Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Current Issues in Knee Reconstruction 10 articles

Articles

Hinged Total Knee Arthroplasty in the Presence of Ligamentous Deficiency

Daniel Hernández-Vaquero PhD, Manuel A. Sandoval-García PhD

Rotating-hinge total knee prostheses may be used for the treatment of global instability about the knee. The designs of previous generations were associated with suboptimal outcomes.

Results after Late Polymicrobial, Gram-negative, and Methicillin-resistant Infections in Knee Arthroplasty

José Cordero-Ampuero MD, PhD, Jaime Esteban MD, PhD, Eduardo García-Rey MD, PhD

Previous studies of knee arthroplasty infections caused by high-virulence organisms suggest poor outcomes. Polymicrobial and Gram-negative infections are less studied.

Midterm Assessment of Causes and Results of Revision Total Knee Arthroplasty

Fahad Hossain MRCS, Shelain Patel MRCS, Fares Sami Haddad FRCS (Tr & Orth)

There is limited information regarding revision total knee arthroplasty (TKA) with respect to etiology, outcome, and long-term survival comparing different implant types.

Postoperative Analgesia in TKA: Ropivacaine Continuous Intraarticular Infusion

Primitivo Gómez-Cardero MD, E. Carlos Rodríguez-Merchán MD, PhD

Postoperative pain control is a challenge in patients undergoing TKA due to side effects and technical limitations of current analgesic approaches. Local anesthetic infiltration through continuous infusion pumps has been shown to reduce postoperative pain in previous studies.

Functional Performance with a Single-radius Femoral Design Total Knee Arthroplasty

Enrique Gómez-Barrena MD, PhD, Carmelo Fernandez-García MD, PhD, Almudena Fernandez-Bravo MD, Raquel Cutillas-Ruiz MD, Gloria Bermejo-Fernandez MD

Better muscular recovery of the extensor mechanism after TKA is claimed by femoral designs based on a sagittal single radius.

Outcomes of Meniscal Preservation Using All-inside Meniscus Repair Devices

Sujith Konan MRCS, Fares S. Haddad MCh, FRCS (T&O)

The thrust of meniscal surgery has now moved toward meniscal preservation. Repair is particularly indicated on the lateral side where the sequelae of resection are severe even in an older patient population.

Computer Assistance Increases Precision of Component Placement in Total Knee Arthroplasty with Articular Deformity

Daniel Hernández-Vaquero MD, PhD, Abelardo Suarez-Vazquez MD, PhD, Manuel A. Sandoval-Garcia MD, PhD, Alfonso Noriega-Fernandez MD

The accuracy of computer navigation applied to total knee arthroplasty (TKA) in knees with severe deformity has not been studied.

Minimally Invasive Subvastus Approach: Improving the Results of Total Knee Arthroplasty: A Prospective, Randomized Trial

José Ramón Varela-Egocheaga PhD, Miguel Angel Suárez-Suárez PhD, María Fernández-Villán MD, Vanessa González-Sastre MD, José Ramón Varela-Gómez MD, Carlos Rodríguez-Merchán PhD

Minimally invasive knee arthroplasty seeks to diminish the problems of traditional extensile exposures aiming for more rapid rehabilitation of patients after surgery.

The Outerbridge Classification Predicts the Need for Patellar Resurfacing in TKA

E. Carlos Rodríguez-Merchán MD, PhD, Primitivo Gómez-Cardero MD Patellar resurfacing (PR) in total knee arthroplasty (TKA) is controversial. The Outerbridge classification of cartilage defects in the patella is commonly used in the literature. The purpose of this study was to determine if the Outerbridge classification can predict the need for PR as part of total knee arthroplasty. Between 1995 and 2000, we performed a prospective, randomized study of 500 TKAs. We carried out PR depending on the Outerbridge classification of the patella at the time of surgery. Patients with Outerbridge Grades I, II, and III formed Group A, whereas patients with Grade IV formed Group B. Within each group, resurfacing was completed on half of the patients. Group A had 328 patients (164 with PR, 164 without PR). In Group B, there were 172 patients (86 with PR, 86 without PR). An identical prosthetic design was used for both groups. The minimum followup was 5 years (average, 7.8 years) for both Group A and Group B. At the end of followup, we assessed the number of patients in each group that required secondary resurfacing as a result of patellofemoral pain. Patients in Group A required fewer revisions for PF pain. In Group A, only one patient required a secondary PR (0.6% rate), whereas in Group B, 10 patients needed PR (11.6% rate). In Group B, the risk of need of a patellar resurfacing was 21.5 times greater than in Group A. On the basis of these findings, we recommend PR in Outerbridge Grade IV patellae, but not in Grades I, II, and III.,[object Object]