Revision Total Knee Arthroplasty using a Novel 3D Printed Titanium Augment: A Cadaveric Biomechanical Study

During revision total knee arthroplasty (rTKA), proximal tibial bone loss is frequently encountered and can result in a less-stable bone-implant fixation. A 3D printed titanium augment that conforms to the irregular shape of the proximal tibia was recently developed. The purpose of this study was to evaluate the fixation stability of rTKA with this augment in comparison to conventional cemented rTKA. Fixation stability testing was conducted on eleven pairs of thawed fresh-frozen cadaveric tibias (22 tibias) after primary and revision TKA. During the loading protocol, the bone-implant micromotion was measured using a high-resolution optical system. There was significantly less micromotion in the experimental rTKA in comparison to the standard fully cemented rTKA (p= 0.04). The novel 3D printed titanium augment offers better fixation in rTKA that would be sufficient for bony ingrowth of the augment in vivo

A Prospective study of functional outcome of bicondylar tibial plateau fracture managed with locking compression plate

INTRODUCTION: Tibial plateau fractures account for 1% of all fractures in adults and 8% in elderly. Fractures of tibial plateau more common in recent days due to increasing number of road traffic accidents. These fractures resulting from direct axial compression (valgus) and indirect coronal forces. The injuries span a wide spectrum, ranging from low energy unicondylar fractures to high energy bicondylar and comminuted fractures. In addition, in elderly with osteoporotic bones, even low energy injuries such as domestic falls may lead to complex tibial plateau fractures. Hence the treatment of proximal tibial fractures has become a challenge for the orthopaedic surgeons. LCP has the advantages of better distribution of forces along the axis of bone. They can be inserted with minimal soft tissue stripping using minimally invasive percutaneous plate osteosynthesis (MIPPO). Substantially reducing failure of fixation in osteoporotic bones. Reducing the risk of a secondary loss of intraoperative reduction by locking with screws to the plate. Unicortical fixation option. Better preservation of blood supply to the bone as a locked plating does not rely on plate bone compression. Provide stable fixation by creating a fixed angle construct and angular stability. LCP is technically mature and as it offers numerous fixation possibilities and has proven to worth in complex fracture situations and in osteoporotic bones. AIM OF THE STUDY: This prospective study aims at evaluating the functional outcome of schatzker type V and VI tibial plateau fracture treated by locking compression plate at Department of orthopaedics and Traumatology ,Govt Mohan Kumaramangalam Medical college and Hospital ,Salem Between May 2012 and August 2014. MATERIALS AND METHODS Our study was a prospective study, conducted at the Department of Orthopedics and Traumatology, Government Mohan Kumaramangalam Medical College and Hospital, Salem between May 2012 and August 2014. Inclusion Criteria: Schatzker type V and VI tibial plateau fractures, Age > 18 years, Closed fractures, Grade I compound fractures. Exclusion criteria : Age < 18 years, Grade II and III compound fractures, Associated with vascular injury, Pathological fractures. DISCUSSION: We presented the clinical study of surgical treatment of 27 proximal tibial plateau fractures treated with locking compression plate ..The analysis of the results made in terms of age of patients, gender distribution , Laterality of fracture ,mode of injury , analysis of the types ,medial condyle fracture planes ,primary bone grafting ,method of reduction and fixation ,pre operative external fixation , dual plating , associated injuries and complications . In our study maximum incidence involving tibial plateau fracture >40 yrs (81%) . Average age group in our study was 51.25 years compared to Gosling et al 2005 study (Average age group 51.5 years) CONCLUSION: At the end of our study, following conclusions could be drawn from the treatment of proximal tibial fracture with locking compression plate. Early mobilization is possible with LCP because of absolute stability given by the implant and this contributes to better knee range of motion . Medial condyle coronal fracture and small posteromedial fragment should be buttressed by posteromedial plating . LCP gives the promising results in osteoporotic bones .It prevents collapse of fracture both intraoperatively and postoperatively . Not all bicondylar fractures are same ,treatment should be precise to individual fracture pattern . Bicondylar tibial plateau fractures treated with locking compression plate have an excellent to good functional outcome with very minimal wound complication

Functional Outcome Analysis of bicolumn plating in bicondylar tibial plateau fractures

INTRODUCTION: Fractures of tibial plateau involve the articular surface of proximal tibia. The injuries span a wide spectrum, ranging from low energy unicondylar fractures to high energy bicondylar and comminuted fractures. The surrounding soft tissues are severely damaged in high energy injuries and this complicates management of these challenging lower limb fractures. The treatment of bicondylar tibial plateau fractures still remains a highly demanding surgical procedure with a wide variety of perioperative complications. The goal of treatment of high energy tibial plateau fractures are to restore joint line congruity, joint stability and alignment with minimal soft tissue dissection to allow for early mobilization and establishment of good function. AIM: The aim of our study is to analyze prospectively the functional outcomes of Schatzker type V and type VI tibial plateau fractures treated by dual incision bicolumn plating at the Institute of Orthopedics and Traumatology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai between May 2010 and November 2012. MATERIALS AND METHODS: Our study was a prospective study, conducted at the Institute of Orthopedics and Traumatology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai between May 2010 and November 2012. Inclusion Criteria: • Age > 18 years, • Schatzker type V and VI tibial plateau fractures, • Closed fractures, • Grade I and II compound fractures, Exclusion Criteria: • Age 4 weeks old), • Extensive soft tissue injury with healing period more than 3 weeks. RESULTS: 20 patients sustained injury as a result of road traffic accident, whereas one patient alone sustained train traffic accident. Functional analysis was done using Knee Society Score, which is a clinical scoring system filled by the surgeon. Lateral locking compression plate was used in 11 patients and lateral buttress plates were used in 10 patients. All patients also had medial plating – buttress plates in two patients and reconstruction plates in all other patients. Due to incomparable group numbers, medial column implant was not analysed separately in our study. Of the 11 patients, eight had excellent score, two had good score and one had fair scoring according to Knee Society Score. The average score was 83.63. CONCLUSION: From our study, we conclude that ;Bicondylar tibial plateau fractures have an excellent to good functional outcome with dual incision bicolumn plating with very minimal wound complications. •Early joint mobilisation is possible with this technique and this contributes to better final knee range of motion •Posteromedial plating provides buttressing against late varus collapse in patients with posteromedial fracture pattern. •Anatomical joint reduction and internal fixation provides the best outcome in patients with good soft tissue status, and this should not be deferred for fear of wound complications in cases with closed injuries with healthy soft tissue cover. •There is no significant difference in functional outcome between use of locking plate or buttress plate in lateral column for bicondylar fractures when medial plating has been done. This observation will have to be validated with longer follow up

