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It is the start of a new soccer season, and Lacy Sheridan is anxious. She spent the winter recovering from a knee injury that still gives her nightmares. But Lacy is trying not to let fear get the best of her. She needs to bring her A-game if she wants to impress soccer recruiters.
Book
Fundamentals of Revision Knee Arthroplasty
Fundamentals of Revision Knee Arthroplasty: Diagnosis, Evaluation, and Treatment
is a unique and very timely book designed for surgeons who are beginning to more commonly encounter knee revisions in their practice.
Unlike many traditional books on revision,
Fundamentals of Revision Knee Arthroplasty
does not focus on the most difficult and challenging of cases. Rather,
Fundamentals of Revision Knee Arthroplasty
is intended to guide the surgeon in the evaluation of the failed or painful total joint replacement, review basic tenants and surgical principles of revision arthroplasty, and guide the surgeon in determining whether a given case is one that should be managed or is best referred to a tertiary orthopedic center.
Along with their 32 contributors, Dr. David J. Jacofsky and Dr. Anthony K. Hedley provide detailed information inside
Fundamentals of Revision Knee Arthroplasty
, including appropriate preoperative evaluation, equipment requirements, surgical planning, need for augments and allograft, and surgical techniques.
Surgeons will be tackling knee revision surgery more frequently as the number of these cases is exponentially increasing.
Fundamentals of Revision Knee Arthroplasty
provides a \"go-to\" resource to turn to for guidance by community arthroplasty surgeons, arthroplasty fellows, and residents.
eBook
Wounded Knee : party politics and the road to an American massacre
Argues the fierce partisanship, heated political rhetoric, and an irresponsible, profit-driven media were responsible for the massacre of three hundred Lakota Sioux at Wounded Knee.
Book
Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty
Purpose
Knee adduction moment (KAM) has been recognized as a good clinical surrogate for medial tibiofemoral joint loading and is associated with implant durability after total knee arthroplasty (TKA). This study aimed to examine the effects of joint line obliquity in kinematically aligned TKA (KA-TKA) on KAM during gait.
Methods
The study enrolled 21 knees from 18 patients who underwent cylindrical axis reference KA-TKA and a matched group of 21 knees from 18 patients who underwent mechanically aligned (MA)-TKA as controls. Gait analyses were performed the day before TKA and at an overall mean of 2.6 years postoperatively. First peak KAM and variables associated with frontal knee kinetics were determined and compared between groups.
Results
In KA-TKA, the proximal tibia was resected with 3.4° ± 1.5° of varus in relation to the mechanical axis, and the final femorotibial shaft axis was 176.7° ± 3.8° with KA-TKA and 174.4° ± 3.0° with MA-TKA. KAM was significantly smaller with KA-TKA than with MA-TKA (
p
< 0.032). Regarding variables affecting KAM, significant differences were evident between the two TKAs for knee adduction angle (
p
= 0.0021), lever arm (
p
= 0.028), and Δlever arm (
p
= 0.0001).
Conclusions
In KA-TKA, joint line obliquity reduced peak KAM during gait, despite slight varus limb alignment, and this reduced KAM in KA-TKA can tolerate constitutional varus alignment. In clinical settings, KA-TKA thus represents a promising technical option for patients with large coronal bowing of the shaft carrying a risk of increased KAM after TKA.
Level of evidence
III.
Journal Article
A Second Decade Lifetable Survival Analysis of the Oxford Unicompartmental Knee Arthroplasty
Background
The role of unicompartmental arthroplasty in managing osteoarthritis of the knee remains controversial. The Oxford medial unicompartmental arthroplasty employs a fully congruent mobile bearing intended to reduce wear and increase the lifespan of the implant. Long-term second decade results are required to establish if the design aim can be met.
Questions/purposes
We report the (1) 20-year survivorship for the Oxford mobile bearing medial unicompartmental knee arthroplasty; (2) reasons for the revisions; and (3) time to revision.
