Outcomes of Combined Unicondylar Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction.

Young and more active patients with medial compartmental osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency are challenging for orthopaedic surgeons. The aim of the present study was to examine the early-mid clinical and radiological outcomes of combined Oxford unicondylar knee arthroplasty (UKA) and ACL reconstruction for the patients presenting ACL deficiency and concomitant medial compartment symptomatic OA. Twelve patients were included in the study. All patients were treated by combination of ACL reconstruction with medial UKA. The varus-valgus angles of the tibial and femoral components, and pathological radiolucent lines were measured on anteroposterior and lateral knee radiographs. Clinical evaluations include knee osteoarthritis outcome score (KOOS pain, symptom, daily life, sports, and quality of life), Oxford knee score (OKS), EQ-5D-3L, and EQ-visual analog scale (VAS). All the patients were followed up for an average of 45.6 months. The leg alignment showed 3.6 degrees ± 1 of varus deformity before surgery and 2.6 degrees ± 1 of valgus after surgery. With the exception of KOOS sports (p > 0.001), the KOOS pain, symptom, daily life, and quality of life, OKS, EQ-5D-3L, and EQ-VAS improved significantly after surgery (p < 0.001). Preoperative knee instability showed anterior translation of 5 to 10 mm in eight patients and >10 mm in four patients. There were no complications at follow-up. The early-mid clinical data have shown that UKA in conjunction with ACL reconstruction has revealed promising results. However, long-term follow-up studies are required to confirm the combined procedure in these patients.

Self-reported metal hypersensitivity in patients undergoing unicondylar knee arthroplasty.

OBJECTIVES: There is ongoing discussion about arthroplasty surgery of patients with metal hypersensitivity. The aim of this study was to compare the functional outcomes and eosinophil counts of unicondylar knee arthroplasty (UKA) patients with and without a history of metal hypersensitivity. METHODS: A retrospective review was made of the medical records of 148 extremities of 140 consecutive patients who underwent primary UKA between January 2016 and December 2017. The patients who met the inclusion criteria were screened for history of metal hypersensitivity using a questionnaire. The functional outcomes of patients and eosinophil levels were evaluated immediately before and at 6 weeks after surgery. RESULTS: The mean follow-up period was 37 months (range, 18-48 months). Of the total 128 patients, 13 (10.2%) reported a history of metal hypersensitivity before the operation. There was no statistically significant difference between patients with or without a history of metal hypersensitivity in respect of the functional outcomes or eosinophil counts (p > 0.05). CONCLUSIONS: The results of this study showed that the functional outcomes of patients who underwent UKA using a standard alloy did not change between the groups who reported having or not having a history of metal hypersensitivity. Although the study also showed that the eosinophil counts decreased after surgery compared to the preoperative counts, there was no statistical relationship between the eosinophil count and functional outcomes or metal hypersensitivity history.

Is there any change in surgeon's attitude to the management of ankle fractures accompanying syndesmotic injury? A nationwide survey.

OBJECTIVES: This study aims to investigate the attitudes of orthopedic surgeons to the management of ankle fractures accompanied by syndesmotic injury with a nationwide survey. PATIENTS AND METHODS: In the first step of this descriptive study, an electronic survey was prepared in Google drive and a survey link was sent to the Turk-Ortopedi e-mail group between 09 and 19 January 2019. The orthopedic surgeons and residents were requested to complete the questionnaire. A total of 320 orthopedic surgeons (77%) and residents (23%) participated in the survey. The responses were analyzed statistically. To evaluate the changing attitudes, our results were compared with the surgeon survey studies key worded "syndesmotic injury" in PubMed. RESULTS: The majority of the participants stated that they used the hook test, external rotation stress test, and fluoroscopy together (47.2%) for the diagnosis of syndesmotic injury during the operation. Of the participants, the majority (93%) reported to use metallic syndesmotic screws, and 59% reported to remove the syndesmotic screw routinely. Young surgeons with 5 to 10 years of experience preferred intraoperative diagnosis methods compared to surgeons with more than 20 years of experience. Foot and ankle surgeons and sports surgeons reported to allow weight bearing before removal of the screw much more than other unspecified branches. CONCLUSION: The preferences of the surgeon vary in syndesmotic injuries and there is still no consensus regarding diagnosis and rehabilitation. Compared to the past decade, fewer surgeons prefer to remove the screws today.

