Patella scores are similar both with gap balancing and measured resection after total knee arthroplasty: a randomized single-centre study.

PURPOSE: The purpose of this prospective study was to compare femoral component rotation (FCR) values when adjusted with 'gap balancing' (GB) and 'measured resection' (MR) techniques following total knee arthroplasty (TKA). The study hypothesis was that the GB technique would be better on FCR than MR in TKA. METHODS: From a total of 93 unilateral TKAs performed between August 2019 and November 2020, the FCR values were adjusted by GB in 46 cases and MR in 47. Post-TKA magnetic resonance imaging (MRI) was applied for FCR assessment. Orthoroentgenograms and lateral knee radiographs were taken to determine the mechanical axis and posterior condylar offset (PCO) ratio, respectively. Both groups were compared radiologically. The Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Hospital for Special Surgery (HSS) patella scores were calculated and compared between the groups preoperatively and at the end of 6 months, and 1 and 2 years postoperatively. RESULTS: There was no difference between the groups in respect of the demographic data. The mean HSS patella score was 86.4 ± 4.1 in the GB group and 84.6 ± 3.8 in the MR group in the 2nd year (p = 0.047). A higher degree of external rotation in the FC was determined in the GB group [2.2° (1.7°-4.3°)] compared to the MR group [1.7° (0.8°-3.0°)] (p = 0.009). The postoperative increase in PCO ratio was higher in the GB group (p = 0.005). All other variables were similar in both groups. CONCLUSION: The results of this study showed that at the end of the 2nd year, the HSS patella scores were better, FCs were more externally rotated and PCO ratios were higher in TKAs using the GB technique. However, taking into account that the difference between the 2nd year HSS patella scores was too small to be considered clinically significant, it was shown that both the GB and MR techniques can be used for FCR in clinical practice without any hesitation.

Surgical treatment of displaced intraarticular calcaneus fractures using anatomical lateral frame plate.

BACKGROUND: The present study evaluated the results obtained from the anatomical lateral frame plate treatment of displaced intraarticular calcaneus fractures. METHODS: Overall, 14 displaced intraarticular fractures of 13 patients (3 females, 10 males; Mean age, 37.5 years) were included in the present study. Surgery was performed using widened lateral approach and supported by auto grafts following joint line reduction in all patients. They were then fixated by anatomical lateral frame plate. All the joints were stabilized by casting after the operation. All patients were prescribed controlled and full weight bearing at 6-8th and 12th weeks, respectively. RESULTS: Mean follow-up of patients was 28 months. The fractures were classified according to Sanders system. Clinical scoring of the patients was performed according to American Orthopaedic Foot and Ankle Society, Creighton-Nebraska, and Maryland systems. According to these systems, the mean scores of the patients were 83.7, 75.7, and 88.5 respectively. CONCLUSION: In the present study, we have defined the results of anatomical lateral frame plate treatment in patients with displaced intraarticular calcaneus fractures. We have obtained clinically and radiologically satisfactory results with the anatomical compatibility of plate to the lateral surface of the calcaneus.

Influence of sagittal plane malpositioning of the patella on anterior knee pain after tibia intramedullary nailing.

PURPOSE: Anterior knee pain (AKP) is one of the most common complications after tibia intramedullary surgery. We evaluated changes in patellar tendon length after tibia intramedullary nailing surgery using a transtendinous approach and assessed the importance of nail position in relation to the anterior tibial cortex and joint line. METHODS: Two surgeons blinded to patients' pain status measured both the knee Insall-Salvati and Caton-Deschamps indexes on 30° flexion lateral knee X-rays of 33 patients. Superior nail prominence (the distance from the proximal tip of the nail to the tibial plateau) and anterior nail prominence (the distance from the anterior tip of the nail to the anterior tibial cortex) were measured on the CT. RESULTS: Clinical assessment showed that 10 patients (30 %) had AKP at the last follow-up. HSS and Lysholm scores and the incidence of AKP were similar between patients whose IM nails were removed and those who still had them. HSS score, Insall-Salvati, and Caton-Deschamps indexes were significantly lower in the operated extremity than in the healthy limb at last follow-up. No association was demonstrated between AKP and nail position in relation to the anterior tibial cortex or tibial plateau. CONCLUSIONS: According to our study, although the patellar tendon shortened significantly on the affected side compared with the contralateral side, these measurements did not correlate with the presence or absence of pain. AKP and functional knee scores after tibia IM nailing using a transtendinous approach were not associated with nail position in relation to the anterior tibial cortex or tibial plateau. LEVEL OF EVIDENCE: Level 3 (Case control study).

Irreducible fifth metatarsophalangeal joint after car crush injury.

Metatarsophalangeal joint dislocations are uncommon injuries. Herein, an irreducible dislocation of fifth metatarsophalangeal joint with fractures on the second, third, and fourth metatarsal head was reported. Joint reduction could not be achieved which necessitated open reduction. Six months after surgery the patient was walking and doing his daily activities without any complaints. He had returned to his pretrauma functional level.

Intra-articular hyaluronate, tenoxicam and vitamin E in a rat model of osteoarthritis: evaluation and comparison of chondroprotective efficacy.

OBJECTIVE: The aim of this experimental study was to evaluate and compare the chondroprotective efficacy of intra-articular hyaluronic acid, tenoxicam and vitamin E in osteoarthritis. METHODS: An osteoarthritis model was created by anterior cruciate ligament transection and medial menisectomy in knees of 28 rats. The rats were randomized into four groups; first group served as a control group and received intra-articular injections of saline solution, intra-articular HA, intra-articular tenoxicam and intra-articular Vit E were applied to the treatment groups. First intra-articular injections were applied at second week postoperatively and repeated once a week for 5 weeks. At 8th week after the operation groups were compared based on the histologic scores of cartilage degeneration by Mankin Histological Grading Scale. RESULTS: Total cartilage degeneration score was significantly increased in the control group (P=0.004). Total Mankin scores of HA, tenoxicam and Vit E groups were significantly lower than the control group (P=0.004, P=0.016, P=0.012 respectively). There was no statistically siginificant difference between the treatment groups in terms of total Mankin scores (P>0.05). CONCLUSION: Intra-articular application of HA, tenoxicam and Vit E are chondroprotective in early osteoarthritis model in rats. Chondroprotective activity of tenoxicam and Vit E are comparable with the beneficial effects of HA on articular cartilage.