Introduction: Patients with end-stage renal disease (ESRD) are at an increased risk of knee joint osteoarthritis and osteonecrosis and therefore undergo total knee arthroplasty (TKA). This study compared the postoperative outcomes and complications of TKA on patients with and without ESRD. Methods: A retrospective study of New York’s Statewide Planning and Research Cooperative System (SPARCS) database between 2009 and 2013 was performed. A total of 92,627 patients that completed TKA and had a minimum two-year follow up were isolated. A 1:1 propensity score-match by sex and age was conducted to split the patients with and without ESRD (n=170 each; 340 total). Univariate analysis compared demographics, post-operative complications, reoperation, readmission, revisions of TKA and hospitalized mortality between the ESRD and non-ESRD cohorts. Multivariate binary logistic regression models that controlled for sex and age were used to evaluate the ESRD as an independent predictor of postoperative outcomes for patients undergoing TKA. Results: The ESRD cohort had a longer length of stay (8.3 days vs 4.0 days; p<0.001) and higher surgical charges ($75,555.21 vs $43,532.27; p<0.001). Multivariate logistic regression models revealed that ESRD patients had higher frequencies of surgical complications, wound complications, postoperative blood transfusions, medical complications, acute myocardial infarctions (MI), pneumonias, sepsis, readmissions, and hospitalized mortalities after surgery (all, p<0.05). Conclusions: ESRD patients undergoing TKA have higher surgical costs, longer hospital stays, and higher rates of complications and mortalities. The impact of ESRD on postoperative outcomes of TKA should be strongly considered when deciding to operate.
 

Introduction: Robotic-assisted total knee arthroplasty (TKA) enables more extensive preoperative planning and a more personalized approach. However, short and long-term outcomes of robotic-assisted unicompartmental and totalrobotic knee arthroplasty (raUKA, raTKA) needs to be compared to the traditional TKA. We sought to compare peri and postoperative outcomes across raUKA, raTKA, and TKA in patients aged ≥70 years. Methods: This was a retrospective review of patients aged ≥70 years who underwent traditional TKA, raUKA, or raTKA from 2010-2018. Demographics, intraoperative and perioperative parameters, pre and postoperative ROM and KSS, and postsurgical complications were collected. All parameters were compared via univariate analysis. Results: 48 TKA, 48 raUKA, and 42 raTKA patients were identified. Cohorts had variable baseline ROM (p=0.008) and KSS (p<0.001). ROM was comparable at 90-day follow-up (p=0.136), but raUKA had greater ROM than other cohorts (p=0.012). KSS was found to be comparable across TKA, raUKA, and raTKA at 90-day (p=0.266) and one-year (p=0.967). Pre- to postoperative change in ROM was found to be comparable at 90-day follow-up but was significantly greater at one-year for raTKA (p=0.002). raTKA patients experienced a significantly greater improvement in KSS at both time periods (p=0.013, p=0.008). The rate of TKA patients requiring an overnight stay and mean LOS was higher (both, p<0.001). No complications, readmissions, or revisions were observed. Conclusion: This study found that patients over 70 years of age undergoing raUKA and raTKA experienced comparable short-term and mid-term outcomes to TKA, with reduced lengths of stay and significant gains in ROM at one-year follow-up.

Introduction: Consensus remains elusive on whether to resurface or to retain the patella during total knee arthroplasty (TKA). This study aimed to review if there was a clinically significant difference in mean Oxford Knee Score (OKS) for a large cohort of patients who received either patellar resurfacing or patellar retaining techniques for primary TKA. It also aimed to identify whether patient satisfaction and specific components of the OKS related to patellofemoral function were influenced by resurfacing. Methods: A retrospective cohort study was undertaken using an established arthroplasty database from a high volume, elective orthopaedic centre. Patient demographics, body mass index, Oxford knee score (OKS), EuroQoL five-domain (EQ-5D) score were collected preoperatively and at 1 and 2 years postoperatively. Patient satisfaction was assessed at 1 and 2 years postoperatively. Results: 3127 patients met the inclusion criteria, 46.5% (n=1454) of these underwent resurfacing. Patients undergoing resurfacing were more likely to be female (odds ratio (OR) 1.53, 95% CI 1.30 to 1.79, p<0.001) and had a significantly (p=0.017) worse response to question 12 (walking down stairs) of the OKS pre-operatively. There was no difference in patient satisfaction and OKS at 1 and 2-years between groups. There was however, a significantly greater improvement in question 12 of the OKS at 1 year (p=0.019) in the resurfaced group. Conclusion: There was no clinically significant change in the OKS between patella resurfacing and retaining techniques in the short to mid-term.

