Total knee arthroplasty in patients with severe obesity: outcomes of standard keeled tibial components versus stemmed universal base plates.

BACKGROUND: Patients with severe obesity [body mass index (BMI) ≥ 40 kg/m2] potentially overload the tibial component after total knee arthroplasty (TKA), risking tibial subsidence. Using a cemented single-radius cruciate-retaining TKA design, this study compared the outcomes of two tibial baseplate geometries in patients with BMI ≥ 40 kg/m2: standard keeled (SK) or universal base plate (UBP), which incorporates a stem. METHODS: This was a retrospective, single-centre cohort study with minimum 2 years follow-up of 111 TKA patients with BMI ≥ 40 kg/m2: mean age 62.2 ± 8.0 (44-87) years, mean BMI 44.3 ± 4.6 (40-65.7) kg/m2 and 82 (73.9%) females. Perioperative complications, reoperations, alignment and patient-reported outcomes (PROMS): EQ-5D, Oxford Knee Score (OKS), Visual Analogue Scale (VAS) pain score and satisfaction were collected preoperatively, and at 1 year and final follow-up postoperatively. RESULTS: Mean follow-up was 4.9 years. SK tibial baseplates were performed in 57 and UBP in 54. There were no significant differences in baseline patient characteristics, post-operative alignment, post-operative PROMs, reoperations or revisions between the groups. Three early failures requiring revision occurred: two septic failures in the UBP group and one early tibial loosening in the SK group. Five-year Kaplan-Meier survival for the endpoint mechanical tibial failure was SK 98.1 [94.4-100 95% confidence interval (CI)] and UBP 100% (p = 0.391). Overall varus alignment of the limb (p = 0.005) or the tibial component (p = 0.031) was significantly associated with revision and return to theatre. CONCLUSIONS: At early to mid-term follow-up, no significant differences in outcomes were found between standard and UBP tibial components in patients with BMI ≥ 40 kg/m2. Varus alignment of either tibial component or the limb was associated with revision and return to theatre.

Biting the hand that feeds you: Management of human and animal bites.

Bites from animal and humans represent a very small proportion of all the patients presenting to emergency departments, However, they require prompt medical and surgical intervention in order to minimise the risk of infection, that may lead to limb and life-threatening complications. In this review article we synthesise the existing literature for treatment of human and animal bites and offer practical considerations when managing bite injuries.