Introduction: At the British Orthopaedic Association meeting 2019, advantages of performing lower limb surgery without tourniquet were highlighted. Although use of cell salvage in total hip arthroplasty has been well established, it is not common practice in total knee arthroplasty (TKA), which is traditionally performed under tourniquet control. We looked at our series of non-tourniquet TKA using cell salvage. Our aim was to see if there were advantages using cell salvage in TKA in regard to transfusion requirement, early wound problems or haemoglobin drop. Methods: This was a single surgeon series of 20 consecutive TKA patients without tourniquet using cell salvage during surgery. All patients had medial parapatellar approach, 1g Tranexamic acid intravenously at induction of anaesthesia, use of autologous bone plug for the femur drill hole and skin closure technique with subcuticular undyed braided absorbable sutures and skin glue. Results: TKA without tourniquet no cell salvage (38): F:M 20:18, Age 74.1 years (49-88), Hb drop 24g/L (12-58). Two patients needed blood transfusion post-operative. TKA without tourniquet using cell salvage (20): F:M 8:12, Age 72 years (56-81), Hb drop 25g/L (15-33). In eighteen patients cell salvage volume transfused 223ml (107- 406). In two patients the salvaged volume was negligible and therefore not processed. None of the patients needed blood transfusion post-operative. Conclusions: In our small cohort of patients, use of cell salvage in TKA without tourniquet seemed to negate blood transfusion requirement thereby reducing risks and costs associated with blood transfusion. Early results using cell salvage in TKA appear promising.

Introduction: Total knee arthroplasty (TKA) have been traditionally performed under tourniquet control. Practices vary among surgeons with tourniquet being used throughout the procedure, only during cementation, or deflation after component implantation prior to wound closure. Methods: Single surgeon series of 48 consecutive TKA patients without tourniquet were compared with a similar cohort performed with tourniquet. All patients had prosthesis from the same manufacturer, subcutaneous undyed absorbable skin sutures and skin glue. As per out institution protocol all patients had single of dose of 120mg Gentamycin, 800mg Teicoplanin intravenously and 1g Tranexamic acid intravenously at induction of anaesthesia. Results: Tourniquet TKA (48): F:M 28:20, Age 74.1 years (51-90), Hb drop 18g/L (4-35), LOS 4.7 days (2-19), preoperative OKS 17/48 (0-33). None of the patients needed blood transfusion. Seven patients had wound ooze which settled before discharge. TKA without tourniquet (48): F:M 24:24, Age 73.7 years (49-88), Hb drop 22g/L (12-58), LOS 4.3 days (2-8), preoperative OKS 16/48 (6-29). Two patients needed blood transfusion. Four patients had wound ooze which settled before discharge. None of the patients with wound ooze required additional antibitoics. No patient in either group have microbiology proven superficial of deep infection. Conclusions: Based on our results, we would advocate TKA without tourniquet as there seemed to be no difference between the two groups. The proposed advantages being reduced pain, reduced rare but possible post-tourniquet syndrome, reduced venous thromboembolic events, better assessment of patellar tracking and improved quadriceps excursion. We conclude that performing TKAs without tourniquet was safe.

introduction: acquired genu recurvatum (GR) is a complex and debilitating deformity. Posttraumatic conditions and neuromuscular diseases are the most common causes. We aimed to present satisfactory results of an old osteotomy technique in two cases with severe GR deformity. case presentation: the first case was a 56-year-old man, who had recurvatum as a sequela of poliomyelitis. physical examination revealed 30° of hyperextension in the right knee. radiographs showed 30° of recurvatum, and 12° of tibial slope angles. the second case was a 48-year-old female who had recurvatum secondary to right knee trauma. she had been undergone surgery including soft tissue repair and proximal tibial osteotomy 7 years before the presentation. physical examination revealed valgus laxity besides 20° of hyperextension. recurvatum and tibial slope angles were 25° and 26°, respectively. both patients were operated by using lateral incision. an oblique osteotomy was performed on the distal diaphyseal-metaphyseal junction and distal part of osteotomy was angled in flexion while invaginated into the proximal part. the osteotomy gap was filled by autogenous graft and fixed with titanium anatomic locked plate. additional medial collateral ligament repair was applied in the female patient. postoperatively, patients used an adjustable knee brace and started knee exercises. weight-bearing was avoided for six weeks. they were allowed full weight-bearing at 3 months postoperatively. at the end of the first-year follow-up, patients could walk independently without pain. conclusion: in cases with poliomyelitis or recurrence of GR, distal femoral flexion type osteotomy shows satisfactory radiologic and clinical outcomes without any complications.

Charcot knee is a rare condition with few reported cases in the literature. Although the clinical presentation is highly variable, Charcot knee classically presents with painful arthropathy in addition to instability and decreased range of motion. Herein, we describe the case of a 72-year-old man with idiopathic Charcot knee. The diagnosis was established on the basis of history of neuropathic arthropathy of the knee, supported by knee radiographs and the exclusion of all known etiologies of Charcot knee. Due to a highly destructed knee joint, the patient underwent a total knee Arthroplasty using the Global Modular Replacement System (GMRS®) proximal tibial prosthesis. The surgery was performed without any major complications, resulting in symptomatic and functional improvements.

Objectives: The present study evaluates the effect of hand dominance on postoperative recovery following total
knee arthroplasty (TKA). Methods: Ninety-eight adult patients who were admitted to our hospital to undergo TKA were prospectively evaluated. Demographic data, limb dominance, and side of indicated surgery were collected during admission. Following surgery, all patients were asked to complete the Reintegration to Normal Living Index (RNLI) questionnaire. Additionally, time to recovery was collected on a discrete scale, and length of stay was recorded on discharge. The Mann–Whitney U test and chi-square test were used for analysis. Results: The patients who underwent TKA on the nondominant side scored 94.4% (p < 0.001) on the RNLI, whereas those who underwent TKA on the dominant side scored 80.4% on average. Furthermore, patients who underwent TKA on the nondominant side demonstrated approximately 2 days shorter length of stay (p = 0.008) than those who underwent TKA on the dominant side. Finally, the nondominant group had quicker time to recovery, as 54% of the patients experienced full recovery within 3 months; however, approximately 26% of the patients who had surgery on the dominant side showed full recovery in the same time frame (p = 0.008). Conclusions: TKA on the nondominant side yields better outcomes than TKA on the dominant side. The shorter length of stay and postoperative rehabilitation duration were directly affected by hand dominance. Additionally, higher RNLI scores were evident, suggesting that performing TKA on the nondominant side positively affected patients’ quality of life.

INTRODUCTION: Despite the recent advancement in arthroplasty, clinically 20% patients are dissatisfied.The intent is to restore the pre-arthritic alignment of the knee with the objective to obtain a proper geometry and better functional results becomes more and more consistent and the kinematic alignment (KA) was developed as alternative to the mechanical one. Let us contemplate the various alignments over the hip knee axis, and kinematic alignment is more of a measured resection.METHODOLOGY: A Prospective study of 20 knees, (Grade III & IV kellegren - Lawrence) operated from May 2019 to May 2020. All patients were categorized as per diagnosis. Preoperative and postoperative scoring includes WOMAC score, Knee society score and Oxford score were modulated to know the functional outcome. All surgeries were done by a solitary knee arthroplasty expert.RESULT: At a minimum of 1 year follow-up, functional outcomes in terms of the 3 scores proved to be superlative. The mean scores were WOMAC (8.7), OXFORD (41.8), and COMBINED KSS (177). Patients of this group also had a convincing knee ROM and deformity has been corrected to their constitutional joint line.CONCLUSION: In this study, measured resection using kinematic TKA, our experience provides enhanced pain relief at early postoperative period and enthusiastic range of movements immediate postop in the kinematically aligned patients. The idea is to restore the natural alignment & not neutral alignment.