Introduction: About 10-15% of patients are dissatisfied with the result of their Total Knee Arthroplasty (TKA). One of the reasons for dissatisfaction is believed to be altered knee kinematics.
Medial pivot TKA(MP-TKA) have been developed to mimic knee kinematics. However, studies have failed to demonstrate its superiority in short-term. The aim of this work is to compare mid-term patient reported outcomes measures (PROM) between posterior stabilized total knee arthroplasty (PS-TKA) and MP-TKA.

Materials and methods: Retrospective analyses of 165 TKA ‘s performed in our institution between 2013 and 2014. PROM’s used were Forgotten Joint Score (FJS) and WOMAC. Radiographic analyze was performed according to the modern knee society radiographic evaluation system.

Results: Our sample had 82% of females with mean age of 73.3 years old and median follow-up of 7 years. 107 were MP-TKA and 58 were PS-TKA. Analysis of demographic data and BMI showed no difference between both groups. There were no statistical differences between the WOMAC and FJS scores between groups.
Coronal alignment was similar between the two groups, but a difference was found in sagittal alignment, with higher tibial slope and femoral flexion angle values in PS-TKA.

Discussion: Despite the theoretical advantages of MP-TKA, the evidence that this can translate into greater patient satisfaction is small and conflicting. Our results show no difference in PROM's between MP-TKA and PS-TKA in mid-term. Both groups were within the recommended radiographic values for good TKA alignment.

Conclusion: There is no difference in patient satisfaction between MP-TKA or PS-TKA.

Technological advancements, improved long-term implant survival and increasing recognition of the clinical benefits are rapidly broadening the indications for total knee replacement (TKR) including both in younger, more active patients and in frailer, elderly patients. We studied the impact of age on patients’ satisfaction following TKR. We performed a multi-surgeon study on patients who underwent TKR between 2017-2018. We collected their post-operative satisfaction scores using a 0-100 visual analogue scale (0 – poorly satisfied to 100 – highly satisfied) at four time-points post-operatively – 6-week, 6-month, 1-year and 2-year follow-up intervals. We used analysis of variance to compare the scores across the time points. Between 2017-2018, a total of 3357 TKRs were performed. Across all four time points, the average satisfaction score was 79.9 in age group 31-50, 83.7 in age group 51-60, 85.7 in age group 61-70, 86.1 in age group 71-80, 85.9 in age group 81 and above. There was no statistically significant difference between the age groups at 6 weeks (p=0.092) and 6 months (p=0.192). There was statistically significant difference in the satisfaction scores across the age groups at 1-year (p=0.011) and at 2-year follow-up (p=0.005). At the 1-year follow-up age group 51-60 scored less than age groups 61-70 and 71-80. At the 2-year interval age group 31-50 scored less when compared to all other age groups. Our findings showed high patients’ satisfaction following TKR across all ages. Age may influence patients’ satisfaction and awareness of its impact may be useful for surgeons in tailoring patient consultations.

Aim: The present Narrative Review gathers the indications, contraindications, techniques, and results of two methods for massive posterosuperior rotators cuff tears treatment: the transfer of latissimus dorsi and lower trapezius. Background: Massive posterosuperior rotator cuff tears are an important cause of shoulder dysfunction. Its treatment is challenging, especially in young individuals who have a high functional demand. Methods: A literature research was carried out through PubMed and Web of Science databases and were considered the articles published after 2015. Results: Transfer of latissimus dorsi was described for the first time in 1988, showing good results, improving pain and joint function due to the robustness and wide excursion of this muscle. Transfer of lower trapezius was most recently described in 2016 by Elhassan. This technique has potential advantages in restoring glenohumeral kinematics because the muscle contracts synergistically with the external rotators of the shoulder (“in-phase” function), according to a traction line similar to the infraspinatus. The harvesting of its tendon is technically easier and faster, however, due to its shorter excursion, it is necessary to complete it with a graft. Conclusions: In selected cases of massive posterosuperior rotator cuff tears, tendon transfers of latissimus dorsi or lower trapezius are valid and present good functional results improving external rotation, frontal flexion and abduction. However, several factors regarding the choice of the technique and tendon must be considered, in order to offer the patient, the best outcome.

