Intraoperative calprotectin lateral flow immunoassay can assist decision-making between one- and two-stage revision total hip arthroplasty for patients with suspected periprosthetic joint infection.

Aims: Accurate diagnosis of chronic periprosthetic joint infection (PJI) presents a significant challenge for hip surgeons. Preoperative diagnosis is not always easy to establish, making the intraoperative decision-making process crucial in deciding between one- and two-stage revision total hip arthroplasty (THA). Calprotectin is a promising point-of-care novel biomarker that has displayed high accuracy in detecting PJI. We aimed to evaluate the utility of intraoperative calprotectin lateral flow immunoassay (LFI) in THA patients with suspected chronic PJI. Methods: The study included 48 THAs in 48 patients with a clinical suspicion of PJI, but who did not meet European Bone and Joint Infection Society (EBJIS) PJI criteria preoperatively, out of 105 patients undergoing revision THA at our institution for possible PJI between November 2020 and December 2022. Intraoperatively, synovial fluid calprotectin was measured with LFI. Cases with calprotectin levels ≥ 50 mg/l were considered infected and treated with two-stage revision THA; in negative cases, one-stage revision was performed. At least five tissue cultures were obtained; the implants removed were sent for sonication. Results: Calprotectin was positive (≥ 50 mg/l) in 27 cases; out of these, 25 had positive tissue cultures and/or sonication. Calprotectin was negative in 21 cases. There was one false negative case, which had positive tissue cultures. Calprotectin showed an area under the curve of 0.917, sensitivity of 96.2%, specificity of 90.9%, positive predictive value of 92.6%, negative predictive value of 95.2%, positive likelihood ratio of 10.6, and negative likelihood ratio of 0.04. Overall, 45/48 patients were correctly diagnosed and treated by our algorithm, which included intraoperative calprotectin measurement. This yielded a 93.8% concordance with postoperatively assessed EBJIS criteria. Conclusion: Calprotectin can be a valuable tool in facilitating the intraoperative decision-making process for cases in which chronic PJI is suspected and diagnosis cannot be established preoperatively.

Patella Fracture After Total Knee Arthroplasty: A Review.

The management and underlying causes of patellar periprosthetic fractures (PPF) after total knee arthroplasty (TKA) constitute an issue of growing importance given the rising frequency of these procedures. Patella periprosthetic fractures, though relatively rare, pose significant challenges and are a frequent indication for revision surgeries. Despite a decrease in overall incidence, PPFs remain the second most common type of periprosthetic fractures after TKA. Several factors have been identified and associated with patient-specific factors, surgical technique errors, and implant-related causes. Currently extensor apparatus integrity, bone stock, and component loosening are the major concerns and indications for the selective treatment approach. In this study, a thorough review of the existing literature was performed summarizing the epidemiology, clinical manifestation, treatment approach, and functional outcome of PPF. This review aims to underline the significance of such predisposing factors, point out the severity of PPF, and offer insights into the optimal intra- and post-operative management of the patella.

Acetabular erosion after bipolar hip hemiarthroplasty for femoral neck fracture in elderly patients: a retrospective study.

BACKGROUND: The choice between total hip arthroplasty (THA) and hemiarthroplasty (HA) to treat displaced femoral neck fractures, particularly among the elderly, is still controversial. Acetabular erosion consists of a late multifactorial process that may happen after hip HA resulting in significant postoperative burden. This study aims to investigate the impact of acetabular erosion progress after hip HA in patients over 70 years old. MATERIALS AND METHODS: This is a 5-year (2013-2018) retrospective study including consecutive series of patients >70 years who were treated with bipolar hip HA for femoral neck fractures. Patients were categorised into 3 groups for analysis (A = 70-75 years, B = 75-80 years, C = >80 years). The study enrolled a total number of 813 patients who met the inclusion criteria. We assessed acetabular erosion through radiological examinations and measured functional deterioration using the modified Harris Hip Score (mHHS) at 6 and 12 months follow-up. Our comprehensive investigation extended over a maximum period of 5 years. The correlation of patients' characteristics and HA features on erosion progress was assessed. RESULTS: There were no significant differences in sex distribution, injury side, BMI, ASA score, bipolar head diameter, mHHS and leg-length discrepancy among the groups (p > 0.05). During the follow-up period, acetabular erosion with consequential conversion to THA was observed in 6.13%, 4.22% and 1.96% for Groups A, B and C respectively (p = 0.009). A statistically significant difference of acetabular erosion was observed in Group A compared to patients of Group C. CONCLUSIONS: Age constitutes a significant factor of acetabular wear after HA in the elderly. The higher rate of acetabular wear in patients <75 years suggests that THA is a more viable option, as HA is for patients >80 years old.

