Long-Term Outcomes of High-Flexion Design Total Knee Arthroplasty with a Short Posterior Flange.

Background: The purpose of this study was to evaluate the clinical and radiological outcomes of high-flexion total knee arthroplasty (TKA) using Vega Knee System (B. Braun, Aesculap) at a long-term follow-up and to analyze the implant survivorship. Methods: We enrolled 165 patients (232 knees) with a minimum 7-year follow-up after TKA (VEGA Knee System). For clinical assessment, range of motion (ROM), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were used. For radiologic assessment, hip-knee-ankle angle, component position, and the existence of radiolucent lines and loosening were used. Survival analysis was conducted using the Kaplan-Meier method. Results: The mean follow-up period was 9.8 years. The mean ROM increased from 124.4° to 131.4° at the final follow-up. The WOMAC score decreased from 38.5 to 17.4 at the final follow-up (p < 0.001). All 5 subscales of the KOOS improved at the final follow-up (all subscales, p < 0.001). Revision TKA was performed in 10 cases (4.3%), which included 9 cases of aseptic loosing and 1 case of periprostatic joint infection. Of the 9 aseptic loosening cases (3.9%), 8 cases (3.4%) were loosening of the femoral component and 1 case (0.4%) was loosening of the tibial component. When revision for any reason was considered an endpoint, the 10-year survivorship was 96.2% (95% confidence interval [CI], 93.9%-98.5%). On the other hand, when revision for aseptic loosening was considered the endpoint, the 10-year survivorship was 96.6% (95% CI, 94.4%-98.8%). Conclusions: The Vega Knee System provided good clinical results in the long-term follow-up period. Although the VEGA Knee System showed acceptable implant survivorship, loosening of the femoral component occurred in about 3.4% of the patients. For more accurate evaluation of the survivorship of high-flexion design TKA with a short posterior flange, it is necessary to conduct more long-term follow-up studies targeting diverse races, especially Asians who frequently perform high-flexion activities.

Comparison of the postoperative analgesic effect for infiltration between the popliteal artery and the capsule of the posterior knee and that of periarticular multimodal drug injection in total knee arthroplasty: retrospective study in the immediate postoperative period.

BACKGROUND: The aim of this study is to compare the postoperative analgesic effect of infiltration between the popliteal artery and the capsule of the knee (IPACK) and the effect of periarticular multimodal drug injection (PMDI) in addition to adductor canal block (ACB) after total knee arthroplasty. METHODS: Among patients who received total knee arthroplasty from June 2017 to December 2017, 50 who underwent ACB with additional IPACK and 50 who received ACB with additional PMDI were selected for this study. We compared the postoperative pain numerical rating scale (NRS), the number of times patient-controlled analgesia was administered and the amount administered, the total amount of opioids given, and complications associated with the procedure between the two groups. RESULTS: NRS measured at rest and 45° knee flexion at days 1 and 2 after surgery was significantly lower in the IPACK group than in the PMDI group. The resting NRS measured at day 3 after surgery was also significantly lower in the IPACK group than in the PMDI group, and the NRS at 45° knee flexion measured from day 3 to day 5 showed a significant reduction in the IPACK group. No complications relating to the procedure occurred. CONCLUSIONS: IPACK may be a better option than PMDI for controlling acute phase pain in patients undergoing total knee arthroplasty.

Intraoperative fluoroscopy reduces the variability in femoral tunnel placement during single-bundle anterior cruciate ligament reconstruction.