Failure of extensor mechanism after a primary or a revision total knee arthroplasty (TKA) is uncommon but a serious complication. It is associated with significant morbidity. Its incidence is reported to be between 0.1% and 2.5% in all TKA but significantly higher in revision surgery. Quadriceps tendon rupture, patella fracture or patella tendon rupture are the possible presentations of this complication. Clinical case of periprosthetic fracture of patella after a primary TKA, documented with images of the reconstruction surgery and perioperative radiological study. An obese, diabetic, 61-year-old female patient went on the emergency department presenting with left knee pain, walking inability and extensor lag after a left knee sprain while leaving bus. At physical examination, she had left knee swelling, a palpable gap at the inferior pole of the patella and an incompetent extensor mechanism. 2 months before, she had a left primary cruciate-retaining TKA. Radiologically, a comminuted, displaced fracture of patella was evident. CT showed patellar component loosening. She was submitted to a partial patellectomy. Patellar component was removed. It was performed a patellar tendon augmentation with semitendinous autograft through a transverse tibial tubercle tunnel, using Pulvertaft-weave tendon repair technique. Immobilization in an extension cast for 6 weeks. Rehab is starting. Extensor mechanism failure in TKA is associated with poor function and surgery is imperative. Component malrotation, excessive joint line elevation and previous lateral release are some of the contributors. The acute repair of patella or quadriceps tendon rupture should be augmented due to a high risk of re-rupture.

Introduction:Intra-articular tumor lesions of the knee are clinical challenge for every orthopaedic surgeon in respect of their etiology, diagnosis, and the decision of their adequate treatment. Ganglion cysts are benign, soft tissue formations arising from the joint capsule or tendon sheath and contain mucinous fluid. Intra-articular ganglion cysts of the knee are rare, and only 9% are symptomatic. Case Presentation:A 29 years-old woman, with no previous relevant personal history, presented with a 15-years history of anterior left knee pain, with worsening in the last 2 years. She demonstrated painful range of motion beyond 90°, painful palpation over the patellofemoral joint, but no effusion. Plain radiographs and ultrasound showed no abnormalities. MRI revealed a multilobulated cyst in the medial suprapatellar pouch of about 15x17x8mm, with signs of benignity. The patient underwent marginal surgical excision by an arthroscopic approach. A mass of 23x12x5mm was excised. The histopathological study identified a cyst with fibrous wall, without epithelial lining, confirming the diagnosis of a ganglion cyst. With a follow-up of 6 months, the patient is asymptomatic. Conclusion: The presence of an intra-articular ganglion cyst in the suprapatellar pouch of the knee is a very rare finding, being reported previously in the literature, to our knowledge, only one time. Despite its rarity, in patients with anterior knee pain, this entity should not be overlooked.

Plicae are thin and pliable inward folds of the synovial lining present in multiple joints. Due to idiopathic or secondary causes, plicae become inflamed, thickened and fibrotic. The mediopatellar is the most clinically relevant. It may bowstring across the medial femoral condyle during knee flexion causing pain. The authors report a case of a 60-year-old male, amateur cyclist, with a 3-month history of anteromedial right knee pain. History, physical exam and imagiological findings were consistent with medial plica syndrome. Due to failure of conservative treatment the patient underwent arthroscopic treatment. A Sakakibara type C plica impinging against an Outerbridge grade IV osteochondral lesion of the internal femoral condyle was identified. The plica was resected and the osteochondral lesion treated through abrasion chondroplasty and microfracture technique. Following eight weeks of protected weight bearing physical therapy was started. At three months the patient presented with no functional limitation and return to sport was allowed. Medial plica syndrome symptoms are often indistinguishable from other intra-articular conditions such as meniscal tears, osteochondritic or osteoarthritic lesions. In spite of patient’s age, diagnosis was straightforward due to history of recent anteromedial pain with repetitive knee flexion, combined with negative meniscal tests and positive Stutter and Hughston tests. On MRI the presence of a medial plica and ipsilateral osteochondral lesion of the femoral condyle supported this diagnosis. Conservative treatment failed due to large type C plica and associated osteochondral lesion, as predicted in literature. Arthroscopic resection of plica and treatment of osteochondral injury yielded a good outcome.

Rheumatoid Arthritis is a leading cause of early-onset joint degeneration. 5 patients suffering from osteoarthritis of knee replacement who underwent successful index total knee arthroplasty with good post-operative knee scores at 1, 3 and 6 months developed laxity, which was symptomatic in 3 patients. This study evaluates the immediate and late post-op results of these patients, with management of the same. All 3 symptomatic patients had to undergo revision procedures with good resultant outcome. 2 patients who developed hyper laxity but were asymptomatic were treated conservatively and have been kept on regular follow up. This study aims to address the common causes of such laxity developing more than 6 months after successful index knee replacement.

Infection in Unicompartmental Knee Arthroplasty (UKA) has an incidence varying from 0.1% to 1.0%, significantly lower than Total Knee Arthroplasty (TKA). Due to the different perceptions of UKA, surgeons may adopt different treatment protocols than those applied to an infected TKA. Given the limited data available concerning UKA infection, the best treatment option remains unclear.
This study is the largest recent multi centre retrospective analysis of treatment of UKA infection. Twenty cases are analysed.
Treatment strategies are highlighted with outcomes and complications and include debridement and polyethene liner exchange (DAIR) and one or two stage revisions, depending on early or late onset as well as on the causative bacteria.
Different criteria for diagnosing infection in a UKA may be relevant given to the higher proportion of native tissue present in the joint in comparison to a TKA.
This study shows a high percent usage of the DAIR procedure in early UKA infections with a high success rate. It is suggested that as the higher proportion of the knee is natural around the much smaller implant of UKA, the knee immunological status and natural defenses are more effective than in a TKA. This may alter the response to the rare challenge of infection. Surgeons might wish to adopt a slightly different strategy than in TKA infection, with more emphasis on the less invasive and potentially more successful DAIR procedure. This severe complication should be managed by a multidisciplinary team to achieve best functional results.

Introduction: Post-operative pain in TKA is a common complication causing delayed mobilization and increased opioid demand. We evaluated postoperative pain, opioid-sparing effect, and rehabilitation with preoperative Celecoxib administration. Methods: We performed a comparison study of 24 patients who underwent TKA. We divided the patients into two groups and one group was given 200 mg of celecoxib and Gabapentin 75mg 2 hours before surgery. Post-operative pain management was done with oral analgesics and subcutaneous Morphine. The outcome was measured with visual analog pain scale, morphine requirement, the incidence of nausea and vomiting, post-operative knee range of motion was assessed. Results: Two groups were comparable for age, preoperative range of motion, and indication for surgery. VAS improved in the preemptive analgesia group at 24hrs (6.13 ±1.87 vs 7.88 ±1.31). The range of motion was comparable in both groups. The morphine requirement in the first 24 hours was reduced in the preemptive analgesia group (35%). There was no difference in the incidence of vomiting, two patients in the preemptive analgesia group and three people in the non-preemptive analgesia group developed nausea. Conclusions: Preemptive analgesia with celecoxib and gabapentin significantly reduced postoperative pain and opioid requirement in the first 48 hours of TKA.