Cervical Spinal Epidural Abscess: Diagnosis, Treatment, and Outcomes: A Case Series and a Literature Review.

Although recent diagnostic and management methods have improved the prognosis of cervical epidural abscesses, morbidity and mortality remain significant. The purpose of our study is to define the clinical presentation of cervical spinal epidural abscess, to determine the early clinical outcome of surgical treatment, and to identify the most effective diagnostic and treatment approaches. Additionally, we analyzed studies regarding cervical epidural abscesses and performed a review of the literature. In this study, four patients with spinal epidural abscess were included. There were three men and one woman with a mean age of 53 years. Three patients presented with motor deficits, and one patient was diagnosed incidentally through spinal imaging. All the patients had fever, and blood cultures were positive. Staphylococcus aureus was the most common organism cultured from abscesses. All patients underwent a surgical procedure, and three patients recovered their normal neurological functions, but one remained with mild neurological disability that was resolved two years postoperatively. The mean follow-up period was 12 months, and no deaths occurred in this series. Furthermore, we identified 85 studies in the literature review and extracted data regarding the diagnosis and management of these patients. The timely detection and effective management of this condition are essential for minimizing its associated morbidity and mortality.

Complete disruption of vastus intermedius tendon and partial rupture of vastus medialis tendon.

Quadriceps tendon ruptures are common injuries, however isolated ruptures are rare. Particularly, reports for isolated vastus intermedius ruptures are very scarce. We present a case of a 62-years-old male patient who sustained a complete rupture of vastus intermedius tendon with a partial rupture of vastus medialis while rectus femoris tendon was intact, after a fall from standing height. Due to lag in extension, surgical treatment was performed, consisted of an end-to-end Krakow suture technique accompanied with two anchors placed on osseous attachment to the superior pole of the patella. A hinged knee brace locked in full extension was applied for 4 weeks. Gradual range of flexion was suggested after the 3rd postoperative week. Full range of motion was achieved in the 7th postoperative week.

Cryptococcus neoformans osteomyelitis of the tibia: a case report and review of the literature.

INTRODUCTION: Osteomyelitis is a bone inflammation that can be related to various infectious agents. As with any other type of inflammation, the prevailing symptoms and signs may include redness, swelling, pain, and heat. Fungal osteomyelitis is rare and usually found in immune-compromised patients. CASE PRESENTATION: A non-human immunodeficiency virus immunocompromised Greek female patient, 82 years old, visited the emergency department due to a 3 day pain located mainly over the left tibia's anterior surface, accompanied by swelling and redness. There was also a subcutaneous lesion of her left breast. Medical history revealed that the patient had an unmasked close contact with pigeons, a main host of the disease. Initial x-ray imaging showed an osteolytic area in the upper third of the tibial diaphysis. The patient was admitted and underwent a computed tomography-guided biopsy. The specimen revealed a Cryptococcus neoformans infection of the bone and the breast. She was treated with 400 mg fluconazole twice a day for 3 weeks while in hospital and 200 mg twice a day upon discharge for 9 months. After that, she underwent surgical debridement because of lasting local irritation. She was closely monitored in our outpatient office, and in her last visit, 1 year after the initial admission, inflammatory signs had regressed vastly. CONCLUSIONS: To our knowledge, this is the ninth cryptococcal osteomyelitis of the tibia to be recorded since 1974, and the most unusual finding was the bifocal nature of the infection, affecting both the tibia and the breast.

Biophysical Enhancement in Fracture Healing: A Review of the Literature.

Bone healing constitutes a complex process involving cellular and pathophysiological mechanisms. Despite progress in osteosynthesis techniques, fracture union continues to be challenging. In some cases, it is not ultimately achieved or is delayed relative to the expected time resulting in economic and social outcomes for the patient and the health system. In addition to surgical treatment, biophysical methods have been developed to assist in fracture healing used in combination or individually. Biophysical stimulation is a non-invasive therapy used in orthopedic practice to increase and enhance tissue's reparative and anabolic activities. This study reviewed the existing literature, including electromagnetic fields, ultrasound, laser, extracorporeal shockwave therapy, and electrical stimulation, and revealed the efficacy of biophysical stimulation for bone healing. This study aims to define if these methods are helpful, especially in cases of non-union. Biophysical stimulation requires care and precision in use to ensure the success expected of it by physicians and patients.