PURPOSE: To evaluate the effect of using intraoperative fluoroscopy on femoral and tibial tunnel positioning variability in single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: A total of 80 consecutive patients with single-bundle ACL reconstruction between 2014 and 2016 were retrospectively reviewed. Among them, 40 underwent ACL reconstruction without fluoroscopy (non-fluoroscopy group) and 40 underwent fluoroscopy-assisted ACL reconstruction (fluoroscopy group). Femoral and tibial tunnel locations were evaluated using a standardized grid system with three-dimensional computed tomography images. Femoral and tibial tunnel location variability was compared between the groups. RESULTS: The operation time was longer in the fluoroscopy group than in the non-fluoroscopy group (61.3 ± 5.2 min vs. 55.5 ± 4.5 min, p < 0.001). In the fluoroscopy group, a guide pin was repositioned in 16 (40%) cases on the femoral side and 2 (5%) cases on the tibial side. No significant difference in the femoral tunnel location was observed between the fluoroscopy and non-fluoroscopy groups (anterior-posterior plane, 29.0% ± 3.2% vs. 30.0% ± 6.1%; proximal-distal plane, 30.8% ± 4.8% vs. 29.4% ± 8.3%; all parameters, n.s.); variability was significantly lower in the fluoroscopy group (p < 0.001 for both anterior-posterior and proximal-distal planes). No significant difference in the tibial tunnel location and variability was observed between the fluoroscopy and non-fluoroscopy groups (medial-lateral plane, 45.8% ± 2.0% vs. 46.6% ± 2.4%; anterior-posterior plane, 31.2% ± 4.0% vs. 31.0% ± 5.4%) (all parameters, n.s.). CONCLUSIONS: Tunnel positioning with fluoroscopic assistance is feasible and effective in achieving consistency in femoral tunnel placement despite a slightly longer operation time. Intraoperative fluoroscopy can be helpful in cases wherein identifying anatomical landmarks on arthroscopy was difficult or for surgeons with less experience who performed ACL reconstruction. LEVEL OF EVIDENCE: IV.

Clinical outcomes of two-stage total knee arthroplasty using articulating cement spacer in patients with infected arthritic knee: A comparison with arthroscopic surgery.

BACKGROUND: The aim of this study was to compare the functional outcomes and recurrence rate of infection between patients who underwent arthroscopic surgery and two-stage total knee arthroplasty (TKA) for infected arthritic knees. METHODS: A retrospective analysis was conducted on 52 patients (52 knees) with advanced knee joint arthritis who underwent arthroscopic surgery or two-stage TKA using articulating cement spacer (ACS) for knee joint infection between January 2009 and November 2013. Of the 52 patients (52 knees), 38 and 14 patients underwent arthroscopic surgery (AS group) and two-stage TKA using ACS (ACS-TKA group), respectively. Patient-reported outcomes (Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQol-Visual Analog Scales (EQ-VAS)); range of motion; and recurrence rate of infection were evaluated. RESULTS: Recurrence of infection was observed in 7/38 patients who underwent arthroscopic surgery, all of whom received two-stage TKA using ACS. Regarding the functional outcomes of the ACS-TKA group obtained before conversion to TKA and those of the AS group obtained six months after arthroscopic surgery, the former group had better outcomes for KOOS pain, KOOS activities of daily living, KOOS quality of life, and EQ-VAS. Regarding the functional outcomes of the ACS-TKA group obtained during the last follow-up and after conversion to TKA and those of the AS group who underwent TKA after arthroscopic surgery, no significant between-group differences were observed. The infection recurrence rate was higher in the AS than in the ACS-TKA group. CONCLUSIONS: Considering infection control and functional outcomes, two-stage TKA using ACS can be an effective alternative treatment for patients with infected arthritic knees.

Second-look arthroscopic findings and clinical outcomes of meniscal repair with concomitant anterior cruciate ligament reconstruction: comparison of suture and meniscus fixation device.

INTRODUCTION: The purpose of this study was to evaluate the healing rate of repaired meniscus and functional outcomes of patients who received all-inside meniscal repair using sutures or devices with concomitant arthroscopic anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: Among the patients who have ACL tear and posterior horn tear of medial or lateral meniscus, 61 knees who received all-inside repair using sutures (suture group, n = 28) or meniscal fixation devices (device group, n = 33) with concomitant ACL reconstruction during the period from January 2012 to December 2015, followed by second-look arthroscopy, were retrospectively reviewed. Healing status of the repair site was assessed by second-look arthroscopy. Through the clinical assessment, clinical success (negative medial joint line tenderness, no history of locking or recurrent effusion, and negative McMurray test) rate of the repaired meniscus and functional outcomes (International Knee Documentation Committee subjective score and Lysholm knee score) was evaluated. RESULTS: In a comparison of healing status of repaired meniscus evaluated by second-look arthroscopy, suture group had 23 cases of complete healing (82.1%), 4 cases of incomplete healing (14.3%), and 1 case of failure (3.6%). Device group had 18 cases of complete healing (54.5%), 4 cases of incomplete healing (24.2%), and 7 cases of failure (21.2%) (p = 0.048). Clinical success rate of the meniscal repair was 89.3% (25 cases) and 81.8% (27 cases) in suture group and device group, respectively (p = 0.488). No significant difference of functional outcomes was observed between the two groups (p > 0.05, both parameters). CONCLUSIONS: Among the patients who received meniscal repair with concomitant ACL reconstruction, suture group showed better healing status of repaired meniscus based on the second-look arthroscopy than device group. However, no significant between-group difference of clinical success rate and functional outcomes was observed.

