Long-term outcome of total knee arthroplasty in patients with morbid obesity.

Introduction: Patients with morbid obesity and advanced painful knee osteoarthritis are considered as poor candidates for total knee replacement. Our aims were to evaluate the outcomes of TKR surgery and the risks for post-operative complications in patients with morbid obesity (BMI > 40 kg/m) as compared with obese patients (30 < BMI ≤ 40 kg/m) and non-obese patients, BMI < 30 kg/m); to evaluate if there are differences between morbid-obese patients (BMI 40-49.99 kg/m) and extreme morbid obese patients (BMI > 50 kg/m); and to present some surgical tips which can improve the TKR outcomes in morbid obese patients.

Comparison of Lateral Closing-Wedge Versus Medial Opening-Wedge High Tibial Osteotomy on Knee Joint Alignment and Kinematics in the ACL-Deficient Knee.

Background: Lateral closing-wedge (LCW) and medial opening-wedge (MOW) high tibial osteotomies (HTOs) correct varus knee alignment and stabilize the anterior cruciate ligament (ACL)-deficient knee. Tibiofemoral and patellofemoral alignment and kinematics after HTO are not well quantified.

Purpose: To compare the effect of LCW and MOW HTO on tibiofemoral and patellofemoral alignment in the ACL-deficient knee.

The ACL Graft Has Different Cross-sectional Dimensions Compared With the Native ACL: Implications for Graft Impingement.

Background: Impingement of anterior cruciate ligament (ACL) grafts against the femoral notch and the posterior cruciate ligament (PCL) is thought to be influenced primarily by tunnel position and graft orientation. Recent data have implied that the native ACL is ribbon-shaped.

Purpose: To evaluate the 3-dimensional shape and cross-sectional area of the native ACL versus the ACL graft and to compare the degree of impingement against the femoral notch and PCL.

Medial unicompartmental knee arthroplasty improves congruence and restores joint space width of the lateral compartment.

Background: Osteoarthritic progression of the lateral compartment remains a leading indication for medial unicompartmental knee arthroplasty (UKA) revision. Therefore, the purpose of this study was to evaluate the alterations of the lateral compartment congruence and joint space width (JSW) following medial UKA.

Methods: Retrospectively, lateral compartment congruence and JSW were evaluated in 174 knees (74 females, 85 males, mean age 65.

Predictors of Subjective Outcome After Medial Unicompartmental Knee Arthroplasty.

Background: Unexplainable pain after medial unicompartmental knee arthroplasty (UKA) remains a leading cause for revision surgery. Therefore, the aim of this study is to identify the patient-specific variables that may influence subjective outcomes after medial UKA to optimize results.

Methods: Retrospectively, we analyzed 104 consecutive medial UKA patients.

Unicompartmental knee arthroplasty versus total knee arthroplasty: Which type of artificial joint do patients forget?

Purpose: During recent years, there has been an intensive growth of interest in the patient's perception of functional outcome. The Forgotten Joint Score (FJS) is a recently introduced score that measures joint awareness of patients who have undergone knee arthroplasty and is less limited by ceiling effects. The aim of this study was to compare the FJS between patients who undergo medial unicompartmental knee arthroplasty (UKA) and patients who undergo total knee arthroplasty (TKA) 1 and 2 years post-operatively.

Medial Subluxation of the Tibia After Anterior Cruciate Ligament Rupture as Revealed by Standing Radiographs and Comparison With a Cadaveric Model.

Background: Biomechanical studies indicate that the tibia shifts medially and has a more valgus orientation in the anterior cruciate ligament (ACL)-deficient knee. However, it is not known whether these differences can be detected on standing radiographs.

Purpose: To determine whether medial subluxation and more changes in coronal alignment of the tibia are detectable in both weightbearing radiographs and a cadaveric model simulating quiet standing.

Coronal tibiofemoral subluxation in knee osteoarthritis.

Objective: To analyze knees in varying stages of osteoarthritis (OA) for the presence of coronal tibiofemoral (CTF) subluxation and to determine if CTF subluxation severity is related to knee OA worsening.

Methods: We retrospectively evaluated CTF subluxation and limb alignment in 113 patients with different stages of knee OA who were being considered for an arthroplasty procedure. Knee OA was classified as "mild" or "severe" according to Kellgren-Lawrence scale.

Medial Unicondylar Knee Arthroplasty Improves Patellofemoral Congruence: a Possible Mechanistic Explanation for Poor Association Between Patellofemoral Degeneration and Clinical Outcome.

The purpose was to determine the effect of medial fixed bearing unicondylar knee arthroplasty (UKA) on postoperative patellofemoral joint (PFJ) congruence and analyze the relationship of preoperative PFJ degeneration on clinical outcome. We retrospectively reviewed 110 patients (113 knees) who underwent medial UKA. Radiographs were evaluated to ascertain PFJ degenerative changes and congruence.

