BACKGROUND: During ligament balancing for severe medial contracture in varus knee total knee arthroplasty (TKA), complete distal release of the medial collateral ligament (MCL) or a medial epicondylar osteotomy can be necessary if a large amount of correction is needed. METHODS: This study retrospectively reviewed 9 cases of complete distal release of the MCL and 11 cases of medial epicondylar osteotomy which were used to correct severe medial contracture. The mean follow-up periods were 46.5 months (range, 36 to 78 months) and 39.8 months (range, 32 to 65 months), respectively. RESULTS: There were no significant differences in the clinical results between the two groups. However, the valgus stress radiograph revealed significant differences in medial instability. In complete distal release of the MCL, some stability was obtained by repair and bracing but the medial instability could not be removed completely. CONCLUSIONS: Medial epicondylar osteotomy for a varus deformity in TKA could provide constant medial stability and be a useful ligament balancing technique.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*methods ; Female ; Humans ; Knee Joint/physiopathology/radiography/*surgery ; Ligaments ; Ligaments, Articular/*physiopathology ; Medial Collateral Ligament, Knee/physiopathology/*surgery ; Middle Aged ; Osteotomy/*methods ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo study the examination,surgical opportunity and surgery methods of lost instability of traumatic dislocation of the knee joint.

METHODSSixty-three patients (48 males and 15 females,ranging in age from 16 to 75 years,with an average of 36.6 years) were checked, treated and followed up from January 2001 to April 2006. According to classification of Wascher for knee dislocation, there was 1 case of KD-I, 13 KD-II, 17 KD-III, 18 KD-IV, 14 KD-V. Stability of the knee was evaluated by physical and radiological examinations, of which 53 patients were treated with open surgery, 4 patients were treated with arthroscope, 4 patients were treated with arthroscope and open surgery, 1 patient was treated with amputation, 1 patient was treated with total knee arthroplasty.

RESULTSThe detection rate of MRI was 100% (39/39), stress radiography was 100% (19/19), arthroscpoe was 93.3% (14/15). According to Lysholm Criteria for knee joint function,the preoperative Lysholm score in old traumatic group was 37.17 +/- 5.33, fresh traumatic group was 37.41 +/- 5.38. The postoperative Lysholm score in old traumatic group was 67.33 +/- 14.72, fresh traumatic group was 82.45 +/- 12.13 (Z = -3.061, P = 0.002).

CONCLUSIONMRI stress radiography and arthroscope do well for the evaluation of stability of the knee. Instable traumatic dislocation of the knee joint must be operated promptly. Fresh instable dislocations of knee prefer repair,old instable dislocations of knee prefer reconstruction.

Adolescent ; Adult ; Aged ; Arthroscopy ; Female ; Humans ; Joint Instability ; diagnosis ; rehabilitation ; surgery ; therapy ; Knee Dislocation ; diagnosis ; rehabilitation ; surgery ; therapy ; Knee Joint ; diagnostic imaging ; physiopathology ; surgery ; Male ; Middle Aged ; Physical Examination ; Radiography

OBJECTIVETo report the clinical and radiological results of 24 total knee arthroplasty in which all-polyethylene tibial components were used.

METHODSBetween December 2000 and December 2002, 24 cemented total knee arthroplasty in 21 patients were performed using all-polyethylene tibial components. The mean age of the 21 patients (9 men and 12 women) at operation was 55 years, ranging 48-61 years. The mean preoperative hospital for special surgery (HSS) score was 40.2 (range, 36-43). The diagnoses were degenerative osteoarthritis in 15 patients, rheumatoid arthritis in 5 and traumatic arthritis in 1. All the operations were performed by the same surgeon group and there were unilateral operations in 18 patients and bilateral operations in 3.

RESULTSEighteen patients were followed up with a follow-up rate of 85.7%. The mean follow-up is 2.5 years (range, 1-3 years) and mean postoperative HSS scores was 87.5 (range, 83-89). Among them, 18 were excellent, 3 good, 3 poor and none was fair (the results of three lost patients were classified as poor). Of those reviewed, the prosthesis was all in situ and no revision occurred. Radiological assessment of these patients revealed 4 (16.67%) tibial components with radiolucent lines (mean width < or = 2 mm) distributed mainly in zone 1 and zone 4. None of these knees was symptomatic.

CONCLUSIONSThe result of total knee arthroplasty using all-polyethylene tibial components is encouraging. The operative techniques are similar to those in arthroplasty using metal-backed tibial component.

Arthritis ; diagnostic imaging ; surgery ; Arthroplasty, Replacement, Knee ; instrumentation ; Equipment Failure Analysis ; Female ; Follow-Up Studies ; Humans ; Knee Joint ; diagnostic imaging ; physiopathology ; Knee Prosthesis ; Male ; Materials Testing ; Middle Aged ; Polyethylene ; Radiography ; Range of Motion, Articular ; Tibia