Long-term outcomes of unicompartmental knee arthroplasty in patients requiring high flexion: an average 10-year follow-up study.

INTRODUCTION: To evaluate the long-term survival of unicompartmental knee arthroplasty (UKA) in the Asian population and assess differences in clinical outcomes between mobile- and fixed-bearing UKA. MATERIALS AND METHODS: Among 111 cases of UKA that were performed by 1 surgeon from January 2002 to December 2009, we retrospectively reviewed 96 cases (36 mobile-bearing, 62 fixed-bearing) for this study. We examined cause of revision or failure, type of reoperation/revision, and duration from the surgery date to the revision upon reviewing the medical record. Survival analysis was conducted using the Kaplan-Meier method. Functional outcomes were evaluated based on range of motion and patient-reported outcome (PRO) measures (Knee Injury and Osteoarthritis Outcome Score) for cases with at least 8 years of follow-up (average, 10.2 years). RESULTS: Overall, the 10-year survival was 88% [95% confidence interval (CI) 0.81-0.95], and the estimated mean survival time was 13.4 years (95% CI 12.5-14.2). In a comparison of survival between the mobile- and fixed-bearing groups, the former had a 10-year survival of 85% (95% CI, 0.72-0.97) and an estimated mean survival time of 13.5 years (95% CI 12.2-14.7) and the latter had a 10-year survival of 90% (95% CI 0.82-0.99) and an estimated mean survival time of 13.4 years (95% CI 12.3-14.4). Thus, there was no significant difference in survival between the two groups (log-rank test, p = 0.718). In addition, no significant difference in functional outcomes was observed between the two groups (p > 0.05 for all). CONCLUSIONS: UKA performed in the Asian population showed a relatively good functional outcome and survival rate at an average 10-year follow-up. No difference in survival and PROs was observed according to the bearing type. Although the present study demonstrated a good survival rate, similar to that in other Western studies, further studies investigating the impact of the Asian lifestyle on the long-term survival of UKA is necessary.

Survival of total knee arthroplasty after high tibial osteotomy versus primary total knee arthroplasty: A meta-analysis.

BACKGROUND: Theoretical considerations suggest that total knee arthroplasty (TKA) is technically more challenging after high tibial osteotomy (HTO), resulting in inferior results compared to primary TKA. However, several studies on this issue have shown contradictory results. The purpose of this meta-analysis to compare survivorship and clinical outcomes between TKA with and without previous HTO. METHODS: We reviewed studies that evaluated pain and function scores, range of motion (ROM), operation time, Insall-Salvati (IS) ratio, complications, and survival rates in patients treated with TKA with previous HTO or with primary TKA with short- to midterm (<10 years) or long-term (>10 years) follow-up. RESULTS: Fifteen studies were included in the meta-analysis. There were no significant differences between TKA with and without previous HTO in pain score (95% CI: -0.27 to 0.29; P = .94), function score (95% CI: -0.08 to 0.24; P = .32), operation time (95% CI: -5.43 to 26.85; P = .19), IS ratio (95% CI: -0.03 to 0.08; P = .40), complication rates (TKA with previous HTO, 62/1717; primary TKA, 610/31386; OR 1.31, 95% CI: 0.97-1.77; P = .08), and short- to midterm survival rates (TKA with previous HTO, 1860/2009; primary TKA, 37848/38765; OR 0.55, 95% CI: 0.28-1.10; P = .09). Conversely, ROM (95% CI: -7.40 to -1.26; P = .006) and long-term survival rates (TKA with previous HTO, 1426/1523; primary TKA, 29810/31201; OR 0.71, 95% CI: 0.57-0.89; P = .003) were significantly different between the two groups. In addition, both groups had substantial proportions of knees exhibiting short- to midterm survivorship (92.6% by TKA with previous HTO and 97.6% by primary TKA) and long-term survivorship (93.6% by TKA with previous HTO and 95.5% by primary TKA). CONCLUSIONS: This meta-analysis suggests that a previous HTO affected ROM or survival of TKA in the long-term even though both groups have equivalent clinical outcomes and complications. Thus, orthopedic surgeons should offer useful information regarding the advantages and disadvantages of both procedures to patients, and should provide advice on the generally higher risk of revision after TKA with previous HTO at long-term follow-up when counseling patients.

