Tibial bowing and tibial component placement in primary total knee arthroplasty in valgus knees: Are we overlooking?

PURPOSE: Tibial bowing in valgus knees with arthritis can lead to component malplacement during total knee arthroplasty (TKA). Incidence of valgus knees with medial tibial bowing, its effect on tibial component placement during primary TKA and methods to improve accuracy of the component placement were studied. METHODS: Full-length weight-bearing alignment radiograph was taken in 117 patients (149 knees) with valgus deformity undergoing TKA. In these cases, the proximal tibial reference for extramedullary jig placement was planned preoperatively with reference to the tibial spines and classified as four zones. RESULTS: The mean preoperative hip-knee-ankle (HKA) angle was 192.9° (180.3-234.5°). Bowing >3° was considered significant (p < 0.001) and at this level of bowing, the proximal tibial reference was shifted from centre to medial. Tibial bowing <3° was considered straight and >3° as tibia valga. Tibia was bowed in 70 knees (46.97%). Severity of valgus deformity had strong positive correlation with the tibia valga (p < 0.001). The post-operative medial proximal tibial angle (MPTA) and HKA angle were 91.63° (87.9-95.7°) and 182.6° (178.1-189.7°), respectively. The mean MPTA and post-operative HKA angle in bowed and straight tibiae were 90.35° versus 89.78° (p = 0.547) and 181.5° versus 180.7° (p = 0.5716), respectively, and the difference was not statistically significant. CONCLUSION: Medial tibial bowing is very common in valgus knees. Tibia valga has a strong positive correlation with the severity of valgus deformity. Accurate tibial component placement can be achieved with a medialized reference point for extramedullary tibial cutting jig in knees with significant tibia valga. The study has been registered in clinical trials registry - India (CTRI/2018/03/012283).

Tubercular infection after arthroscopic rotator cuff repair.

Tubercular septic arthritis after shoulder arthroscopy has not been reported in the English literature to our knowledge. A case of Tubercular septic arthritis of the shoulder following arthroscopic rotator cuff repair is presented. The sinus and the wound healed well, and laboratory parameters returned to normal, which suggests that the infection was well controlled with the treatment follow-up of 1 year. But the functional score was poor due to repeated surgeries; long-standing infection and the arthritic changes developed. Tubercular infection can occur after arthroscopic shoulder surgery especially in healthcare workers in zones endemic for Tuberculosis. Level of evidence V.

Patient - implant dimension mismatch in total knee arthroplasty: Is it worth worrying? An Indian scenario.

BACKGROUND: The correct sizing of the components in both anteroposterior and mediolateral (ML) dimensions is crucial for the success of a total knee arthroplasty (TKA). The size of the implants selected is based on the intraoperative measurements. The currently used TKA implants available to us are based on morphometric measurements obtained from a Western/Caucasian population. Hence, the risk of component ML mismatch is more common in Asian sub-population, as they are of a smaller built and stature. This study aims to look into the following aspects agnitude of the ML mismatch between the femoral component and the patient's anatomical dimension, evaluation of gender variations in distal femur dimensions, and gender-wise and implant-wise correlation of ML mismatch. MATERIALS AND METHODS: Intraoperatively, the distal femoral dimensions were measured using sterile calipers after removing the osteophytes and compared with the ML dimension of the implant used. ML mismatch length thus obtained is correlated with the various parameters. RESULTS: Males showed larger distal femoral dimensions when compared to females. Males had larger ML mismatch. None of the implants used perfectly matched the patient's anatomical dimensions. Patients with larger mismatch had lower scorings at 2 years postoperative followup. CONCLUSION: Implant manufacturers need to design more options of femoral implants for a better fit in our subset of patients. The exact magnitude of mismatch which can cause functional implications need to be made out. The mismatch being one of the important factors for the success of the surgery, we should focus more on this aspect.