Prosthetic fixation in cementless total knee arthoplasty. Influence of techniques, prosthetic design and bone graft enhacement

The knowledge of the biological and mechanical factors which have an influnce in non cemented knee prosthesis' survival and the complexity of the biomechanical (kinematic) demands to which are summitted the different non cemented prosthesis, show the importance of a "natural" solution specially in the field of the substitition of the interposition fibrocartilague structures, such as the meniscus. In the same way it is important to study the behaviourof the different revetment surfaces (Titanium, chrom-cobalt etc..) Lastly, a solid fixation of the implant demands a quality bone, that, in its case, will have come from an autograft

Anterolateral approach with tibial tubercle osteotomy versus standard medial approach for primary total knee arthroplasty: does it matter?

The purpose of this prospective consecutive multicenter study was to investigate whether the type of surgical approach (medial parapatellar (MPA) or lateral parapatellar with tibial tubercle osteotomy (TubOT)) influences the early clinical and radiological outcomes of primary total knee arthroplasty (TKA)

The controversy of patellar resurfacing in total knee arthroplasty: Ibisne in medio tutissimus?

Early arthroplasty designs were associated with a high level of anterior knee pain as they failed to cater for the patello-femoral joint. Patellar resurfacing was heralded as the saviour safeguarding patient satisfaction and success but opinion on its necessity has since deeply divided the scientific community and has become synonymous to topics of religion or politics. Opponents of resurfacing contend that the native patella provides better patellar tracking, improved clinical function, and avoids implant-related complications, whilst proponents argue that patients have less pain, are overall more satisfied, and avert the need for secondary resurfacing. The question remains whether complications associated with patellar resurfacing including those arising from future component revision outweigh the somewhat increased incidence of anterior knee pain recorded in unresurfaced patients. The current scientific literature, which is often affected by methodological limitations and observer bias, remains confusing as it provides evidence in support of both sides of the argument, whilst blinded satisfaction studies comparing resurfaced and non-resurfaced knees generally reveal equivalent results. Even national arthroplasty register data show wide variations in the proportion of patellar resurfacing between countries that cannot be explained by cultural differences alone. Advocates who always resurface or never resurface indiscriminately expose the patella to a random choice. Selective resurfacing offers a compromise by providing a decision algorithm based on a propensity for improved clinical success, whilst avoiding potential complications associated with unnecessary resurfacing. Evidence regarding the validity of selection criteria, however, is missing, and the decision when to resurface is often based on intuitive reasoning. Our lack of understanding why, irrespective of pre-operative symptoms and patellar resurfacing, some patients may suffer pain following TKA and others may not have so far stifled our efforts to make the strategy of selective resurfacing succeed. We should hence devote our efforts in defining predictive criteria and indicators that will enable us to reliably identify those individuals who might benefit from a resurfacing procedure. Level of evidence V

Minimally invasive total knee replacement : techniques and results

In this review, we outlined the definition of minimally invasive surgery (MIS) in total knee replacement (TKR) and described the different surgical approaches reported in the literature. Afterwards we went through the most recent studies assessing MIS TKR. Next, we searched for potential limitations of MIS knee replacement and tried to answer the following questions: Are there selective criteria and specific patient selection for MIS knee surgery? If there are, then what are they? After all, a discussion and conclusion completed this article. There is certainly room for MIS or at least less invasive surgery (LIS) for appropriate selected patients. Nonetheless, there are differences between approaches. Mini medial parapatellar is easy to master, quick to perform and potentially extendable, whereas mini subvastus and mini midvastus are trickier and require more caution related to risk of hematoma and VMO nerve damage. Current evidence on the safety and efficacy of mini-incision surgery for TKR does not appear fully adequate for the procedure to be used without special arrangements for consent and for audit or continuing research. There is an argument that a sudden jump from standard TKR to MIS TKR, especially without computer assistance such as navigation, patient specific instrumentation (PSI) or robotic, may breach a surgeon's duty of care toward patients because it exposes patients to unnecessary risks. As a final point, more evidence is required on the long-term safety and efficacy of this procedure which will give objective shed light on real benefits of MIS TKR

Results and complications of the LCS (Low Contact Stress) knee system.

Low Contact Stress moveable bearing (meniscal and rotating) total results are reported in a prospective FDA-related series. Multi-center results (918 cemented, 963 cementless) were good/excellent in over 95%. More recently analyzed meniscal bearing data in non-inflammatory arthritis revealed good/excellent results in 93.7% of 355 cemented and 93.5% of 451 cementless knees with 2-5 year follow-up. Personal experience with 275 LCS knees (all types/all diagnoses) over 2 years revealed 97.4% good/excellent results. Evaluation scores improved from 53 to 89 points. Device-related complications have decreased from 5.8% cemented to 2.8% cementless. However, fewer sizes were available in the cemented series, contributing to increased loosening. Tibial bearing problems were under 2%. Patella complications have remained under 1%, with or without patella resurfacing. Survival analysis has been greater in the cementless group. The LCS design has remained unchanged for 11 years