RESUMEN
BACKGROUND: The surgical management of isolated medial compartment degenerative disease of the knee causes debate. Unicompartmental arthroplasty options include fixed and mobile bearing implant designs with fixed bearing becoming increasingly popular. We present the largest cohort of a fixed bearing single radius design, Stryker Triathlon Partial Knee Replacement (PKR). METHODS: We prospectively collected demographic data and patient reported outcome measures (PROMs) on our cohort of PKR implants since its adoption in our unit, 2009 until March 2015. RESULTS: A total of 129 implants in 115 patients with a mean follow-up of 5.5â¯years (2.5 to 8.5â¯years) were included. There were 11 revisions at an average of 1.7â¯years (0.6-4.1â¯years), two for infection, two for mal-alignment, five for progression of disease and two for loosening. The survivorship of the implants at five years is 90%. CONCLUSION: The PKR provides good survivorship at five years and PROM scores that are equal to the largest and most popular comparable implants. There is an associated learning curve with this implant, as there is with all systems and this is reflected in our results.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/instrumentación , Prótesis de la Rodilla , Osteoartritis de la Rodilla/cirugía , Falla de Prótesis , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Estudios Prospectivos , Diseño de Prótesis , Rango del Movimiento Articular , Factores de TiempoRESUMEN
BACKGROUND: We present the largest series of Avon patellofemoral joint (PFJ) replacements outside of the design centre. There is discussion over its efficacy and usefulness. We report an independent opinion of its indications, survivorship and outcomes. METHODS: We prospectively collected demographic data and patient reported outcome measures (PROM's) on our cohort of Avon Patellofemoral replacements since its adoption in our unit in 2003 until 2014. We performed a retrospective review of radiographs. RESULTS: We performed 103 PFJ replacements in 85 patients, 36 were male (mean age 61 - range 34 to 78) and 67 female (mean age 60 - range 38 to 82), mean follow up time was 5.6years (range 2.9 to 14.2years) with 93 implants still in situ. Their mean post-operative Oxford Knee Score was 36 (range seven to 48). There were nine conversions to TKR for disease progression and one revision of a femoral component for trochlear malpositioning. Mean time to revision was 2.9years (1.0 to 6.0years). Radiographic evidence of progression on Kellgren and Lawrence score in the un-replaced compartments was demonstrated in 23% of cases with imaging available. The Avon PFJ replacement delivers reproducible and effective pain relief and function to patients with isolated patellofemoral osteoarthritis. We believe PFJ replacement has an important role to play, and we will continue to perform this procedure for a carefully selected group of patients. Conversion to TKR does not and should not be regarded as failure of the index operation.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/instrumentación , Prótesis de la Rodilla , Articulación Patelofemoral/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Estudios Prospectivos , Reoperación , Resultado del TratamientoRESUMEN
We assessed hyperextension of the knee and joint laxity in 169 consecutive patients who underwent an anterior cruciate ligament reconstruction between 2000 and 2002 and correlated this with a selected number of age- and gender-matched controls. In addition, the mechanism of injury in the majority of patients was documented. Joint laxity was present in 42.6% (72 of 169) of the patients and hyperextension of the knee in 78.7% (133 of 169). All patients with joint laxity had hyperextension of their knee. In the control group only 21.5% (14 of 65) had joint laxity and 37% (24 of 65) had hyperextension of the knee. Statistical analysis showed a significant correlation for these associations. We conclude that anterior cruciate ligament injury is more common in those with joint laxity and particularly so for those with hyperextension of the knee.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Inestabilidad de la Articulación/complicaciones , Adolescente , Adulto , Femenino , Humanos , Inestabilidad de la Articulación/fisiopatología , Articulación de la Rodilla/fisiopatología , Masculino , Rango del Movimiento Articular , Factores de Riesgo , Rotura/etiología , Rotura/fisiopatologíaRESUMEN
PURPOSE: The aim of the study is to show, on an MRI scan, that the posterior border of the anterior horn of the lateral meniscus (AHLM) could guide tibial tunnel position in the sagittal plane and provide anatomical graft position. METHOD: One hundred MRI scans were analysed with normal cruciate ligaments and no evidence of meniscal injury. We measured the distance between the posterior border of the AHLM and the midpoint of the ACL by superimposing sagittal images. RESULTS: The mean distance between the posterior border of the AHLM and the ACL midpoint was -0.1mm (i.e. 0.1mm posterior to the ACL midpoint). The range was 5mm to -4.6mm. The median value was 0.0mm. 95% confidence interval was from -0.5 to 0.3mm. A normal, parametric distribution was observed and Intra- and inter-observer variability showed significant correlation (p<0.05) using Pearsons Correlation test (intra-observer) and Interclass correlation (inter-observer). CONCLUSION: Using the posterior border of the AHLM is a reproducible and anatomical marker for the midpoint of the ACL footprint in the majority of cases. It can be used intra-operatively as a guide for tibial tunnel insertion and graft placement allowing anatomical reconstruction. There will inevitably be some anatomical variation. Pre-operative MRI assessment of the relationship between AHLM and ACL footprint is advised to improve surgical planning. LEVEL OF EVIDENCE: Level 4.
