Should central osteophytes within the articular cartilage of the lateral compartment be considered when determining the indication of unicompartmental knee arthroplasty for medial osteoarthritis?

Patients with central osteophytes in the lateral compartment may be poor candidates for unicompartmental knee arthroplasty (UKA) for medial knee arthritis given the thin overlying articular cartilage above the central osteophytes that is inadequate for supporting weight-bearing after UKA. Therefore, attempts should be made to detect central osteophytes to confirm suitability for UKA.

Ultra-thin surgical swab: its development and clinical application.

INTRODUCTION: Ultra-thin (diameter: 3 mm) surgical swabs have not been in practical use as it is difficult to manufacture these using the pre-existing methods; therefore, a new technology has been adopted. This study aimed to evaluate the safety and efficiency of ultra-thin surgical swabs in bench-top and preclinical settings. MATERIAL AND METHODS: We performed liquid particle counter (LPC) test, cotton strength test, shaft bending comparison and surgical vision test for checking the durability of swabs as bench-top investigation, and laparoscopic surgery in a porcine model as preclinical investigation. All tests were compared with conventional 5-mm swabs. RESULTS: The ultra-thin swabs had fewer eluted particles in the LPC test, endured a 5 kg pulling force in the cotton strength test, their shaft did not break at 100 mm bending in the shaft bend comparison test, and interfered less in the surgical vision test. They were used for manipulating organs with no damage in preclinical investigation. CONCLUSIONS: Three millimeters ultra-thin surgical swabs manufactured with the new manufacturing technology are effective and safe.

A Right Angle Guide for Distal Tuberosity Osteotomy With Medial Open Wedge High Tibial Osteotomy for Varus Knee Osteoarthritis.

Medial open wedge high tibial osteotomy (OWHTO) is usually performed with proximal tuberosity osteotomy or setting the osteotomy line proximal to the tuberosity. However, OWHTO can result in patellofemoral complications due to postoperative patella infera. A new OWHTO technique, biplanar osteotomy with a distal tuberosity osteotomy, was reported in 2004 to prevent postoperative patella infera. To ensure that the 2 osteotomy lines maintain perpendicular, we describe the OWHTO procedure with a distal tuberosity osteotomy technique using a TriS Medial HTO Plate System (Olympus Terumo Biomaterials Corp., Tokyo, Japan) and a right angle guide we developed. In this Technical Note, we describe the procedure and advantages, risks, and limitations, as well as the pearls and pitfalls based on our experience.

The effect of morphine added to periarticular multimodal drug injection or spinal anesthesia on pain management and functional recovery after total knee arthroplasty.

BACKGROUND: The efficacy of morphine added to periarticular multimodal drug injection (PMDI) for pain management after total knee arthroplasty (TKA) is controversial. Adding morphine to spinal anesthesia has reportedly improved pain relief for the first 24 h. We examined the effect of morphine added to PMDI or spinal anesthesia on pain management and functional recovery after TKA. METHODS: A total of 97 patients were randomized into three groups: in Group A (34 patients), 10 mg morphine was added to PMDI; Group B (31 patients), 0.1 mg morphine was added to spinal anesthesia; and Group C (32 patients), morphine was added to neither the PMDI nor spinal anesthetic. To evaluate the efficacy of added morphine for pain management, we assessed rest pain, the number of times analgesics were used, and the time period until the first analgesic use. The adverse effects of morphine were assessed by counting the numbers of times vomiting occurred and antiemetics were used. Functional recovery was evaluated by recording the range of motion of the knee and the date of ability to walk. RESULTS: Rest pain was the least in Group B at 6 and 12 h after operation. The number of times analgesics were used was the least in Group B. The time period until the first analgesic use was the longest in Group B. The number of vomiting episodes was the least in Group C. The number of times antiemetics were used was higher in Group A than in Group C. There were no significant differences in the range of motion and date of ability to walk among the three groups. CONCLUSIONS: The efficacy of morphine added to PMDI was limited, and that of morphine added to spinal anesthesia disappeared within 20 h postoperatively. Adding morphine to PMDI or spinal anesthesia did not improve functional recovery and caused some adverse effects.

Comparison of intraoperative anthropometric measurements of the proximal tibia and tibial component in total knee arthroplasty.

