Unexplained pain after total knee arthroplasty

Although total knee arthroplasty (TKA) improves function and reduces pain for the large majority of the patients, a few continue to have pain and require investigation. The causes of dysfunction and pain after total knee arthroplasty can be described as intrinsic (intra-articular) or extrinsic (extra-articular) sources of pain. For the majority of the cases, following a complete evaluation protocol, the cause of pain can be identified and a specific treatment can be applied, however occasionally there remains a group of patients with unexplained pain whose management is difficult. It was our hypothesis that revising a TKA without pre-operative diagnosis of the failure is not worth. Therefore, the aimed of this review was to: 1) analyse the results of revision TKA for unexplained pain, and 2) described the potential solutions for an alternative conservative management of the painful TKA

Isolated patellofemoral osteoarthritis: A systematic review of treatment options using the GRADE approach

Background and purpose The optimal treatment for isolated patellofemoral osteoarthritis is unclear at present. We systematically reviewed the highest level of available evidence on the nonoperative and operative treatment of isolated patellofemoral osteoarthritis to develop an evidenced-based discussion of treatment options

Metal backed versus all-polyethylene unicompartmental knee arthroplasty: the effect of implant thickness on proximal tibial strain in an experimentally validated finite element model

Objectives Up to 40% of unicompartmental knee arthroplasty (UKA) revisions are performed for unexplained pain which may be caused by elevated proximal tibial bone strain. This study investigates the effect of tibial component metal backing and polyethylene thickness on bone strain in a cemented fixed-bearing medial UKA using a finite element model (FEM) validated experimentally by digital image correlation (DIC) and acoustic emission (AE). Materials and Methods A total of ten composite tibias implanted with all-polyethylene (AP) and metal-backed (MB) tibial components were loaded to 2500 N. Cortical strain was measured using DIC and cancellous microdamage using AE. FEMs were created and validated and polyethylene thickness varied from 6 mm to 10 mm. The volume of cancellous bone exposed to 3000 µε and > 7000 µε maximum principal (tensile) microstrain was computed. Results Experimental AE data and the FEM volume of cancellous bone with compressive strain < -3000 µε correlated strongly: R = 0.947, R2 = 0.847, percentage error 12.5% (p < 0.001). DIC and FEM data correlated: R = 0.838, R2 = 0.702, percentage error 4.5% (p < 0.001). FEM strain patterns included MB lateral edge concentrations; AP concentrations at keel, peg and at the region of load application. Cancellous strains were higher in AP implants at all loads: 2.2- (10 mm) to 3.2-times (6 mm) the volume of cancellous bone compressively strained < -7000 µε. Conclusion AP tibial components display greater volumes of pathologically overstrained cancellous bone than MB implants of the same geometry. Increasing AP thickness does not overcome these pathological forces and comes at the cost of greater bone resection

Can we achieve bone healing using the diamond concept without bone grafting for recalcitrant tibial nonunions?

International audienceThe purpose of this study was to evaluate the efficacy and safety of a combination of recombinant human bone morphogenetic protein 7 (rhBMP-7) and resorbable calcium phosphate bone substitute (rCPBS) as a salvage solution for recalcitrant tibial fracture nonunions. Twenty consecutive patients, 16 male and four female, with a mean age of 46.8 +/- 15.7 years (21-78) and a mean body mass index (BMI) of 24.2 +/- 5.3 kg m(-2) (21.5-28.5), suffering from 20 recalcitrant tibial fracture nonunions were included. The mean number of operations performed prior to the procedure was 3.3, with homolateral iliac crest bone grafts being used for all of the patients. All patients were treated with a procedure including debridement and decortications of the bone ends, nonunion fixation with a locking plate, and filling of the bony defect with a combined graft of rhBMP-7 (as osteoinductor) with an rCPBS (as scaffold). The mean follow-up was 14 +/- 2.7 months. Both clinical and radiological union occurred in 18 cases, within a mean time of 4.7 +/- 3.2 months. A recurrence of deep infection was diagnosed for one of the non-consolidated patients. No specific complication of rCPBS or rhBMP-7 was encountered. This study supports the view that the application of rCPBS combined with rhBMP-7, without any bone grafting, is safe and efficient in the treatment of recalcitrant bone union. (C) 2015 Elsevier Ltd. All rights reserved

