Value of preoperative radiographic evaluations on knee bone defects for revision arthroplasty

OBJETIVO: Avaliar o valor da avaliação radiográfica pré-operatória nas revisões de artroplastias totais do joelho. MÉTODOS: Trinta e um joelhos operados no período de 2006 a 2008 em uma série consecutiva de casos de cirurgia de revisão de artroplastia total de joelho foram analisados retrospectivamente. CRITÉRIOS ANALISADOS: número de cunhas ou enxertos ósseos estruturados utilizados para preenchimento dos defeitos ósseos; localização das cunhas e enxertos ósseos utilizados e espessura média do polietileno utilizada. A classificação AORI era estabelecida previamente através de radiografias pré-operatórias segundo critérios preestabelecidos. Após a análise, os joelhos foram divididos em quatro grupos (I, IIA, IIB e III). RESULTADOS: O número médio de cunhas ou enxertos ósseos utilizados em cada joelho variou de maneira crescente entre os grupos (grupo I: 1,33; grupo IIA: 2; grupo IIB: 4,33; grupo III: 4,83) (P = 0,0012). As localizações mais comuns foram: medial na tíbia e posteromedial no fêmur. Não houve diferença estatisticamente significante na espessura do polietileno utilizado. CONCLUSÃO: A classificação AORI para defeitos ósseos no joelho baseada em radiografias pré-operatórias mostrou correlação crescente com a necessidade de utilização de cunhas e/ou enxertos estruturados na revisão de artroplastia total do joelho. Porém, até 46% dos joelhos dos grupos I e IIA apresentaram falhas ósseas de até 5mm não diagnosticadas através das radiografias pré-operatórias

Fresh Osteochondral Allograft Transplantation for Fractures of the Knee

Objective The purpose of this study was to evaluate functional outcomes and allograft survivorship among patients with knee fracture who underwent fresh osteochondral allograft (OCA) transplantation as a salvage treatment option. Design Retrospective analysis of prospectively collected data. Setting Department of Orthopaedic Surgery at one hospital. Patients Fresh OCAs were implanted for osteochondral lesions after knee fracture in 24 males and 15 females with an average age of 34 years. Twenty-nine lesions (74%) were tibial plateau fractures, 6 (15%) were femoral condyle fractures, and 4 (10%) were patella fractures. Main Outcome Measurements Clinical evaluation included modified Merle d'Aubigne-Postel (18-point), International Knee Documentation Committee, and Knee Society function scores, and patient satisfaction. Failure of OCA was defined as revision OCA or conversion to total knee arthroplasty (TKA). Results Nineteen of 39 knees (49%) had further surgery. Ten knees (26%) were considered OCA failures (3 OCA revisions, 6 TKA, and 1 patellectomy). Survivorship of the OCA was 82.6% at 5 years and 69.6% at 10 years. Among the 29 knees (74%) that had the OCA still in situ, median follow-up was 6.6 years. Pain and function improved from preoperative to latest follow-up83% of patients reported satisfaction with OCA results. Conclusion OCA transplantation is a useful salvage treatment option for osteochondral lesions caused by knee fracture. Although the reoperation rate was high, successful outcome was associated with significant clinical improvement.Univ Fed Sao Paulo, Dept Orthopaed Surg, Sao Paulo, BrazilUniv Sao Paulo, Dept Orthopaed Surg, Fac Med, Sao Paulo, BrazilScripps Clin, Shiley Ctr Orthopaed Res & Educ, La Jolla, CA 92037 USAScripps Clin, Div Orthopaed Surg, 10666 North Torrey Pines Rd,MS 116, La Jolla, CA 92037 USAUniv Fed Sao Paulo, Dept Orthopaed Surg, Sao Paulo, BrazilUniv Sao Paulo, Dept Orthopaed Surg, Fac Med, Sao Paulo, BrazilWeb of Scienc

Judet quadricepsplasty in the treatment of posttraumatic knee rigidity: Long-term outcomes of 45 cases

BACKGROUND: Posttraumatic knee stiffness is a very debilitating condition. Judet's quadricepsplasty technique has been used for more than 50 years. However, few reports of quadricepsplasty results exist in the literature. METHODS: We report the results of 45 cases of posttraumatic arthrofibrosis of the knee treated with Judet's quadricepsplasty. The results of the procedure were analyzed by measuring the degrees of flexion of the operated knees at different time points (before, immediately after, and late postoperatively). RESULTS: The degree of flexion increased from 33.6 degrees (range, 5-80 degrees) preoperatively to 105 degrees (range, 45-160 degrees) immediately after surgery, followed by a slight fall in the range of motion (ROM) in the late postoperative period, which reached an average of 84.8 degrees. There was no significant correlation between knee strength and the patient's gender, but there was a slight trend of lower strength with age. Although Judet's quadricepsplasty technique dates from more than 50 years ago, it still provides good outcomes in the treatment of rigid knees of various etiologies. In general, all cases showed the same pattern of a small decrease in the ROM in the late postoperative period. CONCLUSION: Judet's quadricepsplasty can increase the ROM of rigid knees. The ROM obtained with the surgery persists long term. (J Trauma. 2012; 72: E77-E80. Copyright (C) 2012 by Lippincott Williams & Wilkins

Epidemiology of septic arthritis of the knee at Hospital das Clínicas, Universidade de São Paulo

Background:Septic arthritis is an infrequent disease although very important due to the possibility of disastrous outcomes if treatment is not adequately established. Adequate information concerning the epidemiology of septic arthritis is still lacking due to the uncommon nature of the disease as well as the struggle to establish a correct case-definition.Objective:To epidemiologically characterize the population seen at Hospital das Clínicas, University of São Paulo with a diagnosis of septic arthritis between 2006 and 2011.Methods:Sixty-one patients diagnosed with septic arthritis of the knee between 2006 and 2011 were retrospectively evaluated. The patients' clinical and epidemiological characteristics, the microorganisms that caused the infection and the patients' treatment and evolution were analyzed.Results:Septic arthritis of the knee was more common among men, with distribution across a variety of age ranges. Most diagnoses were made through positive synovial fluid cultures. The most prevalent clinical comorbidities were systemic arterial hypertension and diabetes mellitus, and the most commonly reported joint disease was osteoarthritis. Staphylococcus aureus was the prevailing pathogen. Fever was present in 36% of the cases. All patients presented elevation in inflammatory tests. Gram staining was positive in only 50.8% of the synovial fluid samples analyzed. Six patients presented complications and unfavorable evolution of their condition.Conclusion:S. aureus is still the most common pathogen in acute knee infections in our environment. Gram staining, absence of fever and normal leukocyte count cannot be used to rule out septic arthritis