Objectives
The aim of this systematic review was to evaluate the evidence on reservation of posterior Femoral condylar offset (PFCO) and Joint line (JL) with improved functional results after Revision Total Knee Arthroplasty (RTKA).
Methods
A comprehensive search of PubMed, Medline, Cochrane, CINAHL, and Embase databases was conducted since the inception of the database to October 2020. All relevant articles were retrieved, and their bibliographies were hand searched for further references on Posterior condylar offset and revision total knee arthroplasty. The search strategy yielded 28 articles. After duplicate removal titles, abstracts and full text were reviewed. Nine studies were assessed for eligibility, four studies were excluded because they did not fully comply with the inclusion criteria. Sex articles were finally included in this systematic review.
Results
Based on this systematic review restoration of the JL and PFCO in RTKR is associated with significant improvement in the post operative range of motion, KSS, OKS, patellar function, and SF-36.
Conclusion
Preservation of JL should be a major consideration when undertaking RTKA. Of note, increasing PFCO to balance the flexion gap while maintaining joint line should be well assessed intra-operatively.

Introduction: Some authors have postulated that different risk factors are involved in the development of tibiofemoral osteoarthritis, but only a few tried to distinguish between the etiology of medial and lateral osteoarthritis. Objectives: To study the effect of hip and pelvic geometry on the knee osteoarthritis to prove whether it had relation to biomechanics of the hip joint. Methodology: Hospital based descriptive observational study, in Sudanese patients with knee pain seen at ShargElneel hospital from August 2015 To October 2016. Patients were assessed both clinically, radiologically using scanogram and questionnaires. Results: 60 patients were enrolled in this study, 53.3% are females and all of them are in the middle and elderly age groups (41-80 year). The most prevalent deformity was Varus deformity 63.3% by clinical examination and 75% by radiological measurement. a statistically significant correlation was found between Clinical assessment of knee alignment and radiological assessment. The specific compartmental knee osteoarthritis is significantly correlated with the femoral offset which is statistically significant, the largest the offset the more likely the medial compartment to be affected. Conclusion and recommendations: The clinical assessment is good as radiological assessment. The femoral offset proved to be the most important determining factor for developing specific knee compartment osteoarthritis. No association was found between neck shaft angle, acetabulum to acetabulum distance and the affected side. Large multicenter genetic and anthropometric studies are needed to evaluate more the observed associations. Our results can be used to modify the current diagnostic and operative interventions for knee osteoarthritis.

Pigmented villonodular synovitis is a rare benign condition that is locally aggressive to the surrounding soft tissues and bone causing functional loss of the joint. The knee is the most affected joint (range, 28% to 70%) but bone involvement is not common at this site.
We report a case of a 44 year-old male healthy patient, that presented with right medial knee pain and swelling after minor trauma. He had a knee sprain 12 years before. The x-rays showed degenerative changes and an osteolytic lesion of the medial condyle. An MRI was done, which confirmed the degenerative changes and showed a medial meniscus tear associated with proliferative synovitis.
A right knee arthroscopy was performed in which a medial partial meniscectomy was done and inflammatory tissue was ressected and collected to histopathologic analysis. A pigmented villonodular synovitis was confirmed.
2 years after surgery the patient is readmitted with severe right knee pain. The x-rays showed progression of the degenerative changes and of the osteolytic lesion of the medial femoral condyle. A total knee arthroplasty is performed with excision of the entire inflammatory tissue.
At 1 year of follow-up the patient is very satisfied, with no pain and a range of motion of 95º of flexion and maximal extension.
Treatment options in these rare cases include arthroscopic excision, open synovectomy or a combined technique. Advanced disease leads to irreversible damage of the cartilage and bone loss. In this setting, knee replacement is the only surgical option in symptomatic patients.

Introduction: Total knee arthroplasty is one of the most rewarding procedures in orthopedic surgery. However, and despite the progress in surgical techniques and the implants development, one in five patients remains dissatisfied with their prosthesis. The aim of this work was to evaluate the satisfaction rate after total knee arthroplasty and to establish predicting patient satisfaction factors. Methods: Our retrospective study included 170 primary total knee arthroplasties placed between 2015 and 2017 with a minimum follow-up of three years. Satisfaction was estimated by a yes or no question. Results: At the last follow-up, all our patients reported a functional improvement with better WOMAC and IKDC scores. The overall dissatisfaction rate was 22.9%. Two parameters concerning the patient's background had a statistically significant link with dissatisfaction: the female sex and the history of diabetes. Only one parameter related to the knee preoperatively had a direct, statistically significant influence on increasing dissatisfaction risk: limited range of motion with flexion <90°. No parameters related to surgery had a statistically significant link with satisfaction. Regarding parameters related to the knee after surgery, only moderate to severe residual pain (VAS>3) was associated with patient dissatisfaction after total knee replacement. Conclusions: Recognition of factors predicting patient satisfaction after total knee arthroplasty should influence our behavior so as to act on the modifiable factors, allowing to reduce the risk of dissatisfaction to minimum, or to have a more alert attitude towards unmodifiable factors in order to adapt the therapeutic care and to better inform and educate patients.

INTRODUCTION.
Although the number of total knee replacements (TKR) is rising, the uncertainty of the benefits of patella resurfacing is reflected by the split in operative practices. Our results aimed to help with decision process.

METHODS.
We reviewed our joint arthroplasty database from 2015-2020. All primary TKR were included and divided into TKR with resurfaced patella (RP) and unresurfaced patella (URP). The data was analysed for clinical outcomes, complications, revisions (patella resurfacing as a secondary procedure) and related costs.

RESULTS.
We identified 2700 TKRs (RP cohort–960, URP–1740). Patients’ average age–70years (23-95), 73% females. The average follow-up–43months (6-72, median 45). Complication rate and mortality in RP versus URP groups were 1.2% vs 1.9% and 1.1% vs 1.4%, respectively. In URP–10 cases (0.58%) underwent patella-related procedures, while in RP group–0%. 174 TKRs needed primary resurfacing (£120/procedure; total–£20,880) to avoid one secondary resurfacing procedure (£2,200/procedure). Oxford Knee Score (OKS) improved from pre-operative to 1year post-TKR from 18 to 42 and 18 to 38 in RP and URP, respectively. The post-operative OKS scores were statistically and clinically superior in RP versus URP cohort (p<0.001 and Minimal Clinically-Important Difference–4). Secondary patella resurfacing led to improvement in OKS, although failed to reach the improvement of primary RP cohort.

CONCLUSIONS.
Patella resurfacing (versus no resurfacing) was found to lead to significant improvement in functional outcomes. However, while avoiding a secondary procedure with its risks, the cost of routine patella resurfacing as a primary procedure was higher than occasional secondary resurfacing.

