Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years.

PURPOSE: The purpose was to report detailed patient-reported outcome measures (PROMs) and satisfaction rates for computed tomography (CT)-based custom TKA at minimum follow-up of 2 years. The hypothesis was that custom TKA combined with 'personalised alignment' would yield equivalent or better PROMs compared to values reported in systematic reviews and meta-analyses on off-the-shelf (OTS) TKA. METHODS: Of an initial cohort of 150 custom TKAs, four died (unrelated to surgery), one required a revision, and five refused participation, leaving 140 patients for analysis. Patients completed pre- and post-operative PROMs (Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster osteoarthritis index (WOMAC)) as well as overall level of satisfaction. Proportions that attained a patient acceptable symptom state (PASS) were calculated for OKS and FJS. Clinical findings were compared to the average scores reported for PROMs in recent systematic reviews and/or meta-analyses on OTS TKA. Descriptive statistics were used to summarise the clinical findings as means, standard deviations (SD) and ranges, or numbers and percentages. RESULTS: At mean follow-up 33.5 ± 4.5 months, 94% (135/143) were either satisfied or very satisfied. Proportions that achieved PASS were 89% for OKS (120/135), and 85% for FJS (118/139). Median OKS, WOMAC and KOOS Symptoms and Pain scores were all within the 4th quartile of medians reported in systematic reviews and/or meta-analyses. CONCLUSIONS: At a minimum follow-up of two years following custom TKA combined with 'personalised alignment', 94% of patients were either satisfied or very satisfied, and the PASS criteria were achieved in 89% for OKS and 85% for FJS, all of which compare favourably to published outcomes of OTS TKA. Direct comparisons to the literature may not be appropriate, however, considering the heterogeneity of patient demographics and alignment techniques. Randomised controlled trials with sufficient statistical power are needed to corroborate these findings and generalise them to unselected TKA patients. LEVEL OF EVIDENCE: IV, retrospective cohort study.

Sagittal femoral condylar shape varies along a continuum from spherical to ovoid: a systematic review and meta-analysis.

INTRODUCTION: Considerable anatomic variations of sagittal femoral condylar shape have been reported, with a continuum between spherical (or single-radius) and ovoid (or multi-radius) condyles. The purpose of this systematic review and meta-analysis was to critically appraise and synthesise the available literature on the sagittal femoral profile. The hypothesis was that studies would reveal considerable variability among individuals, but also in their methodology to quantify sagittal profiles. METHODS: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. On 10 September 2021 two authors searched for Level I to IV studies that reported on the sagittal curvature of the medial and/or lateral femoral condyles using the MEDLINE®, EMBASE® and Cochrane Library. Results were summarised by tabulating means, standard deviations and/or ranges for the reported radii-of-curvature, or ellipsoidal semi-major and semi-minor lengths of the condyles. To quantify sagittal 'ovoidicity' and asymmetry, results were stratified according to coordinate reference frame (posterior condylar axis (PCA), clinical and surgical transepicondylar axis (cTEA and sTEA), unified sagittal plane (USP), or unclear) and summarised in forest plots as standardised mean differences (SMD). RESULTS: Thirty-eight articles were eligible for full text extraction, quantifying sagittal radii-of-curvature by best-fit circles (BFC), ellipsoids, polynomials, spherical or cylindrical fitting. Studies with clear definition of the measurement plane revealed that both condyles were generally ovoid, with considerably greater 'ovoidicity' at the medial condyle (SMD, 4.09) versus the lateral condyle (SMD, 3.33). In addition, distal condylar radii were greater medially when measured normal to the TEA (cTEA: SMD, 0.81; sTEA: SMD, 0.79), but greater laterally when measured in a USP (SMD, - 0.83). Posterior condylar radii were greater laterally when measured in a USP (SMD, - 0.60). CONCLUSION: Studies reported considerable variability of sagittal femoral condylar radii-of-curvature, which are not incremental, but rather a continuum that ranges from spherical to ovoid. Although this variation could be accommodated by single-, dual- and multi-radii femoral components, a surgeon typically uses only one or two TKA designs. Hence, there is a risk of mismatch between the native and prosthetic sagittal profile that could result in mid-flexion ligament imbalance unless other parameters are changed. These findings support the drive towards patient-specific implants to potentially achieve accurate sagittal bone-implant fit through implant customisation. LEVEL OF EVIDENCE: IV.

