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Preoperative Patient Characteristics and Outcomes of Total Knee Arthroplasty in a Multiethnic Asian Population Stratified by Ethnicity.

J Arthroplasty. 2013 Jul 25;

Authors: Jiang L, Bin Abd Razak HR, Chong HC, Tan A

Abstract
We aim to compare the patient profile and outcomes after TKA between the different racial groups in Singapore. Prospective data were collected from 364 patients who underwent TKA in Singapore General Hospital from January 2006 to May 2010. Patients were stratified according to ethnicity and we compared their preoperative demographic data, Short-Form 36 (SF-36), Oxford Knee (OKS) as well as Knee Society Scores (KSS). Malays were younger (62.0±5.3) at time of surgery (p=0.05) and the body mass index of Chinese (27.9±4.7) was lower than Malay (30.4±5.0) and Indian (31.5±4.5) patients (P<0.005). Malay (40.3±11.0) and Indian (39.2±9.3) patients had less favourable preoperative OKS than Chinese (35.9±7.8) patients (P<0.05). All 3 ethnic groups achieved statistically significant improvements in outcome measures but did not differ significantly between the ethnicities.

PMID: 23891052 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23891052?dopt=Abstract

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Comparison of Outcomes and Survivorship Between Patients of Different Age Groups Following TKA.

J Arthroplasty. 2013 Jul 23;

Authors: McCalden RW, Robert CE, Howard JL, Naudie DD, McAuley JP, Macdonald SJ

Abstract
A total of 6275 consecutive TKA patients were divided into three groups based on their age: <55, 55-70 and >70years. There was a statistically significant difference in the change in WOMAC score (32 vs 31 vs 26, P<0.001) and Knee Society Score (78.9 vs 76.0 vs 69.0, P<0.001) favoring the younger populations. However, the revision rate was higher in the younger patients with a Kaplan-Meier survivorship at 5years of 95.5%, 97.2% and 98.1% and at 10years of 92.2%, 95.9% and 97.6%. Infection was the most frequent cause for failure in all groups although aseptic loosening and instability accounted for the increased revision rate in the younger patients. Younger patients may experience slightly better clinical outcomes following TKA but lower survivorship, when compared to older patient populations.

PMID: 23890522 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23890522?dopt=Abstract

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Conflict of Interest in the Assessment of Hyaluronic Acid Injections for Osteoarthritis of the Knee: An Updated Systematic Review.

J Arthroplasty. 2013 Jul 23;

Authors: Printz JO, Lee JJ, Knesek M, Urquhart AG

Abstract
The search results of a recent systematic review of prospective, randomized, placebo-controlled trials on hyaluronic acid injections for knee arthritis were updated and reviewed for funding source and qualitative conclusions. Forty-eight studies were identified; 30 (62.5%) were industry funded, and 3 (6.25%) were not. Fifteen (31.3%) studies did not identify a funding source. An association was observed between a reported potential financial conflict of interest of the author and the qualitative conclusion (P=0.018). None of the studies with a reported financial conflict of interest of at least one author had an unfavorable conclusion; 11 (35%) of the 31 studies with no industry-affiliated authors indicated that hyaluronic acid injection for knee osteoarthritis was no more effective than a placebo injection.

PMID: 23890521 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23890521?dopt=Abstract

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Improvement of femoral component size prediction using a C-arm intensifier guide and our established algorithm in unicompartmental knee arthroplasty: A report from a Chinese population.

Knee. 2013 Jul 23;

Authors: Tu Y, Xue H, Cai M, Ma T, Liu X, Xia Z

Abstract
BACKGROUND: Unicompartmental knee arthroplasty (UKA) is becoming more widely used with the recent increase in popularity of the use of minimally invasive techniques. However, it is difficult to judge about the femoral component size in UKA using preoperative templating digitally or otherwise. Even when using navigation it is impossible to control the femoral component size. The aim of this study is to develop a better pre- or intra-operative measure that will predict femoral component size.
METHODS: Ninety-two UKA cases were studied from June 2007 to December 2011 with a mean 26-month follow-up. We developed an intra-operative C-arm intensifier guide (CAIG) method for determining femoral size instead of pre-operative templating. The accuracy of prediction of both methods was compared from a review of post-operative radiographs. In addition, we summarized all cases and developed a Chinese algorithm to determine the femoral component size pre-operatively.

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Why are Total Knee Arthroplasties Being Revised?

