Ten year outcomes for the prospective randomised trial comparing unlinked,modular bicompartmental knee arthroplasty and total knee arthroplasty

BackgroundA sizeable proportion of knee osteoarthritis is limited to the medial and patellofemoral compartments. Whilst short- and medium-term studies comparing bicompartmental knee arthroplasty (BCA) and total knee arthroplasty (TKA) have shown similar outcome scores, there are no studies comparing long-term outcomes. This study aims to determine which procedure resulted in superior long-term outcome scores.MethodsForty-eight patients with medial and patellofemoral compartment knee osteoarthritis were randomised to receive treatment in two groups: unlinked, modular BCA and TKA. The main outcome measures compared were the range of motion, Knee Society Function Score, Knee Society Knee Score, Oxford Knee Score, Physical Component Score and Mental Component Score of SF-36 pre-operatively and post-operatively up to 10 years. Radiographs of the operated knees were taken pre-operatively, post-operatively and at 10-year follow-up.ResultsTwenty-six underwent BCA and 22 underwent TKA. Overall improvement was seen in both groups compared to pre-operatively, however there were no significant differences detected between the groups at 10 years. The median Hip–Knee–Ankle (HKA) angle was 183.38 (175.17–187.94) in the BCA group and 180.73 (174.96–185.65) in the TKA group. One patient from the BCA group had a peri-prosthetic fracture necessitating revision surgery to a TKA.ConclusionsOutcome scores for BCA results were comparable to TKA at long-term follow-up. BCA is an alternative arthroplasty option in selected patients.     

Clinical and radiological outcomes of robotic-assisted unicompartmental knee arthroplasty: Early lessons from the first 100 consecutive knees in 85 patients

IntroductionRobotic-assisted unicompartmental knee arthroplasty (UKA) is associated with improved component positioning and comparable short- and mid-term implant survivorship with manual UKA. This study aims to evaluate clinical and radiological outcomes following robotic-assisted UKA as well as any potential learning-curves associated with the introduction of such new technology.MethodsProspective study of patients undergoing robotic-assisted UKA. Outcome measures were patient-reported outcome measures (PROMs) including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS) and Oxford Knee Score (OKS), complications, implant survivorship, component positioning and learning curve.ResultsEighty-five patients comprising 100 knees were recruited and followed up for 21.0 ± 4.3 months. At two years, there were significant and sustained improvements in PROMs and 100% implant survivorship rate. A high degree of implant accuracy was achieved with the robotic system. A cumulative learning curve of 20 cases was noted.ConclusionRobotic-assisted UKA achieves excellent implant accuracy and clinical outcomes in the short-term. Long-term follow up is needed to evaluate this relationship.     

Mid-term functional,clinical, and radiological outcomes with factors affecting revision of mobile-bearing medial unicompartmental knee arthroplasty

BackgroundTo evaluate and compare the clinical and radiological outcomes of patients subjected to medial unicompartmental knee arthroplasty (UKA).MethodsThe study included 146 knees of 115 consecutive medial UKAs patients with a minimum five-year follow-up. Pre- and postoperative functional and clinical outcomes were measured using the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), American Knee Society Score (AKSS-O), knee range of motion (ROM), and Short-Form Health Survey (SF-36). The Kellgren–Lawrence osteoarthritis (OA) grading system was used for the evaluation of the OA status. The joint line convergence angle (JLCA) of the operated and contralateral knee, the tibiofemoral coronal angle (TFCA), and the tibial slope angle were used in the radiological evaluation.ResultsThe mean age of patients was 58.8 ± 7.0 years. The mean follow-up period was 7.41 ± 1.54 years. Good to excellent functional outcomes were obtained according to VAS, WOMAC, OKS, AKSS-O, and SF-36 scores. Insert dislocation was the main reason for revision surgery (nine patients, 90%). Preoperative body mass index (BMI), postoperative BMI, American Society of Anesthesiologists (ASA) Score, postoperative knee flexion contracture, mean increase in postoperative medial joint space (PMJS) height, and OA progression were found to affect the revision status.ConclusionsGood to excellent functional, clinical, and radiological outcomes were obtained with medial UKA at a minimum follow-up of five years. Differences in preoperative and postoperative radiological parameters except an increase in PMJS height had no impact on revision status.     

