Primary total knee arthroplasty in the management of epiphyseal fracture around the knee

SummaryIntroductionOver the past few years the use of arthroplasty was broadened to treating complex epiphyseal fractures at the shoulder and elbow joints. Similar trends to treat this type of fractures at the knee are less documented. Based on a multicenter retrospective series study, the aims of this work is to evaluate the short term clinical results of total knee prostheses in the management of comminuted epiphyseal fractures around the knee, to identify the technical issues and fine tune the indications.Material and methodsFollowing the initiative of the French Hip and Knee Society (SFHG) and the Traumatology Study Group (GETRAUM), 26 charts from eight different centers in France were included in this multicenter retrospective series. Inclusion criteria were: primary total knee arthroplasty (TKA) in the management of complex articular fractures involving the proximal end of the tibia or distal end of the femur. Surgical features were identified and complications were analyzed. The assessment protocol at last follow-up was standardized and included patient demographic data, analysis of the Parker and IKS scores.ResultsDuring the immediate postoperative period, six patients (23%) reported a general complication and four patients (15%) a local arthroplasty-related complication. At last follow-up (mean 16.2 months), the overall final Parker score was 6.3 (a mean decrease of 1.7) and the mean IKS knee score was 82 points for a mean function score of 54 points.DiscussionPrimary TKA is a suitable management option for complex fractures in autonomous elderly patients suffering from knee osteoarthritis. The key technical details of this procedure should be respected and meticulously planned to achieve optimal results and limit the risk of complications. This risk in these acute complex fractures remains higher than after conventional TKA but comparable to that observed after TKA for post-traumatic arthritis.Level of evidenceIV; retrospective cohort study

Function and quality of life following medial unicompartmental knee arthroplasty in patients 60years of age or younger

SummaryIntroductionUKA is an appropriate bone-sparing solution for focal advanced knee osteoarthritis in young patients. As the expectations of patients younger than 60 years of age are different from those in an older population, we aimed to evaluate quality of life and the quality of sports activity after UKA in this population.Patients and methodsSixty-five UKAs in 62 patients younger than 60 (mean age: 54.7 years; mean BMI: 28kg/m2) performed between 1989 and 2006 were included. At last follow-up (minimum 2 years), before the objective evaluation, patients were asked to fill in a KOOS questionnaire and a specific sports questionnaire including the UCLA score and questions from the Mohtadi score.ResultsWith a mean follow-up of 11.2±5 years (range, 2–19 years), the KOOS score was higher than 75 points in 90% of the patients for the quality-of-life categories but also for the score's four other categories: 83.4% of the patients had resumed their sports activities and the mean UCLA score was 6.8 (range, 4–9); 90% of the patients reported no or slight limitation during sports activities. The function KSS improved from 52±4 to 95±3 points postoperatively and the Knee KSS from 50±4 to 94±4 points. With three patients undergoing revision for an isolated insert exchange, one for septic loosening and three for osteoarthritis in the external compartment, the 12-year Kaplan-Meier survivorship was 94%.Discussion and conclusionThese results confirmed that UKA can provide good patient-rated outcomes, which is very important in this demanding population. As for TKA, wear remains a problem in this active population.Level of evidenceTherapeutic study, level IV

Clinical, ultrasonographic and CT markers for botulinum toxin injections into the piriformis muscle

Pla general de la platja de la Barceloneta. Hi destaca l'escultura Peix

Reliability of 2D ultrasound imaging associated with transient ShearWave Elastography method to analyze spastic gastrocnemius medialis muscle architecture and viscoelastic properties

PurposeThe aim of the study was to assess the reliability of pennation angle (PA) and muscle thickness (MT) 2D measurements and of shear elastic modulus measurement, using ultrasound imaging (US). Those measurements were made on spastic gastrocnemius medialis muscle at rest and at maximal passive stretching, in post-stroke hemiplegic patients. The paretic side measurements were compared to non-paretic side.Material and methodsFourteen patients took part in 2 inter-session reliability experiments, realized at a 7 days interval by the same operator. The Aixplorer® Supersonic US scanner with the transient ShearWave Elastography (SWE) software was used. The stretching experiments were made manually and controlled by a goniometer.ResultsThe reliability of the 2D measurements was good. The coefficient of variation (CV) was 6.30% for MT measurement at rest, 6.40% and 8.26% for PA at rest and at maximal passive stretching respectively. The reliability of the shear elastic modulus measurement in the sagittal plane was good only at rest with a CV of 9.86%, versus 40.58% at stretching. None of the shear elastic modulus measurements in the axial plane were good. At rest, MT and PA were weaker on the paretic side (14.25±3.12mm and 17.32±5.10°) versus non-paretic side (16.30±3.19mm and 21.08±5.05°) (P<0.0001 and P=0.006). At rest, there was a small difference in the shear elastic modulus between the paretic side and the non-paretic side (5.40±1.67kPa versus 6.20±2.18kPa, P=0.041).DiscussionThis is the first description of muscle spastic structure using SWE with Supersonic Shear Imaging. 2D US associated with SWE shows promise in terms of muscular atrophy quantification and muscle histological quality assessment. These structural properties reflect some of the functional abilities regardless of motor control. It should enable further research on therapies, which impact muscle tissue quality, such as botulinum neurotoxin injections

Необъяснимая боль после тотального эндопротезирования коленного сустава

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.Несмотря на то, что тотальная артропластика коленного сустава приводит к улучшению функции и уменьшению болевого синдрома у подавляющего большинства пациентов, ряд больных после операции продолжают испытывать болевые ощущения. Причины боли и нарушения функции после эндопротезирования могут быть обусловлены как внутрисуставными, так внесуставными факторами. Системный подход к обследованию таких пациентов чаще всего позволяет установить источник боли и провести соответствующее лечение. Тем не менее, существует небольшая группа пациентов с необъяснимой болью, лечение которых является крайне сложной клинической задачей. Нами выдвинута гипотеза, что без четкого понимания причины неудачи первичного вмешательства проведение ревизионного эндопротезирования таким пациентам не показано. В данном обзоре литературы проведён анализ результатов реэндопротезированя коленного сустава, выполненных пациентам с необъяснимой болью и описаны возможные варианты консервативных подходов к лечению этой категории больных

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