Effect of Femoral Tunnel Position on Stability and Clinical Outcomes After Single-Bundle Anterior Cruciate Ligament Reconstruction Using the Outside-In Technique.

PURPOSE: To evaluate the effects of the femoral tunnel location in the femoral footprint of the anterior cruciate ligament (ACL) on postoperative knee stability and clinical outcomes after ACL reconstruction (ACLR) using the outside-in technique. METHODS: From December 2012 to August 2014, ACLR was performed using the outside-in technique in 137 patients. Among these patients, those who had a follow-up period of over 2 years were retrospectively reviewed. A total of 102 patients met the inclusion criteria. The relative location of the femoral tunnel in the lateral condyle was evaluated as a percentage using the standardized grid system on a 3-dimensional computed tomography image. Each patient was then classified into the anterior group, center group (anteroposterior plane, 29.3% ± 3.5%), or posterior group depending on the location of the femoral tunnel. Knee laxity was evaluated using a GNRB knee arthrometer, stress radiography, and the pivot-shift test. From a clinical perspective, patient-reported outcomes (International Knee Documentation Committee subjective form and Lysholm knee score) were then evaluated. RESULTS: Of 102 patients, 31 (30.4%) were assigned to the anterior group, 46 (45.1%) were assigned to the center group, and 25 (24.5%) were assigned to the posterior group. Postoperative side-to-side differences, which were measured using stress radiographs and the GNRB arthrometer, were significantly smaller in the posterior group (1.7 ± 0.6 mm and 1.5 ± 0.5 mm, respectively) than in the center group (2.3 ± 0.9 mm and 2.2 ± 2.8 mm, respectively) and anterior group (2.4 ± 0.7 mm and 2.4 ± 1.3 mm, respectively) (P = .002 for stress radiography and P = .002 for GNRB arthrometer). No significant between-group differences were observed in the pivot-shift test results and patient-reported outcomes among the 3 groups. CONCLUSIONS: The location of the femoral tunnel in the anatomic ACL footprint did not affect postoperative stability and clinical outcomes in the case of ACLR using the outside-in technique. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Outcomes of total knee arthroplasty in degenerative osteoarthritic knee with genu recurvatum.

BACKGROUND: This study aimed to assess the incidence of genu recurvatum without neuromuscular disorders in knees that underwent navigation-assisted total knee arthroplasty (TKA), to evaluate short-term radiologic and clinical results of navigation-assisted TKA in genu recurvatum, and to evaluate differences in results according to the degree of pre-operative hyperextension and type of implant and insert. METHODS: This study retrospectively reviewed 510 knees that underwent navigation-assisted TKA from January 2005 to December 2011. The incidence of knees that showed hyperextension of ≥5° (genu recurvatum) on navigation, and the accompanying alignment were evaluated. It assessed radiologic, intraoperative, and clinical results in recurvatum and control groups by using propensity score matching. RESULTS: A total of 465 knees underwent navigation-assisted TKA for degenerative osteoarthritis. Genu recurvatum was observed in 55 knees (11.8%). Of these, 41 knees (74.5%) had degree of hyperextension between five degrees and 10°, and 47 (85.4%) had varus alignment. The thickness of the resected distal femur in the recurvatum group (7.6±1.6mm) was less than that in the control group (8.4±1.4mm, P=0.001). The thickness of the insert in the recurvatum group (12.5±2.3mm) was greater than in the control group (10.8±1.5mm, P<0.001). The sagittal alignment at the final follow-up was 1.3±3.4° in the control group and -0.1±0.7° in the recurvatum group (P=0.003). Subgroup analyses in the recurvatum group showed no significant difference in sagittal alignment and patient-related outcomes by degree of pre-operative hyperextension and implant/insert type (P>0.05 for all parameters). CONCLUSIONS: Genu recurvatum was not uncommon among patients undergoing primary TKA. This review obtained satisfactory short-term clinical and radiologic results, with a smaller distal femoral resection and thicker insert.

