Bicompartmental (uni plus patellofemoral) versus total knee arthroplasty: a match-paired study.

BACKGROUND: Osteoarthritis (OA) of the knee, whether primary or post-traumatic, does not always involve all three compartments (tibiofemoral medial and lateral and the patellofemoral ones). Bicompartmental knee arthroplasty (BKA) was proposed as a good alternative to total knee arthroplasty when two of the three knee compartments were affected. MATERIALS AND METHODS: We performed a retrospective comparative study collecting all BKAs performed between March 2010 and January 2016. During this period, we treated 27 patients with BKA for medial or lateral and patellofemoral OA. Seven of them were lost to follow-up and were not included in the study. Group A (BKA group) was compared to a homogeneous group of 20 patients who underwent TKA during the same period (group B). RESULTS: Patients treated with TKA were younger than those treated with BKA (mean age 65 vs. 67.2; p = 0.2149). BKA resulted in longer mean operating time (87 vs. 82.4 min; p = 0.2983), less blood loss (413 vs. 458 ml; p = 0.0052) but higher blood transfusion rate (12 vs. 10%). Medium follow-up was 34 months for BKA group and 38 months for TKA group. No statistically significant differences were found in KSS score between the two groups (KSS score 92.3 for BKA, 94.5 for TKA; p = 0.5221; KSS function was 87.2 for BKA and 89.2 for TKA; p = 0.4985). CONCLUSION: The most important finding of the present study was that although BKA seemed to be theoretically more favorable in terms of functional recovery and blood loss, patients of group A had lower KSS score and higher transfusion rate than those of group B. Our data confirm that BKA could be proposed as an alternative to TKA, especially in young and high-demanding patients.

Femoral press-fit fixation versus interference screw fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: 20-year follow-up.

INTRODUCTION: The aim of this paper is to present our experience with femoral press-fit fixation in anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. METHODS: The patient population was randomly placed in two groups: group A (58 patients), who underwent femoral screw fixation; group B (62 patients), who underwent femoral press-fit fixation. RESULTS: At last follow-up 9.2% of patients were lost; 28% of patients in group A and 64% of patients in group B had excellent International Knee Documentation Committee score (grade A); 66% of patients in group A and 32% of patients in group B had good International Knee Documentation Committee scores (grade B). The difference was statistically significant (p < 0.05). CONCLUSIONS: Femoral press-fit fixation of bone- patellar tendon- bone autograft provides stable fixation at low cost, it ensures unlimited bone-to-bone healing and high primary stability, avoiding the disadvantages of hardware and the need for removal in case of revision.

Bi-unicompartmental versus total knee arthroplasty: a matched paired study with early clinical results.

INTRODUCTION: The authors performed a matched paired study between two groups: bi-unicompartmental (Bi-UKR) versus total knee replacements (TKR) for the treatment of isolated bicompartmental tibio-femoral knee arthritis with an asymptomatic patello-femoral joint. The Authors believe that Bi-UKR could achieve comparable outcomes than TKR, but with a real less invasive surgery and maintaining a higher joint function. MATERIALS AND METHODS: A total of 22 patients with bicompartmental tibio-femoral knee arthritis, who underwent Bi-UKR between January 1999 and March 2003, were included in the study (group A). In all the knees the arthritic changes were graded according to the classification of Alback. All patients had an asymptomatic patello-femoral joint. All patients had a varus deformity lower than 8 degrees , a body-mass index lower than 34, no clinical evidence of ACL laxity or flexion deformity and a preoperative range of motion of a least 110 degrees . At a minimum follow-up of 48 months, every single patient in group A was matched with a patient who had undergone a computer assisted TKR between August 1999 and September 2002 (group B). In the Bi-UKR group, in two cases we registered intraoperatively the avulsion of the treated tibial spines, requiring intra-operative internal fixation and without adverse effects on the final outcome. Statistical analysis of the results was performed. RESULTS: At a minimum follow-up of 48 months there were no statistical significant differences in the surgical time while the hospital stay was statistically longer in TKR group. No statistically significant difference was seen for the Knee Society, Functional and GIUM scores between the two groups. Statistically significant better WOMAC Function and Stiffness indexes were registered for the Bi-UKR group. TKR implants were statistically better aligned with all the implants positioned within 4 degrees of an ideal hip-knee-ankle (HKA) angle of 180 degrees . CONCLUSIONS: The results of this 48 months follow-up study suggest that Bi-UKR is a viable option for bicompartmental tibio-femoral arthritis at least as well as TKR but maintaining a higher level of function.