Methods
We reviewed a series of 543 patients who underwent 682 medial Oxford meniscal bearing unicompartmental knee arthroplasties performed between 1983 and January 2005. The mean age at implantation was 69.7 years (range, 48–94 years). The median followup was 5.9 years (range, 0.5 to 22 years). One hundred and forty-one patients (172 knees) died. None were lost to followup. The primary outcome was 20-year survival, a key variable in assessing the longevity of arthroplasty.
Results
The 16-year all cause revision cumulative survival rate was 91.0% (CI 6.4, 71 at risk) and survival was maintained to 20 years (91.0%, CI 36.2, 14 at risk). There had been 29 revision procedures: 10 for lateral arthrosis, nine for component loosening, five for infection, two bearing dislocations, and three for unexplained pain. In addition, five patients had undergone bearing exchange, four for dislocation and one for bearing fracture. The mean time to revision was 3.3 years (range, 0.3–8.9 years).
Conclusions
Mobile bearing unicompartmental knee arthroplasty is durable during the second decade after implantation.
Level of Evidence
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Journal Article
PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study
Purpose
Kinematic alignment in TKA is supposed to restore function by aligning the components to the premorbid flexion–extension axis instead of altering the joint line and natural kinematic axes of the knee. The purpose of this study was to compare mechanically aligned TKA to kinematic alignment.
Methods
In this study, 200 patients underwent TKA and were randomly assigned to 2 groups: 100 TKAs were performed using kinematic alignment with custom-made cutting guides in order to complete cruciate-retaining TKA; the other 100 patients underwent TKA that was manually performed using mechanical alignment. The WOMAC and combined Knee Society Score (KSS), as well as radiological alignment, were determined as outcome parameters at the 12-month endpoint.
Results
WOMAC and KSS significantly improved in both groups. There was a significant difference in both scores between groups in favour of kinematic alignment. Although the kinematic alignment group demonstrated significantly better overall results, more outliers with poor outcomes were also seen in this group. A correlation between post-operative alignment deviation from the initial plan and poor outcomes was also noted. The most important finding of this study is that applying kinematic alignment in TKA achieves comparable results to mechanical alignment in TKA. This study also shows that restoring the premorbid flexion–extension axis of the knee joint leads to better overall functional results.
Conclusion
Kinematic alignment is a favourable technique for TKA.
Clinical relevance
The kinematic alignment idea might be a considerable alternative to mechanical alignment in the future.
Level of evidence
II.
Journal Article
American carnage : Wounded Knee, 1890
\"American Carnage--the first comprehensive account of Wounded Knee to appear in more than fifty years--explores the complex events preceding the tragedy, the killings, and their troubled legacy\"-- Provided by publisher.
Book
Remaining mild varus limb alignment leads to better clinical outcome in total knee arthroplasty for varus osteoarthritis
Purpose
Postoperative neutral limb alignment [femorotibial mechanical axis (FTMA) 180° ± 3°] is generally considered to be one of the prerequisites for successful total knee arthroplasty (TKA). However, the influence of residual malalignment on clinical and functional outcomes after TKA is unknown. Therefore, the purpose of this study was to investigate the relationship between postoperative limb alignment and clinical outcomes in Asian patients who underwent primary TKA.
Methods
The study included 220 knees with a mean age of 73.5 years who underwent primary TKA for varus-type osteoarthritis; the mean follow-up period was 3.6 years. Patients were divided into four groups based on postoperative FTMA: severe varus (FTMA < 174°,
n
= 15), mild varus (FTMA >177°and ≤174°,
n
= 61), neutral (FTMA 180° ± 3°,
n
= 128), and valgus (FTMA > 183°,
n
= 16). Knee Society Knee Score (KSKS) and Knee Society Functional Score (KSFS) were compared among the 4 groups.
Results
KSKS and KSFS showed significant improvement in all groups. There were no statistically significant differences for postoperative KSKS among the four groups. For KSFS, however, the severe varus and valgus groups exhibited significantly lower values compared with the mild varus and neutral groups.
Conclusion
Postoperative mild varus alignment as well as neutral mechanical alignment of the lower limb led to excellent functional outcomes. For the clinical relevance, postoperative mild varus alignment of the lower limb is acceptable following TKA for varus-type osteoarthritis.
Level of evidence
IV.
Journal Article