Mid-Term Survival of Total Knee Arthroplasty in Patients with Posttraumatic Osteoarthritis.

PURPOSE OF THE STUDY There is limited evidence on survival and complication rates in patients after total knee arthroplasty for posttraumatic osteoarthritis. The failure mechanisms leading to revision remain an issue of constant debate. The purpose of this study was to analyze the mid-term survival of primary total knee arthroplasties as well as to evaluate complications and failure mechanisms in patients with posttraumatic knee osteoarthritis. MATERIAL AND METHODS This retrospective study included 79 patients with an average age of 59 years at the time of primary total knee arthroplasty. A functional and radiographic assessment was obtained during outpatient clinical follow-up at 3 and 12 months postoperatively and yearly intervals after that. Survival rates were calculated using Kaplan-Meier analyses. The mean postoperative follow-up was 69 months. RESULTS At 69 month the revision-free survival rate was 88.6%. In nine cases (11.4%) a revision procedure was performed. The leading cause of revision was a periprosthetic infection (n = 6, 66.6%). An age of fewer than 55 years at the time of total knee arthroplasty had a significant influence on implant survival (p = 0.018) with superior survival in favor of the older patient population. At most recent follow-up, a mean Knee Society Score of 82 points and an average Function Score of 77 points were observed. CONCLUSIONS Periprosthetic joint infection is the primary failure mechanism leading to a revision in patients with total knee arthroplasty for posttraumatic osteoarthritis. Apart from the increased infection rate, total knee arthroplasties in patients with posttraumatic osteoarthritis revealed results that were comparable to patients with primary osteoarthritis. Key words:posttraumatic knee osteoarthritis, total knee replacement, survival, complications, revision, outcome.

[Surgical hip dislocation : Current status in the treatment of femoral acetabular impingement]. / Die chirurgische Hüftluxation : Derzeitiger Stellenwert in der Therapie des femoroazetabulären Impingements.

INTRODUCTION: Surgical hip dislocation (SHD) in the therapy of femoral acetabular impingement (FAI) has been mostly replaced by minimally invasive techniques. Nevertheless, in the circumstances of complex FAI types and combined impingement located in inaccessible areas of the hip, SHD is an option to reach those deformities. The advantage of the complete overview of the hip joint enables the circumferential therapy of bony deformity, but at the expense of higher invasivity. In the literature there is still a lack of mid to long-term studies of SHD to determine the overall treatment outcome. Therefore, the aim of this study is to evaluate the treatment outcome, risks and complications of SHD in FAI therapy within a mid-term follow-up. METHODS: A total of 43 patients (mean follow-up 54 months.) with combined ventral and dorsal impingement who undertook SHD were retrospectively reviewed. Outcome parameters were range of motion (ROM), the Harris hip score (HHS), the hip outcome score (HOS), the activity level, pain, complications, conversion to total hip arthroplasty (THA) and patient specific surveys. Additionally, radiographs and the influence of preoperative osteoarthrosis were evaluated. RESULTS: We were able to demonstrate a significant increase of ROM, HHS (69 â†’ 80 Pkt.; p < 0.05), hip function and a decrease in pain level. The return to sport rate was 81%, but in most cases the patients had to reduce the intensity or change to a low impact sport activity. Overall, 75% were satisfied with the treatment outcome. The alpha angle improved from 70 to 45° (p < 0.05). Patients with preoperatively advanced hip osteoarthrosis showed no decent improvement of hip function. Conversion to THA was necessary in 36% of cases. The complication rate was about 13%. CONCLUSION: SHD is successful in the treatment of combined ventral and dorsal impingement within a mid-term follow-up. The improvement of hip function and the reduction of pain symptoms is possible. In case of a manifest arthrosis an indication for SHD is no longer reasonable.

Comprehensive visualization of multimodal cardiac imaging data for assessment of coronary artery disease: first clinical results of the SMARTVis tool.

PURPOSE: In clinical practice, both coronary anatomy and myocardial perfusion information are needed to assess coronary artery disease (CAD). The extent and severity of coronary stenoses can be determined using computed tomography coronary angiography (CTCA); the presence and amount of ischemia can be identified using myocardial perfusion imaging, such as perfusion magnetic resonance imaging (PMR). To determine which specific stenosis is associated with which ischemic region, experts use assumptions on coronary perfusion territories. Due to the high variability between patient's coronary artery anatomies, as well as the uncertain relation between perfusion territories and supplying coronary arteries, patient-specific systems are needed. MATERIAL AND METHODS: We present a patient-specific visualization system, called Synchronized Multimodal heART Visualization (SMARTVis), for relating coronary stenoses and perfusion deficits derived from CTCA and PMR, respectively. The system consists of the following comprehensive components: (1) two or three-dimensional fusion of anatomical and functional information, (2) automatic detection and ranking of coronary stenoses, (3) estimation of patient-specific coronary perfusion territories. RESULTS: The potential benefits of the SMARTVis tool in assessing CAD were investigated through a case-study evaluation (conventional vs. SMARTVis tool): two experts analyzed four cases of patients with suspected multivessel coronary artery disease. When using the SMARTVis tool, a more reliable estimation of the relation between perfusion deficits and stenoses led to a more accurate diagnosis, as well as a better interobserver diagnosis agreement. CONCLUSION: The SMARTVis comprehensive visualization system can be effectively used to assess disease status in multivessel CAD patients, offering valuable new options for the diagnosis and management of these patients.

Cardiac magnetic resonance imaging in stable ischaemic heart disease.

Cardiac magnetic resonance imaging (CMR) is a new robust versatile non-invasive imaging technique that can detect global and regional myocardial dysfunction, presence of myocardial ischaemia and myocardial scar tissue in one imaging session without radiation, with superb spatial and temporal resolution, inherited three-dimensional data collection and with relatively safe contrast material. The reproducibility of CMR is high which makes it possible to use this technique for serial assessment to evaluate the effect of revascularisation therapy in patients with ischaemic heart disease.

Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results.

OBJECTIVE: High tibial osteotomy (HTO) for the treatment of unicompartmental knee osteoarthritis in the presence of axial malalignment is recognized as an effective treatment for young and active patients. The aim of this study was to identify HTO prognostic factors. METHODS: A total of 94 patients who had undergone HTO with additive arthroscopy were scored using the "knee injury and osteoarthritis outcome score" (KOOS). A KOOS of less than 114 points was judged as a poor outcome. RESULTS: A total of 84 patients were available for follow-up after a time-interval of 45.9+/-7.6 (range 34-60) months. The KOOS increased from 46.1+/-11.1 to 120.3+/-40.8. The preoperative varus angle in all patients was 7.5 degrees +/-1.9 (range 5-14 degrees ). In follow-up the patients had a mean valgus angle of 3.7 degrees +/-2.5. Twenty-three patients (27.4%) had suffered a loss of correction (0.8 degrees , range 0-2 degrees ). A loss of correction correlated with a minor result in tendency. A total of 25 patients (29.8%) had a poor KOOS. Factors associated with a poor HTO outcome were a patient history of more than 24 months, a preoperative KOOS>50 points, obesity, and smoking. However, the results were also influenced by radiological findings, such as medial tibial exophyte, a medial joint space width of less than 5mm, and intraarticular damage, such as a degree IV cartilage defect of the tibia. Gender was also a minor prognostic factor. Patient's age and the event of prior surgery did not influence the outcome. CONCLUSION: This study identified relevant factors that significantly influenced HTO results. It was possible to create a "predictive score" for HTO patients. Patients with more than 4 of the poor prognostic factors should chose primary arthroplasty.