Introduction:Normally we use semiconstrained for total knee arthroplasty(TKA) in cases of osteoarthritis or RA ,also we used cruciate retaining(CR) semiconstrained knee,but in the cases of that we have some deformities like genu varum or genu valgum or in the cases of range of motion(ROM) problems we used posterior stabilized(PS) type Tibial insertion now during the last last 2 years.We used also tibial insertion ultra congruent(UC) type.The result between UC comparing with PS in these cases was good.Material and method:During last 2 years we had about 100 cases of TKA that we used semiconstrained knee,CR or PS.Among all these cases 35% were PS tibial insertion and about 12% were semiconstrained UC type,53% were cruciate retaining and investigations for ROM,stability of knee and pain comparing between UC and PS were approximately similar together.Result:We could be able to explain that we can use for TKA UC type instead of PS type and we also had one cut less for PS ,so we prefer to use instead of Ps, UC type tibial insertion in the cases of mild genu varum and genu valgum of the knee.

Total knee arthroplasty after failed proximal tibia fracture fixation


Introduction:
Fixation failure of platue fracture is challenging. Join surface usually can not be restored. Total knee arthroplasty is an option in this situation.
But it is not a usual arthroplasty. There is some special conditions which need special attentions.

Materials and methods:
From 2010 to 2019 ,arthroplasties after fixation failures of proximal tibia fractures are studied. Bone defects, knee scores and level of costrain in TKA were recorded. Infection, soft tissue problems and extensor mechanisem dysfunction were considered.

Results:
12 cases of TKA failure of fixation of proximal tibia were studied. All of rhem need stemed tibial component. There were proximal tibia bone defect in all of them. But Augment was used in only one patient. The rest of them were managed with morselized allograft impacted in contained defects. There were 2 persistent wound drainage treated with irrigation and debridement. No deep infection was seen and tehre was no soft tissue necrosis. Knee scores rise dramatically after total knee arthroplasty. No extensor mechanism injury was seen but one collateral ligament laxity was founded which treated with brace.

Discussion:
Total knee arthroplasty after fixation failure of proximal tibia needs stemed tibial component to be fixed in diaphysis and bypass weak metaphysial segment. Fotunately deep infection, cllateral ligament insufficiency and extensor mechanism injury was senn infrquent. Knee scores rise so it is recommended to be done.

Introduction:Aneurysmal bone cyst(KOA)is a bone lesion of unknown origin characterized by multiple cysts consisting of fibrous walls and containing blood.The contours are delimited by a thin"blown"cortical bone shell which can be replaced in places by uncalcified periosteum.KOA represents 1 to 2% of primary bone tumors 80% of cases are observed in patients who have less than 20 years.The main sites affected are:long bones 53%,spine15%, small bones hand or foot10%and 6%in the pelvic girdle. Methods:we report an observation of a patient aged 37,treated symptomatically for sciatica for 6 months,who consulted for the appearance of an evasive lameness,the range of motion was preserved and the radiological assessment was objective.Lytic blowing image of the lower pole of the moderately aggressive patella.Results:the patient was operated,the exploration of which found a fine blown cortical shell,a recess followed by filling with spongy tissue was performed after sampling for anatomopathological study,the result in favor of an aneurysmal cyst,the evolution was towards the absence of recurrence and good bone remodeling on the radiological assessment.Discussion:KOA is a bone tumor that was first described by Jaffe and Lichtenstein,her name is due to the macroscopic appearance of this lesion which is formed of intraosseous cavities filled with blood.The more recent use of osteoinductive protein and calcitonin injection appears to be a promising avenue.In our case, we performed a radical excision of the cyst.No recurrence was noted on the last examination.Conclusion:Epiphyseal KOA is very rare,its treatment must be surgical to fill the bone defect,prevent pathological fracture and avoid recurrence.

We present the case of a 96-year-old patient treated for severe osteoarthritis with primary total knee arthroplasty (TKA) using a rotational prosthesis. This patient had significant medical co-morbidities and her independence was limited due to her severe functional immobility. This case demonstrates that TKA can be a safe procedure with good outcomes in nonagenarians with severe osteoarthritis. Thorough discussion of treatment options is crucial for elderly patients with multiple medical comorbidities. TKA in the nonagenarian population can restore function and independence for patients which may reduce the burden on social care.

Aim: To identify the aseptic causes and evaluate other variables leading to revision total knee replacement (TKR) with its functional outcomes. Materials and Method: We performed a retrospective review of 80 patients who underwent non-infective revision TKR from July 2013 to June 2018 at two Hospitals. To evaluate the functional outcomes, a postoperative subjective assessment was done as either satisfied or unsatisfied after revision TKR based on the parameters of pain or restricted movement during follow-ups. Results: Out of the 80 patients, the causes of aseptic revision TKR identified were loosening of implant in 28 followed by pain in 26, instability/malposition 13, restricted range of motion 5, periprosthetic fracture 3 and allergy to the implant 3, respectively. Majority of the primary surgery was performed by Surgeon A. Also, 50.8% patients had an early knee revision within three years after the primary knee surgery. There were more females than males and about 72.7% of patients had underlying comorbidities. Additionally, patients were from an older age group with the most seen between the ages of 71-80 years. Postoperatively, 75.5% of patients were satisfied with their revision TKR. Conclusion: The study showed that the most common causes for aseptic revision TKR was due to loosening of the implant (35%) followed by pain (32.%). Majority of the patients had an early revision within 3 years, therefore more attention to the other variables associated with revision TKR needs to be considered cautiously. Overall, revision TKR provided an improvement in patient satisfaction.

Purpose of review: Patient selection and medical optimization of comorbidities before surgery may improve the outcome of total knee arthroplasty (TKA). Pre-operative clinical evaluation is essential in determining the current medical status and assessing the risk profile of the patient. The purpose of this review was to analyze systems-based evidences regarding pre-operative optimization of patients to improve post-operative TKA outcomes. Whilst TKA is widely regarded as an effective and reliable procedure for the treatment of end-stage arthritic knees, it can be associated with complications. These complications can be life-threatening and the incidence may be greatly reduced if the patients are properly optimized for this elective procedure.
Keywords: Total knee arthroplasty, peri-operative, patient selection, optimization.

Purpose
Predictive modeling promises to improve our understanding of what variables influence patient satisfaction following total knee arthroplasty (TKA). The purpose of this paper was to systematically review the relevant literature using predictive models of clinical outcomes following TKA. The aim was to identify the predictor strategies used for systematic data collection with the highest likelihood of success in predicting clinical outcomes.
Methods
A PRISMA systematic review was conducted using three databases (MEDLINE, EMBASE, Pubmed) to identify all clinical studies that had used predictive models or that assessed predictive features for outcomes after TKA between 1996 and 2020. The ROBINS-I tool was used to evaluate the quality of the studies and the risk of bias.
Results
A total of 64 studies were identified of which 43 met our inclusion criteria. Pre-operative predictive factors strongly associated with post-operative clinical outcomes were knee pain, knee specific Patient-Reported Outcome Measure (PROM) scores, and mental health scores. Demographic characteristics, pre-existing comorbidities, knee alignment had an inconsistent association with outcome. The outcome measures that correlated best with the predictive models were improvement of PROM scores, pain scores and patient satisfaction.
Conclusion
Several algorithms, based on PROMs improvement, patient satisfaction, or pain after TKA, have been developed to improve decision making regarding both indications for surgery and surgical strategy. Functional features such as preoperative pain and PROMs scores were highly predictive for clinical outcomes following TKA. Some variables such as demographics data or knee alignment were less strongly correlated with TKA outcomes.