Intra-operative tibial fracture during computer assisted total knee replacement: a case report.

Recently computer-assisted joint replacement surgery has been introduced to improve implant alignment. To date no intra-operative fractures have been reported related to the insertion of the navigation trackers used in this technique. The authors present the case of a 76-year-old man who sustained an intra-operative tibial fracture at the site of insertion of the navigation tracker during computer assisted total knee replacement.

Tissue sparing surgery in knee reconstruction: unicompartmental (UKA), patellofemoral (PFA), UKA + PFA, bi-unicompartmental (Bi-UKA) arthroplasties.

Recently mini-invasive joint replacement has become one of the hottest topics in the orthopaedic world. However, these terms have been improperly misunderstood as a "key-hole" surgery where traditional components are implanted with shorter surgical approaches, with few benefits and several possible dangers. Small implants as unicompartmental knee prostheses, patellofemoral prostheses and bi-unicompartmental knee prostheses might represent real less invasive procedures: Tissue sparing surgery, the Italian way to minimally invasive surgery (MIS). According to their experience the authors go through this real tissue sparing surgery not limited only to a small incision, but where the surgeons can respect the physiological joint biomechanics.

Navigated shorter incision or smaller implant in knee arthritis?

Minimally invasive approaches for unicompartmental knee arthroplasty are well-accepted for treating knee arthritis because of the smaller implant size, shorter operative time, and tissue-sparing nature of the procedure. With the introduction of computer alignment systems, a well-aligned and balanced total knee arthroplasty (TKA) can be achieved even with smaller surgical exposures. We hypothesized a unicompartmental knee arthroplasty would provide better midterm outcomes than a computer-assisted minimally invasive TKA in patients with isolated medial compartment knee arthritis. We matched (preoperative arthritis severity, age, gender, and preoperative range of motion) 64 knees that had a medial unicompartmental knee arthroplasty or a mini-incision computer-assisted TKA. All patients had a varus deformity no greater than 8 degrees and a body mass index lower than 30 kg/m. Patients were followed a minimum of 48 months. In the mini-incision computer-assisted TKA group, all the implants were positioned within 4 degrees of ideal alignment. The surgical time and hospital stay were longer in the computer-assisted TKA group. A unicompartmental knee arthroplasty was estimated to cost at least 3100 euros (approximately US $4100) less. The clinical assessment showed higher functional and Italian Orthopaedic UKA Users Group scores for the unicompartmental knee arthroplasty group.

Intertrochanteric fracture of an arthrodesed hip.

We report the case of a 74-year-old woman who sustained an intertrochanteric fracture of the femoral neck in a previously arthrodesed hip. The hip arthrodesis had been performed 53 years earlier to treat septic arthritis. The fracture was treated successfully using a double-plating technique with 4.5 mm titanium reconstruction plates.

Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis: a matched paired study.

Patients older than 60 with unicompartmental knee arthritis can be treated with total or unicompartmental knee replacement. The aim of this study was to compare the results of matched paired groups of patients with isolated medial compartment knee arthritis replaced with either UKR (group A) or computer-assisted TKR (group B). The results included 68 knees at a minimum follow-up of 3 years. All patients had a varus deformity no greater than 8 masculine and a BMI lower than 30. Patients were matched in terms of preoperative arthritis severity, age, gender and preoperative range of motion. In the computer-assisted TKR group, all the implants were positioned within 4 masculine of the correct hip-knee-ankle angle and frontal tibial component angle. The surgical time and hospital stay were statistically longer in the CA TKR group. During the study no implant required revision. The results showed higher scores for a UKR in the treatment of isolated primary unicompartmental knee arthritis in patients older than 60 compared to a computer-assisted TKR. In this study a computer-assisted alignment system for TKR with optimal implant positioning did not produce equivalent clinical results compared to a UKR, but did increase the financial costs.

Grafting of tibial bone defects in knee replacement using Norian skeletal repair system.