RESUMEN
Acute fractures of the scaphoid were randomly allocated for conservative treatment in a Colles'-type plaster cast with the wrist immobilised in either 20 degrees flexion or 20 degrees extension. The position of the wrist did not influence the rate of union of the fracture (89%) but when reviewed after six months the wrists which had been immobilised in flexion had a greater restriction of extension. We recommend that acute fractures of the scaphoid should be treated in a Colles'-type cast with the wrist in slight extension.
Asunto(s)
Huesos del Carpo/lesiones , Moldes Quirúrgicos , Fracturas Óseas/terapia , Adolescente , Adulto , Anciano , Femenino , Humanos , Inmovilización , Masculino , Persona de Mediana EdadRESUMEN
We describe a surgical technique that has been used successfully during arthroscopic anterior cruciate ligament reconstruction to enhance the visual clarity of the operating field specifically during tunnel placement. The precise siting of both tibial and femoral tunnels is critical to both the short- and long-term success of this procedure. Gentle insufflation of the knee joint with air prior to tunnel siting allows for an excellent view of the intercondylar notch. This visual clarity helps in the precise placement and measurement of the femoral tunnel.
Asunto(s)
Ligamento Cruzado Anterior/cirugía , Artroscopía/métodos , Insuflación/métodos , Aire , Lesiones del Ligamento Cruzado Anterior , Fémur/cirugía , Humanos , Osteotomía/métodos , Cloruro de Sodio , Irrigación Terapéutica , Tibia/cirugíaRESUMEN
A rare case of trans-radial styloid, trans-scaphoid, trans-triquetral perilunate dislocation is described. The injury was treated by reduction and internal fixation using a Herbert screw and Kirschner wire. A good functional result was achieved. A review of the literature illustrates that early surgery is recommended. Alternative surgical approaches are discussed.
Asunto(s)
Huesos del Carpo/lesiones , Luxaciones Articulares/cirugía , Fracturas del Radio/cirugía , Accidentes de Tránsito , Adulto , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Humanos , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/etiología , Masculino , Motocicletas , Radiografía , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/etiologíaRESUMEN
A case of traumatic radio-ulnar dislocation in a limb previously affected by poliomyelitis is presented. Treatment with Kapandjii's procedure is described and discussed.
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Brazo , Luxaciones Articulares/cirugía , Poliomielitis/complicaciones , Traumatismos de la Muñeca/cirugía , Anciano , Humanos , MasculinoRESUMEN
Many radiographic techniques have been described for measuring patellar height. They can be divided into two groups: those that relate the position of the patella to the femur (direct) and those that relate it to the tibia (indirect). This article looks at the methods that have been described, the logic behind their conception and the critical analyses that have been performed to test them.
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Rótula/anatomía & histología , Rótula/diagnóstico por imagen , Adulto , Antropometría/métodos , Niño , Femenino , Fémur/anatomía & histología , Fémur/diagnóstico por imagen , Humanos , Articulación de la Rodilla/anatomía & histología , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Tibia/anatomía & histología , Tibia/diagnóstico por imagen , Adulto JovenRESUMEN
A series of 107 undisplaced or minimally displaced distal third radial fractures in children were assessed to try to identify the incidence and the factors associated with displacement. Of 27 fractures showing a volar (pronation) pattern, there were no cases of progression of the deformity. Of the 80 fractures showing a dorsal (supination) pattern, 22.5 per cent progressed. Of the unicortical fractures, 13.6 per cent showed a progression of the deformity compared with 47.6 per cent of the bicortical fractures. Of the unicortical fractures, 7.1 per cent of those showing a dorsal buckle displaced compared with 29.4 per cent of those with a cortical breach.
Asunto(s)
Fracturas del Radio/patología , Moldes Quirúrgicos , Niño , Estudios de Seguimiento , Fijación de Fractura/métodos , Humanos , Radio (Anatomía)/cirugía , Fracturas del Radio/cirugíaRESUMEN
We report a series of 20 children with 24 fractures that were treated using the AO tubular external fixator in a paediatric orthopaedic unit. There were no major complications related to fixator use. There were two cases of superficial pin track sepsis and one case of non-union. There were no cases of refracture after fixator removal or of leg length inequality.
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Fijadores Externos , Fijación de Fractura/métodos , Adolescente , Niño , Preescolar , Femenino , Fracturas del Fémur/cirugía , Fracturas Cerradas/cirugía , Fracturas Abiertas/cirugía , Humanos , Masculino , Traumatismo Múltiple , Fracturas de la Tibia/cirugía , Fracturas del Cúbito/cirugíaRESUMEN
Intra-articular ganglion cysts of the knee joint are rare. Percutaneous aspiration of ganglion cysts of the knee, which has both diagnostic and therapeutic value, has been described, but usually under guidance by computed tomography (CT). We describe ultrasound-guided aspiration of posterior cruciate ligament cysts in two patients.