We intend to present the clinical case of a 47 years old woman who was run over by a car. From the accident, bilateral fractures of the leg bones resulted. On her right leg, she had a grade II open fracture AO42-C2 and a tibial plateau Schatzker VI. On the left leg, a AO42-C2 closed fracture.
Initial management was performed with an external fixator and after 2 weeks definite surgery was performed. On her left leg, anterograde tibia nailing was performed. On her right leg, open reduction and internal fixation of the proximal tibia with an anterolateral plate and tibia nailing.
On the follow up, the patient remained symptomatic, with mechanical knee pain . Objectively, a 11º valgus deformity of her right knee and a 2,1cm dismetry was apparent (longer right limb). After hardware removal, and nearly 4 years after the accident, due to a sequelar valgus deformity of her right knee, she was submitted to a medial subtraction high tibial osteotomy (HTO) with plate fixation.

Correction of an post-traumatic deformity tends to be more complex than standard osteotomies. Surgical planning is of utmost importance, with correct angle measurement to achieve an adequate correction. Metaphyseal osteotomies must be fixed with a plate, allowing early rehabilitation.
An addition osteotomy of the distal lateral femur is an option for larger correction and is more precise than the medial subtraction HTO. Nevertheless, medial subtraction is simple, safe and does not compromise articular mobility, with the benefit of a faster consolidation and rehabilitation process.

Patellofemoral osteoarthritis can be associated with anterior knee pain, stiffness and functional impairment. In selected cases, an unicompartimental patellofemoral arthroplasty can be a bone sparing solution when other treatments have failed.

We report the case of a 48 years old woman that has suffered from anterior knee pain for nearly 12 years. The pain was progressive and there was no reference to an initial traumatic event / dislocation. During this period she submitted to several treatments, ranging from physical therapy and weight loss, to hyaluronic acid and platelet-rich plasma infiltrations and then to 2 arthroscopic surgeries in the last 6 years (soft tissue realigment, curettage and condroplasty of a pattelar chondral lesion). Despiste the multiple treatments performed, she remained symptomatic.

Radiographically, she had signs of throclear dysplasia (Dejour B), patellofemoral osteoarthritis (Iwano III) with no evidence of tibio-femoral arthritis. The patelar height and lower limb axial alignment were within normal range. She referred significant limitation to daily activities and hence a patellofemoral unicompartimental arthroplasty was proposed.

The surgery was performed using a medial parapatellar approach, and a third-generation onlay implant was utilized. The patient initiated a rehabilitation program on day 1 post op. She referred an initial mild worsening of the pain with physical therapy with progressive improvement afterwards. Currently the patient has 6 months of follow up, full active range of motion 0-130º, VAS 1, Oxford Knee Scale 38. A good radiographical result was obtained. Clinically, the patient is satisfied with the outcome.

Purpose: To investigate whether WOMAC scores changes after THA or TKA are gender and joint specific. Methods: A retrospective database cohort study was conducted. The data of 855 (553 female) THA and 684 (444 female) TKA patients who underwent surgery between January 2016 and December 2018 were analyzed. Generalized linear mixed models (GLMM) with a repeated measures data structure and fixed effects for “follow-up time” (FU), “gender”, “joint” (TKA vs. THA) and interactions for “FU by joint” and “gender by joint” were carried out for the dependent variables WOMAC total score and the sub-scores pain, stiffness and function. Results: The patients were on average 69.2 ± 10.7 years old. Follow-up time (FU) (p< 0.001), gender (p< 0.001), joint (p< 0.001), and the interaction FU by joint (p< 0.001) had significant effects on the WOMAC total and sub-scores. All patients perceived significant improvement in pain, stiffness and function between all FU times (p< 0.001), however patients after TKA perceived less improvement in all dimensions in comparison to patients after THA (p< 0.001). Regardless the FU time and the procedure, male patients perceived overall higher improvements in comparison to female (p< 0.001). Conclusion: The WOMAC score changes after THA or TKA arthroplasties are joint-specific. Patients after TKA perceived less improvement in all dimensions. The results of this study can be used to adjust patients’ expectations before surgery.

Introduction: Unicompartimental knee arthroplasty (UKA) is an attractive treatment option for a selected group of patients with knee osteoarthritis (OA). We investigated the results of a series of UKAs after a minimum fifteen-year follow-up. Methods: From 2003 to 2005 thirty-five medial UKAs were performed through a minimally invasive approach using the Johnson&Johnson®´s Preservation® system. Mean age at the time of surgery was 64.4 years. Clinical and radiological outcomes were analyzed using the Knee Society Clinical Rating system and weightbearing anteroposterior and lateral radiographs. Results: A total of twenty-nine UKAs with a mean follow up of 16,2 years were evaluated. At a mean follow up of 3.8 years after surgery six UKAs required revision (17,1%). Implant survival was 83,9% at fifteen-years follow up. Mean Knee Society (KSS) and KSS function scores were 88.1 and 81.9 respectively. Mean range of motion was 122,6º. Mean fem-orotibal angle was 3,4º (+/- 3,9º) of varus prior to UKA and 3,6º (+/- 3,4º) of valgus after surgery. Non-progressive radiolucent lines around the tibial component were found in 14,3% of patients. Conclusion: Our results suggest that minimally invasive UKA is a good option when performed in selected OA cases with an acceptable survival rate and good clinical and radiographic outcomes fifteen years after surgery

Introduction: It is not clear whether outcomes differ between computer-navigated and conventional unicompartmental knee arthroplasty. The purpose of this study was to perform an analysis comparing the radiographic component position and clinical and functional outcomes between computer-navigated and conventional unicompartmental knee arthroplasty. Methods: A retrospective study about 41 unicompartmental knee prostheses has been carried out: 22 of them following a conventional method and 19 through computer-navigated. A statistical analysis of 14 radiological variables was performed in both groups of patients. Clinical outcomes were assessed with the Knee Society Score (KSS). Results: In the computer-assisted group an improvement in prosthetic disposition was obtained in 3 of the radiological variables (metaphyseal-diaphyseal postoperative angle of the medial tibial component, difference between the metaphyseal-diaphyseal angle of the plateau and medial tibial component before and after surgery as well as in the distribution of the femoral load on the tibial plateau in the coronal plane) with statistical significance (p <0.05) compared to the manual technique. Conclusions: Computer-navigated unicompartmental knee arthroplasty is an emerging technique as well as a good therapeutic option for the treatment of osteoarthritis knee and its working to improves de position component. Although good results have been obtained as for the survival situation, longer-term studies are necessary to assess the real consequence of the malpositions on each of the components of the prosthesis.