INTRODUCTION: The authors have been using Norian skeletal repair system (SRS) to repair cancellous bone defects in knee replacements since 1999. Norian SRS is injectable, biocompatible calcium phosphate cement with a high mechanical strength. This product is similar to the mineral phase of bone and should undergo gradual remodeling with time. We present our experience with this bone substitute in a total of 13 knee replacement surgeries. MATERIALS AND METHODS: This included three unicompartmental knee replacements (UKR), two bilateral UKR following tibial plateau fractures, five revisions of UKR to total knee replacements (TKR), two TKR revisions and one hinged knee prosthesis for significant deformity. Full weight bearing was permitted as soon as tolerated in all patients. Patients were evaluated at the latest follow-up using both the Knee Society Score (KSS) and GIUM (Italian UKR Users Group) knee scores. RESULTS: At the latest follow-up, no poor results were seen with an improvement between pre-operative and post-operative knee scores in all cases. There was no evidence of bone loss or post-operative deformity. Complete compound resorption was seen in the first 4 cases. CONCLUSIONS: The authors state that Norian SRS is a practical alternative as bone grafting in knee replacement surgery for type 1 and 2 bone defects.

Mini-invasive computer assisted bi-unicompartimental knee replacement.

In the treatment of knee osteoarthritis there are no reports using bi-unicompartimental implants and many orthopaedic surgeons are sceptical about this demanding surgical procedure despite its theoretical advantages in terms of less invasive surgery. The bi-unicompartmental approach also offers the potential advantage of maximal preservation of normal anatomy, with benefits for functional aspects such as gait, muscle activity, and proprioception.Computer-aided knee replacement surgery has been gaining popularity and an improvement in limb alignment and kinematics has been demonstrated in several studies. During the procedure the surgeon can check both implant position and ligament balance during the full range of joint movements, which helps to reduce the complications traditionally associated with failure in the past. The authors present a computer-aided technique for performing bi-unicompartimental knee replacement which permits a less invasive alternative for knee replacement surgery.

Comparison of a mobile with a fixed tibial bearing unicompartimental knee prosthesis: a prospective randomized trial using a dedicated outcome score.

Between February 1996 and December 1997, forty consecutive patients with medial compartment knee arthritis were assigned randomly into two groups. All underwent a unicompartimental knee replacement. The tibial prosthesis in group A (20 knees) had a fixed bearing and in group B (20 knees) a mobile bearing. The average age was 69. Five in group A and 71 in group B. Pre-operatively, and at an average follow-up of 5.7 years, all the knees were assessed using both a dedicated UKR score specifically developed and adopted by the Italian Orthopaedic Unicompartimental Knee Replacement Users Group (GIUM) and the Knee Society Score. During surgery in group B we experienced a medial tibial plateau fracture fixed intra-operatively. One prosthesis in group A required an early revision to a TKR because of a continuous pain without any evident sign of loosening. There were no meniscal dislocations in group B. No statistically significant difference in outcome was observed between the two groups at the latest follow-up.

Is closed-suction drain necessary in unicompartmental knee replacement? A prospective randomised study.

In a prospective randomised trial we evaluated the use of a post-operative closed-suction drain in unicompartmental knee replacement (UKR). Seventy-eight patients were divided into two groups: one without a post-operative closed-suction drain (Group A) and one with a drain (Group B). Both groups were matched for age, sex and pre-operative haemoglobin. In group A we observed a lower day one post-operative analgesic requirement, smaller knee circumference 3 days post-operatively and less local wound complications. Drain usage in UKR resulted in no significant advantage in post-operative pain, range of motion and hospital stay. Post-operative drainage does, however, increase the cost of the procedure both in labour and equipment expenditure. No deep infections occurred in either group during the follow-up period. We conclude that avoiding post-operative closed-suction drainage in UKR does not influence the outcome.

[Intramedullary nailing with a Rush pin in the treatment of diaphyseal humeral fractures]. / L'inchiodamento endomidollare con infibulo di Rush nel trattamento delle fratture diafisarie di omero.

The authors discuss their 20 years of experience in the treatment of diaphyseal fractures of the humerus with Rush-type intramedullary nailing. The various operative and nonoperative methods for the treatment of this type of fracture are critically analyzed. The results were excellent in 60.5% of the cases, good in 29.6%, and poor in only 9.9%, in which healing was over 4 months late and a hypotrophic callus was present. The advantages of this treatment are as follows: adequate reduction of the fracture, simplicity of execution, good results, and shorter period of immobilization compared to other methods.

[Our experience in arthroscopy of the knee under local anesthesia in a day hospital regimen]. / La nostra esperienza con l'artroscopia del ginocchio in anestesia locale in regime di ricovero day hospital.

The author reports his experience with arthroscopy under local anesthesia for the diagnosis of affections of the knee. He emphasises the criteria that must be used to guide the surgeon in his choice, illustrates the method commonly used, and reports the positive results obtained in a group of patients. The author concludes by suggesting that arthroscopy under local anesthesia for joint pathology of the knee is a safe and indispensable method to be used by knee surgeons.