SICOT-J最新文献

Total knee arthroplasty (TKA) in valgus knee deformities presents unique challenges, including alignment, soft tissue balance, and implant positioning. The lateral approach offers advantages over the traditional medial approach by improving direct access, patellar tracking, and soft tissue preservation. Robotic-assisted TKA enhances precision, ligament balancing, and patient-specific alignment strategies, such as functional knee positioning (FKP). This study describes a surgical technique integrating the lateral approach with robotic-assisted TKA using FKP principles. The technique is based on an image-based robotic system, ensuring accurate preoperative planning, intraoperative adjustments, and optimized prosthetic placement. Key intraoperative steps, including bone resection strategies, soft tissue balancing, and trial component evaluations, are detailed. The lateral robotic approach with FKP was found to be effective and reproducible, allowing for precise implant alignment and optimized soft tissue balance in valgus knees. This method minimizes the need for extensive lateral releases, preserves vascularity, and ensures postoperative stability. The combination of the lateral approach, robotic-assisted TKA, and FKP represents a promising strategy for valgus knee deformities. Further long-term studies are needed to validate the durability and functional benefits of this technique.

This narrative review evaluates the purpose and functionality of rotating hinged total knee arthroplasty (RHTKA). The main indications for an RHTKA are poor bone stock, soft tissue compromise, gross instability, and periprosthetic fractures. Studies have shown that an RHTKA may be used in both the primary and revision scenarios to improve the range of motion and functional outcomes. Radiostereometric analysis has shown that some RHTKA designs are associated with early femoral component micromotion, but this has not translated to increased failure or revision rates. Implant survivorship with a modern RHTKA is comparable to a condylar-constrained TKA at mid-term follow-up. The most common complications associated with RHTKA are aseptic loosening, periprosthetic joint infection, stiffness and periprosthetic fractures.

Purpose: To clarify the location of the popliteal artery (PA) is relative to the tibial osteotomy plane in patients with medial and lateral unicompartmental knee osteoarthritis (KOA) undergoing UKA.

Methods: Preoperative MRI and postoperative radiographs obtained from 50 patients with unicompartmental KOA who underwent fixed-bearing UKA were analyzed. The amount of tibial resection was determined from the surgical records, and a line was drawn parallel to the tibial posterior tilt angle on the sagittal MR image to create a virtual tibial cut line. The tibial resection width measured from the anteroposterior image of the postoperative radiograph was projected onto the transverse plane containing the intersection between the virtual tibial cut line and the posterior tibial cortex, after which a line was drawn parallel to the medial or lateral intercondylar ridge. We then determined whether the PA was within an extension of the osteotomy area. The shortest distance (Distance 1) between the posterior tibial cortex and the PA within the osteotomy area was measured. In addition, the shortest distance between the line extending the osteotomy posteriorly and the PA was measured (Distance 2).

Results: The medial UKA (group M) and lateral UKA (group L) group comprised 41 and 9 cases. The percentage of PA located behind the osteotomy plane was significantly higher in group L than in group M [6/9 knees (66.7%) vs. 2/41 knees (4.9%); P < 0.001]. The distance 1 was 12.6 (4.3) mm in group M and 7.9 (3.7) mm in group L (P = 0.004). The distance2 was 11.1 (4.9) mm in group M and 2.6 (3.5) mm in group L (P < 0.001).

Conclusion: During lateral UKA, the PA was often located behind the tibial osteotomy plane and close to the posterior tibial cortex. Nearly 5% of medial UKAs, the artery was located behind the osteotomy plane.

Level of evidence: Retrospective comparative LEVEL III study.

Purpose: Severe varus knee osteoarthritis (OA) alters weight-bearing mechanics, leading to progressive stress concentration on the posteromedial tibial plateau. In select cases, this results in the development of a Posteromedial Varus Fatigue Fragment (PVFF), a chronic stress-related fracture that remains ununited and influences knee stability, surgical planning, and implant selection. This study aims to evaluate the incidence, radiographic detectability, and intraoperative significance of PVFF in patients undergoing total knee arthroplasty (TKA).

