Comparison of Functional Outcomes Between the First and Second Knee in Staged Bilateral Total Knee Arthroplasty With Diverse Intervals Between Stages.

BACKGROUND: The objective of the study was to analyze if the length of interval time between stages influenced functional and quality of life outcomes in patients with staged bilateral primary total knee arthroplasty (TKA). METHODS: This is a retrospective comparative study between 93 patients with an interval between stages of 6-8 months (6-month group), 112 of 12-14 months (1-year group), and 108 of 24-26 months (2-year group). Outcome variables were Knee Society scores, Western Ontario and McMaster Universities, Short Form, and patient satisfaction. RESULTS: Overall, the mean follow-up for the first TKA was 8.2 (range, 7-10) years, and for the second TKA, 6.7 (range, 5-10) years. At last follow-up, functional and patient-related outcomes were similar for both knees, regardless of the interval. However, mental score and patient satisfaction were significantly better for the second than for the first TKA in the 2-year group. Age did not correlate significantly with the functional scores but was significantly correlated with the mental score. CONCLUSION: The performing staged bilateral TKA with a wide interval between surgeries provided equivalent functional outcomes and quality of life for both knees. Postoperative outcomes were not affected by the length of the time interval between procedures or age. Our results can help the surgeon to inform the patients reliably about what they can expect in the delay of a second knee replaced. Thus, patients could make an informed decision.

Cruciate-Retaining vs Posterior-Stabilized Primary Total Arthroplasty. Clinical Outcome Comparison With a Minimum Follow-Up of 10 Years.

BACKGROUND: Controversy continues regarding whether the posterior cruciate ligament should be retained or removed during total knee arthroplasty (TKA) procedure. The objective was to compare the clinical outcomes with a minimum follow-up of 10 years between patients who received contemporary cruciate-retaining or posterior-stabilized primary TKA. METHODS: Case-control study of 268 patients who underwent cruciate-retaining TKA vs 211 to posterior-stabilized design, with the same arthroplasty system, and a minimum follow-up of 10 years. Clinical assessment was performed by Knee Society scores, Western Ontario and MacMasters Universities and Short-Form 12 questionnaires, range of motion, and patient satisfaction. RESULTS: Successful outcomes were found for both designs. No significant differences in functional scores, range of motion, patient-related scores, or patient satisfaction. Between the 5-year and last postoperative follow-up, there were a significant decrease of all clinical scores in both groups. In addition, complication rate and implant survival were similar between groups. CONCLUSION: The superiority of one design over the other was not found. Both designs can be used expecting long-term successful outcomes and high survival. The choice of the design depended on the status of the posterior cruciate ligament and surgeon preference.

Cementless acetabular reconstruction after acetabular fracture: a prospective, matched-cohort study.

BACKGROUND: Total hip arthroplasty (THA) is a common surgical treatment when significant joint changes and pain are present after acetabular fracture. Few series have been reported in the literature with cemented and uncemented acetabular components. The aim of this study was to analyze the long-term results of cementless acetabular components inserted in acetabula that had been altered with previous fracture and to compare these results to those of routine THA. METHODS: Twenty-four uncemented total hip arthroplasties were performed for the treatment of posttraumatic arthritis after acetabular fracture. The mean age and follow-up was 56 years and 8.4 years, respectively. The results were compared with 48 primary uncemented total hip arthroplasties in patients with nontraumatic arthritis. Clinical assessment with Harris hip score and radiologic with special interest in the socket was made. RESULTS: No significant difference between the two cohorts was found with regard to postoperative follow-up, perioperative transfusion requirements, reoperations, and acetabular survival. Between both cohorts, there were significant differences with regard to operative time and postoperative Harris score. CONCLUSIONS: Cementless THA is a suitable treatment for posttraumatic arthritis after acetabular fracture. LEVEL OF EVIDENCE: Therapeutic study, level III.

Outcomes in nonagenarians after hemiarthroplasty for femoral neck fracture. A prospective matched cohort study.

A prospective cohort of 33 nonagenarians with hemiartroplasty for femoral neck fracture was matched with 33 patients aged between 70 and 89, using preoperative and postoperative data, and the following were studied; epidemiological data, physical dependence, and SF-12 and WOMAC questionnaires. The mortality rate at one year was 24.2%, influenced by the presence of 3 or more comorbidities, dementia, and previous dependence. The perioperative period was the most vulnerable time, and in some cases delaying surgery should be considered to stabilise the patient's medical condition in very elderly patients. Mortality and functional outcomes were worse than in younger patients, but the surgical complication rate was similar. Prognostic factors for a decline in quality of life were dementia and previous dependence.