Does the Type of Knee Arthroplasty Affect the Patient's Postural Stability?

Background and Objectives: The aim of this study was to assess postural stability in patients after total and unicompartmental knee arthroplasties. Materials and Methods: The study included 40 women who had undergone knee arthroplasties-20 women who had undergone total knee arthroplasty (TKA) (mean age 63.47 ± 2.17) and 20 women who had undergone unicompartmental knee arthroplasty (UKA) (mean age 64.65 ± 1.93). The comparison group consisted of 20 healthy women aged 60-69 years (mean age 64.45 ± 3.12). The average time from surgery to stabilometry was 14.4 months. Each patient underwent stabilography using a single-plate stabilography platform, which included both Romberg's test and a dynamic test. Additionally, the WOMAC scale was administered, where patients assessed their condition both before surgery and at the present time. Results: The averaged Romberg's test results show a slight displacement in the center of mass (COM) toward the forefoot and towards the right limb in both the TKA and UKA groups. The WOMAC scale results showed significant improvement and satisfactory functional outcomes in both groups. Conclusions: The study indicated that one year after surgery, patients in both groups required a larger base of support to maintain postural control. However, the results for the UKA group were more similar to those of healthy individuals.

Functional assessment and quality of life of patients after reverse total shoulder arthroplasty in the late follow-up period.

BACKGROUND: Due to the systematically increasing number of shoulder replacement procedures among older people, the need to assess their quality of life is becoming more and more important. OBJECTIVE: The aim of the study was to functionally assess the shoulder joint and the quality of life of patients before and after reverse total shoulder arthroplasty (rTSA). METHODS: The observational study included 15 patients after the rTSA procedure (randomly selected). The quality of life and shoulder joint function before and after rTSA were assessed using the following scales: SF-36, Constant-Murley Score, Disabilities of the Arm, Shoulder and Hand Scale (DASH) and the University of California-Los Angeles Shoulder Rating Scale (UCLA scale) and Simple Shoulder Test (SST). RESULTS: There were statistically significant differences (p< 0.001) between measurements in the overall scores of the SF-36 questionnaire. Statistically significant differences (p< 0.001) were found between measurements in terms of the Constant-Murley, DASH, UCLA and SST scales results. CONCLUSIONS: Reverse total shoulder arthroplasty significantly improved the patients' quality of life and the functional condition of the operated limb.

Assessment of Isokinetics and Range of Motion of the Shoulder in Patients after Reverse Shoulder Arthroplasty in the Late Follow-Up Period.

(1) Background: The aim of the study was to evaluate the peak torque (PT) in isokinetic conditions and the range of motion of the shoulder joint in patients after reverse total shoulder arthroplasty in the late treatment period. (2) Methods: The study included fifteen patients aged 60-70 years (13 women and 2 men). The comparison group consisted of 15 healthy subjects (12 women and 3 men) aged 60-69 years. The study included measurement of peak torque (PT) and the range of motion of the shoulder joint, assessed using the Biodex System 4 Pro set, and an electronic goniometer. We conducted tests at two different angular velocities (60°/s and 90°/s), taking into account the operated and non-operated limb and comparing the results to healthy subjects. The average time from surgery to functional examination was 16 months. (3) Results: The non-operated limb generated significantly higher PT values than the operated limb (p < 0.001). The healthy limb of patients from the comparison group generated significantly higher PT values than the operated limb of patients from the study group (p < 0.001). A significant improvement (p < 0.001) in the range of motion in the operated limb was achieved after rTSA. (4) Conclusions: In patients 18 months after the rTSA, the non-operated upper limb has significantly greater muscle strength in flexion/extension and abduction/adduction movements compared to the operated limb. The non-operated limb also has a significantly greater range of motion compared to the operated limb.

Total knee arthroplasty with application of anatomic endoprosthesis journey. Clinical and radiological assessment in a 2-year follow-up.

BACKGROUND: Growing expectations regarding TKA inspire the researchers to look for a perfect endoprosthesis. One of the new-generation prostheses is Journey BCS (Smith&Nephew), introduced in 2004, which, according to its inventors, completely restores anatomy and kinematics of the knee. The aim of this study was to evaluate TKA with Journey endoprosthesis in a two-year follow-up. MATERIAL/METHODS: The study was a prospective analysis. It included 61 patients aged 52-87 years, with primary OA and axial deformity under 15°, and without a significant instability in the frontal plain. A total of 61 TKAs were assessed with the use of WOMAC OI, KSS clinical and radiological scales. The group was evaluated after 6, 12, 24 weeks, 1 and 2 years postoperatively. RESULTS: At the end point of observation, 97% of the patients obtained good and very good clinical and radiological results. Mean knee flexion in the study group increased until 24 week and reached 121.8°. These results are comparable with the results described in the literature, but do not differ significantly from the outcomes of conventional endoprostheses. CONCLUSIONS: In the presented material, TKA with the application of anatomic endoprosthesis Journey allowed to obtain in the majority of patients very good and good early clinical and radiological results.

Impact of preoperative knee deformity on the outcome of total knee replacement using the PFC system.