Methods: A retrospective analysis was conducted of 856 consecutive TKA cases performed by a single surgeon. Preoperative radiographs, intraoperative findings, and surgical modifications were assessed to determine the incidence and implications of PVFF. Correlation with varus severity and absence of ACL was done.

Results: PVFF was detected intraoperatively in 17 of 856 cases (1.99%), but only 9 (53%) were visible on pre-op imaging." All PVFF cases exhibited varus alignment exceeding 15° and complete ACL deficiency. Intraoperatively, fragment removal resulted in an increased medial flexion gap, impacting gap balancing and necessitating adjustments in implant selection, including the use of tibial stems or augments in select cases.

Conclusion: PVFF is an underrecognized structural lesion for precision in severe varus knee OA, affecting tibial fixation, load distribution, and medial knee stability. Its presence requires careful intraoperative assessment, as fragment removal can alter gap balancing. Improved preoperative recognition and surgical planning are essential to optimize TKA outcomes in patients. Further prospective studies and biomechanical analyses are needed to better understand PVFF's long-term clinical implications and refine surgical strategies.

Introduction: Venous thromboembolism (VTE) is a rare but potentially serious complication following anterior cruciate ligament reconstruction (ACLR). There is no guideline for the routine use of anticoagulants post-ACLR surgery.

Methods: This retrospective case-control study reviewed 199 patients who underwent ACLR between February 2020 and November 2024. Two groups were compared: Group A (n = 113) received no pharmacological prophylaxis, while Group B (n = 86) received low-molecular-weight heparin (LMWH) for 2 weeks postoperatively. The incidence of symptomatic VTE, postoperative bleeding, and related complications was evaluated.

Results: No symptomatic VTE or bleeding complications were observed in either group. There was no statistically significant difference between the groups in terms of age, BMI, smoking, comorbidities, and postoperative weight bearing. There was a significant difference in surgical duration, graft type, and meniscal procedure.

Discussion: Our findings support a risk-stratified approach rather than universal pharmacologic prophylaxis in ACLR patients.

Introduction: Although the surgical techniques and functional outcomes of conventional total knee arthroplasty (TKA) are well-established, there is limited data available on robotic arm-assisted TKA (RATKA) in the context of valgus knee arthroplasty. The purpose of this study is to assess the efficacy of RATKA in the correction of moderate to severe valgus knee deformities using minimally constrained implants and to evaluate the short-term functional outcomes associated with this technique.

Methods: This prospective study was conducted on patients with moderate to severe grade valgus knee deformity who underwent RATKA from August 1, 2020 to May 31, 2022. Of 873 primary RATKA cases, 48 cases had valgus knee deformities. Among these, 27 had grade 2-3 valgus with intact medial collateral ligament (MCL), two had grade 3 valgus with incompetent MCL, 14 had grade 1 valgus, and five had post-traumatic valgus deformities. Over a two-year follow-up period, functional outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS), and complications were documented; however, radiological outcomes were not analyzed.

Results: Among 27 patients with Grade 2-3 valgus, the final cohort included 21 patients (24 knees). The mean age was 58.33 ± 9.63 years and 70.8% were female. Ten (41.7%) patients had rheumatoid arthritis and 14 (58.3%) had degenerative osteoarthritis (OA). The median surgical time was 68.00 (13.00) minutes, and the median blood loss was 478.45 (176.25) mL. The valgus grade was reduced from a baseline value of 22.43 ± 7.05 degrees to 5.26 ± 1.53 degrees at 6 weeks. The WOMAC scores improved from 67.58 ± 7.27 at baseline to 1.38 ± 0.57 in the second year post-operatively. Similarly, the KSS scores improved from 26.67 ± 10.34 at baseline to 181.96 ± 7.20 in the second year. One patient sustained a Type II supracondylar femur fracture after a fall, managed with distal femur arthroplasty, while another had delayed tibia pin tract healing, treated with antibiotics and dressings.