Does final component alignment correlate with alignment of the bone resection surfaces in cemented total knee arthroplasty?

PURPOSE: To examine, with a navigation, whether the final component alignments correlate with alignment of the bone resection surfaces in cemented total knee arthroplasty (TKA), and to evaluate the factors affecting alignment deviation. METHODS: A total of 222 patients (276 knees) who underwent navigation-assisted TKA between September 2012 and January 2014 due to osteoarthritis were retrospectively reviewed. The deviation between the alignment of bone resection surfaces and the final alignment of femoral and tibial components was measured. Factors associated with alignment deviation of greater than 2° (outliers) were evaluated. These included age, sex, body mass index, bone mineral density (T score), preoperative and postoperative mechanical femorotibial angle, preoperative and postoperative flexion contractures, and the difference between medial and lateral gaps in knee extension or flexion. RESULTS: Outliers consisted of 24 cases (8.6%) on the femoral coronal plane, 4 cases (1.4%) on the tibial coronal plane, and 48 cases (17.4%) on the tibial sagittal plane. In the coronal plane (femur and tibia), the outliers were associated with preoperative [p < 0.001; odds ratio (OR) 0.774; 95% confidence interval (CI) 0.672-0.891] and postoperative (p < 0.001; OR 0.240; 95% CI 0.123-0.468) flexion contractures; a difference of 3 mm or more between the medial and lateral gaps in knee extension (p < 0.041; OR 5.805; 95% CI 1.075-31.343); and a T score of less than -2.5(p < 0.024; OR 5.899; 95% CI 1.258-27.664). In the sagittal plane of the tibia, the outliers were associated with preoperative (p < 0.001; OR 0.886; 95% CI 0.829-0.946) and postoperative (p < 0.031; OR 0.803; 95% CI 0.659-0.980) flexion contractures. CONCLUSION: There was a deviation between the alignments of the bone resection surfaces and the final alignments of components. With larger preoperative and postoperative flexion contractures in the coronal and sagittal planes, there were more outlier risks. The outliers in the coronal plane were associated with a difference of 3 mm or more between the medial and lateral gaps in knee extension and poor bone quality. Awareness of such alignment deviation and related factors can help diminish the outliers after TKA. LEVEL OF EVIDENCE: IV.

Does Combination Therapy of Popliteal Sciatic Nerve Block and Adductor Canal Block Effectively Control Early Postoperative Pain after Total Knee Arthroplasty?

PURPOSE: We compared adductor canal block (ACB) alone and a combination of ACB and sciatic nerve block (SNB) to control early postoperative pain after total knee arthroplasty. MATERIALS AND METHODS: One hundred patients received continuous ACB alone (group A), and another 100 patients received continuous ACB and single popliteal SNB (group B). Pain was evaluated at rest and 45° knee flexion using the numeric rating scale (NRS). The number of times the patient pressed the intravenous patient-controlled analgesia (PCA) button, total PCA volume infused, and the total dosage of additional analgesics were evaluated. We also investigated complications associated with each pain control technique. RESULTS: The NRS score on postoperative day 1 was significantly lower in group B than in group A. The number of times patients pressed the PCA button on postoperative day 1 and the total infused volume were significantly lower in group B than in group A. Thirty-five (35%) patients in group B developed foot drop immediately after surgery; but they all fully recovered on postoperative day 1. CONCLUSIONS: SNB can be effective for management of early postoperative pain that persists even after ACB. Further research is needed to determine the proper dosage and technique for reducing the incidence of foot drop.

