Residual Deformity of the Trochlea After Non-displaced Supracondylar Fracture in a Child: A Case Report.

Residual deformity of the trochlea after fractures of the distal end of the humerus in children is well known and is referred to as fishtail deformity. Despite numerous reports on this entity, the reason for various types of fractures with the same results remains unknown. Fishtail deformities after non-displaced supracondylar fractures are very rare. A 7-year-old boy with a non-displaced supracondylar fracture was treated conservatively. Three years later, the patient returned to our hospital complaining of mild elbow pain. Radiography revealed a fishtail deformity of the trochlea due to the premature fusion of the epiphysis. At the latest follow-up at the age of 17 years, only a marginal limitation at the excursion of the elbow was observed, and no additional treatment was needed. Fishtail deformities can occur even after a non-displaced supracondylar fracture. Long-term follow-ups are required in children with distal humeral fractures.

Robotic-assisted total knee arthroplasty improves the rotational mismatch between femoral and tibial components, but not the forgotten joint score 12: a single-center retrospective cohort study.

PURPOSE: The primary aim of this study was to compare postoperative short-term patient reported outcome measurements (PROMs) and rotational mismatch between femoral and tibial following conventional jig-based total knee arthroplasty (Conv-TKA) versus robotic-assisted TKA (RA-TKA) using three-dimensional computed tomography (3DCT) measurements. METHODS: This retrospective, consecutive case-control trial included 83 patients with varus osteoarthritis of the knee undergoing Conv-TKA versus RA-TKA using bi-cruciate stabilized TKA. The rotational mismatch of the femoral and tibial components between the two groups were compared using 3DCT measurements. PROMs (2011 Knee Society Score (KSS), forgotten joint score-12 (FJS-12), patella score were compared in patients between 1 and 2 years postoperatively. RESULTS: The two groups did not exhibit significant differences in any of the following preoperative factors: age at surgery, body mass index (BMI), preoperative range of motion (ROM), hip-knee-ankle (HKA) angle. There were no significant differences in postoperative HKA angle and tibial rotation angle, the absolute values of the femoral rotational angle and rotational mismatch were significantly smaller in the RA-TKA group than in the Conv-TKA group (both p < 0.01). Neither Postoperative PROMs (2011 KSS: pain, patient satisfaction, patient expectation, advanced activities score) nor patella score differed significantly between the groups, but FJS-12 was significantly better in the Conv-TKA group than in the RA-TKA group (p < 0.01). CONCLUSIONS: RA-TKA did not improve FJS-12 compared to Conv-TKA, but did result in more accurate rotational alignment of femoral component and rotational mismatch between the femoral and tibial components. LEVEL OF EVIDENCE: IV.

Zoledronic acid for osteoporosis after distal radius fracture surgery: Prospective longitudinal study.

Background: Distal radius fractures (DRFs) are the most frequent first-ever osteoporotic fragility fractures. However, most patients are treated only for fractures and not for osteoporosis. Therefore, we investigated early osteoporosis intervention using zoledronic acid. Methods: This prospective study enrolled 30 patients aged 50 years or older who had no history of fragility fractures or osteoporosis treatment and who underwent surgical treatment for DRFs. Patients whose lumbar spine or femur bone mineral density (BMD) values were less than 80% of the young adult mean (YAM) were treated with a 5-mg intravenous infusion of zoledronic acid. Lumbar spine and femur YAM BMD values, TRACP-5b and PINP were statistically evaluated using the paired t-test. The relationship between adverse effects, age, body mass index (BMI), and creatinine clearance (CCr) was statistically examined using Mann-Whitney's U test. The incidence of the bone fusion and secondary fractures within the 60-months postoperative period were assessed. Results: The mean lumbar spine and femur YAM BMD values before treatment were 76.1 ± 13.1% and 70.7 ± 8.5%. This indicates osteopenia in both locations. These values differed significantly between the pre-treatment period and each subsequent period. Five patients with a target YAM BMD value over 80% within 60 months after treatment were observed. The TRACP-5b and PINP values differed significantly between the pre-treatment period and each subsequent period. Adverse drug reactions were observed in 12 patients (40%). Age, BMI, and CCr did not show statistically significant differences in the occurrence of adverse effects. Bone fusion was confirmed at a mean of 3.6 months postoperatively. Secondary fractures were observed in 3 patients within 60 months after treatment. Conclusion: DRFs occur at a younger age than other fragility fractures, and it is important to intervene aggressively with osteoporosis treatment to prevent secondary fractures. Level of evidence: Level V.

