Unicompartmental knee arthroplasty questionnaire (UniQ-study): Unknown is unloved.

BACKGROUND: Almost 50% of the patients requiring knee replacement are suitable for medial unicompartmental knee arthroplasty (UKA). However, national registries have shown a use far below 50%. AIM: The aim of this study was to identify the factors that could influence the use of UKA. METHODS: A questionnaire was conducted among practicing knee surgeons of the Dutch Orthopedic Association. The questionnaire was classified into three domains: surgeon, patient selection, and professional opinion. Associations between the domains and UKA volume and contra-indications were tested using Pearson's chi-square tests. RESULTS: Of the 113 included respondents, 40% had no hands-on exposure during residency. Frequently reported contra-indications were obesity (68%), lateral osteophytes (21%), chondrocalcinosis (20%), and age (20%). Medial partial thickness lesions were considered a contra-indication by 49% and lateral joint space narrowing by 61% of the respondents. Respondents perceived UKA to outperform total knee arthroplasty regarding all outcomes, except survival (1.8% versus 42%). The reported barriers for UKA use were insufficient experience (20%), high revision rates (20%), and low hospital volume (16%), whereas 60% did not experience any at all. Hands-on UKA exposure during residency was associated with an increased use of correct indications. Furthermore, the use of correct indications was associated with an increased UKA volume. CONCLUSION: We showed a low UKA exposure during residency and considerable variations in contra-indications. These factors may contribute to an underuse of UKA. Improved UKA training could lead to increased experience and better patient selection among surgeons and consequently a higher use of medial UKA.

A structured evaluation of the symptomatic medial Oxford unicompartmental knee arthroplasty (UKA).

Unicompartmental knee arthroplasty (UKA) has several advantages over total knee arthroplasty; however, in many reports, the risk of revision remains higher after UKA.Many reasons for failure of UKA exist.Successful treatment starts with accurate assessment of the symptomatic UKA as a specific mode of failure requires a specific solution.A structured and comprehensive evaluation aids assessment of the symptomatic UKA.This review provides an overview of the causes for a symptomatic medial UKA, its risk factors, diagnostic modalities that can be used, and briefly discusses treatment options. Cite this article: EFORT Open Rev 2021;6:850-860. DOI: 10.1302/2058-5241.6.200105.

Evaluation of 1031 primary titanium nitride coated mobile bearing total knee arthroplasties in an orthopedic clinic.

AIM: To evaluate the influence of the titanium nitride (TiN) coating on the results of a total knee arthroplasty (TKA). METHODS: A total of 910 patients (338 men; 572 woman), with a mean age of 65 (range 36-94) undergoing 1031 primary TKAs were assessed. Clinical evaluation and patient-reported outcomes were gathered one year after surgery. The questionnaires included the Knee injury and Osteoarthritis Outcome Score (KOOS)-Dutch version, Visual Analogue Scale (VAS) pain scores in rest and during active knee movement, VAS-satisfaction scores, and EQ-5D-3L health scores. This was aimed to assess the overall knee function and patient satisfaction, and to enable us to make a gross comparison to other TKAs. RESULTS: At a mean follow-up of 46 mo (range 1-92) the overall implant survival was 97.7% and 95.1% for any operative reason related to the implant. Twenty-three knees (2.2%) required revision surgery. Arthrofibrosis was the most common indication for a re-operation. The clinical evaluation and patient-reported outcomes revealed good to excellent patient satisfaction and function of the arthroplasty. The median postoperative VAS-pain scores on a scale of 0-100, at one year after surgery were 1 in rest and 2 during movement. CONCLUSION: The TiN coated, mobile bearing TKA results are excellent and similar to those of other widely used TKA designs. Residual pain of the knee remains a concern and the TiN coating in combination with the mobile bearing does not seem to be the simple solution to this problem. Future research will have to show that the coating gives a better survival than the cobalt chrome version.

Platelet-Rich-Plasma injection seems to be effective in treatment of plantar fasciitis: a case series.