High early revision rate with the FPV patello-femoral unicompartmental arthroplasty

BackgroundUnicompartmental patellofemoral arthroplasties are uncommon however numbers are increasing and there are a variety of new prostheses available. The Femoro-Patella Vialla (FPV, Wright Medical) device was the second most commonly used patellofemoral unicompartmental prosthesis in the 2012 British National Joint Register. There are however no published outcomes data for this device.Method52 consecutive cases were studied prospectively using Oxford Knee Score and American Knee Society Scores pre-operatively and at follow up to a minimum of two years.ResultsOverall Oxford Knee Scores improved from 30 points pre-operatively (36.6%) to 19 points (60%) at one-year. American Knee Society Knee scores improved from 51 points pre-operatively to 81 points at one-year. Function scores improved from 42 points pre-operatively to 70 points at one-year. 13 (25%) patients had an excellent outcome with pain abolished and near normal knee function. 11 (21%) patients gained very little improvement and scored their knees similar or worse to their pre-operative state. There were no infective or thromboembolic complications. Seven cases have been revised to a total knee replacement for on-going pain in six cases and progression of arthritis in the tibio-femoral compartments in one case. The patellar button was found to be very poorly fixed in all cases that were revised.ConclusionEarly results with the FPV prosthesis demonstrate that successful outcomes can be achieved however the results were unpredictable and a significant minority of patients had on-going symptoms that they found unacceptable. The early revision rate was high in this series.     

Long-term clinical and radiological outcomes after multiligament knee injury using a delayed ligament reconstruction approach: A single-center experience

PurposeTo present long-term clinical and radiological results of patients treated with delayed reconstruction of multiligament knee injuries.MethodsClinical data from 26 patients (21 men, five women, mean age 27.44 years) were retrospectively reviewed. Patients were evaluated at final follow-up with the use of: The International Knee Documentation Committee score (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity level, Lysholm Knee Scoring Scale, EuroQol subjective knee evaluation form, and KT-2000 arthrometer. Mean follow-up time was 105.38 months. Both knees were radiographically evaluated for osteoarthritis according to the Kellgren–Lawrence classification.ResultsNo patient required mobilization under anesthesia for adhesion lysis at the immediate or later postoperative duration. There was no statistically significant difference in range of motion between the healthy and operated sides (P = 0.713). Mean time to final range of motion regain was 2.1 ± 0.4 months. Average KT-2000 side-to-side (operated vs. normal) difference was 2.03 ± 1.1 mm, and the difference was statistically significant (P = 0.007). The mean IKDC, KOOS, Lysholm, Tegner, and Euroqol-5D postoperative scores were 82.13 ± 17.5, 84.59 ± 16.8, 90.6 ± 6.4, 4.3 ± 1.3, and 80 ± 11.74, respectively. Multiple regression analysis showed that age and follow-up time had significant effects on each clinical score, except for the Lysholm and Tegner scores. Progression of osteoarthritic changes of the reconstructed knee and its contralateral side was significantly different (P = 0.003).ConclusionExcellent clinical results were reported from this center's long-term experience with delayed ligament reconstruction, and osteoarthritic changes of reconstructed knees were recorded.     

Short-term and mid-term results of lateral condyle sliding osteotomy in the treatment of valgus total knee arthroplasty: A successful therapy option in Grade 2 valgus total knee arthroplasty

Background

Different methods exist for deformity correction and ligament balancing in total knee arthroplasty (TKA) of valgus knees, the sliding osteotomy being one of them. The objective of the current study was to analyze the clinical and radiological short-term and mid-term results of this technique in a larger series.

Bilateral unicompartmental knee arthroplasty for windswept knee osteoarthritis: A report of 13 cases

BackgroundWindswept deformity is a condition of the lower limbs with a valgus knee on one side and a varus knee on the other. We present a case series of bilateral unicompartmental knee arthroplasty (UKA) for windswept knee osteoarthritis (WSKO).MethodsWe analysed the outcomes of 26 knees of 13 consecutive patients with WSKO treated with bilateral UKA. The mean age was 73.0 years and the mean follow up period was 2.6 years. Pre- and postoperative Oxford Knee Score (OKS) and Japanese Orthopaedic Association (JOA) score, radiological measurements and postoperative complications were evaluated. No knees required revision for either infection or loosening.ResultsThe mean preoperative OKS was 25.3 ± 9.7, which increased to 34.9 ± 5.8 at the latest follow up. The mean preoperative JOA scores for the varus and the valgus sides were 64.6 ± 12.5 and 66.9 ± 14.1, which increased to 85.0 ± 11.3 and 84.6 ± 11.2, respectively, after operation.ConclusionsOur results show that good short-term clinical results can be achieved by bilateral UKA in cases of WSKO. Bilateral UKA may be an effective treatment for WSKO if indications are met.     

