The Knee
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Randomized Controlled Trial
Post-operative bracing after ACL reconstruction has no effect on knee joint effusion. A prospective, randomized study.
It is unclear what factors contribute to knee joint effusion after anterior cruciate ligament (ACL) injury and reconstruction. Knee homeostasis after injury and surgery is crucial for rehabilitation and knee well-being. We examined if effusion was affected by post-operative bracing, and if patients with effusion fit into a common profile. ⋯ Prior meniscus injury and pre-injury Tegner activity levels are predictive significant variables for excessive knee joint effusion after ACL reconstruction. Post-operative bracing had no effect. A larger clinical cohort is needed to confirm findings of this logistic regression.
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Review
Systematic review of medial versus lateral survivorship in unicompartmental knee arthroplasty.
Unicompartmental knee arthroplasty (UKA) has gained popularity in patients with isolated unicompartmental osteoarthritis. To our knowledge no systematic review has assessed and compared survivorship of medial and lateral UKA. We performed a systematic review assessing medial and lateral UKA survivorship and comparing survivorship in cohort studies and registry-based studies. ⋯ This is the first systematic review that shows no difference in the five-, ten- and fifteen-year survivorship of medial and lateral UKA. We found a lower survivorship in the registry-based studies compared to cohort studies.
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Adjusting joint gaps and establishing mediolateral (ML) soft tissue balance are considered essential interventions for better outcomes in total knee arthroplasty (TKA). However, the relationship between intraoperative laxity measurements and weightbearing knee kinematics has not been well explored. This study aimed to quantify the effect of intraoperative joint gaps and ML soft tissue balance on postoperative knee kinematics in posterior-stabilized (PS)-TKA. ⋯ These findings indicate the importance of adequate intraoperative joint gaps in deep flexion and ML soft tissue balance throughout the range of motion.
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Progression of osteoarthritis in the unreplaced compartment following unicondylar knee arthroplasty (UKA) may be hastened if kinematics is disturbed following UKA implantation. The purpose of this study was to analyze tibiofemoral kinematics of the balanced and overstuffed UKA in comparison with the native knee during passive flexion since this is a common clinical assessment. ⋯ Alterations in tibiofemoral kinematics following UKA might have implications for prosthesis failure and progression of osteoarthritis in the remaining compartment. Overstuffing should be avoided as it further increased valgus and did not improve the remaining kinematics.
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Case Reports
Treatment of infected nonunion total knee arthroplasty periprosthetic fracture using a stemmed articulating spacer.
We present a case of multifocal infection involving the left total hip replacement and the right total knee replacement of a patient, further complicated by an infected non-union of a periprosthetic fracture of the right knee. This required the unique simultaneous management of both infection eradication and fracture stabilization in the knee. ⋯ Level V (Case report).