Analysis of Gait Ability and Patient Reported Outcome Measurements after Robotic-assisted Total Knee Arthroplasty for Osteoarthritis of the Knee with Windswept Deformity.

Introduction: Windswept deformity (WD) refers to valgus deformity in one knee and varus deformity in the other. We performed robotic-assisted (RA) total knee arthroplasty (TKA) for osteoarthritis of the knee with WD, made patient reported outcome measurements (PROMs), and performed gait analysis based on triaxial accelerometery. Case Report: A 76-year-old woman presented to our hospital with bilateral knee pain. Image-free handheld RA TKA was performed on the left knee with severe varus deformity and severe pain during walking. RA TKA was performed on the right knee with severe valgus deformity 1 month later. The RA technique was used to determine implant positioning and the plan for osteotomy intraoperatively, taking into account soft-tissue balance. This made it possible to use a posterior stabilized implant instead of a semi-constrained implant for severe valgus knee deformity with flexion contracture (Krachow classification Type 2). At 1 year after TKA, PROMs were inferior in the knee with pre-operative valgus deformity. Gait ability improved after surgery. Even with the RA technique, it took 8 months to achieve left-right balance while walking and for the variability of the gait cycle to become equivalent to that of a normal knee. Conclusion: Primary RA TKA is a viable option for osteoarthritis of the knee with WD. It took time for the gait ability of both knees to become equal and PROMs were better with the varus deformity compared to before surgery.

Coronal alignment classes after robotic-assisted total knee arthroplasty are not associated with variation in patient-reported outcome measurements: A single-center cohort study.

BACKGROUND: The aims of this study were (1) to use three-dimensional computed tomography (3DCT) measurements to determine whether patients undergoing imageless robotic-assisted total knee arthroplasty (RA-TKA) develop a variety of postoperative distal femoral mechanical angle (FMA), proximal tibial mechanical angle (TMA), and hip-knee-ankle angle (HKA) phenotypes as described by Hirschmann et al, and (2) to compare postoperative patient-reported outcome measurements (PROMs) between these phenotypes. METHOD: Fifty patients with knee osteoarthritis underwent RA-TKA. All surgeries were performed using bicruciate-stabilized TKA. In each case, the postoperative HKA, FMA and TMA were classified into one of Hirschmann's five FMA, five TMA, and seven HKA phenotype categories. We investigated how these phenotypes affected patient satisfaction, 2011 Knee Society Score (KSS) subscale scores, the Forgotten Joint Score-12 (FJS-12) score, and patella scores with anterior knee pain at a mean of 15.1 months after RA-TKA. RESULTS: Coronal alignment angles were assigned to three FMA, four TMA, and five HKA phenotypes. The most common FMA, TMA, and HKA phenotypes were valgus FMA 3° (58%), valgus TMA 3° (60%), and varus HKA 3° (38%). The FMA, TMA, and HKA phenotypes showed no significant differences in any PROMs. CONCLUSIONS: RA-TKA led to various HKA, FMA and TMA phenotypes in the coronal plane, none of which affected PROMs.

Alteration of chronic inflammatory status by transarterial embolization in frozen shoulder evaluated by fluorine-18 fluorodeoxyglucose positron-emission tomography/computed tomography.

