature and evaluating our experience gained during study visits abroad, we consider this intervention to be a reasonable and successful technique. Method: Results of 29 hip arthroscopy interventions performed between 01 January 2017 and 15 April 2019 at our department were evaluated by comparing pre- and postoperative modified Harris hip scores (mHHS). Surgeries were performed with 30-degree scopes, typically via standard access sites. The typical indication for surgery was hip impingement syndrome. Results: Isolated cam deformity, isolated pincer deformity and mixed deformity were detected in 3, 9 and 13 cases, respectively. The mean age of the 13 male and 16 female subjects was 44.1 years. The age of our patients ranged between 22 years and 60 years. After surgery, significant improvement of mHHS was detected both according to the F-test and the Student's t-test. Conclusions: Hip arthroscopy is an appropriate treatment alternative for the surgical management of many hip conditions. Even though the learning curve is longer than that of the endoscopic examinations of other joints, adequate surgical design can minimise the risk of complications, making this intervention a potential solution for the management of multiple hip conditions. Orv Hetil. 2020; 161(9): 340-346.

Comparison of total knee arthroplasty after combined high tibial osteotomy with a matched group of primary total knee arthroplasty.

OBJECTIVES: This study aims to compare the results of total knee arthroplasties (TKAs) performed after previous combined high tibial osteotomy (CO) to those of a matched control group of primary TKA. PATIENTS AND METHODS: Between 01 August 2006 and 31 December 2011, we performed 24 consecutive cemented TKAs in 24 patients (10 males, 14 females; mean age 69.5 years; range, 60 to 79 years) who had undergone previous CO (study group). The study group was compared to a control group of 24 patients (10 males, 14 females; mean age 69.9 years; range, 63 to 79 years) who were performed primary TKA during the same period. Pre- and postoperative The Knee Society knee and function score and range of movement were determined. The femorotibial angle, the distance between the tangent to the lateral subchondral plate and the top of the fibular head, the transposition of the tibial condyle, the length of the patellar tendon and the tibial slope angle were measured preoperatively. At final follow-up, the same parameters were calculated and the amount of lateral tibial bone resection was determined. RESULTS: The mean follow-up duration was 97 months (range, 61 to 124 months) in the study group and 97 months (range, 61 to 123 months) in the control group. TKA survivorship rate was 100% in both groups. At final follow-up, there were no significant differences regarding the clinical and radiographic data. However, only the amount of the resected lateral bone was significantly lower in the study group than in the control group. CONCLUSION: In young and active people with medial knee arthrosis, in whom the planned correction is 10° or higher, we continue to suggest CO since it does not seem to influence the results of TKA negatively.

Evaluation of biomarkers following autologous osteochondral transplantation in the equine stifle joint - An experimental study.

The purpose of this study was to evaluate changes in biomarker and synovial parameters following autologous osteochondral transplantation (AOT) in the equine stifle joint, to test the hypothesis whether synovial parameters would show significant differences at selected time points following the surgery (at days 3, 14, 60 and 180) compared to baseline level (at day 0). Surgical intervention was performed in both stifles of nine horses (n = 18). The joints were randomly assigned to operated and sham-operated groups. Grafts 8.5 mm in diameter were harvested from the femoropatellar (FP) joint under arthroscopic control and the medial femorotibial (MFT) joints had AOT using mosaicplasty (MP) instrumentation, while the sham FP and sham MFT joints underwent arthroscopy and miniarthrotomy without transplantation, respectively. Synovial fluid (SF) parameters were evaluated at days 4, 14, 60 and 180. Data were analysed by two-way repeated- measures analysis of variance (ANOVA), and P < 0.05 was considered significant. During the first 10-14 days after surgery, lameness of degree 2-3/5 [American Association of Equine Practitioners (AAEP) scores] was present, which disappeared after 60 days. Joints with transplantation showed significant increases in synovial white blood cell count (WBC), total protein (TP), substance P, C1,2C and CS846 epitope concentration at day 3 compared to baseline and shamoperated joints (P < 0.05). These parameters returned to the baseline values by two months after surgery and remained within normal levels at 6 months postoperatively.

Evaluation of a Novel Screw Position in a Type III Distal Phalanx Fracture Model: An Ex Vivo Study.

OBJECTIVE: Mechanical evaluation of a novel screw position used for repair in a type III distal phalanx fracture model and assessment of solar canal penetration (SCP). STUDY DESIGN: Experimental study. SAMPLE POPULATION: Disarticulated equine hooves (n = 24) and 24 isolated distal phalanges. METHODS: Hooves/distal phalanges cut in a sagittal plane were repaired with 1 of 2 different cortical screw placements in lag fashion. In group 1 (conventional screw placement), the screw was inserted halfway between the proximal border of the solar canal (SC) and the subchondral bone surface on a line parallel to the dorsal cortex, whereas in group 2, the screw was inserted more palmar/plantar, where a perpendicular line drawn from the group 1 position reached the palmar/plantar cortex. Construct strength was evaluated by 3-point bending to failure. SCP was assessed by CT imaging and macroscopically. RESULTS: Screws were significantly longer in group 2 and in forelimbs. Group 2 isolated distal phalanges had a significantly more rigid fixation compared with the conventional screw position (maximum point at failure 31%, bending stiffness 41% higher). Lumen reduction of the SC was observed in 13/52 specimens (all from group 2), of which 9 were forelimbs. CONCLUSIONS: More distal screw positioning compared with the conventionally recommended screw position for internal fixation of type III distal phalangeal fractures allows placement of a longer screw and renders a more rigid fracture fixation. The novel screw position, however, carries a higher risk of SCP.

