Anatomical references to assess the posterior tibial slope in total knee arthroplasty: a comparison of 5 anatomical axes.

There has been no consensus on an ideal anatomical reference to determine the posterior slope of tibia plateau. Posterior slope of the medial tibia plateau was measured with reference to a proposed mechanical axis (MA) and 5 clinically relevant anatomical references in 90 osteoarthritic knees of 66 female patients undergoing total knee arthroplasty. The MA was defined as the line connecting the midpoints of the medial tibia plateau and the tibial plafond, and 5 anatomical references included the anterior cortical line of tibia, anatomical axis of proximal and central tibia, posterior cortical line of proximal tibia, and fibular shaft axis. The average posterior slope was 10.6 degrees with reference to the MA, and the amount of posterior slope varied widely among the patients and depending on the anatomical reference used to measure. This study indicates that the anatomical reference used to measure the posterior slope should be identified in studies where posterior slope is used to evaluate the sagittal alignment of total knee arthroplasty.

Patients' perspective on controversial issues in total knee arthroplasty.

We investigated the level of patient knowledge and preferences over the currently controversial issues in TKA. One hundred patients who had decided to undergo TKA for advanced osteoarthritis were asked to complete a questionnaire inquiring their knowledge and preferences over three controversial issues: (1) computer assisted surgery (CAS), (2) minimal invasive surgery (MIS), and (3) ceramic femoral component. The patient preferences over the three issues were questioned again after they had been informed of advantages and disadvantages of each option using an explanatory document. Most (more than 75%) of the patients did not have sufficient knowledge and their knowledge was based on non-professional sources (more than 85%). Before the information was given, most (more than 80%) of the patients preferred a new option. After the information was provided, more patients preferred a standard option in the issues of CAS (60%) and MIS (88%). This study prompts health care providers to become more active in providing accurate information and to consider patients perspective in making decisions which will influence the benefits and risk of the patients.

Functional disabilities and issues of concern in female Asian patients before TKA.

There is much enthusiasm in the current field of TKA to allow high-flexion activities that might be important for Asian patients. We investigated functional disabilities and their perceived importance before surgery in 97 Korean female patients undergoing TKA for advanced osteoarthritis. The most important issues relating to functional disability were difficulty in squatting, leg deformity, difficulty in kneeling, unequal leg length, and limping. The most important issues relating to perceived importance were difficulty in walking, daytime pain, limping, difficulty in climbing stairs, and need for walking aids. The severity of functional disabilities did not correlate with the perceived importance. The most important issues concerning patients were pain immediately after surgery, pain after discharge from the hospital, chance that surgery would not alleviate pain, pain during surgery, and risk of getting AIDS from a transfusion. We found high-flexion activities were rated as the most difficult functions, but they were not perceived as being as important as other items related to pain relief and routine daily activities. The issues related to high-flexion activities were of no more concern than other issues in Korean patients.