No benefits of knee osteotomy patient's specific instrumentation in experienced surgeon hands.

PURPOSE: To compare the clinical and radiological outcomes of patient-specific instrumentation (PSI) with the conventional free hand (FH) technique in performing coronal plane corrective knee osteotomies in terms of limb alignment and functional scores. The hypothesis is that conventional FH technique in experienced hands with proper pre-operative planning is as precise as PSI. METHODS: Patients who underwent coronal plane corrective knee osteotomies with either PSI or FH technique between 2017 and 2019 by the same senior surgeon and have a minimum of 2 years follow-up period were included in this study. A total of 91 knees (84 patients) with mean age of 42.9 ± 12.5 years who had a pre- and post-operative complete weight-bearing radiographic work-up (50 of them were performed with the FH technique and 41 by means of PSI) were included for comparison. The data were retrospectively reviewed both radiologically and clinically using the Knee Injury and Osteoarthritis Outcome Score (KOOS) sub-scores. All cases in both groups were evaluated for the following measurements: hip-knee-ankle (HKA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (mLDFA), and joint line convergence angle (JLCA) both preoperatively and postoperatively. In addition, FH and PSI osteotomy cases were also compared for their precision in achieving the target correction that was planned preoperatively. All cases were also evaluated clinically preoperatively and at 2-year follow-up using KOOS sub-scores and the two groups were compared. RESULTS: The mean HKA precision was 1.5 ± 0.9 in FH group and 1.3 ± 0.7 in PSI (P value = n.s.), the mean MPTA precision was 1.6 ± 1.6 in FH group and 2.1 ± 1.2 in PSI (P value = n.s.), the mean m-LDFA precision was 1.9 ± 1.7 in FH group and 1.4 ± 1.3 in PSI (P value = n.s.), and the mean JLCA precision in the FH group was 1.5 ± 1.2 and 1.7 ± 1.2 in PSI (P value = n.s.). For all the radiographic parameters, there were no statistically significant differences between the target correction and the obtained correction in both groups. Moreover, PSI and FH techniques were comparable in terms of clinical outcomes and no significant difference was found between the two groups in any of the 2-year follow-up KOOS sub-scores. CONCLUSION: Conventional FH method in the hands of experienced surgeons is as precise as PSI in reliably achieving the planned correction in different coronal plane knee corrective osteotomies. Moreover, there was also no difference between both methods in the 2-year clinical outcome scores.

In slope-changing osteotomy one millimeter is not one degree: results of an artificial intelligence-automated software analysis.

BACKGROUND: Anterior closing wedge osteotomies (ACWO) are performed in revision anterior cruciate ligament (ACL) surgery to correct an excessive posterior tibial slope (PTS). PURPOSE: With the help of automated planning software, this study investigates the assumption that 1mm of wedge height gives 1° of slope correction (1:1). METHODS: Fifty patients underwent ACWO, with the wedge height calculated using the 1:1 formula. Pre- and postosteotomy PTS were measured manually, and the achieved post-operative PTS was compared with the target PTS of 5.3° ± 1.9. The X-ray analysis was repeated virtually with the automated software, which also recommended a resection height. These parameters were then compared with the manually obtained parameters. RESULTS: Using a 1:1 formula, wedge heights of 8.5mm ± 2.3 was resected to achieve a PTS of 4.2° ± 0.32. This showed an overcorrection of 1.6° ± 0.8 from the target slope. This was consistent with the data from the automated software, which recommended a lower wedge height of 7.7mm ± 2.9. CONCLUSION: In trans-tubercle ACW, using a wedge height (mm) to slope correction (°) ratio of 1:1 can lead to slight over-correction. Automated software planning is useful for planning correction osteotomies in the sagittal plane.

Preoperative stiffness is the most important predictor of postoperative patient's satisfaction after total knee arthroplasty.

PURPOSE: To predict the most important preoperative factor affecting the patient satisfaction after total knee arthroplasty (TKA) in trial to improve patient counselling process. METHODS: We retrospectively reviewed all patients who underwent primary TKA from January 1, 2018, to January 31, 2019, with minimum one-year follow-up for the previously collected patient-reported outcome measures (PROMs) as Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score for joint replacement (KOOS, JR) preoperative, 6 months and 12 months postoperative. RESULTS: By using Oxford knee score at 12 months as dependent variable, we found a negative moderate spearman correlation between age and Oxford knee score at 12 months postoperative. Moderate negative spearman correlation was also found between Oxford knee score at 12 months postoperative and KOOS pain, stiffness and function scores at preoperative and 6 months postoperative, denoting higher satisfaction at 12 months with less perceived stiffness, pain and limited function at baseline and 6 months postoperative. A multivariate regression analysis was done using the oxford knee score at 12 months as dependent variable to detect the predictors of oxford knee score at 12 months postoperatively and showed that younger age and less perception of stiffness at baseline were significant predictors of higher Oxford knee score: higher satisfaction at 12 months postoperative. CONCLUSION: Preoperative stiffness can predict the postoperative satisfaction score more than any other factor. We also address the importance of combining more than one PROM in assessing patients as OKS and KOOS, JR.