Midterm outcome after AC Tightrope fixation.

The purpose of our study was to evaluate the clinical and radiological outcome after a single AC TightRope® fixation in patients with an acute Rockwood type III-VI AC joint dislocation. We performed a retrospective cohort study of patients who underwent AC TightRope® fixation for an acute Rockwood type III-VI AC joint dislocation. During follow-up functional outcome was assessed using the Constant Murley Score (CS) and the UCLA Shoulder Rating Scale. A standard anteroposterior x-ray of both the operated and the contralateral shoulder was performed. The coracoclavicular (CC) distance was measured and compared with the day 1 postoperative x-ray. Twenty-nine patients participated the study. Mean follow-up time after surgery was 43,4 months. Clinically the results were excellent : The mean CS was 91, the mean UCLA score was 33. Radiologically a mean loss of reduction of 3.2mm was seen. Following radiological findings were seen : Clavicular tunnel widening, coracoclavicular calcifications, and osteolysis at the clavicular button site. Patients treated with a mini-open single AC TightRope® fixation had excellent midterm functional outcomes.

Spontaneous swelling of the ankle in a child : a difficult diagnosis.

The authors present a case of monoarticular localized pigmented villonodular synovitis (PVNS) in a 7-year old girl. PVNS is a rare benign disease of the synovial tissue. It is especially rare in ankles of children, with only 15 cases reported in literature. The girl presented with swelling and pain in the left ankle since 4 weeks. The tentative diagnosis was made after a joint puncture and a MRI scan. A synovial mass with a brown-yellowish appearance was seen during the excisional biopsy. After removing the entire mass and without adjuvant therapy, no recurrence was detected after 12 months. As it is very rare in children, PVNS is easily misdiagnosed. Early diagnosis is important to prevent bone and cartilage damage. A review of the clinical, radiological and therapeutical features of PVNS are presented.

Comparative study of innovative postoperative wound dressings after total knee arthroplasty.

PURPOSE: Postoperative wound complications, especially surgical site infections, influence the outcome after total knee arthroplasty. The purpose of our study was to compare four different wound dressings. Following research questions were asked : (1) Which dressing is associated with least wound complications? (2) Which dressing application is the cheapest? (3) Which dressing is most comfortable for the patient? METHODS: 111 patients undergoing a total knee arthroplasty were randomized in 4 groups. Each group received a different dressing with its specific wound management protocol : (1) Zetuvit® with Cosmopor E®, (2) Zetuvit® with Opsite Post-Op Visible®, (3) Aquacel Surgical® and (4) Mepilex Border®. Follow-up evaluations were performed on the fifth postoperative day and included assessment of the wound, status of the wound dressing and the patient's own judgment. Cumulative costs were calculated. RESULTS: Clinically Mepilex Border®, a silicone dressing, scored the best. No wound complications were seen in this group. The mean number of dressing renewals was 1.9 for the standard dressing which was significantly higher (p<.0001) compared to the other dressings. Opsite Post-op Visible® was the cheapest dressing. Mepilex Border® had the best scores for pain, freedom of movement and general comfort. CONCLUSIONS: Mepilex Border® is the most skin-friendly dressing. The number of dressing renewals is a defining factor to calculate the costs. Mepilex Border® appeared to be the best dressing to use after a total knee arthroplasty.

Patient-specific assessment of dysmorphism of the femoral head-neck junction: a statistical shape model approach.

BACKGROUND: Objective quantification of anatomical variations about the femur head-neck junction in pre-operative planning for surgical intervention in femoro-acetabular impingement is problematic, as no clear definition of average normal anatomy for a specific subject exists. METHODS: We have defined the normal-equivalent of a subject's anatomy by using a statistical shape model and geometric shape optimization for finding correspondences, while excluding the femoral head-neck junction during the fitting procedure. The presented technique was evaluated on a cohort of 20 patients. RESULTS: Difference in α-angle measurement between the actual morphology and the predicted normal-equivalent, averaged 1.3° (SD 1.7°) in the control group versus 8° (SD 7.3°) in the patient group (p < 0.05). CONCLUSIONS: Defining normal equivalent anatomy is effective in quantifying anatomical dysmorphism of the femoral head-neck junction and as such can improve presurgical analysis of patients diagnosed with femoro-acetabular impingement. Copyright © 2016 John Wiley & Sons, Ltd.