Medial/central PF arthritis and functionally stable ACL deficiency do not compromise outcomes of fixed-bearing medial UKA

BackgroundThere is limited published data assessing functional scores and patient satisfaction following unicompartmental knee arthroplasty (UKA) in patients with patellofemoral (PF) arthritis or anterior cruciate ligament (ACL) deficiency. The purpose of this study was to determine whether medial/central PF arthritis or functionally stable ACL deficiency compromise outcomes of fixed-bearing medial UKA at a minimum follow-up of 2 years. The hypothesis was that equivalent outcomes can be achieved in patients with substantial medial/central PF arthritis or with functionally stable ACL deficiency.MethodsThe authors studied a consecutive series of 229 patients (240 knees) at 36.9 ± 6.3 months after receiving fixed-bearing medial UKA. Patients completed pre- and post-operative (2 years) clinical outcome questionnaires for Oxford Knee Score (OKS), EQ-5D, Knee injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), University of California, Los Angeles (UCLA) activity score, and Forgotten Joint Score (FJS). Multivariable analyses were performed to determine associations between clinical scores, patient demographics, PF arthritis and functionally stable ACL deficiency.ResultsOf the 240 knees, 125 (54%) had substantial medial/central PF arthritis and 21 (9%) functionally stable ACL deficiency. Multivariable analyses revealed no association between outcomes and medial/central PF arthritis, but knees with functionally stable ACL deficiency were associated with better KOOS-PS (β = 8.99, p = 0.012).ConclusionFixed-bearing medial UKA grants satisfactory outcomes at 2 years even in knees with substantial medial/central PF arthritis or functionally stable ACL deficiency. Longer-term prospective studies with larger cohorts are needed to confirm these promising findings regarding outcomes in patients traditionally contraindicated for medial UKA.     

Fixed bearing,all-polyethylene tibia,lateral unicompartmental arthroplasty – A final outcome study with up to 28 year follow-up of a single implant

BackgroundLateral unicompartmental arthroplasty (UKA) constitutes only 5–10% of all unicompartmental replacements performed. Whilst the short and medium term benefits are well documented, there remains concern regarding the higher revision rate when compared with total knee replacement. We report the long term clinical outcome and survivorship of a large series of lateral UKA.Patients and MethodsBetween 1974 and 1994, 71 patients (82 knees) underwent a lateral fixed-bearing St Georg Sled UKA. Prospective data was collected pre-operatively and at regular intervals post-operatively using the Bristol Knee Score (BKS), with later introduction of the Oxford Knee (OKS) and Western Ontario MacMaster (WOMAC) scores. Kaplan Meier survival analysis was used, with revision, or need for revision, as end point. 85% of the patients were female. No patients were lost to follow-up.ResultsFunctional knee scores improved post-operatively up to 10 years, at which point they demonstrated a steady decline. Survivorship was 72% at 15 years, and 68% at 20 and 25 years. Nineteen knees were revised, with progression of disease in another compartment the commonest reason. There were two revisions due to implant fracture. In patients aged over 70 years at time of index procedure, 81% died with a functioning prosthesis in situ.ConclusionThis represents the longest follow-up of a large series of lateral UKA. Results of this early design of fixed bearing UKA demonstrate satisfactory long term survivorship. In elderly patients, further intervention is rarely required. More contemporary designs or techniques may show improved long term survivorship in time.     

