Patellofemoral Arthroplasty for Irreducible Chronic Bilateral Patella Dislocation-A Case Report.

Introduction: Patellofemoral joint arthroplasty (PFJA) is mainly used to treat older patients suffering from osteoarthritis. However, this case report sheds light on the implications of this treatment for young patients suffering from patellar maltracking and secondary patellofemoral osteoarthritis (PFOA). Case Report: A female patient in her late 3rd decade of life presented with long-standing bilateral knee pain and significant functional impairment, including difficulty walking and stair climbing. She also expressed concern as a young female about her walking esthetics. Medical records indicated she underwent bilateral MPFL reconstruction in both knees simultaneously when she was 8 years old. Imaging studies revealed a bilateral complete patellar dislocation accompanied by bilateral patellofemoral joint osteoarthritis worse in the right knee. Various conservative treatment attempts were made with no or minimal relief. Consequently, bilateral PFJA was conducted, resulting in an overall transformational improvement in life quality at 39 months of follow-up on the right knee and 7 months of follow-up on the left knee. Conclusion: PFJA is extremely beneficial for treating young patients suffering from patellar maltracking and patellofemoral arthritis. This is an original case report of interest to orthopedic surgery. Not only does PFJA treat osteoarthritis, but it also improves patellar tracking and may even decrease the progression of tibiofemoral osteoarthritis.

Surgical Correction of Non-traumatic Patella Maltracking. Midterm Clinical Follow-up.

BACKGROUND: Patellar instability comprises a group of pathologies that allow the patella to move out of its trajectory within the trochlear groove during walking. Symptomatic patients who need surgery commonly undergo soft tissue procedures such as medial patellofemoral ligament repair to strengthen the ligaments that hold the patella in place. However, soft-tissue repairs may be insufficient in patients suffering from patellar maltracking, which is characterized by an unbalanced gliding of the patella within its route. In these patients, a different approach is advised. We aim to provide the mid-term clinical outcomes of the Fulkerson distal realignment operation in selected patients with non-traumatic patellar maltracking. METHODS: The clinical outcomes of the Fulkerson distal realignment operation performed in 22 knees of 21 patients were evaluated by a self-administered subjective International Knee Documentation Committee (IKDC) score and the Tegner-Lysholm knee scoring scale. RESULTS: Before surgery, the median IKDC score was 52, and the median Tegner-Lysholm score was 56. Following surgery (mean follow-up 48 months, range 24-156), the median IKDC and the Tegner-Lysholm scores were 67 and 88, respectively. The improvement was statistically significant (P=0.001 and P=0.002 for IKDC and Tegner-Lysholm scores, respectively). Associated procedures included patella microfracture due to grade III-IV cartilage lesion (International Cartilage Repair Society grading system) in four patients, retinacular releases in three patients, medial capsular augmentations in two patients, and medial patellofemoral ligament reconstruction in two patients. One patient with Ehlers-Danlos disease required excessive medialization of the tibial tuberosity. Surgery-related complications occurred in three patients. DISCUSSION: Surgical correction of patellar maltracking with Fulkerson distal realignment combined with associated procedures in individual patients was associated with an increase in subjective and functional clinical scores at medium-term follow-up. Particular attention should address pathologies associated with patellar maltracking and managed accordingly. LEVEL OF EVIDENCE: 4c (case series).

Multiple trauma-induced, secondary osteoarthritis, knee Arthroplasty and technology: Conventional approach to an unconventional scenario.

A 49-year-old man was involved in a high-energy motor vehicle accident. Haemodynamic instability with multiple long bone fractures of lower limbs was the hallmarks of the injury. Closed fragmented fracture of left femur shaft and open displaced supracondylar fracture of the contralateral femur. Closed comminuted high-grade fracture of the Tibia plateau (Schatzker VI) was diagnosed bilaterally. 'Orthopaedic damage control' was initiated with bilateral 'cross knee' external fixation, followed by conversion to open reduction internal fixation of all fracture sits at 8 days later. The patient underwent nine subsequent hospitalisations, of which eight involved operative treatment. The interval from admission to last documented surgery was 7 years. The endpoint was total knee arthroplasty (TKA) with mega prosthesis of the left knee and a primary-type TKA in the right knee. Both arthroplasties were non-assisted, conventional procedures. Postoperative Western Onterio and McMaster Universities Arthritis Index (WOMAC) score was 85 at 9-year follow-up from the injury incurred.

