Two-Stage Primary Arthroplasty in the Infected Native Knee: A Systematic Review and Pooled Analysis.

Introduction: The knee is the commonest native joint to develop an infection. A two-stage primary knee replacement, with an interim stage of debridement and cement spacer application, modelled after two-stage revision for periprosthetic joint infections (PJI) has been reported for the management of chronic infections.

Aims: To systematically review the literature to find the infection-free survival and outcomes of this operation and explore its indications.

Stacked Tantalum Cones as a Method for Treating Severe Distal Femoral Bone Deficiency in Total Knee Arthroplasty.

Severe bone loss in distal femur has traditionally been managed with bulk cementing, bone graft, metal augments, trabecular metal cones, and mega prosthesis. The authors present an alternative method using a stacked configuration of two tantalum cones to manage severe distal femoral bone loss. This study aims to evaluate the mid-term outcomes and possible complications in patients treated with this novel technique.

Management Options in Avascular Necrosis of Talus.

Avascular necrosis (AVN) of the talus can be a cause of significant disability and is a difficult problem to treat. The most common cause is a fracture of the talus. We have done a systematic review of the literature with the following aims: (1) identify and summarize the available evidence in literature for the treatment of talar AVN, (2) define the usefulness of radiological Hawkins sign and magnetic resonance imaging in early diagnosis, and (3) provide patient management guidelines.

Does Prior Failed Debridement Compromise the Outcome of Subsequent Two-Stage Revision Done for Periprosthetic Joint Infection Following Total Knee Arthroplasty?

Background: There has been a debate regarding the outcomes of 2-stage revision total knee arthroplasty (TKA) when debridement, antibiotics, irrigation, and implant retention (DAIR) had been carried out previously. The purpose of this study is to evaluate the influence of prior failed DAIR (F-DAIR) on the outcomes of 2-stage revision TKA done for periprosthetic joint infection (PJI).

Methods: This is a retrospective study of a consecutive series of 184 knees that completed 2-stage revision TKA for PJI, operated by a single surgeon between January 2000 and July 2011.

Early failure with massive metallosis and posteromedial wear following atraumatic anterior cruciate ligament rupture after medial unicompartmental knee arthroplasty.

Severe metallosis following medial unicompartmental knee arthroplasty (UKA) is relatively rare. It is usually due to long-standing wear of the polyethylene component, resulting in frictional wear between the femoral and tibial metallic components. Biomechanical and cadaveric studies have shown the effects of anterior cruciate ligament (ACL) transection following medial UKA.

Unusual periprosthetic joint infection involving bilateral knees: management options and literature review.

A 70-year-old Indian woman, who had undergone primary bilateral total knee arthroplasty (TKA) for rheumatoid arthritis 10 months prior, presented with 10 days history of pain, swelling and erythema over both knees with pus discharging from the right knee. She had type 2 diabetes mellitus and was on long-term steroid, leflunomide and antitumour necrosis factor therapy for rheumatoid arthritis. Her clinical and laboratory features were suggestive of a haematogenous periprosthetic joint infection (PJI).

A Comparative Study on the Long-Term Outcome of Total Knee Arthroplasty Performed for Knees Stiff in Extension and Those Stiff in Flexion.

Background: Patients with chronic stiff knee with extremely restricted arc of motion (AOM ≤ 20°) may present with stiffness either in extension (stiff in extension [SE]) or in flexion (stiff in flexion [SF]). The difference in the functional outcome after total knee arthroplasty between these 2 groups has not been elaborated in literature.

Methods: We retrospectively analyzed 96 patients (115 knees), who had undergone total knee arthroplasty between January 1990 and December 2010 for stiff or spontaneously ankylosed knees (AOM ≤ 20°).

Functional Results of Communited Intra-articular Distal Humerus Fractures Treated with Bicolumnar Plating.

Introduction: Communited intra-articular distal humerus fractures are commonly encountered in orthopaedic practice and they are present with unique difficulties for internal fixation. This problem is especially worse in the elderly due to osteoporotic bone.

Aim: To evaluate the intermediate term results (minimum follow up of two years) of communited intra-articular distal humerus fractures treated with bicolumnar plating with or without olecranon osteotomy in elderly Indian population.