J Arthroplasty. 2013 Jul 22;

Authors: Dalury DF, Pomeroy DL, Gorab RS, Adams MJ

Abstract
Despite technical improvements, revision rates for total knee arthroplasties (TKAs) remain high. Our goal was to report the reason(s) for revision TKA in a large, current, multicenter series and compare those reasons with previously published reasons. We retrospectively identified 820 consecutive revision TKAs (693 patients, 2000-2012) from our 3 centers and recorded the primary reason for the revision. The top seven reasons for the revision were aseptic loosening (23.1%), infection (18.4%), polyethylene wear (18.1%), instability (17.7%), pain/stiffness (9.3%), osteolysis (4.5%), and malposition/malalignment (2.9%). Comparison with previously published reasons showed fewer TKA revisions for polyethylene wear, osteolysis, instability, and malalignment. These changes may represent improvements in surgical technique and implants.

PMID: 23886410 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23886410?dopt=Abstract

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The effects of femoral external derotational osteotomy on frontal plane alignment.

Knee Surg Sports Traumatol Arthrosc. 2013 Jul 26;

Authors: Nelitz M, Wehner T, Steiner M, Dürselen L, Lippacher S

Abstract
PURPOSE: Femoral osteotomies are the preferred treatment in significant torsional deformity of the femur. The influence of torsional osteotomies on frontal plane alignment is poorly understood. Therefore, the aim of the present study was to evaluate the effects of external derotational osteotomies on proximal, mid-shaft and distal levels onto frontal plane alignment.
METHODS: The effect of rotation around the anatomical axis of the femur on frontal plane alignment was determined with a 3D computer model, created from CT data of a right human cadaver femur. Virtual torsional osteotomies of 10°, 20° and 30° were performed at proximal, mid-shaft and distal levels under five antecurvatum angles of the femur. The change of the frontal plane alignment was expressed by the mechanical lateral femoral angle.

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Preoperative asymmetry in load distribution during quite stance persist following total knee arthroplasty.

Knee Surg Sports Traumatol Arthrosc. 2013 Jul 24;

Authors: Thewlis D, Hillier S, Hobbs SJ, Richards J

Abstract
PURPOSE: Preoperative function has been shown to persist posttotal knee arthroplasty. However, it remains unclear whether asymmetries are task specific. Therefore, we investigated postoperative asymmetries in loading during quiet stance and walking gait.
METHODS: Ten patients with end-stage knee osteoarthritis scheduled for total knee arthroplasty were studied at baseline (preoperative), 6-week, 3- and 6-month postoperative. Load distribution and balance were quantified during quiet stance. Furthermore, dynamic loading was quantified during walking gait. Patient satisfaction was assessed using the Knee Osteoarthritis and injury Outcome Score.
RESULTS: Preoperatively, load distribution was significantly different between limbs, with approximately 70 % of the load through the contralateral or 'good' side. Asymmetries persisted and up to 6-month postoperative during quiet stance. No significant change was found in balance. During walking, preoperative loading asymmetry was present; however, no significant postoperative loading asymmetries were identified.

Related Articles

Revision of Unicompartmental Arthroplasty to Total Knee Arthroplasty: Not Always a Slam Dunk!

J Arthroplasty. 2013 Jul 22;

Authors: Sierra RJ, Kassel CA, Wetters NG, Berend KR, Della Valle CJ, Lombardi AV

Abstract
OBJECTIVE: As the number of UKA performed in the world continues to increase, so will the number of failures. A better understanding of the outcomes after revision UKAto TKA is warranted. The objective of this study is to report the outcomes of modern UKA revised to TKA in three US centers.
METHODS: A total of 175 revisions of medial UKA in 168 patients (81 males, 87 females; average age of 66years) performed from 1995 to 2009 in three institutions and with a minimum of 2-year clinical follow-up were reviewed. Individual joint registries and chart reviews were performed to collect data regarding reasons for revision, type of implants used, and re-revision rates.

Related Articles

Evaluation of the morphological variations of the meniscus: a cadaver study.

Knee Surg Sports Traumatol Arthrosc. 2013 Jul 20;

Authors: Ryu K, Iriuchishima T, Oshida M, Saito A, Kato Y, Tokuhashi Y, Aizawa S

Abstract
PURPOSE: The purpose of this study was to reveal the prevalence of the subtypes of the meniscus using human cadaver knees.
METHODS: Four hundred and thirty-seven cadaveric knees in 219 subjects (formalin fixed, Japanese population) with a median age of 83 years (54-97) were included in this study. All soft tissues surrounding the knee, excluding the meniscus, were resected, and macroscopic assessment of the meniscus was performed. Meniscus subtypes were classified as: (1) normal meniscus, (2) complete discoid, (3) incomplete discoid, (4) ring-shaped, and (5) double-layered.
RESULTS: All subtypes of the meniscus were observed in the lateral meniscus. Complete discoid lateral meniscus was observed in 27 knees (6.2 %), incomplete discoid lateral meniscus was observed in 139 knees (31.8 %), ring-shaped lateral meniscus was observed in 4 knees (0.9 %), and double-layered meniscus was observed in 2 knees (0.5 %).