Postoperative pain is an important determinant of rehabilitation and functional outcomes after total knee arthroplasty . In an effort to decrease the need for postoperative opioids, there has been an increasing interest in analgesic techniques, such as local infiltration analgesia. The aim is to evaluate the effectiveness of LIA in reducing postoperative pain and opioid medication, improving functional results and decreasing the length of hospital stay, as well as to reassess its safety and analyse its advantages compared to other analgesic alternatives and / or the combination of the same. Material and methods. An observational descriptive study of a series of cases was conducted on patients undergoing TKA who received LIA for postoperative pain control. Pain was recorded in VAS at 12, 24 and 48 h postoperatively. Results. The majority of patients included in the analysis were women, and the mean age was 69.92 years. The number of right-sided TKA was higher than left-sided, and posterior stabilized prosthesis was the most used. The mean pain levels assessed by the EVA scale at 12, 24 and 48 hours were 3.85, 4.56 and 4.38 respectively, increasing the percentage of patients who presented higher pain intensity at 48 hours. Statistical association was observed between age and pain levels at 12 hours after the intervention. Other parameters studied (sex, degree of osteoarthritis, hospital stay, etc were not statistically significant. Conclusion. The LIA technique offers a safe and effective analgesia, reduces the consumption of analgesic medication, improves subjective parameters, and supports early mobilization after TKA.

The aim of this work was to compare the posterior tibial slope of the tibial component after performing a total knee arthroplasty, as an intramedullary or extramedullary guide was used during the surgical technique, as well as comparing the range of mobility obtained according to the Instrumentation used. We conducted a descriptive, retrospective, observational study of a series of 57 patients operated in our Center during 2012 and 2013, with the same model of total knee arthroplasty (Sigma PS® DePuy), divided into two homogeneous groups in terms of age, sex, degree of osteoarthritis evolution, the first with patients operated by extramedullary guidance and the second by intramedullary guidance. A radiographic study was performed, measuring the posterior slope angle in the sagittal plane.
The range of mobility achieved after arthroplasty and implant survival was studied. . In groups, the mean postoperative posterior fall angle was 4.04 ° in the patients who underwent an EM guide, while those who underwent an IM guide the mean was 1.76 °; the differences being statistically significant. The range of mobility in the ATRs operated by intramedullary guidance was 102.7º on average, while in the group where the Extramedullary guide was used, it was 104.3º no these differences being statistically significant. The posterior drop angle, for the same PS prosthesis model, was statistically different according to the guide used, being within the 3-7º range in the group where the extramedullary guide was used; but despite these differences, no impact on the range of mobility was observed.

Osteonecrosis of the patella is a known etiologic factor of pain in the anterior compartment after knee surgery.
Lateral retinacular release has a causal relationship with the viability of the patella (but it is not the only determinant). Patellar vascular injury occurs in 0-35% of cases by medial arthrotomy, in 0-16% of cases by excision of the infra-patellar fat pad and in 53-75% of cases by lateral retinacular release.
When a medial arthrotomy is associated with lateral retinacular release, the anastomotic genicular ring is compromised, leaving the intratendinous circulation as the major source of vascularization until revascularization occurs.
We present the clinical case of a 20-year-old patient, professional dancer, with pain in the anterior compartment of the left knee, with 2 years of evolution. The pain was progressively increasing and already limiting her professional activity as a dancer. On physical examination she had a slight intra-articular effusion, slight atrophy of the quadriceps, pain on palpation and excursion of the kneecap and pain on extreme flexion.
She had history of a bilateral proximal realignment procedure of Insall and hemitransfer of the rotulian tendon (Goldthwait) 5 years ago.
Complementary diagnostic tests (CT, MRI and Bone Scintigraphy) were performed, which revealed osteonecrosis of the patella, a rare post-surgical complication due to iatrogenic vascular injury.
A knee arthroscopy was proposed, with removal of a fragment of necrosis, curettage of the lesion and radiofrequency of the patella. The postoperative period was uneventful she resumed to her professional activity as a dancer at 6 months postoperatively.

Various factors influence the length of stay (LOS) following Hip and Knee arthroplasty. One of the factors can be the location of the post operative care of the patient. Day case unit is more dynamic than the ward environment and makes difference in discharging patients soon. We retrospectively collected data for patients who had Knee and Hip arthroplasty between August 2019 - February 2020 (6 months) operated by single surgeon. All patients were on enhanced recovery pathway and were suitable for day case unit. Length of stay was measured in Hours from the time patient was admitted for surgery until patient had discharge medications handed over. Fisher's exact test was used for comparision with P value <.05 as significant. 11 patients (5 THR and 6 TKR) were admitted on the ward prior to utilization of day case unit. Average age was 71 years and the average duration of stay was 78 hours. 42 patients (average age 70) were admitted on the Day case unit. 21 had THR and 21 had TKR. The average stay was 40 hours. This was significantly less compated to ward patients (P < 0.0001). Average LOS for TKR patients on the ward was 73 hours compared to 41 hours on the day case unit (P = 0.0002). The average LOS for THR patients on the ward was 83 compared to 39 on day unit (P <0.0001). For suitable patients post op care in day case unit reduces LOS significantly compared to ward following Lowerlimb arthroplasty.

Introduction: Total knee arthroplasty (TKA) is one of the most commonly surgeries performed in the United States, and is associated with a number of complications including hypertension and postoperative desaturation. Acute pancreatitis has been shown to be a rare complication of TKA. Case: We present the case of a 52-year-old patient who developed acute pancreatitis after an elective TKA under general anesthesia. The patient’s course was complicated by hypoxic respiratory failure and the development of an infected pancreatic pseudocyst. The patient was found to be growing gram-positive rods in their bloodstream and received courses of vancomycin and piperacillin-tazobactam. The patient improved and was able to be discharged on post-operative day 19 with a course of oral doxycycline. The patient later underwent outpatient drainage of the pancreatic pseudocyst. Conclusion: Acute pancreatitis is a rare postoperative complication of TKA, with few cases in the literature. To our knowledge this is the first such report in the English literature. It is critical to recognize and address these potential complications as well as counsel patients on modifiable risk factors.

Introduction: Patellar instability is often cause of total knee arthroplasty (TKA) failure, proving necessary to assess the reason behind this instability to correct it. After TKA, the medial patellar restraining structures may be damaged due to use of a medial parapatellar approach or patellar dislocation; this can be the cause, either alone or in combination with other factors of recurring patellar dislocations. Medial patellofemoral ligament (MPFL) reconstruction is often used treating frank patellar instability on an otherwise normal knee. There are few reported cases of MPFL reconstruction after TKA, we describe one such case. Case report: 79-year-old female, right TKA (six years) performed at another institution. Referred for severe pain (VAS 7/10) at rest and on mobilization, worse flexing and on lateral side of knee. Oedema present, without other inflammatory signs. Radiographic study of knee under load and axial of patella performed, showing a low and dislocated patella. MPFL reconstruction using high-resistance tape (2 anchors on medial side of the patella, anchoring the femur with isocentrically positioned screw) due to insufficient ischia-tibial ligaments was completed. Six months follow-up, no pain complaints, knee mobilities preserved, radiographically: patella centred with 30, 60 and 90º of flexion. Conclusion: MPFL reconstruction has a part in treating patellar dislocation after TKA, being effective at treating post-arthroplasty patellar instability. Can be used concomitantly with other procedures as prosthesis revision. This rescue technique using high-resistance tape, still little described in literature, became effective in this case, due to the fragility of the hamstring ligaments.

