Use of semi-constrained total knee arthroplasty in gonarthrosis with collateral ligament insufficiency: Clinical and functional outcomes.

INTRODUCTION: Achieving stability in total knee arthroplasty (TKA) is crucial for long-term implant survival. In cases of severe deformity or ligament laxity, constrained implants may be required. Traditionally, increasing constraint involved intramedullary stems. However, there are intermediary alternatives, including employing a constrained polyethylene insert without stems, thereby avoiding complications related to them. The study aims to evaluate our experience with a non-modular constrained (NMC) implant in primary TKA. MATERIAL AND METHODS: We conducted a retrospective review of the clinical and radiographic outcomes of 108 non-stemmed primary TKAs performed at our institution between 2013 and 2021 in patients with at least 10° deformity or 10mm ligament laxity. Data included demographics, preoperative and postoperative deformities, clinical outcomes and revision rates. RESULTS: A total of 103 patients (108 knees) with a mean age of 74 were followed up for a minimum of 2 years. The mean postoperative range of motion was 105°/0°. The median Oxford Knee Score, Knee Society Score and Knee Society Function Score were 43.5, 92 and 90, respectively. 17 knees had varus deformity (mean tibiofemoral angle of 2.7°), and 87 knees had excessive valgus deformity (mean tibiofemoral angle of 15.1°). The remaining 4 knees had a neutral alignment. The mean postoperative tibiofemoral angle was 6.8°. The overall revision rate was 6.5% (7 patients): 3 deep periprosthetic infections, 2 patellar dislocations, 1 stiffness and 1 aseptic loosening. CONCLUSION: Our experience demonstrates favorable mid-term outcomes with the NMC implant, providing a safe alternative to stemmed implants in primary TKA, particularly in cases of severe deformity or ligament laxity.

Actividades de vida afectadas en pacientes tras artroplastia total inversa de hombro en el contexto de artropatía de manguito rotador / Patient reported activities after reverse total shoulder arthroplasty in rotator cuff arthropathy patients

Introducción y objetivos. La artroplastia total de hombro inversa en el contexto de la artropatía de manguito rotador mejora la anteversión y abducción existentes, no así las rotaciones. Nuestro objetivo es determinar la repercusión de este hecho en la realización de actividades más cotidianas. Material y métodos. Entre 2009 y 2011 se implantaron 210 artroplastias de hombro en nuestro centro. De ellas, 126 artroplastias totales de hombro inversas por artropatía de manguito rotador. El 88% eran mujeres, con una edad media en el momento de la cirugía de 81 años, encontrándose el 95% laboralmente retirados. El seguimiento medio fue de 53 meses. En cada paciente fue valorada la escala Constant, la escala visual analógica e índice de comorbilidad de Charlson, el balance articular así como la capacidad de realización de 40 actividades cotidianas, divididas según grado de demanda funcional para el hombro en un cuestionario nuevo adaptado a nuestro grupo poblacional. Resultados y discusión. El Constant medio normalizado por edad y sexo fue del 81,2%. EL valor medio de la escala visual analógica e índice de comorbilidad de Charlson medios de 3,56 y 1,69 respectivamente. Mejoría del balance articular en anteversión y abducción, no en rotaciones. Limitación para realizar actividades de baja y alta demanda funcional del 20 y 51% respectivamente, apreciándose mayor limitación en aquellas que implican rotación interna. Conclusión. La artropatía de manguito rotador en el paciente anciano tratada mediante artroplastia total de hombro inversa consigue un adecuado control analgésico y buenos resultados funcionales. Sin embargo, hay que asumir un importante riesgo de limitación en actividades cotidianas de alta demanda y que impliquen rotaciones, sobre todo interna (AU)

Introduction and objective. Reverse total shoulder arthroplasty in rotator cuff arthropathy patients, improves anteversion and abduction, but not rotational, outcomes. The main aim of this study is to determine its repercussions on daily life activities in our patients. Material and methods. Between 2009 and 2011 we implanted 210 shoulder arthroplasties, 126 of them were reverse total shoulder arthroplasty in a rotator cuff arthropathy context. About 88% were women, with a mean age at time of surgery of 81 years, 95% were retired. The mean follow up was 53 months. The Constant scale, Visual Analogue Scale, Charlson Comorbidity Index, range of motion were measured for each patient and whether they could manage 40 daily life activities by means of a new questionnaire, classifying them according toshoulder functional demand. Results and discussion. Mean normalized by sex and age Constant value was 81.2%. Mean Visual Analogue Scale and Charlson Index were 3.56 and 1.69 respectively. Improvement in anteversion and abduction, not in rotational range of motion. Limitation was found in low and high functional demand activities in 20% and 51% respectively, especially those which involved internal rotation. Conclusion. Reverse total shoulder arthroplasty treatment for RCA in the elderly, achieves adequate pain management and good functional outcomes. Nevertheless, an important risk of DLA limitation must be accepted in those which involve internal rotation or shoulder high functional demand (AU)

Patient reported activities after reverse total shoulder arthroplasty in rotator cuff arthropathy patients. / Actividades de vida afectadas en pacientes tras artroplastia total inversa de hombro en el contexto de artropatía de manguito rotador.

INTRODUCTION AND OBJECTIVE: Reverse total shoulder arthroplasty in rotator cuff arthropathy patients, improves anteversion and abduction, but not rotational, outcomes. The main aim of this study is to determine its repercussions on daily life activities in our patients. MATERIAL AND METHODS: Between 2009 and 2011 we implanted 210 shoulder arthroplasties, 126 of them were reverse total shoulder arthroplasty in a rotator cuff arthropathy context. About 88% were women, with a mean age at time of surgery of 81 years, 95% were retired. The mean follow up was 53 months. The Constant scale, Visual Analogue Scale, Charlson Comorbidity Index, range of motion were measured for each patient and whether they could manage 40 daily life activities by means of a new questionnaire, classifying them according toshoulder functional demand. RESULTS AND DISCUSSION: Mean normalized by sex and age Constant value was 81.2%. Mean Visual Analogue Scale and Charlson Index were 3.56 and 1.69 respectively. Improvement in anteversion and abduction, not in rotational range of motion. Limitation was found in low and high functional demand activities in 20% and 51% respectively, especially those which involved internal rotation. CONCLUSION: Reverse total shoulder arthroplasty treatment for RCA in the elderly, achieves adequate pain management and good functional outcomes. Nevertheless, an important risk of DLA limitation must be accepted in those which involve internal rotation or shoulder high functional demand.