Improved postoperative kneeling ability in posterior stabilized total knee arthroplasty with medialized dome-patella resurfacing: A retrospective comparative outcome analysis.

OBJECTIVES: This investigation aimed to evaluate if the modifications to prosthesis designs improve patients' clinical and functional outcomes after total knee arthroplasty (TKA), with a special focus on pain and kneeling ability. METHODS: Retrospective and comparative analysis of consecutive patients who were treated with posterior stabilized TKA using two different prostheses designs (single surgeon, single vendor). Group 1 received a traditional design TKA (PFC Sigma; DePuy, Inc., Warsaw, IN) with conventional dome-patella resurfacing, and group 2 received a modern design implant (Attune; DePuy, Inc., Warsaw, IN) with medialized dome-patella resurfacing. Functional outcome (range of motion: ROM) and the Oxford Knee Score (OKS) were collected preoperatively, at 4-6 weeks and 12 months following surgery. RESULTS: Ninety-nine participants were included. Of these, 30 received traditional-design implants and 69 received modern-design knee implants. The comparison between the two implants showed a statistically significant increase in total OKS and kneeling ability in the modern design cohort at 1-year follow-up compared to the traditional design cohort (p â€‹< â€‹0.01). In the modern design group, 53% (N â€‹= â€‹37) could kneel easily or with little difficulty, compared to 30% (N â€‹= â€‹9) in the traditional design group. No statistically significant differences in ROM or the OKS pain component were seen. CONCLUSION: The incorporation of a medialized dome-patella in modern knee implant design may offer advantages over traditional designs, as seen in improved total OKS and kneeling ability at one-year follow-up. Further research with larger cohorts is needed to confirm these findings and explore the broader impact of implant design changes on patient outcomes. LEVEL OF EVIDENCE: Clinical Study, Level III.

Long-term outcome analysis of the supraclavicular surgical release for the treatment of thoracic outlet syndrome.

OBJECTIVE: This is a long-term outcome analysis of patients who underwent surgical treatment with a supraclavicular release for thoracic outlet syndrome (TOS). METHODS: All patients undergoing supraclavicular release between January 1, 1987, and December 31, 2000, at University Hospital, Inselspital, Bern, Switzerland, were included in this study. Of 29 treated patients, 22 patients (24 TOS) underwent both long-term clinical follow-up (median 12.5 years, standard deviation 3.5 years, range 5-18 years) and short-term clinical follow-up (median 6.6 months, standard deviation 4.5 years, range 3-12 months). RESULTS: Eleven patients (12 TOS operations) were classified as having a neurogenic cause of TOS, whereas the other 11 (12 TOS operations) were classified as having disputed TOS. Patient data, including various outcome parameters, such as pain and disabilities of arm, shoulder, and hand scores, were evaluated pre- and postoperatively and at long-term follow-up by an independent examiner. The surgical supraclavicular technique is described in detail. In 21 of 24 surgical release procedures, the first rib was resected. There was a marked permanent long-term postoperative reduction of symptoms in both neurogenic and disputed TOS groups. The pain and disabilities of arm, shoulder, and hand scores improved significantly after surgery, regardless of the etiology, in the short- and long-term postoperative observation periods. There were no patients with workers' compensation or litigation issues. CONCLUSION: This study demonstrates the successful, constant long-term relief of symptoms in carefully selected patients with neurogenic and disputed TOS using the described surgical supraclavicular release technique.