[TOTAL KNEE REPLACEMENT WITH PATIENT SPECIFIC INSTRUMENT IN PATIENTS WITH SECONDARY OSTEOARTHRITIS].

INTRODUCTION: Total knee arthroplasty is the most prevalent operation with a high success rate in the treatment of primary osteoarthritis. However, patients with complex secondary osteoarthritis remained marginalized to the surgical response or otherwise exposed to high risk conventional surgery. Early decades of life, surgical history, technical complexity, high surgical morbidity, variability of pathology and anatomy and poor clinical outcome are a few of the reasons. The assimilation of modern technology shifted the concept and practice in the field of arthroplasty, opening a window of treatment opportunities for patients with secondary osteoarthritis with patient specific implants (PSI). AIMS: Evaluate safety, efficacy and applicability limitations of PSI as an alternative to conventional total knee arthroplasty in complex clinical settings. Furthermore, the study aimed to conduct assessments of clinical outcome and technical aspects. METHODS: This was a prospective cohort clinical study, based on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire pre and post-operative. The study was conducted through a structured analysis of parameters characterizing patients who are candidates for treatment with PSI, highlighting technical points. RESULTS: A curve of 31point improvement (p=0.021) in the WOMAC score at minimum 12 month follow up was observed. There was demonstration of the specific elements required for balancing lower limb axis deformity and previous metal retaining situations. CONCLUSIONS: PSI technology offers a reduction of surgical complexity, morbidity and complication potential with significant improvement in clinical outcome, in patients with secondary osteoarthritis associated with extra articular deformities, presence of hardware, and in musculoskeletal rare diseases. DISCUSSION: A first time presentation of focused, isolated and specified characteristics of a patient population with secondary osteoarthritis where PSI establishes a step forward in the treatment and outcome of patients with complex clinical presentation.

Knee arthroplasty with hardware removal: complication cascade. Is it preventable?

An elderly woman underwent hardware removal and total joint replacement (TJR) of her right knee. Ipsilateral total tip replacement was performed 7 years earlier, and 12 months later, a supracondylar fracture of the index femur was successfully treated by open reduction internal fixation (ORIF) of the distal femur with a locking compression plate condylar plate. Hardware removal attempt, prior to the arthroplasty, resulted in fracture of the distal femur. Total knee replacement (TKR) was commenced with temporary reduction and final stabilisation of the femur fracture with a condylar plate. Postoperatively, non-union of the femur fracture developed twice with fatigue failure of the plate fixation device in both instances. Refixation of the femur was performed on both occasions and additional bone healing augmentation measures were performed for each subsequent surgery. Femur union was achieved fourteen months after the last surgery.

Assessment of cartilage repair after chondrocyte transplantation with a fibrin-hyaluronan matrix--correlation of morphological MRI, biochemical T2 mapping and clinical outcome.

OBJECTIVE: To evaluate change over time of clinical scores, morphological MRI of cartilage appearance and quantitative T2 values after implantation with BioCart™II, a second generation matrix-assisted implantation system. METHODS: Thirty-one patients were recruited 6-49 months post surgery for cartilage defect in the femoral condyle. Subjects underwent MRI (morphological and T2-mapping sequences) and completed the International Knee Documentation Committee (IKDC) questionnaire. MRI scans were scored using the MR Observation of Cartilage Repair Tissue (MOCART) system and cartilage T2-mapping values were registered. Analysis included correlation of IKDC scores, MOCART and T2 evaluation with each other, with implant age and with previous surgical intervention history. RESULTS: IKDC score significantly correlated with MOCART score (r = -0.39, p = 0.031), inversely correlated with previous interventions (r = -0.39, p = 0.034) and was significantly higher in patients with longer follow-up time (p = 0.0028). MOCART score was slight, but not significantly higher in patients with longer term implants (p = 0.199). T2 values were significantly lower in patients with longer duration implants (p < 0.001). This trend was repeated in patients with previous interventions, although to a lesser extent. CONCLUSIONS: Significant improvement with time from BioCart™II implantation can be expected by IKDC scoring and MRI T2-mapping values. Patients with previous knee operations can also benefit from this procedure.