Cementless revision TKA with bone grafting of osseous defects restores bone stock with a low revision rate at 4 to 10 years.

BACKGROUND: Addressing bone loss in revision TKA is challenging despite the array of options to reconstruct the deficient bone. Biologic reconstruction using morselized loosely-packed bone graft potentially allows for augmentation of residual bone stock while offering physiologic load transfer. However it is unclear whether the reconstructions are durable. QUESTIONS/PURPOSES: We therefore sought to determine (1) survivorship and complications, (2) function, and (3) radiographic findings of cementless revision TKA in combination with loosely-packed morselized bone graft to reconstruct osseous defects at revision TKA. PATIENTS AND METHODS: We retrospectively reviewed 56 patients who had undergone revision TKAs using cementless long-stemmed components in combination with morselized loose bone graft at our institution. There were 26 men and 30 women with a mean age of 68.3 years (range, 56-89 years). Patients were followed to assess symptoms and function and to detect radiographic loosening, component migration, and graft incorporation. The minimum followup was 4 years (mean, 7.3 years; range, 4-10 years). RESULTS: Cumulative prosthesis survival, with revision as an end point, was 98% at 10 years. The mean Oxford Knee Scores improved from 21 (36%) preoperatively to 41 (68%) at final followup. Five patients (9%) had reoperations for complications. CONCLUSIONS: Our observations suggest this technique is reproducible and obviates the need for excessive bone resection, use of large metal augments, mass allografts, or custom prostheses. It allows for bone stock to be reconstructed reliably with durable midterm component fixation. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

An 8- to 10-year review of the Rotaglide total knee replacement.

Mobile-bearing knee arthroplasty (MBKA) is an alternative to fixed-bearing knee arthroplasty. This was a retrospective study of the Rotaglide Total Knee System. We present the results of the monitoring of 77 patients (85 knees) with a median duration to failure or end of follow up of 8.5 years (range 0.4 to 10.1 years). Patients were clinically and radiologically assessed at dedicated follow up clinics. The Hospital for Special Surgery (HSS) and Knee Society Score (KSS) systems were used to describe the clinical and radiological findings. The prosthesis had an estimated survival probability of 93.5% (standard error 3.4%) at 9 years. It is associated with good rates of patient satisfaction and high scores on the HSS and KSS systems. No knees were revised for aseptic loosening. This knee replacement has a survival rate equivalent to other prostheses. It is a safe and reliable prosthesis associated with good clinical outcome.

An unexpected complication of DVT prophylaxis.

We report a case in which a complication of routine chemoprophylaxis with subcutaneous low-molecular-weight heparin led to the postponement of a total hip replacement. This unusual reaction reinforces the current debate regarding the use of chemoprophylaxis for joint replacement surgery.

Closing the audit circle: effect of continuing audit on arthroscopic practice.

A prospective study in a single orthopaedic unit for one calendar year was carried out to examine the effect of continuing audit on arthroscopic practice. A standard proforma was introduced to record information and results were analysed using a system of audit codes. Two audit periods were examined, the first 3 months and the subsequent 9 months. Results after audit of the first period were compared with the second period; diagnostic accuracy and clarity had improved as had the accuracy of audit coding. The subset of patients with a preoperative diagnosis of a meniscal tear was analysed and the diagnostic accuracy for this group improved over the year. We found that the Audit Circle had been closed in the areas of diagnostic clarity, diagnostic accuracy of meniscal tears and the accuracy of audit coding.

Anti-inflammatory drug therapy after arthroscopy of the knee. A prospective, randomised, controlled trial of diclofenac or physiotherapy.

We report a prospective, randomised, controlled trial of the effect of either a non-steroidal anti-inflammatory drug (diclofenac sodium) or physiotherapy on the recovery of knee function after arthroscopy. At 42 days after surgery there was no significant benefit from either form of postoperative treatment compared with the control group. Complications attributable to the anti-inflammatory drug occurred in 9.6% of the patients so treated. Neither the routine administration of a non-steroidal anti-inflammatory agent nor routine physiotherapy is justified after arthroscopy of the knee.