Recurrent lateral patellar dislocation is a multifactorial problem. Among tibial tubertcle osteotomy procedures, complications can occur in 4% to 8% of cases. Most of the fractures and failed TTO reported in the literature are treated non-opertively or with revision of fixation.
This is the case of a young patient who was referenced to our practice after both a failed patelar re-alingnement procedure and a failed revision surgery. Here we present our ultimate revision option and its 5-year clinical outcome.
We performed a reconstruction of the extensor apparatus using cadaver allograft (quadriceps tendon, patelar bone, patelar tendon and tibial tubercle bone), an adaptation of a techinque described by Dejour in 1992 for chronic or recurrent ruptures of the patellar ligament. The patelar bone block of the allograft graft was fixed to the native patella with 2 steel cables and the tibial tubercle block was fixed in the osteotomy site with 2 screws. Additionaly, a protecting cerclage was placed and anchored to a 3rd screw, distal to the tibial tubercle fragment.
No complications occurred in the imediate post-operative period. Five years after the procedure, patient refers only occasional pain (grade 3/10 on the Visual Analogue Scale) and walks without any walking aid. The patient has a full range of motion, no aparent muscle atrophy and is very satisfied with the outcome.
Allograft reconstruction of the extensor apparatus is an effective option to consider as a rescue procedure after failed revision procedures for recurrent patellar instability.

Introduction: An anterior cruciate ligament (ACL) rupture is a common sports injury and associated bone bruises are thought to represent a footprint of impact of the femur and the tibia at the time of the injury and many studies focus on its relation with the injury mechanism and ACL rupture.
In sports, the large majority of ACL injuries are caused by non-contact trauma.
In recent years, the sport of strongman has undergone rapid growth and research in this area continues to grow. The farmer’s walk and yoke walk are the most common exercises.
Case description: In this case report we present a male athlete who sustained an ACL in situ insertional stress injury while performing the Yoke Walk exercise. This injury consists in a ACL insertional bone marrow edema pattern without ACL rupture, possibly stress related, different from all the pattern descriptions avaliable in the current literature, which are sistmatically associated with ACL rupture. The patient was then advised to stop practicing sport and prescribed pain medication. One after the injury, the patient was assymptomatic and the MRI revealed the resolution of the bone edema on ACL insertion site, and no signs of ligament stretch or rupture.
Conclusion: This case presents a previously unreported injury patterr associated with a recent, growing sports modality such as Strongman.

introduction: fractures of proximal tibia are especially challenging to orthopaedic surgeons because of their complexity, number and variations. fractures of tibial plateau comprises 1% of all the fractures and 8% of all elderly fractures, producing unacceptable results in 50% of patients. tibial plateau fractures are generally classified according to the method developed by schatzker, which is primarily based on x ray findings. however, with advent of CT Imaging, the 3-column classification of tibial plateau fractures have gained popularity. surgical fixation based on 3 column classification of tibial plateau fractures have shown promising results. aims and objectives : to review functional outcome (by using column specific fixation technique) in cases of complex tibial plateau fractures (schatzker classification type v and vi). to assess postoperative union rates and complications perioperatively . methods and materials : It is a prospective study involving 20 cases of complex tibial plateau fractures (CT based 3 column classification) managed with open reduction and column specific plating. preoperative fracture pattern is assessed. postoperative fixation and progress of union rates is assessed with serial radiographs and functional outcome with pain relief and scoring system (oxford knee score).
conclusion: complex tibial plateau fractures are high velocity fractures with significant soft tissue injury. delayed fixation after soft tissue healing with column specific plating and reconstruction of articular surface have excellent clinical outcome.

Introduction: Primary total knee arthroplasty (TKA) for the treatment of knee arthritis has substantially increased over the past years. Because of its success, the indications for primary TKA have expanded to include patients who have more complex issues. Materials and Methods: The authors report a case of a 79-year-old female patient with severe chronic pain and deformity of both knees. The x-ray demonstrated a tricompartimental knee arthrosis Ahlback IV with a varus of 35º and 25º of the right and left knee respectively. VAS score of 7 and KSS of 17. The patient was submitted first to a total right knee arthroplasty with a constrained nonhinged implant and after 18 months the same surgery was performed on the left knee. Results: The patient accomplished a physiotherapy protocol so that she was able to do 0-120 and 1-110 of ROM of the right and left knee, respectively. We did not verify any instability, the VAS was1 and KSS 85. Discussion: In severe cases, the use of varus and valgus constrained or rotating-hinge implants in the primary total knee arthroplasty setting is occasionally necessary. Although, the benefits of the implant constraint can negatively affect implant survival and complication rates, which may lead to reoperation or revision, the use of constrained implants when necessary in the primary total knee arthroplasty setting should not discouraged. Conclusion: TKA is somewhat challenging in patients who have deformity, therefore, the surgeons sould be aware of some general principles that may help minimize complications and improve outcomes.

Introduction: There is conflicting evidence regarding the usage of closed-suction drainage in elective TKR surgery. Drains are associated with increased blood loss and transfusion rates, but benefits include reduction of wound hematomas and prosthetic joint infections. The aim of the study is to determine the efficacy of the usage of drains in TKR . Methods: Patients undergoing TKR during five month period in 2019 were randomized into 2 groups, and the data was collected prospectively. The operations were performed by a single surgeon using a medial para patellar approach with no difference in the technique or the anticoagulation protocol.
Results: A total of 34 patients were included in the study with 15 patients in Group A (with a drain) and 19 in Group B (without a drain). The mean preoperative and postoperative hemoglobin in Group A was 131.0 and 112.7 g/L respectively with a mean drop of 19.18. In Group B the mean preoperative and postoperative hemoglobin was 133 and 119.5 g/L respectively with a mean drop of 13.50. Mean average age in group A and group B was 63 and 68.99 years respectively. Mean average length of stay for group A and B was 3.06 and 3.38 days respectively excluding one patient in group B who had a stroke post operatively. No differences were noted in terms of wound healing, early infection, transfusion rates and complications between the two groups. Conclusion: Our study demonstrates that there are no benefits gained by using closed-suction drainage in routine elective TKR surgeries.

Recent years total arthroplasty became widespread in the surgical treatment of terminal stages of knee joint diseases. Accordingly the number of complications increases after this surgical intervention. Reducing the number of errors and complications after total knee replacement is an important task of modern orthopedics. Under our supervision were 50 patients with complications after a total knee replacement (TKR), with 5 years follow-up after the primary knee arthroplasty. Of these, women accounted for 35 (70%) and men - 15 (30%). Among the patients examined, 5 patients had septicemia (10%) and 45 (90%) aseptic instability of the components of the endoprosthesis. In the course of the examination, clinical-anamnestic, X-ray, MRI and CT tests were used. The main factors that lead to the complications of TKR are identified. Of these, the complications associated with the surgical intervention (40%) are distinguished. These included incorrect positioning of the components of edoprosthesis (varus or valgus position), ligamental balancing etc. Complications associated with the patient were 20% (trauma of operated joint, increased body weight, etc.). The combination of these factors was observed in 30% of the examined patients, and only in 10% of cases the cause of complications was not detected. The conducted research proves the importance of carrying out preventive actions directed on improvement of surgical technique and a healthy lifestyle of operated patients, and this issuw requires further clinical research.