Long-term results of arthroscopic medial reefing for patellar instability

BackgroundThe purpose of the study was to investigate the long-term outcomes of the all-inside arthroscopic medial reefing (AAMR) procedure for patellar instability and the factors that affect successful outcome.MethodsIn this retrospective study, AAMR with suture was performed in 16 knees of 15 patients who had at least one patellar dislocation and did not experience a decrease in pain and who did not have a major radiological bony abnormality. Preoperatively, Tegner and Lysholm scales were used; for the final evaluation Tegner, Lysholm, Kujala and Knee injury and Osteoarthritis Outcome Score (KOOS) were used.ResultsThe average age of the patients at the time of operation was 18 years (range: 11–36 years). The average follow-up time was 118.3 months (range: 85–143 months). Six of the 16 knees (37.5%) exhibited re-dislocation. Preoperatively, the mean Lysholm and Tegner were 66.5 and 4.0, respectively; and postoperatively increased to 89.3 (P = .001) and 4.66, respectively. At the final follow-up, mean Kujala was 89.3 (good), and mean KOOS was 91.4. In all patients with re-dislocation, fewer than four knots were used, and none of the patients with four knots exhibited re-dislocation. Re-dislocations occurred in two, two, one and one patients at two, three, five and eight years, respectively.ConclusionsThe AAMR technique is associated with minimal incisional scarring and an increase in functional scores. It is also associated with a high risk of re-dislocation compared with other methods. If the technique still needs to be used, despite the high re-dislocation rate, at least four knots should be applied.     

Long-term survivorship of total knee arthroplasty with a single-radius,high-flexion posterior stabilized prosthesis

BackgroundThe purpose of this study was to determine functional outcomes, implant survival rate, and complications of a single-radius, high-flexion posterior stabilized (PS) total knee prosthesis at a minimum follow up of 10 years for a consecutive series.MethodsThis retrospective observational study included 395 consecutive patients who underwent 585 single-radius, PS total knee arthroplasties (TKAs) between January 2009 and December 2009. Their functional outcomes, implant survival rates, radiological findings, and complications were evaluated.ResultsAt a mean follow up of 11.2 years (range, 10.6–11.8 years), 395 (80.8%) patients were available for review. At final follow up, preoperative Knee Society knee scores were improved from 37.3 to 80.1 (P < 0.05) and function scores were improved from 35.7 to 80.5 points (P < 0.05). Sixteen knees (2.7%) in 15 patients required revision surgery due to 11 septic loosening (1.9%) and five aseptic loosening events (0.8%). Cumulative survival for the prosthesis was 97.3% for any cause at 10 years. A total of 34 radiolucent lines (5.8%) were detected an average of 2.4 years following surgery and radiological assessment did not reveal any evidence of component migration at final follow up.ConclusionsSingle-radius, high-flexion PS TKA showed good long-term survival rates and clinical outcomes. Further study is required to determine whether limited radiolucency findings at the tibial component–tibial plateau could progress to or result in the loosening of components.     

What is the patient experience following revision knee replacement: A systematic review and meta-analysis of the medium term patient reported outcomes

AimsRevision knee replacement is an increasingly common procedure, however, information on patient-focused outcomes is limited. This systematic review and meta-analysis aimed to investigate the medium-term patient reported outcomes following a revision knee replacement.MethodsWe performed a systematic review of MEDLINE and EMBASE (from inception to 1st March 2021) for articles reporting five year or greater patient reported outcome measures (PROMs) following revision knee replacement. A meta-analysis of PROMs data was undertaken using the Standardised Mean Difference (SMD). Quality of methodology was assessed using Wylde’s non-summative four-point system. The study was registered with PROPSERO (CRD42021199289).ResultsA total of 23 studies met the inclusion criteria containing 2414 patients at a mean minimum follow-up of 74 months (60–122). The reporting of PROMs were poorly standardised with several PROMs being used. The most commonly reported patient reported outcome was the Knee Society Score reported in 65% of studies (15/23). A meta-analysis of 629 eligible patients undergoing revision knee replacement revealed a significant improvement in pre-operative state with a SMD 2·05 95% CI 0.87, 3.23.ConclusionThis systematic review has found a significant and sustained improvement in patient-reported outcomes following a revision knee arthroplasty beyond five years. We found a variation in the usage and administration of PROMs which hinders a clear synthesis of results. Furthermore, the PROMs have not been robustly tested for validity in the context of a revision knee replacement.     

