The Knee
-
Recent reports suggest good outcome results following unicompartmental knee replacement (UKR). However, a number of authors have commented on the problem of osseous defects requiring technically difficult revision surgery. We reviewed clinical outcomes following revision total knee replacement (TKR) for failed UKR and analysed the reasons for failure and the technical aspects of the revision surgery. ⋯ Two thirds of the revisions were technically difficult and required additional constructs. The clinical outcome after revision surgery was inferior to that of primary TKR. The role of UKR needs to be more clearly defined.
-
The management of distal femoral fractures following a total knee replacement can be complex and requires the equipment, perioperative support and surgical skills of both trauma and revision arthroplasty services. Recent advances in implant technology have changed the management options of these difficult fractures. This article describes the options available and discusses the latest evidence.
-
Randomized Controlled Trial Comparative Study
Patellar reshaping versus resurfacing in total knee arthroplasty - Results of a randomized prospective trial at a minimum of 7 years' follow-up.
To compare the results of primary total knee arthroplasty with patellar reshaping or resurfacing. ⋯ With the numbers available, there was no significant difference between the groups treated with patellar reshaping or patellar resurfacing with regard to the KSS, anterior knee pain rate and radiographs. We prefer reshaping the patella to resurfacing the patella because the former preserves sufficient patellar bone stock and can easily be converted to patellar replacement if patients complain of recurrent anterior knee pain.
-
Randomized Controlled Trial Comparative Study
Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture.
The posterolateral shearing tibial plateau fracture is uncommon in the literature, however with the increased usage of computer tomography (CT), the incidence of these fractures is no longer as low as previously thought. Few studies have concentrated on this fracture, least of all using a biomechanical model. ⋯ Vertical displacement of the posterolateral fragment was measured using three different strengths of axial loading force, and finally loaded until fixation failure. It was concluded that the posterolateral buttress plate is biomechanically the strongest fixation method for the posterolateral shearing tibial plateau fracture.
-
Randomized Controlled Trial Comparative Study
Mobile bearing UKA compared to fixed bearing TKA: a randomized prospective study.
We prospectively evaluated a consecutive series of 56 patients with unicompartmental knee arthritis who underwent unicompartmental knee replacement or total knee arthroplasty and received an average of 52months of follow-up. These patients were enrolled in a prospective randomized clinical trial. There were no significant differences in the pre-operative parameters of both groups. ⋯ Seven cases of UKA were converted to total knee arthroplasty - all of them within the first 2years of starting the procedure and all of them in relatively young patients. From the study we concluded that mobile bearing UKA can obtain similar clinical effect with TKA by surgeons who have the adequate training and experience. After the learning curve UKA should be considered the primary treatment option for unicompartmental knee arthritis.