Backgrund. The purpose of our study was to evaluate the impact of preoperative knee deformity on TKR results and the effectiveness of unconstrained PFC systems in the correction of these deformities in knees affected by degenerative disease. Material and methods. We performed a retrospective study of 91 consecutive TKRs performed between 1995-2000 in 79 patients (71 women and 8 men, mean age 67.2 years), during which 74 PFCs and 17 PFCSs were implanted. The mean follow-up was 48.3 months (range: 13-58 years). Functional status was evaluated using the Knee Society Score (KSS), and the radiological results were assessed on the basis of standard plain x-ray pictures. Results. We found 26.7% excellent outcomes, 67.8% good, 3.3% fair and 2.2% poor. There were no statistically significant differences between the anatomical and radiological outcomes of TKR in knee joints with flexion, valgus or varus preoperative deformities. The effectiveness of the unconstrained system of total knee arthroplasty in correction of the flexion or valgus/varus knee joint deformity was very good, given proper patient selection and meticulous surgical technique. Conclusions. Clinical and radiographic studies show that preoperative knee deformation has no impact on the early results of TKR with an unconstrained PRC system. The functional and radiographic results of TKR with an unconstrained PFC system confirm the very high effectiveness of this technique in the correction of preoperative deformation of the knee with degenerative changes. The results of TKR with un-constrained PFC systems in short-term follow-up (1-5 years) are very good.

[Total hip arthroplasty in rheumatoid arthritis: results of 12-years follow-up]. / Specyfika calkowitej alloplastyki stawu biodrowego w reumatoidalnym zapaleniu stawów--wyniki 12-letniej obserwacji.

UNLABELLED: The aims of retrospective cohort study were: analysis of general and local factors, evaluation of clinical and radiographic results and presentation of authors' experience in total hip arthroplasty in rheumatoid arthritis. Study group consists of 222 consecutive total hip arthroplasties (205 cemented and 17 cementless) made in 216 patients. Mean patients' age was 58.4 y.o (range: 34-77 y.o.). In study group were 192 women and 24 men. Mean preoperative function was poor: 28.4 points (range: 24-32 p.). Clinical evaluation was made with Harris hip score, and radiographic one with criteria of Joined Committee of Hip Society, AAOS and SICOT. Clinical results of the study group were as follow: excellent--53 (23.9%), good--128 (57.6%), fair--34 (15.3%) and poor--7 (3.2%). Mean postoperative function was good: 86.8 points (range: 28-94 p.). There were following radiographic results of study group: good--176 (79.3%), fair--28 (12.6%) and poor--18 (8.1%). Complications another than aseptic loosening were observed in 56 (25.2%) hips. CONCLUSIONS: 1) general and local factors make total hip arthroplasty in rheumatoid arthritis more difficult procedure than the same one in osteoarthritis, 2) log-term survival rate of hip replacement in rheumatoid arthritis mainly depends on proper bone stock reconstruction, 3) 80-85% of excellent and good clinical and radiographic results are achieved at 12-year follow-up, 4) incidence of local and systemic postoperative complications are similar to osteoarthritis population, 5) preoperative autologous blood donation does not decrease demand of postoperative blood transfusion.

[Possibilities and profits of blood saving in orthopedics and traumatology]. / Mozliwosci oszczedzania krwi na oddziale ortopedyczno-urazowym i wynikajace z tego korzysci.

The author presents his own experiences related to blood saving methods in orthopedics and traumatology. The analysis was carried out on 56 patients who underwent major orthopedic procedures: 35 total hip arthroplasties, 19 total knee arthroplasties and two fusions of fractures of the spine performed between the end of 1998 and the beginning of 1999. Patients were prepared for elective surgery by carrying out autotransfusion, which gave on average 2 units of blood for each patients. During the post operative period blood for retransfusion was obtained through active drainage using CBC Consta VAC (Strayker) equipment and through active drainage using standard Baxter transfusion bags. This gave approx. 350-700 ml of blood after hip arthroplasties, 500-800 ml after knee arthroplasty and 500 ml after stabilization of spine fractures. An analysis of the morphotic values of blood from CBC (Strayker) and the transfusion bags (Baxter) did not reveal any statistically significant differences. This confirmed that both methods are equally useful for obtaining blood from the post-operative wound. However, the low cost and simplicity of downward drainage make this method more suitable for our hospitals. Autotransfusion yielded in our department an annual saving of 250 l of blood and in many planned operations eliminate the necessity for allogenic blood transfusion.

[Treatment of fragmented femur fracture following unilateral hip hemiarthroplasty and total knee arthroplasty]. / Zaopatrzenie wieloodlamowego zlamania trzonu kosci udowej po jednostronnej alloplastyce polowiczej stawu biodrowego i calkowitej stawu kolanowego.

In this paper is presented a case of the 80 years old patient with femur fracture after unilateral hip arthroplasty because of femur neck fracture and knee arthroplasty following osteoarthritis. First was done the stabilization of the fracture using a plate. Because of second fracture and damage the plate stabilization next operation was done using intramedullary Küntscher nail which was non typically inserted and with additional fixation by bone cement. The result were good stabilization and healing of the fracture after 4 months.