The Journal of arthroplasty
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Comparative Study
Open Reduction vs Distal Femoral Replacement Arthroplasty for Comminuted Distal Femur Fractures in the Patients 70 Years and Older.
The ideal management of distal femur fractures in the elderly is unclear. Acute arthroplasty has the theoretical advantage of earlier mobilization. We examined the outcomes of patients 70 years and older who underwent open reduction internal fixation (ORIF) vs distal femoral replacement (DFR) for comminuted, intra-articular distal femur fractures. ⋯ Nearly 1 in 5 patients older than 70 years developed a nonunion after ORIF of an intra-articular distal femur fracture. At 1-year follow-up, all patients in DFR group were ambulatory while 1 in 4 in the ORIF group were wheelchair bound.
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Accelerometer-based computer navigation has been shown to be highly accurate for performing distal femoral and proximal tibial component alignment in total knee arthroplasty (TKA), although the procedure for the femoral component is less accurate than for the tibial component. ⋯ Accelerometer-based navigation sometimes has technical issues during registration associated with hip adduction. We showed that femoral registration without large adduction movements will enable more accurate femoral implantation. Surgeons should also keep in mind that the coronal tibial component is likely to be in valgus alignment (about 1°) even if a neutral angle (0°) is selected with this particular device.
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Randomized Controlled Trial
Gait Parameters and Functional Outcomes After Total Knee Arthroplasty Using Persona Knee System With Cruciate Retaining and Ultracongruent Knee Inserts.
Total knee arthroplasty is a well-established treatment for managing end-stage symptomatic knee osteoarthritis. Currently, different designs of prostheses are available with majority ensuring similar clinical outcomes. Altered surface geometry is introduced to strive toward gaining superior outcomes. We aimed to investigate any differences in functional outcomes between 2 different polyethylene designs namely the Persona CR (cruciate retaining) and Persona UC (ultracongruent) tibial inserts (Zimmer-Biomet, Warsaw, IN). ⋯ Ultracongruent tibial inserts show significantly better functional outcomes as compared to CR inserts during a 2-year follow-up period. However, in this study these findings were not shown to be attributed to differences in gait parameters.
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Due to the potential reduction of morbidity and mortality, unicompartmental knee arthroplasty (UKA) may represent an interesting solution for older patients with unicompartmental arthritis. It was our hypothesis that UKA can represent an alternative to total knee arthroplasty (TKA) for patients older than 75. We, thus, aimed to compare in those patients (1) functional results, (2) rates of forgotten joint, and (3) survivorships of UKA vs TKA. ⋯ The results of our study showed that UKA provide higher function and better forgotten joint scores with similar survivorship, compared to TKA, for patients older than 75.
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Revision surgery of failed metal-on-metal (MoM) total hip arthroplasty (THA) for adverse tissue reaction (pseudotumor) can be challenging as a consequence of soft tissue and muscle necrosis. The aims of this study were to (1) report the revision outcomes of patients who underwent revision surgery for failed MoM hip arthroplasty due to symptomatic pseudotumor and (2) identify preoperative risk factors associated with revision outcomes. ⋯ Revision outcomes of revision surgery for failed MoM THA due to symptomatic pseudotumor demonstrated 14% complication rate and 7% re-revision rate at 30-month follow-up. Our study identified prerevision radiographic loosening, solid lesions/abductor deficiency on MRI, and high grade intraoperative tissue damage as risk factors associated with poorer revision outcomes. This provides clinically useful information for preoperative planning and perioperative counseling of MoM THA patients undergoing revision surgery.