Cruciate retaining versus posterior-stabilized total knee arthroplasty: a short-term comparative study

Background: Total knee arthroplasty has got excellent results. Among the techniques (posterior-stabilized vs posterior cruciate retaining total knee arthroplasty) it is unclear whether one design has superior outcome over another. The purpose of the present study was to directly compare clinical and radiological outcomes of these two designs.Methods: A prospective study involving 36 patients who received a cruciate-retaining implant were compared to 30 patients who received posterior-stabilized prosthesis. At 3 months follow-up time clinical and radiological evaluation done and results were analyzed.Results: At 3 months follow-up time mean knee society scores improved from 49.9/46.9 (objective/subjective score) points to 80.9/82.5 points in the cruciate-retaining group and from 48.2/43 (objective/subjective score) points to 80.4/80.2 points in the posterior-stabilized group. The ranges of motion was 117.2° (range, 90° to 130°) and 125.3° (range, 100° to 140°) in the cruciate-retaining and posterior-stabilized group respectively, at 3 month follow-up. One patient had post-operatively periprosthetic fracture reported after 2 weeks (treated conservatively), one had superficial infection (treated with dressing) and one patient with superfical infection required debridement.Conclusions: This study did not conclusively demonstrate the superiority of one knee design over the other, suggesting that the choice of implant should be based on surgeon preference, patients knee dimensions, pre-op knee deformity and existing pathology of the posterior cruciate ligament

Functional outcome of intra-articular tongue type of calcaneus fractures treated with percutaneous technique

Background: Intra-articular calcaneus fracture is relatively rare and morbidity correlates with displacement and relative alignment of fragments. The treatment should address both components to maintain mechanics of foot. Among the available options open reduction and internal fixation is associated with major soft tissue complications and wound healing problems. As an alternative percutaneous fixation offer fewer complications yet good results for less severe calcaneus fractures. Our study aimed to contribute paucity of data available for these rare fractures and help to propose a preferred method of treatment.Methods: A hospital based study carried out on 20 patients over period of 2 year with closed displaced intra-articular tongue type of calcaneal fracture treated with percutaneous fixation and outcome was evaluated using clinical, radiological criteria and American Orthopaedic Foot & Ankle Society (AOFAS) score. All patients were followed up for minimum 9 months with mean follow up of 13.5 month.Results: All patients had evidence of union within 2 month follow up. Mean correction in Bohler angle and Gissane angle was 23.2° and 25.4° respectively at final follow up. Mean change in heel height was 3.15 mm and width change was 2.75 mm compare to opposite side. Mean eversion inversion arch was 28° and near normal ankle range of motion. Functional outcome calculated on bases of AOFAS score revealed 18 patients (90%) had good results and 2 patients (10%) had fair results. Mean AOFAS score was 81.25. Complications were reported in three patients, one had signs of peroneal tendinitis and two had persistent pain and heel widening. Conclusions: We believe percutaneous fixation should be considered as a preferred method for mild to moderately displaced tongue type of intraarticular calcaneus fractures. It potentially allows anatomical fracture reduction with lesser complications and good functional outcome