Long-term results of the Sauvé-Kapandji procedure in the rheumatoid wrist.

This retrospective long-term study evaluates the clinical and radiological results of the Sauvé-Kapandji procedure in rheumatoid wrists. Fourteen patients with rheumatoid arthritis who had undergone a Sauvé-Kapandji procedure were examined 10 to 16.5 years after surgery. Range of motion and grip strength were measured. The patients' complaints related with instability of the ulnar stump, the residual pain in the wrist, and the function of the operated hand were assessed. The review also included a radiological examination. Pain was found to have decreased and the gripping strength of the hand to have increased in all the patients. The range of wrist rotation was significantly improved. On radiographs, there were no signs of increased ulnar translation of the carpus. We noted no instance of subluxation or dislocation of the ulnar stump. In this long-term evaluation, the Sauvé-Kapandji procedure was found to provide long-term improvement of the function of the wrist-hand complex, by eliminating the distal radio-ulnar joint which is a major source of pain in the rheumatoid wrist.

Combined high tibial osteotomy decreases biomechanical changes radiologically detectable in the sagittal plane compared with closing-wedge osteotomy.

PURPOSE: The purpose of this randomized, prospective study was to compare radiologic changes in the sagittal plane after closing-wedge and combined high tibial osteotomies (HTOs) performed in patients with medial knee arthrosis associated with a varus deformity and requiring a 10 degrees correction. METHODS: The patellar height, determined by the Insall-Salvati index (ISI), and tibial slope (TS) angle, measured by the Dejour-Bonnin method, were compared after 45 closing-wedge osteotomy (CWO) and 46 combined osteotomy (CO) procedures. CO is a relatively new technique effectively being the combination of closing-wedge and opening-wedge HTOs. It involves performing a proximal osteotomy parallel to the tibial plateau, followed by a distal osteotomy extending from the lateral part of the tibia to the line of the proximal osteotomy at the center of the tibial condyle. After closure of the lateral part of the osteotomy and consequent opening of the medial part, the removed lateral bone wedge is transferred to the gap on the medial side. RESULTS: We found that at the end of the study, 12 months after the operation, CO resulted in significantly smaller changes in TS angle (4.7% v 38.2%) and ISI (2.2% v 5.7%) values than CWO. CONCLUSIONS: The main conclusion of this study is that based on our radiologic findings, CO results in significantly smaller changes in TS angle and ISI values than CWO; therefore, CO is better at preserving the normal or near normal condition of the knee than CWO. Altogether, when a 10 degrees correction is required during HTO, we recommend choosing CO instead of CWO. LEVEL OF EVIDENCE: Level II, prospective comparative study.

The patella and tibial condyle position after combined and after closing wedge high tibial osteotomy.

High tibial osteotomy changes the patella and tibial condyle position, which makes the subsequent total knee replacement technically demanding. From 1 January 1993 to 31 December 2000, combined osteotomy [After the first osteotomy made 2 cm distally to the joint line, a bone wedge is removed based laterally. Its tip ends at the center of the tibial condyle (half bone wedge). The distal part of the tibia is placed into the valgus position and the half bone wedge is placed into the gap opened medially.] was performed on 103 knees and closing wedge osteotomy was performed on 47 consecutive knees. Eighty combined (group A) and 41 closing wedge (group B) osteotomy were studied. All knees were assessed radiologically before surgery, in the 10th postoperative week, in the 12th postoperative month and at the time of the final follow-up (in group A-66.15 months, in group B-66.61 months). We examined the change of the femorotibial angle, of the patellar height according to the method of Insall and Salvati, of the tibial slope angle according to the method of Bonnin, of the tibial condylar offset according to the method of Yoshida and of the distance between the lateral tibial plateau and the top of the fibular head. In group A and B, the recurrence of the varus deformity was not noted and valgus alignment did not increase in any case. In group-A, the Insall-Salvati ratio remained unchanged in 65% of knees. The tibial slope angle decreased in both groups. There was correlation between the change of the tibial condylar offset and the angle of the correction in both groups. There was correlation between the change of the distance between the lateral tibial plateau and the top of the fibular head. After combined osteotomy, the transposition of the tibial condyle and the decrease of the distance between the lateral tibial plateau and the top of the fibular head was less than after closing wedge osteotomy, although the average angle of correction was more after combined osteotomy (11.835 degrees ), than after closing wedge osteotomy (9.465 degrees ). Theoretically, the recurrence of the varus deformity, the increase of the valgus alignment and (in majority of cases) the shortening of the patellar tendon do not compromise the likelihood of successful conversion to the subsequent total knee replacement, either after combined or after closing wedge osteotomy. The combined osteotomy does not lead to considerable transposition of the tibial condyle and to considerable lateral tibial bone loss; therefore, theoretically, the combined osteotomy does not impair the subsequent total knee replacement.

Short- and mid-term results after combined high tibial osteotomy.

In a consecutive series, 103 knees were treated with combined osteotomy. From these 103 knees, 80 knees were studied. Mean follow-up was 54.15 months (range: 13-96 months). After the first osteotomy is made 2 cm distally to the joint line, a bone wedge is removed based laterally. Its tip ends at the center of the tibial head/half bone wedge. The distal part of the tibia is placed into the valgus position and the half bone wedge is placed into the gap opened medially. The result was excellent in 44%, good in 45%, and poor in 11% of the knees.