Long-term outcomes of total knee arthroplasty in patients with windswept deformity.

BACKGROUND: This study compared the functional outcomes, implant survival rates, and complications of total knee arthroplasty (TKA) performed in patients with windswept deformity (WSD) and non-WSD patients over at least 10 years of follow-up. METHODS: From January 2008 to December 2010, 40 TKAs were performed in 20 patients with WSD (WSD group). Additionally, 60 propensity score-matched patients without WSD who had undergone primary bilateral TKA were chosen for the control group in a three-to-one ratio. Then, the functional outcomes, implant survival rates, and complications of TKA in the two groups were compared. The mean follow-up periods were 10.8 years in the WSD group and 11.5 years in the control group. RESULTS: The mean Knee Society knee scores in the WSD and control groups improved from 37.7 to 38.1 points preoperatively to 79.5 and 79.2 points at final follow-up (p = 0.974), while the mean function scores in the WSD and control groups improved from 36.5 to 37.2 points preoperatively to 77.8 and 77.4 points at final follow-up (p = 0.863). Two knees in the WSD group required revision surgery, including one due to septic loosening and one due to aseptic loosening. Five knees in the control group required revision surgery, including three due to septic loosening and two due to aseptic loosening. Kaplan-Meier survivorship analysis with the revision of either component as an endpoint in the WSD and control groups estimated 95.0% and 95.8% chances of survival for 10 years, respectively (p = 0.824). CONCLUSIONS: TKA performed in patients with WSD yielded good clinical outcomes and survivorship at least 10 years later. LEVEL OF EVIDENCE: IV.

Poor outcomes of revision total knee arthroplasty in patients with septic loosening compared to patients with aseptic loosening.

BACKGROUND: The purpose of this study was to compare the functional outcomes, activity levels, mortalities, implant survival rates, and complications in revision total knee arthroplasty (TKA) of patients with septic loosening with those in patients with aseptic loosening over a minimum 10-year follow-up period. METHODS: A cohort of 78 patients (36 septic loosening and 42 aseptic loosening) was selected between January 2008 and December 2009. The functional outcomes, activity levels, mortalities, implant survival rates, and complications of revision TKA in patients with septic and aseptic loosening were compared. RESULTS: The mean Knee Society knee scores in the septic and aseptic groups improved from 36.7 and 37.4 preoperatively to 65.3 and 76.8 points at the final follow-up, respectively (p < 0.05). Outdoor ambulatory patients at the final follow-up included 20 of 29 (69.0%) patients in the septic group and 35 of 39 (89.7%) patients in the aseptic group (p < 0.05). The cumulative mortality rates in the septic and aseptic groups were 19.4% (7/36) and 7.1% (3/42) (p = 0.102) at final follow-up, respectively. Kaplan-Meier survivorship analysis with re-revision of either component as an endpoint in the septic and aseptic groups estimated 86.5% and 95.5% chance of survival for 10 years, respectively. CONCLUSIONS: Revision TKA in patients with septic loosening had worse functional outcomes and higher mortality over a minimum 10-year follow-up period compared with that in patients with aseptic loosening. LEVEL OF EVIDENCE: IV.

Open-wedge high tibial osteotomy for the treatment of osteoarthritis of both knee and ankle in the same leg: A report of two cases.

We report two cases of patients with concurrent osteoarthritis of the knee and ipsilateral ankle. The patients were treated with high tibial osteotomy (HTO). In well-planned and selected cases, HTO may be effective in treating not only the knee, but also the ankle in patients with ipsilateral double-joint osteoarthritis.