Early results of HemiCAP(®) resurfacing implant.

OBJECTIVE: Metallic implants in the first metatarsophalangeal (MTP) joint have been used for many years in the treatment of hallux rigidus (HR). The HemiCAP(®) prosthesis is the first implant used for resurfacing the metatarsal head in HR treatment. The aim of our study was to evaluate the early results of the HemiCAP(®) prosthesis for the treatment of HR. METHODS: A total of 27 toes of 25 patients with MTP arthritis of the great toe were treated with an Arthrosurface(®)HemiCAP(®) resurfacing implant. The average follow-up time was 37.6 (range: 30 to 43) months. All patients were evaluated clinically and radiographically. Postoperative satisfaction and function were scored according to the American Orthopaedic Foot and Ankle Society (AOFAS) score. Pain was assessed with the use of a visual analogue scale (VAS) ranging from 0 to 10, with 0 indicating the absence of pain and 10 describing the worst pain imaginable. RESULTS: Mean preoperative AOFAS score improved from 40.94 (range: 25 to 63) to 85.1 (range: 54 to 98) at the final follow-up (p<0.0001). Preoperative average VAS pain scores improved from 8.30 preoperatively to 2.05 at the final follow-up (p<0.0001). The average MTP joint range of motion (ROM) the improved from 14.36 degrees preoperatively to 54.38 degrees at the final follow-up. No radiologic loosening or osteolysis was observed in patients with HemiCAP(®) implant. CONCLUSION: The early results of the HemiCAP(®) implant on the metatarsal head are promising. However, studies over a longer period involving more patients would be beneficial in terms of defining and reviewing the stability of the implant and any innovations in the treatment strategy for HR.

[Midterm results of Oxford phase 3 unicondylar knee arthroplasty for medial osteoarthritis]. / Medial gonartrozda Oxford faz 3 unikondiler diz artroplastisinin orta dönem sonuçlari.

OBJECTIVES: We evaluated midterm results of Oxford phase 3 unicondylar knee arthroplasty (UKA) in patients with medial osteoarthritis. METHODS: Twenty-seven patients (24 females, 3 males; mean age 57 years; range 47 to 73 years) underwent Oxford phase 3 UKA with the diagnosis of medial knee osteoarthritis. All patients had primary osteoarthritis but one with spontaneous osteonecrosis. Nine knees were Ahlback grade 2, and 18 knees were grade 3. All femoral and tibial components were cemented and mobile tibial polyethylene inserts were used in all the patients. Pre- and postoperative evaluations were made using the Knee Society clinical rating system. The mean follow-up was 28 months (range 24 to 36 months). RESULTS: Compared to the preoperative values, significant improvements were obtained in the following at final follow-up (p<0.05): knee flexion (106.4 degrees and 117.4 degrees , respectively), tibiofemoral angle (7 degrees varus and 1 degrees valgus), knee score (47.5 and 78.9), and functional knee score (48.7 and 83.6). Only two patients needed blood transfusion. No major complications occurred including infection, deep vein thrombosis, pulmonary emboli, and neurovascular injury. Two patients underwent revision surgery at postoperative 8 and 10 months, respectively, because of progressive collapse of the tibial plateau. Knee Society clinical scores were excellent or good in 21 (77.8%), moderate in four (14.8%), and poor in two (7.4%) patients. The corresponding figures for functional results were 23 (85.2%), 2 (7.4%), and 2 (7.4%). CONCLUSION: Our results demonstrate that Oxford phase 3 UKA is effective with considerable success in the treatment of medial osteoarthritis.