Epidemiology of injuries in high-level youth sport in Luxembourg [Abstract]

peer reviewe

Quantitative Magnetic Resonance Imaging of Knee Articular Cartilage and Effusion-Synovitis: The Structural Response to Changes in Joint Loading

Knee osteoarthritis (OA) is a progressive degenerative condition that can affect all tissues within the joint. Methods to measure early changes in joint structures and the effect of interventions are required. The purpose of this thesis was to investigate aspects of quantitative magnetic resonance imaging (MRI) as outcome measures in knee OA studies. Specifically, changes in articular cartilage composition and/or effusion-synovitis were examined in people with or at risk for knee OA and healthy controls, and after altering joint loads. Chapter 2 is a systematic review that studied articular cartilage composition using MRI T2 and T1ρ relaxation in patients at risk for knee OA and healthy controls. We performed meta-analyses to examine the effect of knee OA risk factors on T2 and T1ρ relaxation. The presence of risk factors resulted in lengthened T2 and T1ρ relaxation. These findings support the use of compositional MRI to detect articular cartilage degeneration early in the OA disease process. Chapter 3 explores the acute response of knee articular cartilage T2 relaxation to a functional loading stimulus in patients at risk for knee OA and healthy controls. T2 relaxation shortened similarly in both groups following the loading stimulus. The loading stimulus evoked consistent changes in articular cartilage composition but did not detect compromised articular cartilage in patients at risk for knee OA. Chapter 4 evaluates the effect of high tibial osteotomy (HTO), a limb realignment surgery, on T2 relaxation of articular cartilage in patients with knee OA and varus alignment. Shortening of T2 relaxation was observed in the medial compartment, with no change in the lateral or patellar compartments, suggesting HTO can improve articular cartilage composition in the targeted compartment, without harming other compartments. Chapter 5 studies the effect of knee load on effusion-synovitis, using HTO as a model. The change in knee adduction impulse was associated with the change in effusion-synovitis. The findings suggest that mechano-inflammation is an active pathway in knee OA that can respond to biomechanical intervention. Overall, this thesis provides evidence that quantitative MRI is sensitive to structural changes of articular cartilage and effusion-synovitis at various stages of knee OA

Osteoarthritis

Osteoarthritis is one of the most debilitating diseases affecting millions of people worldwide. However, there is no FDA approved disease modifying drug specifically for OA. Surgery remains an effective last resort to restore the function of the joints. As the aging populations increase worldwide, the number of OA patients increases dramatically in recent years and is expected to increase in many years to come. This is a book that summarizes recent advance in OA diagnosis, treatment, and surgery. It includes wide ranging topics from the cutting edge gene therapy to alternative medicine. Such multifaceted approaches are necessary to develop novel and effective therapy to cure OA in the future. In this book, different surgical methods are described to restore the function of the joints. In addition, various treatment options are presented, mainly to reduce the pain and enhance the life quality of the OA patients

Exploration of Three-dimensional Morphometrics of the Hip Joint and Reconstructive Technologies

This dissertation is an exploration of three-dimensional (3D) anatomy using the hip joint as the model of study. Very few studies have taken advantage of 3D modeling to assess the features of commercially available software, or to assess the validity and reliability of 3D morphometrics. This dissertation compared three reconstructive software programs to survey user appreciation concerning how 3D anatomical reconstructive software can be utilized and then established the advantages and limitations of 3D measurements in the hip joint. Three main studies are presented: the first, a comparison of three widely available 3D reconstructive software programs, Amira, OsiriX, and Mimics. This comparison used a decision matrix to outline which software is best suited for construction of 3D anatomical models, morphometric analysis, and building 3D visualization and learning tools. Mimics was the best-suited program for construction of 3D anatomical models and morphometric analysis. For creating a learning tool the results were less clear. OsiriX was very user- friendly; however, it had limited capabilities. Conversely, although Amira had endless potential and could create complex dynamic videos it had a challenging interface. Based on the overall results of study one, Mimics was used in the second and third studies to quantify 3D surface morphology of the hip joint. The second study assessed the validity and reliability of a novel 3D measurement approach of the femoral head (n=45). Study two highlighted the advantages of modeling a convex shape and the advantages of quantifying the proximal femur in 3D. This measurement approach proved to be valid and reliable. The third study assessed the validity and reliability of a similar 3D measurement approach applied to the acetabulum (n=45). This study illustrated the limitations and challenges encountered when quantifying the complex geometry of the concave acetabulum. This measurement approach was reliable, yet the differences between the digital and cadaveric measurements were large and clinically significant. The hip joint is a complex joint that benefits from 3D visualization and quantification; however, challenges surrounding measuring the acetabulum remain