The Knee
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Metal metaphyseal sleeves are an option for reconstruction as well as enhancing fixation in managing challenging bone defects in revision knee replacement. We report our results of revision knee replacement using metaphyseal sleeves with a minimum of seven years of follow-up. ⋯ At mid-term follow-up, metaphyseal sleeves demonstrate durable clinical results and radiographic fixation.
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Randomized Controlled Trial
Evaluation of the patellofemoral joint in total knee arthroplasty: Validation of the weight bearing merchant radiographic view.
Standard radiographic views for patellofemoral joint assessment do not reflect loading at which TKA patients may describe post-operative anterior symptoms. A novel weight bearing (WB) Merchant view has been described and demonstrated a number of tracking changes that correlated with clinical outcomes. In this study, we aim to validate the WB Merchant view and assess relationships with patient outcome scores. ⋯ The WB Merchant radiograph is an easy to perform and reliable view for the evaluation of patellar tracking and may provide additional information to the routinely used NWB view.
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Clinical Trial
The role of meniscal tears and meniscectomy in the mechanical stability of the anterior cruciate ligament deficient knee.
The role of an intact meniscus in providing mechanical stability to the knee of anterior cruciate ligament (ACL) deficient and ACL reconstructed patients has not been well studied. ⋯ PHMM acts as a secondary stabilizer of the knee joint in the absence of functional ACL. There is no effect of partial meniscectomy on mechanical stability of the knee in ACL reconstructed patients. Medial or lateral partial meniscectomy performed at the time of ACL reconstruction does not affect the stability of ACL reconstructed knee. However, the presence of a concomitant tear in PHMM is associated with increased instability in ACL deficient knee.
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Chronic pain is associated with psychological distress, most commonly manifested as anxiety and/or depression. ⋯ Psychological distress is common in our patients pre-operatively. Improvements in knee pain and function as a result of surgery correlate well with lower levels of psychological distress post-operatively. Knee replacement surgery positively influences all of the outcome measures studied rather than recovery being negatively influenced by pre-operative states. Knee replacement arthroplasty is not contra-indicated by pre-operative psychological distress. Successful knee replacement improves knee pain and function, as well as symptoms of anxiety and depression. These improvements persist for many years after the surgery.