Isolated Avulsion Fracture of the Lesser Trochanter in an Adolescent: A Case Report and Review of the Literature.

Avulsion fractures of the lesser or greater trochanter or the iliac crest are uncommon injuries in adolescents. The anterior superior iliac spine, ischium, and anterior inferior iliac spine are the most frequently affected sites. We report a rare case of a 14-year-old boy who sustained an avulsion fracture of the lesser trochanter while playing soccer. No malignancy or associated metabolic bone disease was detected. Conservative treatment was suggested, consisting of a non-weight-bearing period and analgesics. Routine follow-up was performed at one, three, and six months after the injury. Radiographs were utilized to confirm fracture healing. Full recovery and return to a pre-injury functional level were observed at six months. Within this timeframe, a thorough literature review is performed.

Screw Fixation as the Primary and Definitive Treatment of an Isolated Uncommon Fracture of the Anterior Margin of the Distal Tibia.

Tibial plafond fractures constitute one of the most challenging fracture types while they are commonly associated with soft tissue damage and severe bone comminution. We present the clinical outcomes of screw fixation as the initial and definitive treatment of an isolated uncommon fracture of the anterior margin of the distal tibia. This is a case of an uncommon type of fracture of the distal tibia. The patient underwent a successful screw fixation and the fracture healed in three months. There was no bone and soft tissue infection. Sixteen months after the injury, an excellent function of the ankle joint was noted. Although fractures of the anterior margin of the distal tibia are uncommon high-energy injuries, uneventful healing with very good functional results can be achieved with screw fixation as the initial and definitive treatment.

Isolated complete rupture of distal biceps femoris tendon following a motor vehicle accident: A case report and review of the literature.

Isolated complete ruptures of the distal biceps femoris tendon are rare injuries. To our knowledge, very few cases have been reported in English literature. We present the case of a young man who complained of pain on the posterolateral corner of the knee after a motor vehicle accident. Clinical examination and MRI findings revealed a complete rupture at the musculotendinous junction of distal biceps femoris tendon. We describe the surgical treatment performed, and the clinical outcome.

Angiogenesis in Spinal Cord Injury: Progress and Treatment.

Traumatic spinal cord injury (SCI) provokes the onset of an intricate pathological process. Initial primary injury ruptures local micro-neuro-vascularcomplex triggering the commencement of multi-factorial secondary sequences which exert significant influence on neurological deterioration progress. Stimulating by local ischemia, neovascularization pathways emerge to provide neuroprotection and improve functional recovery. Although angiogenetic processes are prompted, newly formed vascular system is frequently inadequate to distribute sufficient blood supply and improve axonal recovery. Several treatment interventions have been endeavored to achieve the optimal conditions in SCI microenvironment, enhancing angiogenesis and improve functional recovery. In this study we review the revascularization pathogenesis and importance within the secondary processes and condense the proangiogenic influence of several angiogenetic-targeted treatment interventions.

Early failure of an uncemented femoral stem, as compared to two other stems with similar design, following primary total hip arthroplasty performed with direct anterior approach.

INTRODUCTION: An increased risk of early femoral component loosening has been reported using the direct anterior approach (DAA) compared with other common surgical approaches. However, long-term data are scarce. The purpose of this study is: (1) to determine the incidence of early femoral loosening in a high volume, single surgeon's practice utilising the DAA approach; and (2) to examine the effect of stem design and type of coating on aseptic loosening in the early and mid-term postoperative period. METHODS: A retrospective review of 1650 consecutive patients (1800 hips) who underwent total hip arthroplasty (THA) using the DAA between August 2011 and December 2017 was conducted at our institution. 3 types of uncemented femoral stems (Quadra-S, Avenir, TwinSys), with similar design, but different coating, were implanted. Patients were evaluated clinically and radiologically at 4 weeks, 3 months, 1 year, and annually thereafter. RESULTS: After a mean follow-up of 46.4 months, the total incidence of revision for aseptic loosening was 0.44% (n = 8). All loose stems were Quadra-S, failing to achieve osseointegration, for an overall incidence of 0.96% (p = 0.002). None of the other stems were loose. Radiolucent lines around the proximal stem portion were visible in 75 Quadra-S stems (4.1%) on radiographs taken at 1 year postoperatively and continued to deteriorate at the latest follow-up. CONCLUSIONS: In this specific cohort of patients, the increased rate of femoral stem aseptic loosening was implant-related and was attributed only to a specific type of femoral stem (Quadra-S). No relation to other factors was proven suggesting that the surface characteristics of this femoral stem and the lack of bioactive coating are responsible for the observed early femoral failures. These findings should be confirmed by additional registry work and larger population sample sizes are needed to evaluate the prosthesis performance after implantation through the DAA.