Titanium-titanium modular neck for primary THA. Result of a prospective series of 170 cemented THA with a minimum follow-up of 5 years

AbstractBackgroundAlthough they have been in use since the end of the 1980s, modular titanium neck components are associated with a risk of wear or fracture, and their safety has recently become a subject of debate and has never been evaluated in a consecutive series of patients. The goal of this study was to evaluate: revision-free survival of these implants after a minimum follow-up of 5 years; clinical and radiographic results; and the potential complications associated with the use of modular titanium neck components.HypothesisThe use of titanium modular neck on cemented titanium THA is safe at a minimum follow-up of 5 years.Patients and methodsBetween January 2006 and December 2008, we prospectively followed 170 patients (170 hips) who underwent primary anatomical THA with a modular cemented titanium stem design implant. The indications were unilateral THA for primary (n=160) or secondary (n=10) hip osteoarthritis (aseptic osteonecrosis of the femoral head or hip dysplasia). Mean age of patients was 75.4±5.8 years old (52–85), and mean BMI was 26.1±4.5kg/m2 (16.6–42.1). Patients were operated on by a modified Watson-Jones anterolateral approach based on preoperative 2D planning. All patients underwent annual clinical and radiological follow-up by an independent observer.ResultsAt a mean follow-up of 71±8 months (60–84), 5 patients died and 7 were lost to follow-up. There was no revision of THA after a maximum follow-up of 84 months. The Harris score improved significantly from 50.4±11.3 (0–76) preoperatively to 84.5±15.2 (14–100) at the final follow-up. There was no difference in postoperative femoral offset or the position of the center of rotation compared to the opposite side. On the other hand, the neck-shaft angle (NSA) and limb length were corrected (2±5° [−11 to +14°] and 2.16±3.6mm [−7.4 to +12.7mm]) respectively. Fifteen patients (9%) had limb length discrepancies of more than 5mm and 4 patients (2%) of more than 10mm. There were no complications due to the modular implant design.DiscussionOur study suggests that the use of cemented titanium implants with a modular titanium stem is safe at a follow-up of 5 years. The modular design does not prevent limb length discrepancies but restores femoral offset.Level of evidenceIV: prospective, non-comparative study

Long-term results of compartmental arthroplasties of the knee LONG TERM RESULTS OF PARTIAL KNEE ARTHROPLASTY

International audiencePartial knee arthroplasty (PKA), either medial or lateral unicompartmental knee artroplasty (UKA) or patellofemoral arthroplasty (PFA) are a good option in suitable patients and have the advantages of reduced operative trauma, preservation of both cruciate ligaments and bone stock, and restoration of normal kinematics within the knee joint. However, questions remain concerning long-term survival. The goal of this review article was to present the long-term results of medial and lateral UKA, PFA and combined compartmental arthroplasty for multicompartmental disease. Medium- and long-term studies suggest reasonable outcomes at ten years with survival greater than 95% in UKA performed for medial osteoarthritis or osteonecrosis, and similarly for lateral UKA, particularly when fixed-bearing implants are used. Disappointing long-term outcomes have been observed with the first generation of patellofemoral implants, as well as early Bi-Uni (ie, combined medial and lateral UKA) or Bicompartmental (combined UKA and PFA) implants due to design and fixation issues. Promising short- and med-term results with the newer generations of PFAs and bicompartmental arthroplasties will require long-term confirmation

Etude de la force excentrique des fibulaires après entorse de la cheville rééduquée

La rééducation excentrique permet de récupérer une meilleure force excentrique et concentriqu

Influence des activités sportives sur la survenue de la gonarthrose : revue de la littérature

L'arthrose du genou chez le sportif vétéran ou l'ancien sportif de plus de 50 ans : effet des activités sportives, qui peuvent accélérer le processus de dégénération articulaire du fait des lésions microtraumatiques (gonarthrose primaire), ou traumatiques (gonarthrose secondaire) qu'elles engendrent. Risque selon le sport, élevé dans les sports en 'pivot contact' (football, rugby, basket-ball, localisation fémoro-patellaire chez les haltérophiles. Effets des méniscectomies. Prévention