The Knee
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When performing total knee replacement (TKR), surgeons are required to decide on the most appropriate size of tibial component. As implants are predominantly selected from incremental sizes of a preferred design, it may be necessary for a surgeon to slightly under or oversize the component. There are concerns that overhang could lead to pain from irritation of soft tissues, and an undersized component could lead to subsidence and failure. Patient reported outcome measures were recorded in 154 TKRs at one year postoperatively (in 100 TKRs) and five years post-operatively (in 54 TKRs) in 138 patients. The Oxford Knee Score (OKS), WOMAC and SF-12 were recorded, and a composite pain score was derived from the OKS and WOMAC pain questions. Tibial component size and position were assessed on scaled radiographs and implants were grouped into anatomic sized tibial component (78 TKRs), undersized component (48 TKRs), minor overhang one to three mm (10 TKRs) or major overhang ≥ 3 mm (18 TKRs). There was no statistically significant difference between the mean post-operative OKS, WOMAC, SF-12 or composite pain score of each group. Furthermore, localisation of the site of pain did not correlate with medial or lateral overhang of the tibial component. Our results suggest that tibial component overhang or undersizing is not detrimental to outcome measures or pain. ⋯ II.
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Randomized Controlled Trial
A prospective double blinded randomized study of anterior cruciate ligament reconstruction with hamstrings tendon and spinal anesthesia with or without femoral nerve block.
Current literature supports the thought that anesthesia and analgesia administered perioperatively for an anterior cruciate ligament (ACL) reconstruction have a great influence on time to effective rehabilitation during the first week after hospital discharge. ⋯ Randomized Clinical Trial Level I.
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Comparative Study Clinical Trial
Assessment of the lateral patellar facet in varus arthritis of the knee.
Lateral patellar arthritis has been associated with poor outcomes in unicompartmental knee arthroplasty. The current study correlates intraoperative findings with MRI imaging, skyline radiographs and the presence of anterior knee pain. ⋯ Diagnostic study, Level II.
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Complex symptomatic ganglion cysts arising from the proximal tibio-fibular joint (PTJ) are not an uncommon presentation in specialist knee clinics and can be managed by aspiration or excision. There is, however, a high rate of recurrence and often there is progressive involvement of the common peroneal nerve (CPN) and its branches, and permanent nerve damage may result. ⋯ IV.