Comparison of the Effect of Continuous Femoral Nerve Block and Adductor Canal Block after Primary Total Knee Arthroplasty.

BACKGROUND: This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty. METHODS: Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0.75% ropivacaine was administered initially, followed by intermittent bolus injection of 10 mL 0.2% ropivacaine every 6 hours for 3 days). The catheters were maintained in the exact location of nerve block in 24 patients in the femoral nerve block group and in 19 patients in the adductor canal block group. Data collection was carried out from these 43 patients. To evaluate postoperative pain control, the numerical rating scale scores at rest and 45° flexion of the knee were recorded. To evaluate quadriceps strength, manual muscle testing was performed. Walking ability was assessed using the Timed Up and Go test. We also evaluated analgesic consumption and complications of peripheral nerve block. RESULTS: No significant intergroup difference was observed in the numerical rating scale scores at rest and 45° flexion of the knee on postoperative days 1, 2, 3, and 7. The adductor canal block group had significantly greater quadriceps strength than did the femoral nerve block group, as assessed by manual muscle testing on postoperative days 1, 2, and 3. The 2 groups showed no difference in walking ability on postoperative day 1, but on postoperative days 2, 3, walking ability was significantly better in the adductor canal block group than in the femoral nerve block group. No significant intergroup difference was observed in analgesic consumption. CONCLUSIONS: The groups showed no difference in postoperative pain control. Adductor canal block was superior to femoral nerve block in preserving quadriceps strength and walking ability. However, adductor canal block was inferior to femoral nerve block in maintaining the exact location of the catheter.

Factors affecting articular cartilage repair after open-wedge high tibial osteotomy.

BACKGROUND: To evaluate the factors that affect articular cartilage repair after open-wedge high tibial osteotomy (OWHTO) and the relationship between regeneration of articular cartilage repair and clinical outcomes. METHODS: Among the cases of OWHTO that were performed from March 2005 to February 2012, the patients who followed up for >2years and received a second-look arthroscopy were retrospectively reviewed. For clinical evaluation, the Knee Society scores and Western Ontario and McMaster Universities Osteoarthritis Index score were measured. For radiologic evaluation, the Kellgren-Lawrence scale, mechanical femorotibial angle, and joint line obliquity were used. In the initial and second-look arthroscopy, the status of the articular cartilage of the medial compartment was evaluated. RESULTS: A total of 62 knees (61 patients) were included in this study. Articular cartilage repair was observed in 18 knees (29.0%). In multiple logistic regression analysis, patients with Kellgren-Lawrence Grade 4 (OR 0.076; 95% CI 0.007-0.822; P=0.034), the existence of a bipolar lesion (OR 0.108; 95% CI 0.016-0.724; P=0.022), or joint line obliquity >5° (OR 0.109; 95% CI 0.013-0.936; P=0.043) had significantly lower odds of articular cartilage repair compared to the corresponding counter group. In a comparison of clinical outcomes between a group that had articular cartilage repair and a group without repair, no significant difference was observed (P>0.05). CONCLUSIONS: Severe arthrosis, existence of a bipolar lesion, and marked postoperative joint line obliquity had a negative impact on articular cartilage repair after OWHTO. However, articular cartilage repair showed unknown clinical significance.

Clinical and Radiologic Outcomes of Partial Lateral Patellar Facetectomy in Total Knee Arthroplasty.

