An Investigation of Medial Tibial Component Overhang in Unicompartmental and Total Knee Replacements Using Ultrasound in the Outpatient Department.

Tibial component overhang is known to be a contributor to worse outcomes in knee arthroplasty. The aim of this study is to investigate the presence of tibial component overhang, and whether overhang correlates to a higher local tenderness in both medial unicompartmental and total knee replacements. Also, to determine if a rotational projection phenomenon is presented with radiographs when investigating tibial component overhang. A prospective study, including 64 participants, was performed, where ultrasound measurements were compared with postoperative radiographs. Local tenderness was measured as a pressure pain threshold, determined at 3 months postoperatively using algometry. Sixty-two of sixty-four patients had an underdiagnosed medial overhang on radiographs, with a mean difference of 2.4 mm between radiographs and ultrasound (p < 0.001), presenting a rotational projection phenomenon. When comparing sites with ultrasound measured overhang to sites without overhang measured by ultrasound, a higher local tenderness was observed (p < 0.001). A positive linear correlation was found between patients' overhang and local tenderness (r = 0.2; p = 0.045). Subgroup analysis of medial overhang showed significantly higher tenderness than all other locations. No significant differences were seen for lateral overhang. An apparent rotational projection phenomenon of overhang on radiographs was seen, and a linear association between overhang and local tenderness was demonstrated. This study warrants the use of ultrasound when a surgeon is presented with a patient with postoperative medial tenderness, but no overhang can be seen on radiographs. It should also raise awareness of implant selection and positioning during surgery, especially avoiding the overhang to be localized directly medially.

The Rosenberg view and coronal stress radiographs give similar measurements of articular cartilage height in knees with osteoarthritis.

PURPOSE: Choosing the optimal radiographic methods to diagnose the cartilage height and degree of knee osteoarthritis is crucial to determine suitability for unicompartmental knee replacement. This study aims to evaluate and compare articular cartilage thickness measured using the Rosenberg view and coronal stress radiography. Intra- and interrater agreement and test-retest reliability of each method were determined. The hypothesis of the study was that the Rosenberg view and coronal stress radiographs provide similar assessments of articular cartilage height in the medial and lateral knee compartments of osteoarthritic knees. METHODS: A prospective diagnostic study, including 73 patients was performed. Inclusion criteria were enrollment for either a medial unicompartmental or a total knee replacement. Radiographs were taken as the Rosenberg view, and coronal stress radiography using the Telos stress device. Repeated measurements were performed. Experienced knee surgeons performed measurements of cartilage height at a standardized location of joint space width (JSW), and a rater-perceived location of minimal joint space width (mJSW), thus allowing for reliability and agreement analysesusing weighted kappa. Coronal stress measurements were ultimately compared to the Rosenberg view using Spearman's rank correlation. RESULTS: A total of 12,264 measurements were performed. The radiographic methods proved substantial reliability. Intra- and interrater agreement showed substantial to almost perfect agreement. A very strong correlation was observed in the medial knee compartment (r = 0.91; CI = 0.84-0.95; p < 0.001), with a mean difference of 0.1 mm and limits of agreement of - 1.5 to 1.7 mm, when comparing JSW between the Rosenberg view and varus stress. Only a strong correlation was observed medially when using mJSW, and when using this measurementmore incidences of bone-on-bone were observed than when measuring with JSW. A Strong correlation was observed in the lateral knee compartment (r = 0.83; CI = 0.71-0.89; p < 0.001), with a mean difference of 0.62 mm and limits of agreement of - 1.5 to 2.7 mm, when comparing JSW between the Rosenberg view and valgus stress. CONCLUSION: The Rosenberg view is similar to 20° coronal valgus-varus stress radiography for determining articular cartilage thickness. Both techniques can be used in a clinical setting. Therefore, extra radiographs, equipment and expertise could be saved, when solely utilizing the Rosenberg view which is simple to perform. LEVEL OF EVIDENCE: III.

The Influence of Ibuprofen on the Healing of Nonsurgically Treated Colles' Fractures.