Minimally invasive lateral unicompartmental knee replacement: Early results from an independent center using the Oxford fixed lateral prosthesis

PurposeThe aim of the present study was to assess clinical outcome as well as short-term survivorship of fixed-bearing lateral unicompartmental knee replacement (UKR) from a non-designer centre using the Oxford Fixed Lateral prosthesis.MethodsThis single-centre retrospective cohort study reports the short-term results of 51 consecutive patients (52 knees) after fixed-bearing lateral UKR with a minimum follow-up of one year. Survivorship analysis was performed with different endpoints and clinical outcome was measured using the Oxford Knee Score (OKS), objective American Knee Society Score (AKSS-O), range-of-motion (ROM), visual analog scale for pain (VAS), Tegner activity score and UCLA score.ResultsThere was no revision surgery, defined as exchange of at least one of the components resulting in a survival rate of 100% at two years. Three patients required further surgical treatment resulting in a survival rate of 94.2% (95% confidence interval (CI): 83.2–98.1%) with the endpoint ‘any reoperation’. Outcome scores, VAS and ROM showed a statistically significant improvement at final follow-up (P < .001). The OKS improved from 26.4 ± 6.9 (12–41) preoperatively to 39.7 ± 8.4 (15–48), the AKSS-O from 54.3 ± 15.3 (18–90) to 82.2 ± 15.6 (40–100), the American Knee Society Functional Score from 56.4 ± 21.3 (10–100) to 83.1 ± 20.2 (five to 100) and the ROM from 123.5 ± 13.5 (90–140) to 134 ± 10.3 (95–150).ConclusionEarly results of fixed-bearing lateral UKR using the Oxford-Fixed-Lateral prosthesis were encouraging with a significant improvement in pain and knee function as well as an excellent survivorship of 100% at a mean follow-up of two years. Further follow-up is necessary to evaluate the long-term effectiveness of this device and the surgical technique.Level of EvidenceLevel IV, retrospective cohort study.     

Minimum 6 year results of an uncemented trabecular metal tibial component in total knee arthroplasty

IntroductionThere are theoretical advantages of using a trabecular metal tibial component in total knee replacement (TKR) for long-term survival. We have previously reported outcomes at 3 years. We now report the clinical and radiological outcome of an unselected series of 109 knees at a minimum of 6 years follow up.MethodsPatient function was assessed in a research clinic using Oxford Knee Score (OKS), Clinical and Functional Knee Society Score (KSS) and SF-12 physical score. Up to date weight bearing radiographs were obtained.ResultsSeventy‐six knees in 72 patients were available for assessment. OKS scores were maintained from the 3‐year assessment with a mean of 36.1 (8.6). KSS and SF-12 scores declined slightly but only to a degree previously reported as normal age related change. The mean KSS at follow up was 87.2 (17.7). There was no radiographic evidence of loosening in any implant. There has been 1 revision for unexplained pain at 27 months.ConclusionThe uncemented TMT in an unselected group is performing as well as any TKR implant at this stage. Future follow up is required to ensure this is maintained. The theoretical advantages may make this the prosthesis of choice in younger patients.Level of evidence: IV. Case series     

All-inside repair of bucket handle meniscus tears – Mid-term outcomes with postoperative magnetic resonance imaging

PurposeThe purpose of this study was to evaluate our results of bucket handle meniscus tear (BHMT) repairs with an all-inside repair technique using postoperative radiological imaging to evaluate meniscus reduction and healing and use them as criteria for evaluation of repair success.MethodsProspective recruitment of 20 patients with 21 BHMT repairs performed with an all-inside technique over a period from 2013 to 2015. All patients had an International Knee Documentation Committee (IKDC) Subjective Knee Form (SKF), Lysholm Score, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner Activity Level Scale obtained pre-operatively and at a minimum of 24 months after surgery. All patients had postoperative knee magnetic resonance imaging (MRI) performed between 18 and 24 months after surgery to assess the stability or failure of their repairs. At 5 years after surgery, the patients were assessed with regard to whether they had undergone repeat surgery or not.ResultsAt 2 years, the mean postoperative SKF, Lysholm and KOOS grand scores were 78.9, 88.5 and 86.8, respectively. The mean pre-injury Tegner Activity Scale was 7.6 and postoperatively it was 6.0. There was a significant difference in all pre- and postoperative outcome scores (P < 0.01).The postoperative MRIs showed that 19 of the 21 BHMT repairs had stable reduction of the tear fragment and two patients had displacement of the torn bucket handle fragment. At 5 years, one patient had undergone revision surgery.ConclusionBHMTs can be repaired with all-inside techniques with good results and successful outcomes.     