introduction: the shoulder , by virtue of its anatomy and biomechanics , is the most unstable and frequently dislocated joints in the body , accounting for nearly 50% of all dislocations . recurrent instability is more commonly seen in patients who are younger ,male sex and with associated bone defects or ligament laxity . selecting an optimal and efficient surgical procedure for patients with anterior glenohumeral instability is a complex problem . latarjet procedure provides a "triple blocking" effect in treatment of anterior glenohumeral instability.first , the coracoid bone block increases the diameter of the inferior portion of glenoid fossa . second , the conjoined tendon acts as a sling reinforcing the inferior capsular ligamentous complex and the inferior portion of subscapularis . finally,reconstruction of capsulolabral anatomy . aims and objectives : to evaluate the functional outcome of latarjet procedure in treatment of anterior shoulder instability.materials and methods: it is a prospective study of 5 cases of recurrent shoulder dislocation managed by open latarjet procedure followed for a mean peroid of 18 months . pre-operatively all patients were assessed for glenoid defomation measured by circle method , glenohumeral instability by apprehension test,rotator cuff instability and multidirectional constitutional hyperlaxity .results: all patients had good bony union . 4 patients had excellent to good outcome based on walch duplay score . 1 patient got infected and was managed by antibiotics. conclusion: open latarjet procedure is an effective surgical method for management of anterior glenohumeral instability with low complications and excellent functional outcome

Purpose: We aimed to evaluate the effects of EVs derived from mesenchymal stem cells mixed with injectable collagen after rotator cuff repair in a chronic rotator cuff tear rabbit model.
Methods: Twenty rabbits were assigned to four groups: normal (N), repair-only (R), injectable collagen after repair (RC), and EV (derived from mesenchymal stem cells) laden injectable collagen after repair (RCE). The EVs were isolated by ultra-centrifugation from the medium of stem cells cultured, and they were mixed with collagen. Additionally, three rabbits were assigned to check the maintenance of green fluorescence-labeled EV with injectable collagen via tracking on the bursal side of the rotator cuff tissue. After 12 weeks, the animals were sacrificed to evaluate the healing of the bone-to-tendon junction and the fatty degeneration of muscle. Histomorphometric scoring for bone-tendon interface, fatty infiltration (%), and biomechanical test were compared.
Results: The EVs were identified that remained in the bursal side of the cuff tissue after 4 weeks. The RCE group showed a significantly higher histomorphometric total score (16.5±0.6) than the RC and R groups (12.3±0.5, p<0.001 and 7.3±3.3, p=0.013, respectively). Fatty degeneration was significantly less in the RCE group compared to that in the other groups (R group, p=0.013; RC group, p=0.001). In the biomechanical test, the R, RC, RCE, and N groups showed significant increasing trends in load-to-failure and stiffness (p=0.002 and 0.013).
Conclusion: EVs loaded in injectable collagen effectively promoted bone-to-tendon healing and simultaneously prevented fatty degeneration of muscle after rotator cuff repair in chronic cuff tear.

Background: Subtle instability in chronic recalcitrant lateral epicondylitis has been issued but only a few studies evaluated MRI to assess LCL complex and no study to correlate arthroscopic findings.
Hypothesis: The purpose of this study is to evaluate concomitant pathology in recalcitrant lateral epicondylitis using MRI with arthroscopic finding correlation.
Material and Method: 49 cases were diagnosed as chronic recalcitrant lateral epicondylitis. All cases were divided into two; radial collateral ligament (RCL) intact and RCL involved group by evaluating MRI that was confirmed by radiologist. Patient information for history of steroid injection and symptom duration were extracted from medical record. Arthroscopic images that was taken during arthroscopic ECRB release was evaluated to assess the quality of lateral capsule and concomitant plica.
Results: 24 and 25 cases were included in INTACT and INVOLVED groups, respectively. 7 cases of complete tear of RCL with LUCL was recorded in INVOLVED. Symptom duration (15±9 vs 22±13, p=0.029) and the number of steroid injection (3±2 vs 5±3, p=0.040) were significantly higher in INVOLVED group than that in INTACT group. Capsular tear was detected for 5 cases (20%) in INTACT and 14 cases (56%) in INVOLVED (p=0.027) concomitant plica was observed for 15 cases (62%) in INTACT and 7 cases (28%) in INVOLVED. (p=0.015)
Conclusion: recalcitrant LE have the concomitant pathology including Plica, RCL and LUCL deficiency. Multiple steroid injection and symptom duration is related with the RCL deficiency in recalcitrant LE. Capsular tear as arthroscopic finding is related with RCL deficiency in recalcitrant LE.