Recently, some authors have performed partial lateral patellar facetectomy in total knee arthroplasty (TKA) and reported good results. However, research on partial lateral patellar facetectomy in TKA is still lacking. The aim of this study was to evaluate the clinical and radiologic results of partial lateral patellar facetectomies in patellar non-resurfacing and resurfacing TKAs. Total 251 TKAs (patellar non-resurfacing: 131; resurfacing: 120) that were followed up for at least 24 months to evaluate the clinical and radiologic results of partial lateral patellar facetectomies in patellar non-resurfacing and resurfacing TKAs were retrospectively reviewed. The radiologic evaluations involved assessments of the patellar tilt angle and the lateral patellar displacement, and the clinical evaluations involved assessments of the Knee Society knee score, Knee Society function score, Feller patellar score, and Kujala score. In patellar non-resurfacing TKA, the average postoperative patellar tilt angle and lateral patellar displacement of the group that did not undergo facetectomy were 7.0 ± 4.8 degrees and 2.4 ± 3.6 mm, respectively, and the average postoperative patellar tilt angle and lateral patellar displacement of the group that did undergo facetectomy were 4.0 ± 3.8 degrees and 0.7 ± 2.5 mm, respectively. Significant differences were observed in the postoperative patellar tilt angle and lateral patellar displacement (p < 0.001 and p = 0.004, respectively). In patellar resurfacing TKA, while the patellar tilt angle showed a significant difference between the group that underwent facetectomy (6.7 ± 3.1 degrees) and the group that did not (8.3 ± 4.4 degrees) (p = 0.023), it exhibited no difference in the lateral patellar displacement between the two groups. In both patellar non-resurfacing TKA and resurfacing TKA, the postoperative clinical results did not show any difference between no-facetectomy group and facetectomy group. Partial lateral patellar facetectomies in patellar non-resurfacing and resurfacing TKAs improved the patellar tilt angles and patellar lateral displacements but were not related to improvements in the clinical outcomes in the minimum 2-year follow-up.

Clinical Efficacy of an Arthroscopic Surgery in Open Wedge High Tibial Osteotomy.

Few studies have identified the effects of arthroscopic surgery on the clinical outcomes when open wedge high tibial osteotomy (OWHTO) and arthroscopic surgery were performed together. The purpose of this study was to evaluate the clinical efficacy of arthroscopic surgery in patients who had varus osteoarthritic knee and were treated with OWHTO combined with arthroscopic surgery. Among the 98 knees (88 patients) who underwent OWHTO between January 2008 and March 2013, 79 knees (71 patients) with more than 2 years of follow-up were reviewed retrospectively. The patients were divided into two groups: Group 1 (24 knees) underwent only OWHTO and Group 2 (55 knees) underwent OWHTO combined with arthroscopic surgery. For clinical evaluation, the range of motion (ROM), pain visual analog scale, Knee Society knee score, Knee Society function score, and complication were used. For radiologic evaluation, Kellgren-Lawrence grade, mechanical femorotibial angle, and posterior tibial slope were used. The average follow-up period was 29.1 months. Group 2 showed a significant increase in the ROM at the last follow-up (133.2 ± 6.0 degrees) compared with the preoperative time point (128.3 ± 7.7 degrees) (p < 0.001). In the comparison of radiologic parameters between Groups 1 and 2, there was no significant difference. In the minimum 24-month follow-up, when OWHTO combined with arthroscopic surgery was performed, arthroscopic surgery helped increase the ROM of patients with mechanical symptoms. However, the amount of the ROM increase of 4.9 degrees was of unknown clinical significance.

Complications and Short-Term Outcomes of Medial Opening Wedge High Tibial Osteotomy Using a Locking Plate for Medial Osteoarthritis of the Knee.

PURPOSE: The purpose of this study was to investigate complications and radiologic and clinical outcomes of medial opening wedge high tibial osteotomy (MOWHTO) using a locking plate. MATERIALS AND METHODS: This study reviewed 167 patients who were treated with MOWHTO using a locking plate from May 2012 to June 2014. Patients without complications were classified into group 1 and those with complications into group 2. Medical records, operative notes, and radiographs were retrospectively reviewed to identify complications. Clinically, Oxford Knee score and Knee Injury and Osteoarthritis Outcome score (KOOS) were evaluated. RESULTS: Overall, complications were observed in 49 patients (29.3%). Minor complications included lateral cortex fracture (15.6%), neuropathy (3.6%), correction loss (2.4%), hematoma (2.4%), delayed union (2.4%), delayed wound healing (2.4%), postoperative stiffness (1.2%), hardware irritation (1.2%), tendinitis (1.2%), and hardware failure without associated symptoms (0.6%). Major complications included hardware failure with associated symptoms (0.6%), deep infection (0.6%), and nonunion (0.6%). At the first-year follow-up, there were no significant differences in radiologic measurements between groups 1 and 2. There were no significant differences in knee scores except for the KOOS pain score. CONCLUSIONS: Our data showed that almost all complications of the treatment were minor and the patients recovered without any problems. Most complications did not have a significant impact on radiologic and clinical outcomes.