Conclusion: RATKA facilitates precise correction of moderate to severe valgus deformity through enhanced surgical planning and execution, achieving adequate functional outcomes with minimal complications through the application of functional alignment philosophy.

Background/objective: Developmental Dysplasia of the Hip (DDH) is the most common congenital musculoskeletal disease of the infantile age. The gold standard for early diagnosis of the disease is the Graf ultrasound method. In our study, we examined the correlation between age of the examined infant and diagnostic errors due to the ultrasound probe tilt effect during examination.

Methods: Forty-two newborns who underwent ultrasound examination with the Graf method, were included. We categorized the neonates into three age groups (Group#1: 0-1 weeks, Group#2: 3-4 weeks, Group#3: 5-6weeks). Two ultrasound examinations were performed in every group. In the first examination, images were obtained with the probe in vertical position. In the second examination, images were taken with a 10° caudocranial tilt of the probe. Our aim was to measure the α angle in both examination and to mention the possible Type changes according to the Graf classification. The α angle defines the osseous coverage of the femoral head from the acetabulum in the neonatal hip joint.

Results: In many cases, the classification changed from type I to type IIa or D and from type IIa to D, when instead of the vertical acquisition, the ultrasound probe was placed in a 10° caudocranial tilt at the hip joint of the examined infant. At Group#1 of the study we observed 60 Graf classification Type changes (90.91%), while in Group#2 and Group#3 we had 18 (33.33%) and 3 (7.96%) Type changes respectively.

Conclusion: As the age of the examined newborns increases, measurement and classification errors due to the tilt effect are significantly reduced. Clinically, the examination will be even more accurate and the use of an incorrect therapeutic approach due to incorrect classification will be avoided. Finally, the optimal time for conducting an ultrasonographic examination is between the 5th and 6th week of life.

There are many variables that influence the decision-making process in the treatment of rotator cuff calcifications. The stage of the deposit, prognostic factors, previous failed treatments, pain level, and functional disability must all be considered. The tendency for spontaneous resolution is an important reason to always exhaust conservative treatment, being non-invasive options the first line of treatment. The emergence of focused shock wave therapy offered a powerful tool for the non-invasive management of rotator cuff calcifications. High-energy focused shock waves have a high degree of recommendation for the treatment of rotator cuff calcifications, supported by meta-analyses and systematic reviews. If non-invasive techniques fail, there is the possibility of moving to a minimally invasive procedure such as ultrasound-guided barbotage. Finally, classic invasive techniques are also a frequent indication, including open surgery and arthroscopy. As each treatment has advantages and disadvantages, the most advisable strategy is to progress from the least invasive therapeutic methods to the most invasive ones without losing sight of the clinical stage of the disease and the general context of each patient.

Complications on the femoral side after performing proximal femoral replacement (PFR), such as stem loosening and periprosthetic fractures, are the major reasons for reoperation. Femoral reconstruction was performed using PFR with a locking plate to minimize the risk of complications. We present the case of an 85-year-old woman with stem loosening and massive proximal femoral bone loss (Paprosky type IV) 10 years after stem revision in bipolar hemiarthroplasty. Femoral reconstruction was performed using the following surgical techniques. After removing the previous implant, a PFR was inserted into the host bone of the distal femur and fixed at the junction with cement. In addition, a locking plate was used for bridging. Full weight-bearing rehabilitation was started the day after surgery. At the 5-year follow-up, the patient could walk steadily without complications. A postoperative radiograph of the femur showed no signs of a radiolucent line, implant-related issues, or bone resorption. This reconstructive technique may reduce the high torsional and compressive stresses on bone cement prostheses, which can cause complications on the femoral side. Even in the case of poor femoral host bone quality, this reconstruction method can achieve robust femoral reconstruction. Femorl reconstruction using PFR with a locking plate is a particularly beneficial reconstruction method for older patients with massive proximal femoral bone loss.