The Knee
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Comparative Study
Postoperative morbidity and mortality following total knee arthroplasty with computer navigation.
The incidence of postoperative complications following computer navigated total knee arthroplasty is unknown. There is no published evidence to support decreased morbidity compared to standard conventional technique. The Nationwide Inpatient Sample database was used to identify 101,596 patients who underwent total knee arthroplasty in 2005. ⋯ We found no differences in postoperative mortality or complications for the majority of our measured outcomes. Under multivariate regression analysis, computer navigation was associated with a lower rate of postoperative cardiac complications (odds ratio 0.40, p=0.042), a shorter length of stay, and a trend towards fewer hematomas. Further clinical study is required to examine the possible association of computer navigation with postoperative morbidity following knee arthroplasty.
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Comparative Study
Inter- and intra-tester reliability of clinical measurement to determine medio-lateral patellar position using a pachymeter or visual assessment.
The aim was to investigate inter-tester and intra-tester reliability and parallel reliability between a visual assessment method and a method using a pachymeter for locating the mid-point of the patella in determining the medial/lateral patella orientation. Fifteen asymptomatic subjects were assessed and the mid-point of the patella was determined by both methods on two separate occasions two weeks apart. Inter-tester reliability was obtained by ANOVA and by intraclass correlation coefficient (ICC); intra-tester reliability was obtained by a paired t-test and ICC; and parallel reliability was obtained by Pearson's Correlation and ICC, for the measurement on the first and second evaluations. ⋯ Although there was statistical similarity between measurements for the first and second evaluations for all testers, intra-tester reliability was not acceptable for both methods: visual (examiner 1 ICC=0.175; examiner 2 ICC=0.189; examiner 3 ICC=0.155) and pachymeter (examiner 1 ICC=0.214; examiner 2 ICC=0.246; examiner 3 ICC=0.069). Parallel reliability gave a perfect correlation at the first evaluation (r=0.828; p<0.001) and at the second (r=0.756; p<0.001) and reliability was between acceptable and very good (ICC=[0.748-0.813]). Both visual and pachymeter methods provide reliable and similar medial/lateral patella orientation and are reliable between different examiners, but the results between the two assessments at 2 weeks' interval demonstrated an unacceptable reliability.
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A retrospective study of a consecutive cohort of 109 patients, under the age of 60, who had either a Patellofemoral replacement (PFR), Unicompartmental replacement (UKR) or a Total knee replacement (TKR). They were operated on by two senior surgeons between 2002 and 2006 at the Avon Orthopaedic Centre in Bristol. The aim of this study was to look at the effect of knee replacement on the employment status of this group of patients. ⋯ This is the first study to compare employment status following Patellofemoral, Unicompartmental knee and Total Knee Replacement. TKR and UKR are effective in returning patients under 60 years old to active employment and this is typically 3 months following surgery. Patients who had a PFR did not experience the same benefits in terms of numbers returning to work, time to do so and their subjective opinion as to their ability to cope with normal duties.
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We evaluated short- and medium-term results of the treatment of articular cartilage defects of the knee with autogenous cylindrical osteochondral grafts (mosaicplasty) in 69 patients (median age 33 years) with symptomatic articular cartilage defects. Data of Lysholm score and visual analogue scale (VAS) of pain (0=no pain; 100=worst possible pain) were collected before the surgery, at 12 months postoperatively and 5 to 9 (median 7) years after the surgery. At the last follow-up the patients were also asked to state their degree of satisfaction with the outcome on a VAS (0=not at all satisfied; 100=completely satisfied), and to answer if they would have undergone the surgery again if necessary (yes or no). ⋯ The mean degree of satisfaction with the outcome was 70 (SD 28), and 61 patients (88%) stated that they would have undergone the surgery again. In conclusion, the mosaicplasty leads to improvement of symptoms and function at short- and medium-term follow-up. A deterioration of the results is observed from 12 months postoperatively to 5-9 years postoperatively.