Despite the large number of surgical interventions, the definition of surgical procedures (bone grafting, metal insertion) for bone bed defects in knee joint replacement (KJ) are not straightforward. On the basis of the computer model, the stress-deformed state of the components of the KJ endoprosthesis in the case of varus deformity of the limb under conditions of endoprosthesis with the use of conventional and elongated prosthesis with bone graft 5 and 10 mm was studied. It was determined that in the case of KJ prosthesis in conditions of varus deformity with the presence of a defect of medial tibial condil, it is possible to fill the defect with the bone autograft up to 5 mm high with the use of the ragular (short) stem of the tibial component of the prosthesis. If the defect is more than 5 mm to 13.5 mm, the use of an endoprosthesis stem with an extension piece is biomechanically justified. At increase of a defect more than 13,5 mm patients need replacement of bone defects by means of massive metal inserts. The study will allow to determine the differentiated approach of treatment of patients with various defects of the tibial bone lesions during the performance of knee joint replacement. Implementation of the recommendations identified in the study will improve the effectiveness of care delivery for this severe category of patients.

We treated 263 patients with knee joints osteoarthrosis of 2-3 stages. We divided them in two groups according to the type of deformation of knees and x-ray data (pictures, inform., facts). First group (20 patients) with valgus knee deformity was treated by supracondylar resection osteotomy of femur. Second group (96 patients) with varus knee deformity underwent supratuberosital correcting osteotomy of the tibia with usage of autografts from ilium. At varus deformations of knee-joint, which are conditioned by violation of axis of tibia we performed supratubercular corriggative osteotomy of tibia with the use of autografting from the wing of ilium with the use of osteosintesis by the metallic plate. At deformations of region of knee-joint of conditioned by violation of axis of femur, that roentgenologic showed up the change of base-femoral corner, at the satisfactory volume of motions in a knee-joint, we executed supracondylar corriggative osteotomy of femur with the resection of wedge and fixing by metallic plate. We received good and excellent results in 75% of cases, poor results in 22,5% and fair results in 2,5%. At deformations of a knee joint which are caused by disturbance of an axis of a tibia it is expedient to carry out a supraglottic corrective osteotomy of a tibia with use of autografts of the corresponding size. At deformations of the knee joint caused by violations of the axis of the femur it is advisable to perform supraorbital, resection corrective osteotomy of the femur and apply stable-functional osteosynthesis.

Objectives
Revision rates for UKA are considerably higher than Total knee arthroplasty according to the National Joint Registry (NJR). The primary objective - survivorship of Unicompartmental knee arthroplasty at our hospital and to compare our results with that of the national Joint Registry. The second objective-analysis of various factors influencing the failure of the implants and to determine if they were statistically significant.
Methods
This was a single centre retrospective case series study of UKA performed from January 2012 to December 2016. Time to revisions was analysed using the Kaplan-Meier methodology.
Results
The average follow-up period was 3.41 years. The majority were females (54.8%). The survival rate was much better in the medial UKA group (p value=0.013). All UKA sub-groups of patients showed a higher failure rate at 1 and 3 years when compared to the results in NJR. Aseptic loosening was the most common cause for implant failure, post-operative tibiofemoral angle of 4-6 degrees had the highest survival rate (p value=0.0167).
Conclusions
A higher failure rate of UKA at our hospital compared to the NJR. Fixed bearing had a better oxford knee score (OKS) than mobile bearing group. No significant difference in survival rate or OKS between cemented and uncemented groups. This was a retrospective non-randomised study with small sample size and thus there are constraints on generalizability and the utility of findings. Patient selection criteria, implant type, cementation, bearing size influences the survival of implants. Thus, future randomised control trials are needed to provide validity for our findings.

Introduction: Limb length alteration following total knee arthroplasty (TKA) has been under-reported. Few studies have shown a significant association between limb length discrepancy (LLD) and poor functional outcome. This prospective study was designed to evaluate the impact of radiographic and perceived LLD on functional outcome in TKA. The variables affecting LLD were also evaluated.
Material and methods: The preoperative and postoperative limb lengths of TKA patients (112 knees, 81 patients, KL grade >=3) were measured in full-length digital radiographs. The HKA angles were also measured. The functional outcome was evaluated after six months using the Western Ontario and McMaster Universities Arthritis Index.
Results: The mean overall lengthening was 0.92 ± 0.98 cm, with 91% of limbs lengthened. 80.2% had postoperative radiographic LLD of <10mm. The functional outcome was significantly affected when LLD exceeded 10mm. Logistic regression analysis revealed no significant effect of age, sex, height, weight, BMI, preoperative LLD, and difference in deformity between the limbs on postoperative LLD. The LLD in unilateral and bilateral TKA patients were not significantly different. 34.5% of patients perceived LLD in the preoperative period, which decreased to 3.7% in the postoperative period. Perceived LLD did not correlate to radiographic LLD and functional outcome.
Conclusion: Limb lengthening following TKA is quite common. Almost one-third of patients perceive LLD in the preoperative period, which improves significantly after TKA. Age, sex, BMI, pre-op LLD and difference in deformity angle do not affect the LLD. The functional outcome is significantly affected by radiographic LLD of ≥10mm.
 

Total joint replacements are being performed more frequently every year. The goal of this surgery is to provide a well-functioning joint, delaying a revision procedure as much as possible. One of the dreaded complications is prosthetic joint infection. In a country like India, the length of post-operative hospital stay is longer. During this period, regular laboratory investigations are done, amongst which, the C-reactive protein is important to recognise infection. An upward trend in the values is considered to be more indicative of infection, rather than an isolated increase. This marker can increase just as a consequence of surgery. There is scant data regarding this for the Asian population. We analyzed the immediate post-operative levels of C-reactive protein over a 3 year period and tried to establish a range which could be expected as a consequence of surgery rather than impending infection.

Introduction: Early aseptic revision within 90 days after a primary total knee arthroplasty (TKA) is a devastating complication. The causes, complications, and re-revision risks of aseptic revision TKA performed within this period are poorly described. Methods: Patients in the United States with unilateral aseptic revision TKA within 90 days of the primary procedure were identified in a national database (PearlDiver Technologies). Exclusion criteria included septic revision, bilateral surgery, follow-up <2 years, and age <18. This cohort was matched based on age, gender, and Charlson Comorbidity Index to a control group of patients who underwent primary TKA without early revision. Two-year re-revision and 90-day complication rates were recorded and analyzed. Results: A total of 414 patients were included and were matched to the control group. Reasons for early aseptic revision TKA were instability (40.0%), fracture (23.2%), loosening (23.0%), pain (10.9%), and arthrofibrosis (6.0%). The two-year re-revision rate for early revisions was 26.3% compared to 2.2% in the control group (RR=12.1, p<0.001). Among early revisions, 10.4% of patients were re-revised to an antibiotic spacer within two years. Complications were more frequent for early revisions compared to control, including renal failure (7.3% vs 3.1%, p=0.007) and pneumonia (3.4% vs 1.2%, p=0.04). Early revision for pain was associated with a higher rate of re-revision (57.8%) compared to early revisions performed for other all other reasons (p<0.001). Conclusion: Acute early aseptic revision TKA carries a high risk of re-revision at two years, high risk of infection, and increased postoperative complication rate compared to control.