BACKGROUND: Frozen shoulder (FS) is speculated to have an inflammatory etiology. On angiography, abnormal angiogenesis is observed around the affected shoulder, suggesting a possible source of inflammation and pain. The effectiveness and safety of transarterial embolization (TAE) targeting abnormally proliferating blood vessels have been reported. This study investigated changes in chronic inflammatory and hypoxic status before and after TAE in FS by [18F]-fluoro-2-deoxyglucose (FDG) positron-emission tomography/computed tomography as a possible mechanism of the therapeutic response to TAE. METHODS: Fifteen patients with unilateral FS, persistent for more than 6 months, who were refractory to conservative treatments, underwent TAE using the temporary embolic agent imipenem/cilastatin. Patients underwent positron-emission tomography/computed tomography with FDG (as a biomarker of inflammation) before and 8 weeks after TAE. Regional uptake was evaluated by the maximum standardized uptake value. The lesion-side-to-(contralateral-) normal-side uptake ratio was also calculated. Pain and functional scales, range-of-motion, and laboratory tests, including white blood cell, C-reactive protein, interleukin 6, vascular endothelial growth factor, and tumor necrosis factor α were evaluated. RESULTS: On FDG-PET, the average maximum standardized uptake value of the lesion-side was significantly greater than that of the normal-side (maximum standardized uptake value before TAE: 3.11 ± 1.25 vs 1.95 ± 1.15, P = .0001; 8-weeks post-TAE: 2.36 ± 0.74 vs 1.78 ± 0.69, P = .0002). The mean lesion-side-to-(contralateral-) normal-side uptake ratios before TAE (1.71 ± 0.60) decreased after TAE (1.37 ± 0.29, P = .011). The decrease of FDG uptake (-21.1 ± 12.2%) showed a significant correlation with the change in the pain scale score (r = -0.56, P = .039) and extension score (r = -0.59, P = .026). CONCLUSION: Chronic inflammation in FS, as demonstrated by FDG uptake, was decreased after TAE. Thus, chronic inflammation is likely to be an underlying mechanism that should be targeted for symptomatic improvement of frozen shoulder.

Intraoperative joint balancing procedure using an imageless robotic assisted technique does not necessarily result in kinematically aligned bicruciate stabilized total knee arthroplasty.

The primary aim of this study was to retrospectively evaluate the hip- knee- ankle. (HKA) angle and prosthetic alignment with three-dimensional computed tomography (3DCT) measurements in patients who underwent robotic-assisted (RA) TKA, with consideration of the soft tissue envelope via an intraoperative joint-balancing procedure. We hypothesized that intraoperative consideration of soft tissue laxity in individual patients using imageless RA technology will not necessarily result in kinematically aligned bicruciate stabilized total knee arthroplasty (KA TKA). This retrospective study included consecutive patients who underwent RA TKA between 2019 and 2020. The indication for TKA was varus osteoarthritis of the knee. During this period, 60 RA bi-cruciate stabilized TKAs were performed. Prosthetic alignments were measured using computer software with 3DCT. We determined prosthetic positioning and bone resection volume with consideration of the soft tissue envelope using an intraoperative full range of motion joint-balancing procedure during RA TKA. 3DCT scans of the entire lower extremity were taken before and after surgery. Postoperative varus HKA alignment occurred in 58% of patients who underwent RA TKA, 31% of knees were in femoral valgus alignment and tibial varus alignment, and 42% had femoral components in internal rotation among knees with femoral valgus alignment and tibial varus alignment. The mean thickness of the osteotomized medial and lateral posterior condyles of the femur were 11.2 and 9.1 mm, respectively, based on 3DCT measurements. Intraoperative consideration of soft tissue laxity in individual patientsusing an imageless RA technique does not necessarily result in KA bicruciate TKA.

The importance of selecting a cruciate-retaining total knee prosthesis for a patient with a large physiological posterior tibial slope: a case report.

For Japanese individuals, deep bending is inevitable in their daily lives, such as during seiza sitting and kneeling. Thus, achieving a good post-operative range of motion is an important factor in improving patient satisfaction. Even normal knees often have a posterior tibial slope of more than 10°. We report the case of a 76-year-old woman who underwent proximal tibial osteotomy at 8° with the Vanguard Knee cruciate retaining total knee arthroplasty (TKA) system. She required the revision TKA 10 years later due to ultra-high-molecular-weight polyethylene wear and breakage of the posteromedial tibial component.

Higher patellofemoral compressive force does not affect anterior knee pain in anatomical bi-cruciate retaining total knee arthroplasty: In vivo prospective analysis of guided motion prosthesis.

