Memoral Component Malrotation Lab Report

The surgical procedure. A total knee replacement is a surgical procedure where the diseased knee joint is completely replaced by artificial materials that resemble the original knee joint. The orthopedic surgeon removed the end of the femur and the end of the tibia by using metal pieces and sawing the bone, to ensure that he removes the right amount of bone. The end of the femur bone is replaced with metal and the end of the tibia bone is replaced with plastic and metal. A plastic piece was added under the patella because the surface under the patella was damaged as well. These artificial materials, called prosthesis, have smooth surfaces so when they rub against each other, it does not cause damage and is pain-free. The purpose of this surgery is to remove the diseased portions of the joint and replace it with artificial materials to prevent further deterioration and eliminate pain, stiffness, and decreases in function that were caused by the osteoarthritis.

Introduction: Because life expectancy is increasing, the number of performed primary knee prostheses is projected to increase 673% by 2030 (Westrich et al.). 20% of patients are unsatisfied with the outcome (Klit et al). The implant misalignment has been reported as a decisive factor in outcome and the primary reason for revision in 7% of revised prostheses (Ritter et al). Misalignment definition however varies among studies, making it difficult to compare the results.

Observational prospective cohort study: An advantage of this design is a careful analysis of the trends and relationships and differences among the variables can be explored. Rationale: to determine the relationship and trends of early activity with postoperative total knee replacement.

Joint replacements are among the most common and successful orthopedic surgeries, giving more people the opportunity to remain active well into their golden years. (American) The American Academy of Orthopaedic Surgeons estimates there are more than 300,000 total hip replacements (THRs) and 600,000 total knee replacements (TKRs) performed every year—numbers that will only increase in the future. Most patients who undergo total joint replacement, or arthroplasty, experience a dramatic reduction in pain and a significant improvement in their ability to function in daily life. (American Hip)

Dr. Cooper’s study of revision hip and knee surgery performed between October 2012 and August 2015 on 102 patients who underwent a total of 138 major hip or knee procedures. Twenty-six of the 102 patients underwent multiple procedures either for an unrelated procedure on the contralateral extremity. Some of these were planned as part of a staged approach and some were unplanned re-operations due to complications. Each operation was counted separately in the outcome analysis. Closed-incision negative-pressure (CiNPT) therapy dressings were used in 30 cases and anti-microbial dressings (AMDs) were used in 108 (Cooper & Bas 2015).

Of note, X-rays of the right knee obtained on this visit showed status post total knee replacement, there is some radiolucency noted on the medial aspect of the tibial component which suggest loosening of this segment. The remaining bone cement interfaces appear stable specifically the lateral tibia, the femoral component and the patellar component. There is good prosthesis alignment with an excellent patellofemoral relationship.

Introduction: In severe knee deformities, traumatic or congenital, malalignment of the mechanical axis of the femur and tibia causes excessive joint loading, which may increase articular cartilage degeneration. Osteotomy is a recognised treatment technique in such cases, as it redistributes the weight-bearing force on the knee. It can be performed in the distal femur or proximal tibia. Varus deformity causes excessive pressure in the medial compartment, therefore proximal tibial osteotomy, medial opening or lateral closing, is an option. In valgus deformity, distal femoral lateral opening wedge procedure is the most consensual choice of treatment, but proximal tibial wedge osteotomy, medial closing or lateral opening, can also be done.

The mean Lysholm score improved from 43 points to 72.7 points. Visual Analogue Scale and Lysholm scores at the latest follow-up were significantly worse in patients with a pre-operative BMI ≥26 kg/m2, HKA >5 degrees, grade 3 or 4 chondral lesion according to Outerbridge classification, degenerative changes in patellofemoral joint surfaces, and an ACL which was either partially ruptured or degenerative with increased laxity. Age at the time of surgery, pre-operative grade of medial joint space narrowing determined according to Kellgren-Lawrence classification, duration of symptoms until decision of the surgery, degenerative changes in the lateral meniscus, presence of a medial supra- or infra-patellar plica, and synovial hypertrophy and/or arthroscopic findings of synovitis had no effects on the clinical

However, the authors report that in major orthopedic surgeries and due to lack of evidence on the subject, more studies need to be performed to determine better results. This study provided specific knowledge of the selected topic and research was based on information obtained from credible databases including MEDLINE, Cochrane and Scopus.

Hip replacement surgery is one of the most performed orthopedic surgeries around the world with high success rate. According to various studies, the hip implant has shown to have a survival rate of at least 15-20 years. Initially hip replacement surgeries were performed only on elderly patients but due to its high success rate and increasing popularity, it has been considered for the younger patients as well. Younger patients have more daily activities associated with them which leads to wearing of joint surface much sooner than expected. Once the joint is worn off, it is required to be replaced. So, replacing the artificial joint through revision surgery is becoming more common. Revision surgery is always more complex than the original operation

There can be disruption of the tibial – femoral joint. There is possible damage to neurovascular structures. It’s possible to disrupt the medial cortex, resulting in instability and non- union between the upper and lower bone because of possible soft tissue interference. It can also be extremely difficult to compute the correct amount of bone to remove, meaning several extra cuts are sometimes made. While closed wedge osteotomy is most common, it also had the most reduced risk of failure. The surgeons use a specific technique where a wedge of bone is removed with the tibia on an anterolateral approach, because it gives the patient a massive disadvantage: “The patient has more inherent stability which allows for faster rehab and weight bearing as well as not requiring bone grafting” (High

The isometric strength of the quadriceps was significantly different side to side (INV QUAD = 2.72 ± 0.77, UNINV QUAD = 3.07 ± 0.78, quad LSI = 89% ± 14%). The hip drop of the two limbs were weakly related to one another (r= 0.237, p = 0.026), the involved limb demonstrated more hip drop than the uninvolved (INV HIP ADD =14.55 ± 5.05, UNINV HIP ADD = 11.00 ± 5.31). Quadriceps strength symmetry and normalized max knee extensor moment were inversely related to hip drop with a stronger relationship on the surgical limb (INV: QUAD MVIC r = -.341 p = .001, KNEE MOM: r = -.425 p < .001 (n=88), UNINV: QUAD MVIC r = -0.278 p = .009, KNEE MOM: r = -.294 p = .005).

Pivec R, Johnson A J, Mears S C, Mont M A. Hip arthroplasty. Lancet 2012; 380 (9855):

Structural failure (collapse) of the femoral head (FH). 6 studies (with 421 participants) provided relevant data (Yamasaki et al. 2010, Gangji et al. 2011, Zhao et al. 2012, Lim et al. 2013, Liu et al. 2013, Ma et al. 2014). The pooled estimate of effect size for structural failure of the FH favored the cell therapy group, as, in this treatment group, the odds of progression of the femoral head to the collapse stage were shown to be decreased by 5 times compared to the control (CD) group (OR = 0.2, 95% CI: 0.08–0.6; p = 0.02). However, this result should be interpreted with caution due to the presence of significant statistical heterogeneity (I2 = 68%, Q-test = 16, df = 5, and p = 0.008) (Figure 4).

Trochanteric osteotomy, the most extensile of approaches is a valuable tool for difficult primary and revision THAs. Extended trochanteric osteotomy is helpful in revision and extraction of well fixed cemented as well as uncemented fremoral components, facilitates in cement extraction and also in enhancing acetabular exposure. Tradional posterolateral ETO is initiated at the posterior aspect of the Femur.