Fixation of Mallet Fractures Using a Modified Hook Plate Technique: A Prospective Case Series of 17 Patients.

Objective Various modalities have been suggested to manage mallet fractures; however, inappropriate treatment can lead to extension lag, a swan neck deformity, or arthritis of the distal interphalangeal joint (DIPJ). The current study aimed to evaluate the results (functional, radiological, and complications) of open reduction and internal fixation (ORIF) of mallet fractures using low-cost hook plates fabricated from low-profile titanium mini plates. Methods A prospective case series of 17 consecutive patients (average age of 32.3 years) with mallet fractures (six were Wehbe Type IB and 11 were Wehbe Type IIB). Eleven (64.7%) were males. The affected hand was dominant in all patients, and the affected digit was the index in 6 (35.3%), the ring in 5 (29.4%), the small in 3 (17.65%), and the middle in 3 (17.65%) patients. The same fellowship-trained hand surgeon performed all surgeries. Results The average operative time was 37.65 minutes. After an average follow-up of 10.94 months (range 6-27), the average DIPJ motion was 50° ° (range 20°-70°), the extensor lag was noted in 4 (23.5%) patients, and complications were reported in 6 (35.29%) patients. According to Crawford criteria, 6 (35.3%) patients achieved excellent results, 7 (41.2%) achieved good results, and 4 (23.5%) achieved fair results. Conclusion The modified hook plate technique for fixation of mallet fractures is a beneficial, economical, yet demanding technique that adequately provides stable fixation to allow early DIPJ motion with acceptable functional outcomes.

Sexual dimorphism of the posterior condylar offset of the femur and the medial posterior slope of the tibia in non-arthritic knees of Egyptian adults: an MRI study.

BACKGROUND: The aim of this magnetic resonance imaging (MRI) study was to investigate controversial sexual dimorphism of the posterior condylar offset of the femur (the offset) and the posterior slope of the tibia (the slope) in non-arthritic knees of Egyptian adults. METHODS: On 100 male and 100 female MRIs of non-arthritic knees, linear measurements of the distal part of the femur (the offset) and the angular measurements of the proximal part of the tibia (the slope) were performed and compared regarding sex and ethnicity. The intraclass correlation coefficient (ICC) was used to test the interrater agreement. RESULTS: Both offsets and the lateral offset ratio were larger in males (p < 0.001), the medial offset ratio, and the medial slope in females (p from < 0.001 to 0.007), whereas the lateral slope was sex-free (p = 0.41). Irrespective of sex, however, the medial offset with its ratio, and the medial slope were larger than their counterparts (p < 0.001). Our means of the offsets, their ratios, and the slopes mostly differed from those of other ethnicities (p from ≤ 0.001 to 0.004). ICCs > 0.8 proved MRI's precision was high. CONCLUSION: There was a sexual dimorphism of both the offset and the medial slope in non-arthritic knees of Egyptian adults. We believe future designs of knee implants should consider these differences in order to improve postoperative range of motion and patients' satisfaction after total knee arthroplasty. Level of evidence Level III Retrospective Cohort Study. Trial registration ClinicalTrials.gov identifier: NCT03622034, registered on July 28, 2018.

Debridement, Antibiotics, and Implant Retention for an Early Periprosthetic Infection After Unicompartmental Knee Arthroplasty: A Technical Note.

Early periprosthetic joint infection in unicompartmental knee arthroplasty (UKA) is shown to have a detrimental effect on the success of UKA surgery not only because of the sequences of the infection but also due to the other healthy lateral compartment. It is well known that Oxford meniscal bearing UKA is a very precise procedure that the use of any excessive force may have an injurious effect on the future prosthesis stability with a higher risk of bearing dislocation. This technical note aims at describing how to deal with a case of early periprosthetic joint infection in a female patient who underwent debridement, wash, implant retention and change of the mobile bearing insert including the demonstration of a difficult step during this procedure.

Anthropometric measurements of non-arthritic knees in an Egyptian population: an MRI-based study.

