Comparison between results of high tibial osteotomy above and below tibial tubercle in relation to future total knee arthroplasty.

This prospective study included 50 patients with medial compartment osteoarthritis and varus knees. Twenty-five patients had high tibial closed wedge osteotomy above the tibial tubercle (TT) (group I), and the other 25 had the osteotomy just below it (group II). The two groups were matched. The osteotomies in both groups were fixed with plates and screws. All patients were followed up radiographically and clinically for more than 12 months. Clinical and radiographic results of both groups are comparable. Regarding factors that will affect future knee arthroplasty (TKA), osteotomies below TT are more advantageous. That is because soft tissues and bony changes of the knees in group II are minimal, and the issue of slower union rates can be diminished by using rigid plate fixation.

Impaction bone grafting for contained acetabular defects in total hip arthroplasty.

BACKGROUND: Acetabular bone loss is a technical challenge in total hip arthroplasty (THA). This study sought to report the functional and radiological results of acetabular reconstruction using impaction bone grafting (IBG) in patients with acetabular bone deficiency undergoing primary or revision THA. METHODS: In this prospective study, full history taking, preoperative clinical and radiological evaluation, and preoperative planning and templating were performed. The Paprosky classification and the American Academy of Orthopaedic Surgeons classification were used to assess the acetabular deficiencies. Clinical outcomes were assessed utilizing the Harris hip score (HHS) and a 4-question satisfaction questionnaire. Graft incorporation was evaluated in the last follow-up X-rays. RESULTS: This study included 50 patients with a mean age of 46.7 ± 15.3 years. The THA was primary in 14 (28%) patients and revision in 36 (72%) patients. The mean HHS improved significantly from 28.8 ± 24.1 preoperatively to 76.6 ± 6.1, with a mean follow-up period of 23 months. Overall, 88% of patients were very satisfied. Complete radiological graft incorporation to host bone was achieved in 35 (70%) patients, and the remaining patients had partial incorporation. Complete graft incorporation was associated more frequently with primary THA, autografts, cementless cups, decreased defect size, and decreased graft layer thickness. CONCLUSIONS: IBG for acetabular reconstruction in THA can achieve excellent clinical and radiological outcomes with a low complication rate. LEVEL OF EVIDENCE: Level IV.

Revision of failed hip hemiarthroplasty. Classification, management, and follow-up.

BACKGROUND: Many types of failed hemiarthroplasties have been reported, but there is no classification of these failures. PATIENTS AND METHODS: Revisions of 217 cases of failed hemiarthroplasty were studied with an average follow-up of 6.2 years. Classification system based on site of problem, mode of failure, and type of revision, was introduced. RESULTS: In most cases, the intra-operative assessment of failure correlated with the preoperative classification (99%). At the last follow-up, there were 15/217 re-revisions; giving a success rate of 93%. CONCLUSION: This classification helps in choosing the appropriate revision method, leading to acceptable results.