The Knee
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Up to 30% of patients undergoing total knee arthroplasty (TKA) have received intra-articular corticosteroid injections prior to surgery. Debate exists as to whether such injections increase the rate of post-operative infection. Given that deep infection is a disastrous complication, a systematic review of the literature was undertaken to evaluate the safety of intra-articular corticosteroid injections given prior to TKA. Other features of corticosteroid use are also discussed including mechanism of action and optimal dosage. ⋯ III.
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Lateral retinacular release is still being performed in patients with recurrent patellar dislocation as an additional procedure with distal realignment or medial patellofemoral ligament (MPFL) reconstruction. However, consensus remains lacking regarding suitable indications for lateral retinacular release. ⋯ Simultaneous MPFL revision and lateral retinaculum reconstruction successfully improved patellar instability in both directions. This case provides an example of iatrogenic medial patellar instability after failed lateral retinacular release.
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The literature results of unicompartmental knee arthroplasty (UKA) for isolated lateral osteoarthritis (OA) are not as good as for isolated medial OA. In 1988 our department started using a UKA with a fixed, all polyethylene tibial component and a resurfacing femoral component. The aim of this retrospective study is to report on the progression of medial OA and the long term results of this prosthesis implanted for isolated lateral OA, at a minimum follow up of ten years. ⋯ The use of a UKA with a fixed, all polyethylene tibial bearing and a femoral resurfacing implant is a reliable option for the management of isolated lateral knee osteoarthritis. We have demonstrated excellent functional results and implant survival in the long term. The most significant factor leading to reoperation is progression of medial disease.
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Unicondylar knee arthroplasty (UKA) is believed to lead to less morbidity and enhanced functional outcomes when compared with total knee arthroplasty (TKA). Conversely, UKA is also associated with a higher revision risk than TKA. In order to further clarify the key differences between these separate procedures, the current study assessing the cost-effectiveness of UKA versus TKA was undertaken. ⋯ UKA yields clear advantages in terms of costs and marginal advantages in terms of health effects, in comparison with TKA.
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Modular bicompartmental knee arthroplasty (BKA) for treatment of medio-patellofemoral osteoarthritis (OA) should allow for close to normal kinematics in comparison with unicondylar knee arthroplasty (UKA) and the native knee. There is so far no data to support this. ⋯ In comparison to UKA modular BKA leads to a more dorsal tibial contact point, a medial femoral condyle being located more posteriorly, and more MCL strain. Mainly the changes to the trochlear anatomy as introduced by PFJ may account for these differences.