Nonsteroidal anti-inflammatory drugs can delay bone healing. This knowledge is mainly derived from retrospective and animal studies. The authors therefore conducted a human study to investigate whether ibuprofen affects radiological, functional, densitometrical, and biochemical outcomes following a Colles' fracture, as well as the analgesic effect of ibuprofen. This was a single-center, triple-blinded, randomized, placebo-controlled clinical trial with a total of 96 patients. All of the patients received basic treatment with 1000 mg of acetaminophen 4 times daily. The placebo group received a placebo for 7 days. The 3-day ibuprofen group received 600 mg of ibuprofen 3 times daily for the first 3 days and a placebo for the following 4 days. The 7-day ibuprofen group received ibuprofen 3 times daily for 7 days. The primary outcome was the fragment migration for a period of 5 weeks. The secondary outcomes were changes in the wrist's range of motion; Disabilities of the Arm, Shoulder and Hand score; bone mineral density of the injured wrist; changes in serum CrossLaps (Roche Diagnostics) and osteocalcin; and analgesic effects. Analyses were performed according to an intention-to-treat approach. No significant differences in radiological migration or functional, densitometrical, and biochemical effects were established among the treatment groups (.06≤P≤.9). During the first 3 days, the pain score was lower (P=.02) in the ibuprofen groups than in the placebo group. The findings of this study offer an indication for ibuprofen as a bone-safe analgesic treatment after Colles' fracture and may be translated into other fields of cancellous bone fracture treatment. [Orthopedics. 2021;44(2):105-110.].

Patients With High Chronic Postoperative Knee Pain 5 Years After Total Knee Replacement Demonstrate Low-grad Inflammation, Impairment of Function, and High Levels of Pain Catastrophizing.

OBJECTIVES: Total knee replacement (TKR) normally provides improvements of physical function and reduces pain. However, ∼20% of the patients report chronic postoperative knee pain. The aims of the present study were to assess the pain, physical function, and physiological characteristics 5 years after TKR surgery. MATERIALS AND METHODS: Eighty patients were recruited 5 years after TKR and divided into 2 groups based on their average 24-hour knee pain intensity assessed on a visual analog scale (VAS 0 to 10) ("high pain group": VAS≥3; "low pain group": VAS<3). The patients completed the PainDETECT Questionnaire (PDQ), Oxford Knee Score (OKS), Pain Catastrophizing Scale, and Forgotten Joint Score-12. Furthermore, the patients underwent a clinical examination of the knees and high-sensitivity serum C-reactive protein was measured as an inflammatory marker. RESULTS: A total of 53% of the patients in the high pain group were not satisfied with the outcome, while only 11% of the patients in the low pain group was not satisfied, and the pain intensities in the 2 groups were 5.1 (4.6 to 5 to 6) and 1.1 (0.6 to 1.5) (P<0.001), respectively. Furthermore, the high pain group demonstrates worse scores in: Forgotten Joint Score-12 (P=0.001), OKS function (P<0.001), OKS pain (P<0.001), and Pain Catastrophizing Scale (P<0.001).The high pain group demonstrated increased level of high-sensitivity serum C-reactive protein (4.3 mg/L [3.2 to 5.5] vs. 1.7 mg/L [1.2 to 2.2], P<0.001), and decreased range of motion in the knee (110 vs. 119-degree range of motion, P=0.013). DISCUSSION: Patients with high chronic postoperative knee pain 5 years after TKR demonstrate decreased physical function, higher levels of catastrophizing thoughts, and increased levels of inflammation.

HOW MANY DOSEMETERS ARE NEEDED FOR CORRECT MEAN ORGAN DOSE ASSESSMENT WHEN PERFOMING PHANTOM DOSIMETRY? A PHANTOM STUDY EVALUATING LIVER ORGAN DOSE AND INVESTIGATING TLD NUMBERS AND WAYS OF DOSEMETER PLACEMENT.

This study evaluated repeated mean organ dose measurements of the liver by phantom dosimetry and statistical modelling in order to find a way to reduce the number of dosemeters needed for precise organ dose measurements. Thermoluminescent dosemeters were used in an adult female phantom exposed to a biplanar x-ray source at three different axial phantom rotations. Generalised mixed linear effect modelling was used for statistical analysis. A subgroup of five to six organ-specific locations out of 28 yielded mean liver organ doses within 95% confidence intervals of measurements based on all 28 liver-specific dosemeter locations. No statistical difference of mean liver dose was observed with rotation of the phantom either 10° clockwise or counter-clockwise as opposed to the coronal plane. Phantom dosimetry handling time during organ dose measurements can be markedly reduced, in this case the liver, by 79% (22/28), while still providing precise mean organ dose measurements.

Obesity Influences the Knee Injury and Osteoarthritis Outcome Score.

