Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures

Purpose: The purpose of this study was to compare femoral head placement, rates of reoperation and cephalic implant cut-out of a screw versus a blade for patients over age 60 with low energy trochanteric fractures (AO/OTA 31-A1, A2, and A3) treated either with sliding hip screw or cephalomedullary nail. Methods: After surgeon selection of either hip screw or nail, hip screw patients were randomised to either a DHS (dynamic hip system screw) or DHS blade (dynamic hip system blade), while nail patients were randomised to either a Gamma3 Trochanteric Nail or a PFNA (proximal femoral nail antirotation). This resulted in a screw group (DHS and Gamma nail), and a blade group (DHS blade and PFNA). Outcome measures included tip-apex distance and zone location of the cephalic implant, as well as reoperation and implant cut-out within the first postoperative year. Results: A total of 335 patients were randomised, 172 to a screw and 163 to a blade. There was no significant difference concerning mean tip-apex distance, percentage of patients with a tip-apex distance >25mm, and patients with a centre-centre position of the cephalic implant. There were 137 patients in the screw group and 132 in the blade group available for follow-up. They did not differ regarding rates of reoperation or cut-out (screw group = 2.9%; blade group = 1.5%). Conclusions: Both a screw and a blade performed equally well in terms of implant placement in the femoral head and outcom

Differences in Patient Characteristics Prior to TKA and THA Between Switzerland and the US

Introduction: Total knee (TKA) and hip (THA) arthroplasty results, including patient-reported outcome measures (PROMs), complication and implant survival rates, are often generalized across countries, although patient- and environment-dependent factors may differ considerably. We described and compared preoperative characteristics from two large TKA and THA cohort studies, one in Switzerland and the other in the US. Materials & methods: Patient characteristics were collected prospectively on all elective primary TKAs and THAs performed (1) at a large tertiary center in Switzerland between 1/2010 and 12/2011 and (2) in FORCE-TJR, a US diverse, large national sample between 6/2011 and 8/2012. Information was obtained on age, sex, BMI, diagnosis, medical co-morbidities, and PROMs (WOMAC pain and function, SF-12/36 physical and mental component scores). We calculated risk ratios, and mean differences, and effect sizes, to compare preoperative scores. Results: Overall, 2508 TKAs and 1,912 THAs (US) and 855 TKAs and 673 THAs (Swiss) were evaluated. U.S. patients, compared to Swiss, were younger (mean age TKA: 67 vs. 72 yrs; THA: 64 vs. 68 yrs), more obese (BMI ≥35 TKA: 27% vs. 17%; THA: 39% vs. 23%). US TKA patients had more cardiac disease, higher preoperative WOMAC pain scores (52 vs. 41 points) indicating less knee-specific pain at time of TKA. US THA patients had more diabetes (13% vs. 10%), higher WOMAC pain scores (47 vs. 40 points) indicating less hip-specific pain at the time of THA. While significant physical disability (SF) was reported in both countries, US TKA and THA patients reported lower physical function scores. Conclusion: We found substantial differences in baseline characteristics with younger age, greater obesity, in the US TKA and THA patients, and more cardiac disease (TKA), diabetes and preoperative hip pain (THA). Significant levels of disability were reported across countries. These findings call for adequate risk adjustment in cross-cultural comparisons

Comparison between passive knee kinematics during surgery and active knee kinematics during walking ::a preliminary study

Recovery of function is among a patient’s main expectations when undergoing total knee arthroplasty (TKA). However, normal gait knee function is not always completely restored, which can affect patient satisfaction and quality of life. Computer-assisted surgery (CAS) allows surgeons to evaluate passive knee kinematics intra-operatively. Understanding associations between knee kinematics measured during surgery and during daily activities, such as walking, could help define criteria for success based on knee function and not only on the correct alignment of the implant or the leg. This preliminary study compared passive knee kinematics measured during surgery with active kinematics measured during walking. Eight patients underwent a treadmill gait analysis using the KneeKG™ system both before surgery and three months afterwards. Knee kinematics were measured during CAS both before and after TKA implantation. The anatomical axes of the KneeKG™ and CAS systems were homogenised using a two-level, multi-body kinematics optimisation with a kinematic chain based on the calibration measured during CAS. A Bland–Altman analysis was performed before and after TKA for adduction–abduction angle, internal–external rotation, and anterior–posterior displacement over the whole gait cycle, at the single stance phase and at the swing phase. Homogenising the anatomical axes between CAS and treadmill gait led to limited median bias and limits of agreement (post-surgery -0.6 ± 3.6 deg, -2.7 ± 3.6 deg, and -0.2 ± 2.4 mm for adduction–abduction, internal–external rotation and anterior–posterior displacement, respectively). At the individual level, correlations between the two systems were mostly weak (R2 < 0.3) over the whole gait cycle, indicating low kinematic consistency between the two measurements. However, correlations were better at the phase level, especially the swing phase. The multiple sources of differences did not enable us to conclude whether they came from anatomical and biomechanical differences or from measurement system errors

Clinical and objective gait outcomes remained stable seven years after total knee arthroplasty ::a prospective longitudinal study of 28 patients

Background : There is a paucity of data on mid to long-term gait outcomes after total knee arthroplasty. The aims of this longitudinal study were: to assess the evolution of both clinical and gait outcomes before and up to seven years after primary total knee arthroplasty (TKA) in a cohort of patients with knee osteoarthritis. Methods : This study included 28 patients evaluated before and up to seven years after primary TKA with both gait analysis and patient reported outcomes; of these, 20 patients were evaluated one year after surgery as well. Kinematic outcomes during gait (gait velocity, dimensionless gait veolicity, maximal knee flexion and knee range of motion), pain relief, Western Ontario and MacMaster Osteoarthritis Index (WOMAC), quality of life and patient satisfaction were assessed and compared at each visit with the paired Wilcoxon signed rank test (p < 0.05). Results : The significant improvement achieved at one year after TKA was stable up to seven years after surgery, with all clinical and kinematic outcomes unchanged, except for gait velocity, with a significant decrease over time (1.3 (1.1–1.4) m/s one year after TKA versus 1.0 (0.9–1.1) m/s, p < 0.05 up to seven years after). Conclusion : Patients with knee osteoarthritis significantly improve their clinical and kinematic outcomes at one year postoperatively and maintain the gain up to seven years after primary TKA, except for gait velocity which decreases over time, most likely along with ageing

Associations between gait analysis parameters and patient satisfaction one year following primary total knee arthroplasty

The purpose of this prospective study was to understand the relation between gait outcomes and patient satisfaction one year after total knee arthroplasty (TKA)

Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures

The purpose of this study was to compare femoral head placement, rates of reoperation and cephalic implant cut-out of a screw versus a blade for patients over age 60 with low energy trochanteric fractures (AO/OTA 31-A1, A2, and A3) treated either with sliding hip screw or cephalomedullary nail