Plantar fasciitis is the most common cause of heel pain. Diverse non-operative treatment options are available. The purpose of this study was to determine if a single platelet-rich-plasma injection at the origin of the plantar fascia in patients with plantar fasciitis gives a functional improvement. Patients with plantar fasciitis and failed conservative treatment were included in this retrospective study. Included patients were sent four questionnaires after platelet-rich-plasma injection. Primary outcome is functional improvement, determined by foot function index in which lower scores correlates with a better foot function. A total of 61 feet in 58 patients were included. The median foot function index before treatment was 69.4 and after treatment 31.8, which is a significant decrease. In 80.3% of the patients the foot function index decreased. Therefore platelet-rich-plasma injection seems to be effective in treatment of patients with plantar fasciitis when conservative treatment failed.

Overstuffing in total knee replacement: no effect on clinical outcomes or anterior knee pain.

PURPOSE: With total knee replacement (TKR), correct sizing and rotational alignment are essential for good clinical outcomes. Overstuffing may result in loss of flexion and adversely affect the outcome of TKR. The purpose of this study was to correlate overstuffing with patient reported clinical outcomes and anterior knee pain (AKP). METHODS: Baseline and follow-up clinical and radiological data of 262 patients who had NexGen LPS posterior stabilized TKR without patellar resurfacing between 2008 and 2009 were prospectively collected. We measured anterior femoral offset, femoral diameter, and posterior condylar offset on the pre-operative and postoperative lateral non-weight bearing radiographs. Overstuffing was defined as an increase in pre-operative to postoperative values. Repeated measures analysis of variance (ANOVA) was used to analyse for differences from preoperative to postoperative WOMAC scores between patients with and without overstuffing. RESULTS: A total of 193 sets of lateral radiographs (preoperative and postoperative) were adequate for analysis. Anterior overstuffing was noted in 84 patients (43.5%), posterior overstuffing in 168 (87%), and total overstuffing in 155 patients (80%). Total WOMAC scores were similar in patients with and without anterior, posterior or total overstuffing (p = 0.11, p = 0.65, and p = 0.06, respectively). We found no relation between the presence of AKP with either anterior, posterior or total overstuffing (chi-square: p = 0.14, p = 0.24, and p = 0.54, respectively). CONCLUSIONS: We found no relation between radiological anteroposterior overstuffing with patient reported outcome measures or AKP.

Popliteal pseudoaneurysm after arthroscopic posterior cruciate ligament reconstruction.

This report presents the case of a 30-year-old motocross (BMX) cyclist with a third-degree posterior cruciate ligament rupture. The technique used for reconstruction was the transtibial single-bundle autologous hamstring technique. Unfortunately, the procedure was complicated by a popliteal pseudoaneurysm, which was located in line with the tibial canal. The pseudoaneurysm was treated with an end-to-end anastomosis and the patient recovered without further complaints. In this case, the popliteal artery was damaged most probably by the edge of the reamer or the guide wire during removal. Vascular complications can be limb- and life-threatening. This case report aims to increase the awareness of this serious complication with a review of the literature.

No difference in anterior knee pain between a fixed and a mobile posterior stabilized total knee arthroplasty after 7.9 years.

PURPOSE: The presence of anterior knee pain remains one of the major complaints following total knee arthroplasty (TKA). Since the introduction of the mobile TKA, many studies have been performed and only a few show a slight advantage for the mobile. In our short-term follow-up study, we found less anterior knee pain in the posterior stabilized mobile knees compared to the posterior stabilized knees. The concept of self-alignment and the results from our short-term study led us to form the hypothesis that the posterior stabilized mobile knee leads to a lower incidence of anterior knee pain compared to the posterior stabilized fixed knee. This study was designed to see whether this difference remains after 7.9 years in the follow-up. A secondary line of enquiry was to see whether one was superior to the other regarding pain, function, quality of life and survival. METHODS: This current report is a 6-10-year (median 7.9 years) follow-up study of the remaining 69 patients with a cemented three-component TKA for osteoarthritis in a prospective, randomized, double-blinded clinical trial. RESULTS: In the posterior stabilized group, five of the 40 knees (13%) versus five of the 29 posterior stabilized mobile group (17%) experienced anterior knee pain. No differences were observed with regard to ROM, VAS, Oxford 12-item knee questionnaire, SF-36, HSS patella, Kujala or the AKSS score. Patients with anterior knee pain reported more pain, lower levels of the AKSS, HSS patella and the Kujala scores than the patients without anterior knee pain. CONCLUSION: In the current clinical practice, the appearance of anterior knee pain persists as a problem; simply changing to a mobile bearing does not seem to be the solution. The posterior stabilized mobile total knee did not sustain the advantage of less anterior knee pain, compared with the posterior stabilized fixed total knee arthroplasty. LEVEL OF EVIDENCE: Therapeutic study, Level II.