Purpose The primary aim of this study was to report the outcome of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in obese patients with a body mass index (BMI) > 35. Methods This is a prospective cohort study, including patients referred with the aim of planning bariatric surgery between October 2015 and January 2017. The primary outcome measurement was KOOS. An experienced radiologist obtained and evaluated standard radiological osteoarthritis examinations of the knee joints. Results The mean age was 43.1 years, and ages ranged from 24 to 69 years. The mean BMI was 48.3, and BMI ranged from 35 to 66. Results show that obese patients reported significantly worse in the KOOS subscales pain, activities of daily living, sport, and quality of life (QOL) compared with a reference population, due to nonoverlapping 95% confidence intervals. No significant differences between obese and superobese patients were observed on the KOOS subscales ( p > 0.08). The KOOS subscales showed worse outcome with increasing severity of radiological knee osteoarthritis; however, only significant differences were observed for the KOOS subscales sport and QOL ( p < 0.05). Conclusion Results imply that the KOOS scores vary significantly with obesity. When utilizing KOOS outcome, considering obesity in the interpretation of outcome is highly recommended. Level of Evidence This is an observational, level III study.

Presurgical Comorbidities as Risk Factors For Chronic Postsurgical Pain Following Total Knee Replacement.

OBJECTIVES: Chronic postsurgical knee pain (CPSP) is a burden for ∼20% of the patients following total knee replacement (TKR). Presurgical pain intensities have consistently been found associated with CPSP, and it is suggested that comorbidities are likewise important for the development of CPSP. This study aimed to identify presurgical risk factors for the development of CPSP 5 years after TKR on the basis of medical records containing information with regard to comorbidities. MATERIALS AND METHODS: Patients undergoing primary TKR surgery were contacted 5 years after TKR. Presurgical Knee Society Score and comorbidities were evaluated. Postsurgical knee pain at 5 years of follow-up was assessed on a Numeric Rating Scale (NRS, 0 to 10). Logistic regression models were utilized to identify patients with moderate-to-severe (NRS≥3) and mild-to-no (NRS<3) CPSP at 5-year follow-up. Odds ratio (OR) for significant factors was calculated. RESULTS: A total of 604 patients were contacted, 493 patients responded, 352 patients provided a completed questionnaire. A total of 107 patients reported NRS≥3 at follow-up. Significant presurgical factors associated with CPSP were fibromyalgia (OR=20.66; P=0.024), chronic pain in body parts other than the knee (OR=6.70; P=0.033), previous diagnosis of cancer (OR=3.06; P=0.001), knee instability (OR=2.16; P=0.021), younger age (OR=2.15; P=0.007), and presurgical knee pain (OR=1.61; P=0.044). Regression analysis identified 36 of 107 (33.6%) patients with CPSP on the basis of presurgical factors, and 231 patients (94.3%) without CPSP were classified correctly. DISCUSSION: The current study found that a variety of presurgical clinical factors can correctly classify 33.6% of patients at risk for developing CPSP 5 years following TKR.

Population-based epidemiology of 9767 ankle fractures.

BACKGROUND: The purpose was to provide up-to-date information concerning the incidence of ankle fractures in a large and complete population including all age groups, spanning a decade, and report the distribution of fractures, trauma mechanism and patient baseline demographics. METHODS: Population-based epidemiological study of all patients treated for an ankle fracture in a 10-year period from 2005 to 2014. RESULTS: A total of 9767 patients with ankle fractures were treated between 2005 and 2014. The mean age at time of fracture was 41.4 (24.3 SD) years. The mean incidence of ankle fractures between 2005 and 2014 was 168.7/100,000/year. Years with cold winters showed increased incidences compared with years with normal winters. For males, the incidence was 157.1/100,000/year, and for females, 179.5/100,000/year. The incidence shows a peak incidence among adolescents in both genders with a male predominance. After the age of 19 the male incidence declines with age, which is in contrast to females, who experience an increasing incidence. The most common fracture type in all age groups was a fracture of the lateral malleolus representing 55% of all fractures. The predominant mode of injury was falls (61%) followed by sports (22%). CONCLUSION: This study shows an incidence of 168.7/100,000/year spanning a decade. The most common fracture type in all age groups was a fracture of the lateral malleolus representing 55% of all fractures. The predominant mode of injury was falls (61%) followed by sports (22%).

Effect of hydroxyapatite-coated tibial components on changes in bone mineral density of the proximal tibia after uncemented total knee arthroplasty: a prospective randomized study using dual-energy x-ray absorptiometry.

Sixteen patients scheduled for an uncemented total knee arthroplasty (TKA) were randomized to receive a tibial component either with (n = 8) or without (n = 8) hydroxyapatite (HA) coating. In 4 regions of interest, prospective measurements of bone mineral density (BMD) using dual-energy x-ray absorptiometry were performed in the proximal tibia. Two years after the operation, the only significant change in BMD was in the lateral tibial condyle, where BMD had increased by 6.1% (95% confidence interval: 2.3%-9.9%) in patients with tibial components without HA. The intragroup changes (0-24 months) in the uncoated group and HA-coated group were significantly different (P = .003) in these regions of interest. There was no significant effect of HA coating on bone remodeling pattern of the proximal tibia.