BACKGROUND: Knee anthropometric characteristics were evaluated for different ethnicities; however, data from North African populations are deficient. The primary aim was to investigate the Egyptian knees' anthropometric characteristics as a representative of North African populations. Secondary aims are as follows: (1) to study the anthropometric gender difference, (2) to compare results with other ethnic groups, and (3) to study the mismatch in comparison to geometric characteristics of modern TKA implant designs. METHODS: Two hundred normal knee MRI scans (100 females and 100 males, aging from 18 to 60) were obtained for analysis. Linear measurements (anteroposterior (AP), mediolateral (ML), and aspect ratio (AR)) of the planned cut surface of the distal femur (f) and the proximal tibia (t) were evaluated. RESULTS: A significant difference between both sexes was found, males had larger measurements in anteroposterior [fAP: 60.97 ± 3.1 vs 54.78 ± 3.3 (P < 0.001), tAP: 46.89 ± 3.0 vs 41.35 ± 2.9 (P < 0.001)] and mediolateral [fML: 74.89 ± 3.2 vs 67.29 ± 3.7 (P < 0.001), tML: 76.01 ± 3.0 vs 67.26 ± 3.2 (P < 0.001)], the mean femoral and tibial AP and ML measurements were different from other ethnic groups. None of the seven studied TKA systems matched the largest ML or the smallest AP dimensions of the distal femur in the current study population. CONCLUSION: A significant difference was found between males' and females' knee anthropometric characteristics. Some of the commonly used TKA implants in our area could not provide a perfect fit and coverage. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03622034 , registered on July 28, 2018.

Fixation of Mallet Fractures Using a Modified Hook Plate Technique: A Prospective Case Series of 17 Patients / Fixação de fraturas em martelo com técnica de placa de gancho modificada: Uma série de casos prospectivos de 17 pacientes

Abstract Objective Various modalities have been suggested to manage mallet fractures; however, inappropriate treatment can lead to extension lag, a swan neck deformity, or arthritis of the distal interphalangeal joint (DIPJ). The current study aimed to evaluate the results (functional, radiological, and complications) of open reduction and internal fixation (ORIF) of mallet fractures using low-cost hook plates fabricated from low-profile titanium mini plates. Methods A prospective case series of 17 consecutive patients (average age of 32.3 years) with mallet fractures (six were Wehbe Type IB and 11 were Wehbe Type MB). Eleven (64.7%) were males. The affected hand was dominant in all patients, and the affected digit was the index in 6 (35.3%), the ring in 5 (29.4%), the small in 3 (17.65%), and the middle in 3 (17.65%) patients. The same fellowship-trained hand surgeon performed all surgeries. Results The average operative time was 37.65 minutes. After an average follow-up of 10.94 months (range 6-27), the average DIPJ motion was 50º º (range 20º-70º), the extensor lag was noted in 4 (23.5%) patients, and complications were reported in 6 (35.29%) patients. According to Crawford criteria, 6 (35.3%) patients achieved excellent results, 7 (41.2%) achieved good results, and 4 (23.5%) achieved fair results. Conclusion The modified hook plate technique for fixation of mallet fractures is a beneficiai, economical, yet demanding technique that adequately provides stable fixation to allow early DIPJ motion with acceptable functional outcomes.

Resumo Objetivo Diversas modalidades têm sido sugeridas para o tratamento de fraturas em martelo; no entanto, o tratamento inadequado pode causar retardo de extensão, deformidade em pescoço de cisne ou artrite da articulação interfalangiana distal (AIFD). Este estudo teve como objetivo avaliar os desfechos (funcionais, radiológicos e complicações) da redução aberta e fixação interna (RAFI) das fraturas em martelo com placas de gancho de baixo custo fabricadas com mini placas de titânio de baixo perfil. Métodos Série de casos prospectivos de 17 pacientes consecutivos (idade média de 32,3 anos) com fraturas em martelo (seis do tipo IB e 11 do tipo IIB de Wehbe). Onze (64,7%) pacientes eram do sexo masculino. A mão acometida era a dominante em todos os pacientes, com acometimento do dedo indicador em seis (35,3%), anelar em cinco (29,4%), mínimo em três (17,65%) e médio em três (17,65%) pacientes. O mesmo cirurgião de mão experiente realizou todas as cirurgias. Resultados O tempo operatório médio foi de 37,65 minutos. Após um acompanhamento médio de 10,94 meses (intervalo de 6 a 27), observou-se movimento médio da AIFD de 50º (intervalo de 20º a 70º), retardo de extensão em quatro (23,5%) pacientes e complicações em seis (35,29%) pacientes. De acordo com os critérios de Crawford, os desfechos foram excelentes em seis (35,3%), bons em sete (41,2%) e regulares em quatro (23,5%) pacientes. Conclusão A técnica da placa de gancho modificada para fixação de fraturas em martelo é benéfica e econômica, mas exigente; permite fixação estável e adequada para permitir a movimentação precoce da AIFD com desfechos funcionais aceitáveis.