BACKGROUND: Precise matching of the tibial component and resected bony surfaces and proper rotational implanting of the tibial component are crucial for successful total knee arthroplasty. We aimed to analyze the exact anthropometric proximal tibial data of Japanese patients undergoing total knee arthroplasty and correlate the measurements with the dimensions of current total knee arthroplasty systems. METHODS: A total of 703 knees in 566 Japanese patients who underwent total knee arthroplasty for osteoarthritis were included. The bone resection in the proximal tibia was performed perpendicular to the tibial axis in the frontal plane. Measurements of the proximal tibia were intraoperatively obtained after proximal tibial preparation. RESULTS: There were significant positive correlations between the lateral anteroposterior and medial anteroposterior and mediolateral dimensions. A progressive decrease in the mediolateral/lateral anteroposterior ratio with an increasing lateral anteroposterior dimension or the mediolateral/anteroposterior ratio with an increasing anteroposterior dimension was observed. The lateral anteroposterior dimension was smaller than the medial anteroposterior dimension by a mean of 4.8 ± 2.0 mm. The proximal tibia exhibited asymmetry between the lateral and medial plateaus. A comparison of the morphological data and dimensions of the implants, one of which was a symmetric tibial component (NexGen) and the others were asymmetric (Genesis II and Persona), indicated that an asymmetric tibial component could be beneficial to maximize tibial plateau coverage. CONCLUSIONS: This study provided important reference data for designing a proper tibial component for Japanese people. The proximal tibial cut surface was asymmetric. There was wide dispersion in the lateral anteroposterior, medial anteroposterior, and mediolateral dimensions depending on the patient. Our data showed that the tibial components of the Genesis II and Persona rather than that of the NexGen may be preferable for Japanese people because of their asymmetric design.

Quality of life after bilateral total knee arthroplasty determined by a 3-year longitudinal evaluation using the Japanese knee osteoarthritis measure.

BACKGROUND: Recently, the Japanese knee osteoarthritis measure (JKOM), a new disease-specific and patient-derived quality of life (QOL) measure, has been developed. The objectives of this study were to longitudinally evaluate QOL assessed by JKOM and objective outcomes including knee society score (KSS), range of motion (ROM), and timed up and go test (TUG) of patients who underwent bilateral total knee arthroplasties (TKAs) for osteoarthritis; to evaluate correlations between JKOM and those objective outcomes; and to test our hypothesis that increased maximum flexion leads to better JKOM. METHODS: Forty patients with bilateral TKAs and ≥ 3-year follow-up were included. There were 35 female and 5 male patients with a mean patient age of 74 years. They were evaluated preoperatively (Pre), 5-29 months after unilateral TKA (after U), 12-21 months after bilateral TKAs (1 year after B), 24-34 months after bilateral TKAs (2 years after B), and 36-46 months after bilateral TKAs (3 years after B) using JKOM, KSS, TUG, and ROM. RESULTS: Improvements in JKOM and TUG were statistically significant between "Pre" and "after U", and between the "after U" and "1 year after B". Improvements in the KSS function score were statistically significant between "after U" and "1 year after B" but not between "Pre" and "after U". The improvements in the JKOM scores, the KSS function score, and TUG did not increase after the 1-year follow-up but was maintained at "3 years after B". The maximum flexion value did not change among the evaluation time points. There were statistically significant correlations between JKOM with KSS and TUG but not with ROM. CONCLUSIONS: There were statistically significant correlations between JKOM with KSS and TUG but not with ROM. Therefore, our hypothesis was false even in a Japanese population.

Estimation of beef marbling in the Longissimus muscle with computer image analysis of ultrasonic pictures of the Iliocostalis muscle area.

This study investigated an objective method for estimating beef marbling using ultrasonic images of the Iliocostalis muscle and the Lomgissimus muscle area sections. Thirty-one Japanese Black cattle steers were used in this study. The end of the left side shoulder blade bone was scanned using an ultrasonic device. Ultrasonic images were captured of the Longissimus muscle area and that around the Iliocostalis muscle area. Twenty items were measured in the two images using computer image analysis software. The level of beef marbling was measured according to the Beef Marbling Standard (BMS) for carcass grading, and the percentage of ether-extractable fat content in the Longissimus muscle (EE). The difference in the gray level between the Iliocostalis muscle and intermuscular fat (X10) was used to estimate the BMS and the EE, which were highly correlated (r(2) = 67.72% and 61.30%). An equation was developed using four parameters from the two ultrasonic images, which could estimate the BMS (r(2) = 85.88%). This equation could also estimate the EE (r(2) = 68.98%). The equations used to estimate beef marbling were based on one to four parameters that included X10. Thus, ultrasonic images of the Iliocostalis muscle area section are important for estimating beef marbling.

In vivo determination of knee kinematics for Japanese subjects having either a low contact stress rotating platform or an anteroposterior glide total knee arthroplasty.

The objective of this study was to work with a consecutive series of patients having Hospital for Special Surgery scores higher than 90 to evaluate kinematic patterns, under in vivo conditions, for 20 Japanese subjects implanted with 2 different mobile-bearing (MB) total knee arthroplasties (TKAs). Femorotibial contact paths for the medial and lateral condyles were then determined using a computer-automated model-fitting technique. This present study has shown that kinematic patterns for subjects having 2 different MB TKA designs differed but were not statistically different. Subjects implanted with a rotating platform (RP) MB TKA experienced minimal anteroposterior (AP) motion and larger axial rotation (RP). Subjects implanted with an anterior glide MB TKA experienced both femoral rotation and femoral translation (AP glide). There was minimal variability in the kinematic patterns for subjects implanted with an RP, whereas subjects implanted with an AP glide experienced more variable kinematic patterns. Key words: total knee arthroplasty, in vivo, fluoroscopy, kinematics.