Rotational mismatch between femoral and tibial components should be avoided in JOURNEY II bi-cruciate stabilized total knee arthroplasty

BackgroundJOURNEY II bi-cruciate stabilized (BCS) knee system, a guided motion total knee arthroplasty (TKA), has been reported to reproduce physiological knee kinematic motion with good clinical outcomes. However, this guided system may be sensitive to the femorotibial rotational alignment.MethodForty-four patients (50 knees) who underwent JOURNEY II BCS TKA were included in this retrospective study. The 2011 Knee Society Score (KSS) and range of motion were assessed pre-operatively and one year postoperatively. The femoral component rotational angle relative to the surgical epicondylar axis and the tibial component rotational angle relative to Akagi’s line were measured postoperatively. The absolute difference between the femoral and tibial component rotational angles was defined as femorotibial component rotational mismatch. The correlation between the parameters of these rotational alignments and postoperative clinical outcomes was evaluated. Additionally, receiver operating characteristic curve analysis was performed to determine the optimal cut-off point of the femorotibial component rotational mismatch.ResultsMean femoral and tibial component rotational angles were 0.4° (internal rotation) and 0.7° (external rotation), respectively. The rotational mismatch of the femorotibial component was 3.2°. There were negative correlations between femorotibial rotational mismatch and clinical outcomes, including objective knee indicators, patient satisfaction, functional activities, and total 2011 KSS. The area under the curve of the femorotibial component rotational mismatch was 0.768 and the cut-off value identified by the Youden index was 2.8°.ConclusionsExcessive rotational mismatch between the femoral and tibial components can negatively influence the clinical outcomes of JOURNEY II BCS TKA.     

Knee arthroplasty system with medialized keel: Seven-year follow-up of a pioneer cohort

BackgroundIn this clinical investigation, a new design with a progressive increased keel medialization according to the size was implanted. The cohort of patients was followed up for seven years.MethodsFrom May 2012 to November 2012, we implanted 70 total knee arthroplasties in 69 patients. The mean age of the patients was 76.2 years. We followed up 56 patients for seven years; we evaluated the patients at six and 60 months after surgery by Patient Reported Outcome Measures score. During the seven-year follow-up, all patients were clinically re-evaluated using the Knee Society Score and the Forgotten Joint Score. All patients underwent a preoperative and postoperative radiographic investigation. At the last follow-up the presence of any radiolucency lines was checked using the Knee Society Total Knee Arthroplasty Radiographic Evaluation and Scoring System.ResultsThe patients defined the surgical results as excellent in 66% of the cases, very good in 23%, good in five percent. The analysis of the functional data at seven years, performed by administering the Forgotten Joint Score, showed average values of 70.4. The clinical analysis, performed through the Knee Society Score at the same follow-up, showed average values of 90.4. The seven-year radiological analysis revealed the presence of radiolucency lines in 20 implants. The sum of the line widths never exceeded the critical value of nine millimeters, always remaining below four millimeters. Only one patient was revised.ConclusionsThe results showed an excellent outcome of this design. The medialization of the tibial keel showed good bone fixation and component alignment at seven-year follow-up.     

Accelerated rehabilitation program following medial patellofemoral ligament reconstruction does not increase risk of recurrent instability