Direct anterior approach vs Hardinge in obese and nonobese osteoarthritic patients: A randomized controlled trial.

BACKGROUND: The increased prevalence of obesity has resulted in orthopedic surgeons being likely to face many patients with a high body mass index (BMI) who warrant total hip arthroplasties (THAs) over the coming years. Studies' findings considered the postoperative clinical, and functional outcomes in these patients are controversial, and selecting the most appropriate surgical approach remains debatable. AIM: To compare pain-levels, functionality, and quality-of-life in obese and nonobese osteoarthritic patients who have undergone primary total hip arthroplasty through either direct-anterior-approach (DAA) or Hardinge-approach. METHODS: One hundred and twenty participants (> 50 years) were divided into four groups according to the surgical approach (DAA or Hardinge) and patients' BMI (nonobese < 30 kg/m2 vs obese ≥ 30 kg/m2). Outcomes were measured preoperatively and postoperatively (6th and 12th week). Pain was measured with Face Pain Scale-Revised (FPS-R). Functionality was measured with Timed Up & Go (TUG) test and Modified Harris Hip Score-Greek version (MHHS-Gr). Quality-of-life was evaluated with the 12-item-International Hip Outcome Tool-Greek version (iHOT12-Gr) (Clinical Trial Identifier: ISRCTN15066737). RESULTS: DAA vs Hardinge: (week 6) DAA-patients showed 12.2% less pain, more functionality (14.8% shorter TUG-performance time, 21.5% higher MHHS-Gr), and 38.16% better quality-of-life (iHOT12-Gr) compared to Hardinge-patients (all P values < 0.001). These differences were further increased on week 12 (all P values ≤ 0.05)]. DAA-obese vs Hardinge-obese: (week 6) DAA-obese patients had less pain, shorter TUG-performance time, better MHHS-Gr and iHOT12-Gr scores than Hardinge-obese (all P values < 0.01). (Week 12) Only the TUG-performance time of DAA-obese was significantly shortened (22.57%, P < 0.001). DAA-nonobese vs DAA-obese: no statistically significant differences were observed comparing the 6th and 12th weeks' outcomes. CONCLUSION: DAA-groups reported less pain, more functionality and better quality-of-life, compared to the Hardinge-groups. The DAA benefited obese and nonobese patients, similarly yet faster, suggesting that it should be the more preferred choice for obese patients, instead of Hardinge. However, more comparative studies with more extended follow-up periods are needed to confirm our results and better evaluate all patients' long-term outcomes.

Drill-guided femoral nail extraction: a novel technique.

Femoral nail extraction, although it is considered a challenging procedure for orthopedic surgeons, can be simplified. We present a new technique to aid the removal of a proximally (antegrade) inserted femoral nail by applying drilling consecutively in order to identify the margins and depth of the nail into the intramedyllary canal of the femur. The damage to the bone is minimal as we use k-wires or drilling and in our practice was uneventful. This technique is the first to be reported in literature. Most authors suggest techniques that enable radiolucent table and fluoroscopy techniques using C-arm. With this technique, traction table and fluoroscopy techniques seem to be less essential to accomplish the removal of a proximally (antegrade) inserted femoral nail.

Peroneus brevis tendon injuries: Report of two cases and review of literature.

The incidence of peroneal tendon disorders in the population is unknown and they are usually overlooked. We report two cases of peroneus brevis injuries and a comprehensive literature review was performed. The first case was a 53-year-old man presented with persistent pain on the lateral aspect on the left ankle during the last four years and difficulty to bear weight during the last year. MRI showed longitudinal tear of peroneus brevis tendon and the patient underwent surgical treatment. The second case was a 46-year-old woman with persistent pain on the lateral aspect of the ankle with a history of a road traffic accident two years ago. Although MRI showed a peroneus brevis tendon tear, this was a false positive finding. Surgical treatment revealed no tear and symphysiolysis managed to relieve patient's symptoms. Even though MRI is the most effective diagnostic tool in depicting peroneal tendon injuries, there are false positive findings. In cases when symptoms persist, surgical exploration is indicated.

Treatment of Schatzker Type II-VI Tibial Plateau Fractures by Means of Syndesmotaxis Using an Ilizarov External Fixator and Postoperative CT Evaluation.

