Medial tibial bone resorption following total knee arthroplasty comparing a traditional with a kinematic design.

BACKGROUND: New total knee prostheses are being designed to improve clinical outcome, survivorship and patient satisfaction following total knee arthroplasty (TKA). A new knee system was developed with improvements in patellofemoral joint, trochlear geometry, polyethylene formulation and tibial baseplate. Aim of this study was to compare the newer kinematic knee system with its existing predecessor knee system in terms of clinical outcome, revision rates, radiographic outcomes specifically medial tibial bone resorption. METHODS: The prospective matched-pair study included 88 TKA surgeries using newer kinematic design knee prostheses, performed between January 2015 and December 2016, out of which 82 patients were available for final follow-up. The control cohort of 82 traditional TKA prosthesis was matched in terms of age, gender and body mass index. All surgeries were performed by the single surgeon using medial parapatellar arthrotomy and posterior stabilized implants were used. Clinical outcomes were assessed using knee society score, range of motion (ROM), anterior knee pain and crepitation. Radiological examinations included recording of radiolucent lines and medial tibial bone resorption. RESULTS: At the 5-year follow-up, no significant differences were noted in terms of mean knee society score (93.3 ± 6.6 vs 94.2 ± 8.1), knee function score (88.5 ± 10.5 vs 89.1 ± 11.2) and ROM. The incidences of anterior knee pain and crepitation were lower in the newer group (8.5% vs 21.9% and 14.6% vs 32.9%, respectively) compared to the traditional prosthesis group. No cases of aseptic loosening were observed in either cohort. No significant difference was seen in terms of radiolucent lines (29.3% vs 26.8%) and medial tibial resorption (2.43% in each group) incidences. CONCLUSIONS: At the 5 years follow-up no significant differences were noted between the two groups in terms of clinical and radiological outcomes, except the former proved to be better for anterior knee pain and crepitation. LEVEL OF EVIDENCE: II.

Unusual Presentation of Aggressive Hemangioma of Thoracic Vertebrae-A Case Report.

Introduction: Hemangioma is most common lesion frequently encountered in dorsolumbar region. Although most of these lesions are asymptomatic and are incidental findings on imaging such as computed tomography (CT)-scan and magnetic resonance imaging (MRI). Case Report: A 24-year-old young male presenting to orthopedic outdoor with complaint of severe mid backache and lower limb paraparesis which developed after trivial trauma and increases with daily routine activities such as sitting, standing, and postural changes. For these lesion, "Enneking staging" was used. Conclusion: In such unusual cases, it is very important to differentiate these lesions from vertebral body metastasis, pott's spine, or aggressive bone tumors to reduce intraoperative or post-operative complications.

Ganglionic Cyst of Periosteal Origin Mimicking as Pes Anserine Bursitis - A Rare Entity and Literature Review.

Introduction: Periosteal ganglion is a form of cystic swelling commonly seen around long bones of lower extremities. Case Report: A 55-year-old male presented to outdoor clinic with gradually increasing swelling around anteromedial aspect of the right knee joint with intermittent pain on prolonged standing and walking for 8 months. Magnetic resonance imaging was suggestive of ganglionic cyst which was confirmed later by histopathological examination. Conclusion: Ganglionic cyst of periosteal origin is a rare entity. Complete excision is the recommended treatment option; if not performed appropriately chances of recurrence are high.

Synovial Hemangioma Presenting as Anterior Knee Pain - A Case Series.

Introduction: Synovial hemangioma is a benign soft-tissue tumor of vascular origin. The knee joint is most common joint affected and with highest incidence noted till date. For diagnosis, of such rare presentation radiological investigations such as digital radiograph and magnetic resonance imaging are of utmost importance, and magnetic resonance imaging being considered as investigation of choice. The gold standard treatment being complete excision of the growth. Case 1: A 13-year-old boy presented in out-patient clinic with chief complaint of right sided anterior knee pain since 10 months and patient had history of trauma in past. Magnetic resonance imaging of knee joint showed well circumscribed lesion in infra-patellar area (Hoffa's fat pad), with internal septations present within lesion. Case 2: A 25-year-old female presented to out-patient clinic with chief complaint of left sided anterior knee pain since 2 year, with no history of prior injury. The magnetic resonance imaging of knee joint showed ill-defined lesion around anterior patella-femoral articulation adherent to quadriceps tendon, internal septations present within lesion. For both cases, en bloc excision was performed and good functional outcome was achieved. Conclusion: Knee joint synovial hemangioma is rare presentation to orthopedic outdoors, has slight female predominance with pre-existing history of trauma. In the present study, both cases were of patella-femoral type (anterior and infra-patellar fat pad). For such lesions, en bloc excision is gold standard procedure to prevent recurrence, same procedure was followed in our study, and good functional outcome was achieved.

An unusual presentation of mycetoma around knee joint as a subcutaneous mass - A case report.

Introduction: Mycetoma is a form of chronic granulomatous disease which involves subcutaneous tissues and causes bone destruction in advanced stages. The characteristic features are sinus formation, granules formation, and mass in subcutaneous region. Case Report: A 19-year-old male presented to our out-patient clinic with complaint of a painless swelling around the medial aspect of the right knee joint for 8 months with no sinus or discharge of granules. Pes anserinus bursitis was thought of as differential diagnosis for the present condition. "Staging-classification of mycetoma" is commonly used for classifying mycetoma and as per classification, the present case had Stage-A. Conclusion: Single-stage local excision was performed and supplemented with anti-fungal agent for 6 months, which showed good outcome at the final follow-up of 13 months.

Mycetoma Presenting as Knee Swelling - "A Rare Entity".

Introduction: It is a form of chronic granulomatous infection involving skin, subcutaneous tissue, and skeletal system. The authors report a case of mycetoma presenting as knee swelling. Case Report: A 25-year-old male presented to outdoor with painless swelling around medial aspect of the right knee joint with intermittent discharge of black granules from sinus since 6 months. The patient reported for mycetoma around knee joint belongs to Stage-B as per "Staging-classification of mycetoma." Conclusion: Knee mycetoma is a very rare presentation. Wide surgical excision and medical treatment are considered as gold standard.