Dutch translation of the Kujala Anterior Knee Pain Scale and validation in patients after knee arthroplasty.

PURPOSE: To translate and validate the Kujala Anterior Knee Pain Scale (AKPS) in patients who have undergone total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) and evaluate the internal consistency, construct validity and ceiling or floor effect. METHODS: After standard forward and backward translation was performed, 302 patients who have received a TKA or UKA filled out the AKPS together with Hospital for Special Surgery (HSS) patella score, visual analogue score (VAS) for pain, the Oxford 12-item questionnaire and the SF-36 at follow-up. The internal consistency was tested using Cronbach's α coefficient. The construct validity was assessed using Spearman's rank correlation (R) to test for correlations between the AKPS and VAS HSS, HSS patella score, VAS month, Oxford 12-item questionnaire and SF-36 subscales. Ceiling or floor effects are given in percentage of patients giving a maximum or minimum score. RESULTS: The internal reliability of the AKPS is acceptable with a Cronbach's α of 0.81 in patients after TKA or UKA. A high correlation was found between the AKPS and the Oxford 12-item questionnaire (R = 0.81). Moderate correlations were found with the VAS month (R = 0.63), HSS patella score (R = 0.51) and SF-36 subscales physical functioning (R = 0.59), role-physical (R = 0.59), bodily pain (R = 0.57). Other correlations were poor, therefore indicating a good convergent and divergent validity. Ceiling effects were observed for the HSS patella score (31 %), VAS HSS (51 %), VAS pain (19 %), SF36-RP (46 %), SF36-RE (80 %) and SF36-BP (24 %). No ceiling or floor effect was found for the AKPS, Oxford 12-item and the other SF36 domains. CONCLUSIONS: The AKPS appears to be reliable and valid in patients after knee arthroplasty, with no ceiling and floor effects, and can be used to assess anterior knee pain in patient who underwent joint replacement surgery.

Tendoscopic treatment of recurrent peroneal tendon dislocation.

PURPOSE: To study the possibility of tendoscopic treatment of recurrent peroneal tendon dislocation. METHODS: The case of one patient is described including the tendoscopic technique to deepen the fibular groove. RESULTS: In this single case, there were no complications, recovery time was short, and there was no recurrence of peroneal tendon dislocation. CONCLUSION: Though it seems possible to deepen the fibular groove tendoscopically, further studies are necessary to determine the role of tendoscopy in recurrent peroneal tendon dislocation.

The important predictors of cycling use in three groups of knee patients.

PURPOSE: Cycling is a popular international professional and recreational sport performed by both sexes and all age groups. Regular exercise is important for the elderly population and it has been shown that cycling is of great value for the osteoarthritis and knee arthroplasty patients. The purpose of this study was to evaluate the predictors of cycle use in three groups of knee patients. METHOD: We included 298 patients, 93 patients had osteoarthritis of the knee, 118 received a total knee arthroplasty and 87 had a meniscal and/or ligamentous injury. Patients were evaluated at the outpatient clinic and asked to complete the SF36-, Oxford 12-item-, IKDC-questionnaire and a specific cycling questionnaire. RESULTS: As the patient gets older, the chances of being able to cycle decrease by 5% every year. The chance to be able to cycle is 1.98 times higher for a male patient compared to a female patient. The chances of experiencing pain while cycling increases by 8% per unit rise of BMI. CONCLUSION: Age and sex, and not the clinical diagnosis, are the predictors of the ability of a patient to cycle. An increased BMI is the only risk factor found for experiencing pain while cycling.

Stress Fracture of the Femoral Neck in a Young Female Athlete.

Stress fractures have been reported to occur in association with running. They typically involve the lower extremity. Although relatively rare, unrecognized or untreated femoral neck fractures carry a much higher morbidity rate than other stress fractures. Stress fractures of the femoral neck should even be considered in young amateur athletes with hip pain. If X-ray is inconclusive, radionuclide bone imaging and MRI can be useful in diagnosing these fractures. This rare diagnosis, as well as classification and treatment options, will be discussed.