BACKGROUND: The purposes of the present study are 1) to measure intraoperative patellofemoral compressive force in patients undergoing anatomical bi-cruciate retaining total knee arthroplasty and to assess the relationship between intraoperative patellofemoral compressive force and patient reported outcome measurements and 2) to compare patellofemoral compressive force and patient reported outcome measurements among patients who underwent anatomical bi-cruciate retaining, cruciate retaining, and bi-cruciate stabilized total knee arthroplasty. METHODS: Twenty-two patients with varus osteoarthritis of the knee who underwent anatomical bi-cruciate retaining total knee arthroplasty, 20 patients who underwent cruciate retaining total knee arthroplasty, and 24 patients who underwent bi-cruciate stabilized total knee arthroplasty were assessed. Patient reported outcome measurements were evaluated at 1.5 years after surgery. FINDINGS: Intraoperative patellofemoral compressive force was significantly lower with anatomical bi-cruciate retaining total knee arthroplasty than with cruciate retaining total knee arthroplasty at 60° to 140° of flexion and nearly equivalent to intraoperative patellofemoral compressive force with bi-cruciate stabilized total knee arthroplasty at all knee flexion angles examined. With anatomical bi-cruciate retaining total knee arthroplasty, there were no significant correlations between intraoperative patellofemoral compressive force and almost all patient reported outcome measurements except for 2011 Knee Society Score expectations, which was positively correlated with patellofemoral compressive force at 10° of flexion, and Patella score quadriceps strength, which was negatively correlated with patellofemoral compressive force at 60° of flexion. INTERPRETATION: There were no significant correlations between intraoperative patellofemoral compressive force and anterior knee pain after anatomical bi-cruciate retaining total knee arthroplasty. Evidence level: 3.

Intra-Arterial Infusion of Imipenem/Cilastatin Sodium through a Needle Inserted into the Radial Artery as a New Treatment for Refractory Trapeziometacarpal Osteoarthritis.

PURPOSE: To evaluate the efficacy and safety of intra-arterial infusion of temporary embolic material with/without radiographic monitoring via a needle placed into the radial artery to occlude abnormal neovessels for trapeziometacarpal osteoarthritis. MATERIALS AND METHODS: Thirty-one patients having Eaton stage II or III osteoarthritis, with a symptom duration longer than 6 months, resistant to conservative therapy for at least 3 months were prospectively enrolled. All procedures were performed by infusing imipenem/cilastatin sodium through a 24-gauge needle that was percutaneously inserted into the radial artery. Seven patients underwent the procedure with fluoroscopy, and 21 patients underwent the procedure without fluoroscopy. The mean Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, numerical rating scale (NRS), and Patient Global Impression of Change (PGIC) scale were evaluated before and at 2, 6, and 24 months after the first procedure. RESULTS: Technical success was 100%. The mean procedure time (from the beginning of local anesthesia to the removal of needle) was 2.9 minutes ± 1.6. The QuickDASH score improved from the baseline to 2, 6, and 24 months (49.2 ± 11.2 vs 22.1 ± 11.2, 20.9 ± 16.6, and 19.5 ± 16.1, respectively, all P <.001). The NRS improved from the baseline to 2, 6, and 24 months (7.2 ± 1.1 vs 3.1 ± 1.8, 2.8 ± 2, and 2.5 ± 2.1, respectively, all P <.001). Improvement on PGIC was observed in 84%, 81%, and 77% of patients at 2, 6, and 24 months, respectively. No major adverse events were encountered. CONCLUSIONS: Intra-arterial infusion of temporary embolic material is a feasible treatment option for trapeziometacarpal osteoarthritis.

Robotic-assisted total knee arthroplasty improves the outlier of rotational alignment of the tibial prosthesis using 3DCT measurements.

BACKGROUND: The aim of the present study was to compare the accuracy of prosthetic alignment with three-dimensional computed tomography (3DCT) measurements following total knee arthroplasty (TKA) performed using a robotic-assisted surgical technique versus a conventional TKA. METHODS: 41 TKAs were performed with a handheld robotic-assisted surgical procedure (Robot group) between 2019 and 2020. Another 41 patients underwent TKA with a conventional manual surgical procedure (Manual group) using the same prosthesis. The operation durations between both groups were investigated. 3DCT scans of the entire lower extremities were taken before and after the surgery and femoral and tibial alignments in the coronal, sagittal, and axial planes were measured using computer software. The differences in prosthetic alignment and translation between the preoperative 3DCT plan and postoperative 3DCT image were also measured. RESULTS: There were no statistically significant differences in the post-operative outliers of the femorotibial angle between the groups. In the tibial-axial plane, the mean of prosthetic alignment in the anteroposterior plane was 4.0° in the Robot group and 6.7° in the Manual group (p < 0.01). The rate of outliers for tibial-axial alignment in the Robot group was significantly less than in the Manual group (p < 0.01). There were no statistically significant differences in prosthetic translation in the proximal-distal, anterior-posterior and medial-lateral orientations between the groups. CONCLUSIONS: In a radiologic study using 3DCT, robotic-assisted TKA reduced the outliers for rotational alignment of the tibial prosthesis in comparison to conventional TKA, which can lead to improved tracking of the femoral-tibial bearing surfaces.