Introduction Tibial plateau fractures are more common in young patients following high-energy trauma. In this study, we aim to evaluate the articular surface reduction quality by means of postoperative computer tomography (CT) in Schatzker type II-VI tibial plateau fractures treated with an Ilizarov frame. Materials and methods This case series study included 45 patients with a mean age of 39.5 years (range: 18 to 65 years) with a Schatzker type II-VI tibial plateau fracture. The surgical technique was a mini-open reduction of the articular surface impaction followed by application of an Ilizarov circular frame with knee bridging. Pre- and postoperative CT scan evaluation was performed in all of the patients. Outcomes were measured using the American Knee Society Score (AKSS). Mean outpatient follow-up was of at least 12 months (range: 12 to 21 months). Mean time for fracture consolidation was 15.5 weeks (range: 13 to 19 weeks). According to the degree of postoperative articular surface impaction, patients were grouped as follows: 11 had less than 2 mm of depression, 27 had 2 to 4 mm of depression, and 7 over 4 mm of depression. Results Patients with articular surface impaction of more than 4 mm presented statistically significant lower values of AKSS compared to those with impaction of lower than 2 mm (p<0.001 ) and 2-4 mm (p<0.001). Patients with joint alignment equal to or more than 5° presented statistically significant lower values of AKSS compared to those with lower than 5°. Conclusions Schatzker type II-VI tibial plateau fractures may be treated successfully with mini-open reduction and the application of an Ilizarov frame. The increase of articular surface impaction by 1 mm causes reduction of AKSS by 15 units. Patients with joint alignment equal to or more than 5° present lower values of AKSS. The preoperative CT scan is important and useful in planning the surgical intervention no matter the classification system is used.

Anterior Cruciate Ligament Reconstruction With the All-Inside Technique: Equivalent Outcomes and Failure Rate at Three-Year Follow-Up Compared to a Doubled Semitendinosus-Gracilis Graft.

PURPOSE: To compare in terms of failure rates, clinical and functional outcomes the all-inside anterior cruciate ligament (ACL) reconstruction with double suspensory fixation and quadrupled semitendinosus autograft with anteromedial portal doubled semitendinosus-gracilis autograft with suspensory femoral and tibial interference screw fixation. METHODS: Forty-four patients were sequentially allocated into two groups and followed up prospectively for a 3-year period. The first group was the all-inside group and the second was the "classic" AM portal with S-G graft. Each group comprised 22 patients. All patients underwent KT-1000 testing preoperatively and at a minimum of six months postoperatively. Visual pain analog was recorded preoperatively and during both the immediate postoperative period and throughout the follow-up. The Lysholm knee score was used comparing the preoperative and 24-month timepoints. RESULTS: The visual analog scale (VAS) pain scores showed a significant difference at two weeks (2.4 vs 1.8, p < 0.01 ) in favor of the all-inside group, but that difference disappeared in the later follow-up visits. Similarly, there was no significant difference with Lysholm knee scores at two years and the side-to-side anterior translation measured with the KT-1000. At the three-year mark, there were no failures in either of the groups. CONCLUSION: The all-inside technique appears to be equivalent in terms of outcomes to the classic S-G technique, and given the less-invasive nature and versatility in graft choices is a safe and effective technique for primary ACL reconstruction.

Falls from height due to accident and suicide attempt in Greece. A comparison of the injury patterns.

BACKGROUND: Falls from height are a common cause of death and disability. Falls from height can be divided between accidental and suicide attempts. The aim of this study is to ascertain the demographic characteristics of these patients, and to identify the fracture patterns. METHODS: In this retrospective cross sectional comparative study we present 244 patients who sustained injuries as a result of a fall from height. They were divided into those with accidental falls (n = 180, group I) and those with suicide attempts (n = 64, group II). Data collected included age, gender, associated trauma, injury severity score (ISS), Glasgow Coma Scale (GCS), haemodynamic status, length of intensive care unit (ICU) and hospital stay. The diagnosis of mental disorder was ascertained by psychiatric specialists using the criteria of the International Classification of Disease Ninth Version Clinical Modification (ICD - 9CM). Postoperative follow-up ranged from 12 months to 10 years. RESULTS: The injuries sustained were as follows: Abdominal trauma in 9 cases (5 in group I, 4 in II), thoracic trauma in 81 cases (49 in group I, 32 in II), head injury in 23 cases (7 in group I, 16 in II), 383 extremities fractures (184 in group I, 199 in II) and 133 spinal fractures (101 in group I, 32 in II). Twenty-one patients died in hospital while 223 patients survived to hospital discharge. The mean height from which the fall occurred was 5.4 m (range, 3 - 25 m). The mean Injury Severity Score was 19 (range, 6 to 58) for all fall victims. CONCLUSIONS: Patients following an accidental high fall mostly had upper limb fractures. Patients following a suicidal high fall mostly had lower limb fractures, pelvis, spinal fractures and head injuries. Spinal fractures are common either when the fall is accidental or following suicide attempt.