BackgroundRehabilitation protocols following medial patellofemoral ligament (MPFL) reconstruction were historically restrictive, with patients often immobilized and/or given weightbearing restrictions. However, more recently published protocols have been more aggressive. We compared patient-reported outcomes and recurrent dislocation risk between patients treated with a restrictive rehabilitation program (early post-operative bracing and weightbearing restrictions) and an accelerated rehabilitation protocol (no post-operative bracing or weightbearing restrictions) following MPFL reconstruction.MethodsPatients who underwent isolated MPFL reconstruction at an academic center between 2008 and 2016 were identified. Patient demographics, anatomical measurements, surgical details, and outcomes were collected. During this period, the rehabilitation protocol at the center transitioned from a restrictive to an accelerated rehabilitation protocol. Failure risk and patient-reported outcomes were compared based on rehabilitation protocol.ResultsOf the163 isolated MPFL reconstructions performed during the study period, 123 (75%) were available for minimum one-year follow up at a mean of 4.0 years post-operative. Overall, 53 knees (43%) underwent the accelerated rehabilitation protocol and the remaining 70 knees (57%) underwent the restrictive protocol. There were 3 recurrent dislocations during the study period (2.4%), all of which occurred in the restrictive rehabilitation group. Multiple linear regression demonstrated that being in the accelerated rehabilitation group was not associated with poorer Knee injury and Osteoarthritis Outcome Score (KOOS) subscales controlling for age, sex, body mass index, Caton-Deschamps Index, tibial tubercle-trochlear groove distance, sulcus angle, MPFL graft choice, and length of follow-up.ConclusionAn accelerated rehabilitation protocol without immobilization or weightbearing restrictions does not increase risk of recurrent patellar dislocation or poorer patient-reported outcome following isolated MPFL reconstruction.     

Long-term results of the subtubercle tibial osteotomy using the circular external fixator for medı̇al compartment osteoarthrı̇tı̇s of knee

BackgroundWe evaluated the long-term clinical and radiographic outcomes of patients who underwent subtubercular tibial osteotomy (STO) with Ilizarov external fixation used for high tibial osteotomy for medial knee osteoarthritis (MKOA).MethodsBetween October 2003 and December 2011, 42 knees of 40 patients who had undergone STO with Ilizarov external fixator with a diagnosis of MKOA were evaluated. Survival analysis was performed by examining the duration of total knee arthroplasty (TKA). Clinical and radiological variables were collected at the time of admission after removal of the fixator and at outpatient follow up.ResultsMean age was 49.3 ± 5.68 (range 37–61) years, mean postoperative follow up time was 14.22 ± 2.93 (range 9–18) years, and mean fixator duration was 14.6 (range 13–20) weeks. Survival analysis showed 100% at 5 years, 95.2% at 10 years and 88.1% at 15 years. Clinical examination of the patients showed significant improvement in American Knee Society score (KSS), KSS functional score and Oxford Knee Score (OKS) score (P = 0.005). In the study, it was observed that the patients' knee osteoarthritis had progressed over time. On examination, radiographic measurements including mechanical axis deviation, medial proximal tibial angle, femorotibial angle, and joint line alignment angle improved significantly after deformity correction (P = 0.001).ConclusionSTO using the Ilizarov method offers long-term survival. It provides effective treatment in young patients with isolated MKOA. Achieving the desired amount of correction in the coronal and sagittal planes can be presented as a surgical technique for the treatment of MKOA as an effective method in clinical and radiological correction.     

External rotation of the tibial component should be avoided in lateral unicompartmental knee arthroplasty

BackgroundLateral unicompartmental knee arthroplasty (UKA) leads to good clinical outcomes for isolated lateral osteoarthritis. However, the impact of the tibial component position on postoperative outcomes in lateral UKA is yet to be determined.PurposeThis study investigated the influence of tibial component malposition on clinical outcomes in lateral UKA.MaterialsThis was a retrospective study of 50 knees (mean age 73.5 years) who underwent lateral UKA between September 2013 and January 2019. The Oxford Knee Score (OKS), Knee Society Score – Knee (KSSK), and Knee Society Score – Function (KSSF) were evaluated. The coronal alignment, posterior slope of tibial component, tibial component rotation relative to Akagi’s line (angle α), and femoral anteroposterior (AP) axis (angle β) were measured postoperatively. The average follow up period was 2.3 (range, 1–4.9) years.ResultsClinical scores were significantly improved after lateral UKA. The mean coronal alignment was 0.9° ± 3.2° varus (range, 9.1° varus to 5.5° valgus), the mean posterior slope was 6.8° ± 3.8° (range, 0.8° to 14.8°). The mean α and β angles, were 4.1° ± 5.8° (range, −9.7° to 16.5°) and 6.7° ± 7.1° (range, −7.0° to 20.5°) external rotation. The angle α had significant negative correlations with postoperative OKS (r = −0.36), KSSK (r = −0.28), and KSSF (r = −0.39), and angle β had significant negative correlations with postoperative OKS (r = −0.34) and KSSK (r = −0.46).ConclusionExcessive external rotation of the tibial component could negatively influence the postoperative outcomes of lateral UKA.