Robotic-Assisted Total Knee Arthroplasty for Distal Femur Fracture with Lateral Knee Osteoarthritis.

Introduction. Open reduction and internal fixation (ORIF) of compound fractures around the knee in elderly patient raise concerns about long-term postoperative external fixation and complications. Total knee arthroplasty (TKA) has been proposed as an alternative solution. We report a case where robotic-assisted (RA) TKA was used to treat lateral knee osteoarthritis (OA) with distal femur fracture. Case Presentation. A 90-year-old female visited our hospital with complications of sustained knee pain after a fall at home. Fracture line from the trochlea to the intercondylar notch was diagnosed on plain radiographs, and prior to this injury, the patient was receiving conservative treatment for lateral OA. We selected a conventional TKA over ORIF because the latter is associated with residual pain and the need for long-term immobilization, which can lead to other complications. However, the fracture site was the entry point for intramedullary rod, and there was concern that the fracture site would be displaced by conventional TKA. Therefore, the unique aspect of the case is that the technique utilized involved robotic milling using the Navio system while temporarily stabilizing the fracture using two tracker pins. RA TKA could determine osteotomy and implant placement by predicting the postoperative patient's soft tissue balance for no medial loosening and lateral contracture. The arthritic cartilage and bone were then methodically removed using the handheld sculptor. After immobilizing the fracture site with a bone grasper before removing the pin tracker, reaming of the femur and insertion of a stem prosthesis with semiconstrained were performed. Primary RA TKA is a viable option for intra-articular fractures in elderly patients with advanced knee osteoarthritis.

In vitro evaluation of the tension band suture method for proximal humerus fracture treatment.

BACKGROUND: Proximal humeral fractures are common, and more than half occur in patients over 65 years of age. Operative treatment may be recommended for displaced, complicated fractures; however, surgery may lead to displacement of the greater tuberosity or humeral head. Supplemental tension band sutures have been recommended to prevent such a complication. In this study, we investigate the best combination of suture, washer, and threading angle for proximal humeral fractures from a mechanical view. METHODS: The mechanical durability of 18 combinations of suture materials (Fiberwire, Ethibond, and Surgilon), threading washers (ring washer, disc washer), and threading angles (15 or 45°) were examined via a cyclic loading test. RESULTS: The most durable combination in the cyclic loading test consisted of threading the Fiber Wire to the washer ring using only one hole (ring washer-1) at 45°. In contrast, the most vulnerable combination was threading Ethibond to the washer disc at 15°. Breakage of all suture materials occurred at the suture-washer interface, and no failure or loosening of the knots was observed. FiberWire gradually eroded until the loss of equilibrium; whereas the rupture of Ethibond and Surgilon occurred suddenly. CONCLUSIONS: From a mechanical viewpoint, we demonstrated that applying a supplemental tension band suture using FiberWire with a single-hole ring washer threaded at a wider angle is recommended.

Autologous chondrocyte implantation with a Reveille cartilage processor for articular cartilage injury: a case report.

Autologous chondrocyte implantation (ACI) is an important operative option when repairing cartilage defects of the knee. This report introduces a new product development with one-stage ACI using a Reveille Cartilage Processor (Reveille CP) as well as the assessment of MRI and clinical results at a 1-year follow-up. The report compared cases between a 42-year-old female who underwent ACI surgery using Reveille CP and a 51-year old female who received treatment with two-stage ACI of tissue-engineered cartilage-like tissue (J-TEC Autologous Chondrocyte Cultured Cartilage [JACC]). One year after JACC, magnetic resonance imaging (MRI) showed signal intensity area in the grafted area, while patients with Reveille CP showed greater thickness than the surrounding healthy cartilage. The Lysholm, pain and QOL scores of Knee Injury and Osteoarthritis Outcome (KOOS) at one 1 year after surgery with Reveille CP were higher than JACC.