Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Sep 2018
Meta AnalysisOutcome of kinematic alignment using patient-specific instrumentation versus mechanical alignment in TKA: a meta-analysis and subgroup analysis of randomised trials.
Kinematic alignment (KA) in total knee arthroplasty (TKA) matches component position to the pre-arthritic anatomy of an individual patient, with the aim of improving functional outcomes. Recent randomised controlled trials (RCTs) comparing KA to traditional neutral mechanical alignment (MA) have been mixed. This collaborative study combined raw data from RCTs, aiming to compare functional outcomes between KA using patient-specific instrumentation (PSI) and MA, and whether any patient subgroups may benefit more from KA technique. ⋯ Patient-reported outcome scores following TKA using PSI-KA are similar to MA. No identifiable subgroups benefited more from KA, and long-term results remain unknown. Inaccuracy of the PSI system used in KA patients could potentially affect outcome.
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Arch Orthop Trauma Surg · Sep 2018
Randomized Controlled TrialFast-track total knee arthroplasty improved clinical and functional outcome in the first 7 days after surgery: a randomized controlled pilot study with 5-year follow-up.
Fast-track protocols (FP) are used more and more to optimize results after total knee arthroplasty (TKA). Many studies evaluating FP in TKA concentrate on clinical outcome and medium to long-term results. Since discharge from hospital after TKA is achieved increasingly quicker worldwide using FP in an increasingly younger and active patient population, the effects of FP on functional outcome in the first days after TKA become more important. The purpose of the current study was to compare FP with a regular joint care protocol (RP), with an emphasis on the first 7 days after surgery. ⋯ Fast-track protocol for primary TKA showed significantly lower knee pain scores and improved functional outcome in the first 7 days after TKA compared to a regular protocol.
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This stem was cleared by the FDA in 2002 and has been implanted in cementless and cemented versions. Despite its long history, there are no long-term clinical results available for the cemented version of this implant. The aim of this study was to provide such data. It was hypothesized that this implant delivers clinical success comparable to other tapered cemented stems. ⋯ This is a modern cemented stem with an excellent survival rate and satisfactory functional outcomes. In this cohort, there were no failures related to the stem through the first decade.
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Arch Orthop Trauma Surg · Sep 2018
The epicondylar ratio can be reliably used on X-ray of the knee to determine the joint line.
The epicondylar ratio (ER) is used to restore the individual joint line (JL), especially in revision total knee arthroplasty. It was first described in magnetic resonance imaging (MRI) but is usually applied to a.p. radiographs of the knee for preoperative planning. The objective of the current study was to define reliable landmarks in MRI and X-ray images of the knee, which allow comparison of the image modalities. Furthermore, the correlation of the measured ER in MRI and X-rays of the knee was calculated. ⋯ The ER can be determined reliably on MRI and X-ray images of the knee. The correlation of the ER in MRI and X-ray is fair.
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Arch Orthop Trauma Surg · Sep 2018
An often-unrecognized entity as cause of recurrent infection after successfully treated two-stage exchange arthroplasty: hematogenous infection.
Reinfection after two-stage exchange arthroplasty is a difficult clinical scenario with limited data on adequate treatment algorithms. Beside the possibility of treatment failure and a new intraoperative infection at the time of reimplantation, hematogenous seeding could play an up to date underestimated crucial role as another cause of an infection after two-stage exchange. The aim of this study was to evaluate its incidence and treatment possibilities in a prospectively followed case series. ⋯ Hematogenous infection after a successful two-stage exchange arthroplasty is a rare but very important cause of a reinfection. With our work, we aim at raising the awareness for this entity and recommend consideration of irrigation and debridement with implant retention in these cases, as well as possibly the identification of a primary infection source.