Does Superficial Medial Collateral Ligament Release in Open-Wedge High Tibial Osteotomy for Varus Osteoarthritic Knees Increase Valgus Laxity?

BACKGROUND: Medial open-wedge high tibial osteotomy (OWHTO) requires the release of the superficial medial collateral ligament (sMCL). However, research on medial laxity among patients who undergo OWHTO is rare. PURPOSE: To evaluate the changes in medial laxity of the knee joint as related to the complete release of the sMCL through serial valgus stress radiographs in patients who underwent OWHTO. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 48 patients (54 knees) who received OWHTO and were followed for more than a year and for whom serial valgus stress radiography data were available were retrospectively reviewed. To assess the medial laxity of knee joint, medial joint space opening (MJO) was measured while valgus stress of 15 kgf was loaded on the knee joint. The MJO was measured before surgery, during surgery before release of the sMCL under anesthesia, after the release, and after fixing with a TomoFix plate following the opening of the osteotomy site, as well as 3, 6, and 12 months after surgery. Serially measured MJOs were analyzed to evaluate the changes of medial laxity. RESULTS: The MJO significantly increased after the release of the sMCL (mean ± SD, 12.2 ± 1.2 mm) compared with before the release (9.0 ± 1.1 mm) (P < .001). The MJO measured after fixing with the TomoFix plate following the opening of the osteotomy site (9.2 ± 1.2 mm) was significantly decreased compared with that measured after the release of the sMCL and was not significantly different from the MJO measured before release of the sMCL. No significant difference was observed among MJOs that were measured 3, 6, and 12 months after surgery. Comparison of MJOs before and after surgery also showed no significant differences. CONCLUSION: Complete release of the sMCL during OWHTO increases the MJO. However, the MJO decreased to the level before sMCL release after fixing with the TomoFix plate following the opening of the osteotomy site. Medial laxity induced by the complete release of the sMCL can be recovered by opening the osteotomy site.

Compression of the Popliteal Artery after Posterior Cruciate Ligament Reconstruction Using the Tibial Inlay Technique.

Popliteal artery compression rarely occurs after posterior cruciate ligament (PCL) reconstruction using the tibial inlay technique that allows for direct visualization of the surgical field. However, we experienced a popliteal artery compression after PCL reconstruction performed using the technique, which eventually required re-operation. Here, we report this rare case and discuss reasons of popliteal artery compression.

Factors affecting the osteolysis around the components after posterior-stabilized total knee replacement arthroplasty.

PURPOSE: The purpose of the present study was to evaluate factors that affect the occurrence of osteolysis through clinical and radiological comparison between a patient group in which osteolysis occurred after total knee arthroplasty (TKA) and a patient group in which osteolysis did not occur after TKA. METHODS: The present study was conducted with 486 knees that had been followed up for at least 2 years after undergoing a posterior-stabilized TKA. The subjects were divided into a group in which osteolysis occurred and a group in which osteolysis did not occur and retrospectively compared and analyzed. Knee Society Knee Score and Function Score, preoperative and postoperative range of motion (ROM), femoral and tibial implant positions, preoperative and postoperative femerotibial angles, posterior femoral condylar offset (PCO), level of joint line (JL), and posterior tibial slopes were measured and clinically and radiologically compared. RESULTS: Osteolysis occurred in 28 knee joints (5.7%). No significant difference was observed between the patient group without osteolysis, and the patient group with osteolysis was observed in preoperative and postoperative ROM, femoral and tibial implant positions, or preoperative and postoperative femerotibial angles. The means of preoperative and postoperative differences in PCO and level of JL were significantly larger in the patient group with osteolysis than in the patient group without osteolysis (p = 0.01, p = 0.007), and regression analyses showed that the means of preoperative and postoperative differences in these two variables were related with the occurrence of osteolysis (p = 0.021, p = 0.018). CONCLUSION: The present study shows that biomechanical changes occurring after TKA are related with the occurrence of osteolysis. For clinical relevance, surgeons should pay great attention to restore normal anatomical structure as much as possible with careful preoperative plans, accurate surgical techniques, and selection of appropriate implants. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.