Less anterior knee pain with a mobile-bearing prosthesis compared with a fixed-bearing prosthesis.

UNLABELLED: Anterior knee pain is one of the major short-term complaints after TKA. Since the introduction of the mobile-bearing TKA, numerous studies have attempted to confirm the theoretical advantages of a mobile-bearing TKA over a fixed-bearing TKA but most show little or no actual benefits. The concept of self-alignment for the mobile bearing suggests the posterior-stabilized mobile-bearing TKA would provide a lower incidence of anterior knee pain compared with a fixed-bearing TKA. We therefore asked whether the posterior-stabilized mobile-bearing knee would in fact reduce anterior knee pain. We randomized 103 patients scheduled for cemented three-component TKA for osteoarthrosis in a prospective, double-blind clinical trial. With a 1-year followup, more patients experienced persistent anterior knee pain in the posterior-stabilized fixed-bearing group (10 of 53, 18.9%) than in the posterior-stabilized mobile-bearing group (two of 47, 4.3%). No differences were observed for range of motion, visual analog scale for pain, Oxford 12-item questionnaire, SF-36, or the American Knee Society score. The posterior-stabilized mobile-bearing knee therefore seems to provide a short-term advantage compared with the posterior-stabilized fixed-bearing knee. LEVEL OF EVIDENCE: Level I, therapeutic study.

Translation and validation of the Dutch version of the International Knee Documentation Committee Subjective Knee Form.

BACKGROUND: For knee-related surgery, there is a great demand for internationally useable subjective scoring systems. Before such measurements can be used, they should be translated and validated for the population they are used on. For the Dutch population, only the Western Ontario and McMaster Universities Osteoarthritis Index and Oxford 12 Questionnaire have been validated. However, these scores can only be used regarding osteoarthritis of the knee. In 2001, the International Knee Documentation Committee presented the Subjective Knee Form, which is a knee-specific rather than a disease-specific questionnaire. STUDY DESIGN: Cohort study (diagnosis/symptom prevalence); Level of evidence, 2. METHODS: The authors describe the translation procedure and validation of the Dutch Subjective Knee Form. After a forward-backward translation protocol, the reliability, validity, and content validity were tested. The responses of 145 consecutive knee patients on 2 questionnaires containing the Short Form-36, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford 12 Questionnaire score, a visual analog scale, and the Dutch International Knee Documentation Committee Subjective Knee Form were used. Reliability was tested by measuring the test-retest reliability and internal consistency. Validity was tested by correlating the questionnaire to the other outcome measurements, and content validity was tested by measuring the floor and ceiling effects. RESULTS: The reliability proved excellent with an intraclass coefficient of 0.96 for test-retest. Internal consistency was strong (Cronbach alpha, .92). The construct, convergent, and divergent validities were good. The content validity was good; no floor or ceiling effect occurred. CONCLUSION: The validation procedure shows that the Dutch International Knee Documentation Committee Subjective Knee Form is an excellent evaluation instrument for Dutch patients with knee-related injuries.

Translation and validation of the Dutch version of the Oxford 12-item knee questionnaire for knee arthroplasty.

BACKGROUND: In 1998, the Oxford 12-item knee questionnnaire was developed by Dawson et al. as a self-administered disease- and site-specific questionnaire, specifically developed for knee arthroplasty patients. Since then,it has proven to be an effective outcome questionnaire, and is widely used. Despite the positive psychometric properties for the Total Knee Arthroplasty (TKA) population, the 12-item knee questionnaire has only been translated into a few languages. We thus translated and validated the Oxford 12-item knee questionnaire for the Dutch population. METHODS AND RESULTS: After translation according to a forward/backward protocol, 174 knee arthroplasty patients were asked to answer the questionnaire together with an SF-36, an AKSS and a VAS. The reliability, validity, content validity and the sensitivity to change were all tested. Our Dutch version of the Oxford 12-item knee questionnaire achieved excellent scores in all of these properties. INTERPRETATION: The Dutch Oxford 12-item knee questionnaire proved to be an excellent evaluation instrument for the Dutch orthopedic surgeon and can be used for all total knee arthroplasty patients.