Intramedullary Nailing of Periarticular Fractures

Plate fixation has historically been the preferred surgical treatment method for periarticular fractures of the lower extremity. This trend has stemmed from difficulties with fracture reduction and concerns of inadequate fixation with intramedullary implants. However, the body of literature on management of periarticular fractures of the lower extremities has expanded in recent years, indicating that intramedullary nailing of distal femur, proximal tibia, and distal tibia fractures may be the preferred method of treatment in some cases. Intramedullary nailing reliably leads to excellent outcomes when performed for appropriate indications and when potential difficulties are recognized and addressed

A modified parapatellar approach for the creation of osteochondral defects in sheep

Osteoarthritis is a problem of great social and economic importance in elderly populations, mostly in developed countries. Current treatments aim to relief the clinical signs and slow the disease development, rather than cure it. Beyond this point, cartilage regeneration has recently received much attention from bioengineering industry, mostly because it’s now that early treatments of osteochondral defects are crucial for slowing or even preventing the chronic development of osteoarthritis. The aim of this study was to develop a modified medial parapatellar approach to the creation of osteochondral defects in sheep to further test novel biomaterials and scaffolds, with the goal of favoring early weight bearing

Anterior knee pain after total knee arthroplasty: does it correlate with patellar blood flow?

Purpose: Total knee arthroplasty (TKA) disturbs patellar blood flow, an unintended accompaniment to TKA that may be a cause of postoperative anterior knee pain. We examine whether disrupted patellar blood flow correlates with anterior knee pain following TKA. Methods: In 50 patients (21 men, 29 women) undergoing TKA, we compared patellar blood flow at flexions 0° to 30°, 60°, 90°, and 110° before and after medial parapatellar arthrotomy to pre- and postoperative anterior knee pain scores by means of a laser Doppler flowmeter (LDF) probe. Anterior knee pain was assessed using the pain intensity numeric rating scale (NRS) of 0-10 (0-no, 10-worst pain). Based on the NRS pain values, patients were divided into two main groups: group A (n=34) with no pain or discomfort (NRS range 0-4) and group B (n=16) with anterior knee pain (NRS range 5-10). Results: Patients of group B demonstrated a significant decrease in blood flow before arthrotomy at flexions from 0° to 90°, and 110° and from 0° to 60°, 90°, and 110° after arthrotomy. For group A, a significant decrease in blood flow was detected at flexions from 0° to 90°, and 110° before and after arthrotomy. For both groups, medial arthrotomy did not have a statistically significant influence on patellar blood flow (margin of significance P<0.05). Prior to TKA, 16 of the 50 patients of group B (32%) complained of anterior knee pain (mean NRS 7.1±1.7). At 2-year follow-up, pain significantly decreased (NRS 3.1±2.1) and only 4 of the 16 patients (25%) complained of moderate anterior pain (average NRS 5.7±0.5), while 8 of 16 (50%) patients reported discomfort (mean NRS 3.5±1.8) around the patella. Patients in group A also demonstrated a significant decrease in pain intensity (from NRS 1.5±1.4 preoperatively to NRS 0.4±1.5 at 2-year follow-up). Statistical analysis demonstrated no statistically significant correlation between pre-arthrotomy/post-arthrotomy patellar blood flow and the presence of preoperative and postoperative anterior knee pain. Only the degree of flexion had an influence on patellar blood flow. Conclusion: Medial arthrotomy had no direct significant effect on patellar blood flow, and the diminished blood flow did not correlate with postoperative anterior knee pain. However, a significant correlation was revealed between patellar blood flow and the degree of flexion: in almost a quarter of patients, blood flow dropped to zero at flexions of 100° and above. Level of evidence: I

Lateral parapatellar approach in primary total knee arthroplasty of the valgus knee

Background Anatomic and pathological characteristics of the valgus knee deformity represent a challenging issue for the implant of a total knee arthroplasty. The surgical approach in such cases should allow a direct ad easy exposure of the joint, easy lateral soft tissue balancing and adequate patellar tracking. Materials and Methods Twenty-four total knee arthroplasties were implanted in valgus knees between January 2002 and September 2005. A mean preoperative valgus deformity of 18\ub0 was assessed on standing x-rays. Four posterior stabilized, eighteen posterior stabilized rotating platform prosthesis and two superstabilized prosthesis were implanted in 21 patients. The surgical approach has been in all cases a lateral parapatellectomy. Follow-up assessments were obtained for all patients at a mean 23 months. They consisted of a Knee Society Score and a Patellar Score evaluation, standing AP and lateral radiograms and skyline x-rays obtained at a flection of 45\ub0. Results A mean preoperative Knee Society Clinical Score of 32,7 points (range, -4 to 64 points) significantly improved at follow-up to an average 88,8 points (range, 57 to 99 points; p<0,05). The Knee Society Function Score significantly increased from a preoperative mean score of 32,7 points (range, -20 to 75 points) to an average followup score of 81,2 points (range, 30 to 100 points; p<0.05). The Patella Score revealed absence of anterior pain in all cases but one that reported severe pain. A satisfactory patello-femoral alignement of 4.7\ub0 (range, 1\ub0 to 10\ub0) was obtained at last follow-up x-rays. One intraoperative condilar fracture occured and was treated with a single screw. Discussion The lateral approach of valgus knees led to satisfactory results in primary total knee arthroplasties in a percentage of cases comparable or superior to those presented in literature for different approaches. In addition, lateral release is performed as a part of the approach itself, allows preservation of the blood supplies of the extensor apparatus and an optimal patellar tracking in most cases. Conclusions In conclusion, the lateral approach for a primary total knee arthroplasty could be recommended in valgus knees affected by osteoarthritis because as it proved to be effective in achieving a satisfactory implant positioning and functional outcome while reporting minor complications

Fracture of the tibial baseplate in bicompartmental knee arthroplasty

Introduction. Bicompartmental knee arthroplasty (BKA) addresses combined medial and patellofemoral compartment osteoarthritis, which is relatively common, and has been proposed as a bridge between unicompartmental and total knee arthroplasty (TKA). Case Presentation. We present the case report of a young active man treated with BKA after unsuccessful conservative therapy. Four years later, loosening with fracture of the tibial baseplate was identified and the patient was revised to TKA. Discussion. Although our case is only the second fractured tibial baseplate to be reported, we believe that the modular titanium design, with two fixation pegs, is too thin to withstand daily cyclic loading powers. Light daily routine use, rather than high-impact sports, is therefore advised. Failures may also be related to the implant being an early generation and known to be technically complex, with too few implant sizes. We currently use TKA for the treatment of medial and patellofemoral compartment osteoarthritis