Complex Tibial Plateau Fractures Treated by Hybrid External Fixation System: A correlation of followup computed tomography derived quality of reduction with clinical results.

BACKGROUND: Tibial plateau fractures are common due to high energy injuries. The principles of treatment include respect for the soft tissues, restoring the congruity of the articular surface and reduction of the anatomic alignment of the lower limb to enable early movement of the knee joint. There are various surgical fixation methods that can achieve these principles of treatment. Recognition of the particular fracture pattern is important, as this guides the surgical approach required in order to adequately stabilize the fracture. This study evaluates the results of the combined treatment of external fixator and limited internal fixation along with the advantages using postoperative computed tomography (CT) scan after implant removal. Materials and. METHODS: 55 patients with a mean age of 42 years (range 17-65 years) with tibial plateau fracture, were managed in our institution between October 2010 and September 2013., Twenty fractures were classified as Schatzker VI and 35 as Schatzker V. There were 8 open fractures (2 Gustilo Anderson 3A and 6 Gustilo Anderson 2). All fractures were treated with closed reduction and hybrid external fixation (n = 21/38.2%) or with minimal open reduction internal fixation and a hybrid system (n = 34/61.8%). After the removal of the fixators, CT-scan was programmed for all the cases, for correlation with the results. At final followup, the American Knee Society Score (AKSS) was administered. RESULTS: All patients were evaluated with a minimum of 12 months (range 12-21 months) followup. Average time to union was 15.5 weeks (range 13-19 weeks). The postoperative joint congruity as evaluated in the postoperative CT-scan was <2 mm of articular step-off in 8 patients (14.5%), between 2 and 4 mm in 18 patients (32.7%) and over 4 mm in 29 (52.7%). The injured limb mechanical axis was restored within 5° compared to the contralateral limb in 36 cases (65%) and with an angulation >5° in 19 cases (35%). Patients with residual joint depression <3.5 mm had a 95% chance of having excellent AKSS knee score results and 80% chance of having excellent AKSS function scores. On the other hand, residual joint depression of >4.5 mm displayed a 100% chance of getting poor-fair scores both in AKSS knee and AKSS function score. The association of a postoperative mechanical axis within 5° of the contralateral limb and improved knee scores was statistically significant for the AKSS function and total scores but not for the AKSS knee score. The AKSS was negatively correlated with postoperative joint depression magnitude which was statistically significant. Only the amount of joint collapse was verified as a prognostic factor in a multivariate logistic regression analysis. CONCLUSIONS: The postoperative CT-scan shows important information about bone healing, and an exact image of the reduction and the shaft alignment. Postoperative radiographs may have led to an underestimation of the degree of residual displacement. On the contrary, CT-scan demonstrates the exact grade of articular displacement and depending on CT-scan results one can better manage the postoperative rehabilitation.

A long term clinical outcome of the Medial Pivot Knee Arthroplasty System.

BACKGROUND: The ideal total knee arthroplasty (TKA) should provide maximum range of motion and functional stability for all desired daily activities and, if possible, to replicate normal knee kinematics and function. The ADVANCE® Medial Pivot (AMP) Knee System was designed with a highly congruent medial compartment and a less conforming lateral compartment to more closely mimic the kinematics of the normal knee and to offer more stability through out of range of motion (ROM). The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of this TKA system. METHODS: Three hundred and twenty-five (325) patients (347 knees) with knee osteoarthritis underwent a TKA using the AMP prosthesis in our Department. For evaluation, objective and subjective clinical rating systems along with radiograph series were used. The average follow-up was 15.2years. RESULTS: All patients showed a statistically significant improvement (p<0.0005) in the Knee Society clinical rating system, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire, SF-12® questionnaire, and Oxford knee score. The majority of patients (94%) were able to perform age-appropriate activities with a mean knee flexion of 120° (range, 105°-135°) at final follow-up. Survival analysis showed a cumulative success rate of 98.8% at 17years. CONCLUSION: The obtained results demonstrate excellent long-term clinical outcome for this knee design.