Good clinical results using a modified kinematic alignment technique with a cruciate sacrificing medially stabilised total knee arthroplasty.

BACKGROUND: This study aims to evaluate the clinical and radiological outcomes of a modified technique of Kinematically Aligned Total Knee Arthroplasty (KA TKA) using a cruciate sacrificing (CS) medially stabilised prosthesis at a minimum 24-months follow-up. METHODS: 59 patients with a varus HKA angle who underwent a TKA from May, 2016 to April, 2017 were retrospectively enrolled. Radiological and clinical evaluations were assessed after 40 days, 6 months and at a minimum follow-up of 24 months. Long leg standing X-rays were performed pre-operatively and the Hip-Knee-Ankle (HKA) angle, the mechanical Lateral Distal Femoral Angle (mLDFA), the mechanical Medial Proximal Tibial Angle (mMPTA) and the Knee Joint Line Obliquity Angle (KJLOA) were analysed. At a minimum follow-up of 24 months, the patients were evaluated subjectively based on the Western Ontario and McMaster Universities Osteoarthritis Index Score (WOMAC) and the Oxford Knee Score (OKS). The post-operative range of motion (ROM) was measured. To reduce flexion instability, an original technique was used, with more posterior positioning of the femoral component, called the "virtuous mistake". Results were compared to the data reported in the literature in patients treated with standard kinematic alignment (KA) technique. RESULTS: No difference was found between the mean pre-operative and post-operative angles regarding mLDFA (p value = 0.410) and mMTPA (p value = 0.242). A difference of 0.8° in HKA angle between males and females was found, with more varus results in males. At a minimum follow-up of 24 months, the WOMAC was 87 (SD 4.3), the OKS was 41 (SD 2.4), and the flexion was 124°, which was similar to the data reported in literature with standard KA. There were not any cases of aseptic failures. CONCLUSIONS: The modified KA TKA surgical technique proposed in this study can achieve good clinical results at minimum 24 months of follow-up, reproducing accurately native mLDFA and mMPTA. LEVEL OF EVIDENCE: Level III, therapeutic study.

Comparison of clinical results and patient's satisfaction between direct anterior approach and Hardinge approach in primary total hip arthroplasty in a community hospital.

INTRODUCTION: Aim of the study is to compare clinical results and patient's satisfaction between direct anterior approach and Hardinge approach in primary total hip arthroplasty. METHODS: A group of 30 patients operated with DAA (group B) were compared to 39 patients operated by Hardinge approach (group A). Peri- and postoperative complications, Harris Hip Score (HHS), implant positioning, experienced pain and patient satisfaction were evaluated at a mean follow-up of 30 months. RESULTS: HHS at follow-up was significantly better in group B (92.2 ± 11.9 vs 95.2 ± 4.5 p = 0.04 Student's t test). There was no difference in femoral stem positioning while cup inclination was significantly better in group B (40.6° ± 6.6° vs 44.3° ± 7.9°, p = 0.04 Student's t test). Overall pain recalled by patients was significantly lower in group B. CONCLUSION: The introduction of DAA does not affect patients' final outcome but comes with comparable functional recovery and greater patient satisfaction.

Influence of personality psychology on outcome of total hip arthroplasty: a cross-sectional study on 69 patients.

AIM: Patient's satisfaction after total hip arthroplasty is influenced by many surgical and rehabilitation aspects, but is not available in the literature, a study that analyses the correlation between patient's psychology and clinical results of this procedure. The aim of this study was to investigate the relationship between memory of pain, clinical outcome and subjective satisfaction with the Multidimensional Health Locus of Control. METHODS: We conducted a cross-sectional study on a cohort of 69 patients operated of total hip arthroplasty in our department from November 2008 to August 2011. Pre- and post-operative hip function was assessed by the Harris Hip Score. At the follow-up visit, patient satisfaction was assessed by means of the Patient Satisfaction Questionnaire. The memory of pain was evaluated by a modified questionnaire of pain experience. Multidimensional Health Locus of Control was evaluated in all patients, and results were connected with patient's subjective satisfaction and pain indexes. RESULTS: Patients were divided into two groups about patient satisfaction, those with GPS > 15 and those with GPS ≤ 15. Patients very satisfied showed a significantly higher mean value of IHLC. Regarding pain experience, patients were divided into two categories: those recalling less pain with OvP score ≤11 (Q1 < 3, avg. score Q2-Q4 ≤ 3) and those recalling more pain with OvP score >11. IHLC score resulted significantly higher in patients recalling less pain. DISCUSSION: Multidimensional Health Locus of Control can be considered a predictor of patient's satisfaction after an invasive surgical procedure as total hip arthroplasty.

Clinical outcome of latissimus dorsi tendon transfer and partial cuff repair in irreparable postero-superior rotator cuff tear.

BACKGROUND AND PURPOSE: Irreparable rotator cuff tears are a common cause of pain in adult population, requiring in many cases a surgical treatment. Possible alternatives are debridement, partial repair, muscle transfers and joint replacement. We evaluated two groups of patients with irreparable rotator cuff tear treated surgically: one group received an arthroscopic-assisted latissimus dorsi tendon transfer (LDTT), and the other an arthroscopic rotator cuff partial repair. Aim of our study was to compare clinical results and quality of life in two groups of patients with massive irreparable rotator cuff tear: one receiving an arthroscopic LDTT and the other receiving an arthroscopic rotator cuff partial repair. METHODS: Forty patients were assigned to two groups: 20 patients to group TT treated with LDTT and 20 patients to group PR treated with a partial repair. The average follow-up duration was 2.8 years (1-5, SD 3). Pre- and postoperative modified UCLA shoulder score, ROM, measurement of the strength and the rotator cuff quality of life (RC-QOL) were used to asses the outcome. RESULTS: LDTT showed significative improvements when compared to partial repair in UCLA score results, strength and RC-QOL questionnaire. No differences were found between the groups in pain relief. CONCLUSION: Both techniques are effective in reducing patients' symptoms. We believe that in younger, high-demanding patients with no or mild osteoarthritis, the LDTT represents a valid treatment option with better modified UCLA score improvement and strength at our follow-up.