Role of magnetic resonance imaging in the diagnosis of the painful unicompartmental knee arthroplasty.

Background: Unicompartmental knee arthroplasty (UKA) is a well established method for the treatment of single compartment arthritis; however, a subset of patients still present with continued pain after their procedure in the setting of a normal radiographic examination. This study investigates the effectiveness of magnetic resonance imaging (MRI) in guiding the diagnosis of the painful unicompartmental knee arthroplasty.

Methods: An IRB-approved retrospective review identified 300 consecutive UKAs performed over a three years period with 28 cases of symptomatic UKA (nine percent) with normal radiographic images.

Lower limb alignment control: is it more challenging in lateral compared to medial unicondylar knee arthroplasty?

Introduction: Limb alignment after unicondylar knee arthroplasty (UKA) has a significant impact on outcomes. The literature lacks lateral UKA alignment studies, making our understanding of this issue based on medial UKA.

Methods: We evaluated limb alignment in 241 patients who underwent medial (229 knees) or lateral (37 knees) UKA.

Onlay tibial implants appear to provide superior clinical results in robotic unicompartmental knee arthroplasty.

Background: Unicompartmental knee arthroplasty (UKA) is an increasingly popular option for the treatment of single-compartment knee osteoarthritis (OA) in adults. Two options for tibial resurfacing during UKA are (1) all-polyethylene inlays and (2) metal-backed onlays.

Questions/purposes: The aim of this study was to determine whether there are any differences in clinical outcomes with inlay versus onlay tibial components.

Lateral robotic unicompartmental knee arthroplasty.

Robotic-assisted unicompartmental knee arthroplasty (UKA) is accurate and repeatable. Lateral UKA is still considered a challenge, as the lateral side of the knee has different anatomy and kinematics compared with the medial side. The lateral compartment of the knee is less constrained than the medial compartment and is therefore less tolerant for mobile-bearing implants and ACL deficiency.

Notchplasty in anterior cruciate ligament reconstruction in the setting of passive anterior tibial subluxation.

Purpose: In an effort to minimize graft impingement among various ACL deficient states, we sought to quantitatively determine requirements for bone resection during notchplasty with respect to both volumetric amount and location.

Methods: A validated method was used to evaluate Magnetic Resonance Imaging scans. We measured the ATT of the medial and lateral compartments in the following four states: intact ACL (27 patients), acute ACL disruption; <2 months post-injury (76 patients), chronic ACL disruption; 12 months post-injury (42 patients) and failed ACL reconstruction (75 patients).

Coronal tibiofemoral subluxation: a new measurement method.

Background: Coronal tibiofemoral (CTF) subluxation is a common finding in knee osteoarthritis (OA) which can be related to poor pain scores and tibial spine impingement. In this study we describe a new method for measuring CTF subluxation and present validation of the method using cadaveric knees.

Methods: A prototype software code based on the ICP mathematical algorithm was developed to measure CTF subluxation; the code finds the rigid transformation that best aligns the articular surfaces, measures CTF subluxation and the angle between articular surfaces.

Neglected rotatory knee dislocation: A case report.

Unlabelled: We report here a unique case of a 3 year neglected rotatory tibiofemoral dislocation associated with a lateral patellar dislocation. The rotational deformity was gradually corrected using a Taylor spatial frame and the patella was realigned by tibial tubercle osteotomy and transfer. The patient also underwent multiple soft tissue releases and quadricepsplasty to improve knee flexion.

Limb alignment, subluxation, and bone density relationship in the osteoarthritic varus knee.

Lower limb alignment, tibiofemoral (TF) subluxation, and bone density changes around the knee are significant factors related to the development of knee osteoarthritis (OA) and have great impact on its severity. The relation of each factor to knee OA was evaluated separately in previous studies; however, few studies have attempted to integrate their respective effects. The purpose of this study was to determine if an identifiable interaction exists between coronal limb alignment, TF subluxation, and bone density in the development of knee OA.

Is tibiofemoral subluxation correctable in unicompartmental knee arthroplasty?

The purposes of this study were to describe a method for measuring tibiofemoral subluxation in UKA, and to report the mean amount of tibiofemoral subluxation seen both preoperatively and postoperatively in a cohort of patients undergoing UKA. Two hundred thirty-five patients who received a medial UKA, and 39 patients who received a lateral UKA, were reviewed. In the medial UKA cohort, the mechanical alignment was corrected from 7.

Outcome of dorsally comminuted versus intact distal radial fracture fixed with volar locking plates.

Objective: Distal radial fractures are common. Modern trends favour operative treatment in many instances, providing stable fixation and early functional recovery. Recent biomechanical evidence suggests that volar locking plates (VLPs) enable adequate stability for dorsally displaced fractures, both in dorsally intact (DI) and in dorsally comminuted (DC) fractures.