The preferred technique for femoral implant sizing in primary total knee arthroplasty (TKA) is debatable. Sizing is based on the anterior femoral cortex or posterior condylar reference. Using a single knee system, this study compared anterior referencing (AR) versus posterior referencing (PR) in patients undergoing simultaneous bilateral TKA, where one reference technique was randomized to each knee. This prospective study compared the two sizing references using one posterior stabilized knee system. The study included 81 subjects with osteoarthritis and similar varus deformity in both knees. All subjects underwent identical surgical procedures, aside from the selected femoral sizing reference. Subjects were followed for at least 2 years. The two sizing techniques did not significantly differ in all measured radiographic, operative, and clinical parameters. The mean posterior condylar offset ratios were similar. Two-year mean knee flexion and Revised Oxford Knee Scores showed no difference. Eighty-four percent of patients stated no preference for either technique. Knees sized with anterior referencing had similar functional outcomes to those sized with posterior referencing. Using a current knee system with multiple sizing options, there is no discernable difference in all measured study parameters. Either reference is acceptable. Level of Evidence 2 (Randomized cohort study).
Total knee arthroplasty (TKA) in obese patients poses multiple challenges and there is a lack of consensus on various aspects of TKA in this patient population. This study is a modified Delphi consensus study of international experts to provide recommendations on TKA in obese patients. The consensus statements were generated using an anonymized two-round modified Delphi questionnaire, sent to an international panel of 53 knee surgeons, with an 80
Objectives: Sleep is an important determinant of quality of life. Sleep disturbance is concomitant with end-stage knee osteoarthritis for which total knee arthroplasty (TKA) is the most commonly done procedure. However, literature on this topic is lacking in terms of the impact of sleep quality on patient satisfaction after arthroplasty, especially the adverse associations of surgery on sleep quality. Improvement in sleep quality may be a necessary prerequisite for any effective rehabilitation program. In our study we aim to assess the changes in sleep quality after TKA, and how it affects patient satisfaction of TKA and other quality-of-life indicators, postoperatively. Methods: Over a period of two years, 104 patients undergoing primary total knee arthroplasty were assessed prospectively using the Pittsburgh Sleep Quality Index (PSQI), Knee Society Score (KSS), Oxford Knee Score (OKS); preoperatively and postoperatively at 3 months, 6 months, and 1 year. Obesity and diabetes status were also included in the analyses. Results: Preoperatively, most patients exhibited poor sleep quality (mean PSQI score 9.23 (Standard deviation (SD) = 3.03), which subsequently improved after surgery. Immediately after surgery, there was an initial worsening in the PSQI scores until 6 weeks (12.58 (SD = 3.59)). However, at 1 year, there was a statistically significant improvement to a mean of 5.69 (SD = 1.91). The mean Visual Analogue Scale (VAS) score showed a statistically significant decrease from 7.26 (SD = 1.90) pre-operatively to 1.80 (SD = 1.37) at 1 year postoperatively (p < 0.001). The mean OKS showed a statistically significant increase from preoperative 18.15 to 33.81 at 1 year and the composite KSS increased from 36.22 preoperative to 87.09 at 1 year (p < 0.001). Improvement in sleep was observed for 61% of non-obese patients while obese patients did not observe any improvement in sleep. Only 8% of diabetics showed improved sleep compared to 55% of non-diabetics. Conclusions: We observed an overall improvement in sleep quality after total knee arthroplasty. However, there was an initial stage of sleep disturbance immediately postoperatively. Obesity and diabetes may lower the chances of achieving optimal improvements in both functional and sleep outcomes. Level of evidence: Level III.
Degenerative rotator cuff tears are one of the most common causes of shoulder dysfunction in the elderly population, significantly impacting quality of life. The advent of arthroscopic repair has revolutionized surgical management, offering less morbidity and faster rehabilitation compared to open techniques. A prospective observational study was conducted on 60 patients above 55 years of age undergoing arthroscopic double-row repair for degenerative tears. Functional outcomes were assessed using the University of California, Los Angeles, and Constant–Murley scores at multiple time points. Statistically significant improvements were seen in the range of motion and functional scores at 12 months. Factors such as diabetes, age, and tear pattern did not significantly alter outcomes. Arthroscopic double-row repair provides reliable and satisfactory outcomes in the elderly, with favorable results even in diabetic patients.
Cementless ultra-short stems (USS), defined as implants that do not engage the diaphyseal cortex (stemless), have been designed to leave diaphyseal bone undisturbed. This study reports midterm clinical results using an USS in relatively younger patients undergoing primary total hip arthroplasty (THA). The study included 32 THA in 26 patients (8 females, 18 males) with end-stage coxarthrosis of various etiologies, with patients ≤ 70 years of age using the USS Proxima hip stem. All cups were of cementless design with several bearing configurations and head diameters. The mean age at surgery was 47.9 years (28–67 years). The mean follow-up was 12.1 years (range 10.8–13.8 years). Seven patients were classified as Dorr A femoral bone type, 18 were Dorr B, and 7 were Dorr C. Mean Harris Hip Score (HHS) improvement was 39.3 points from preoperative (p = 0.0001), with 10-year HHS averaging 88. There were two stem failures. One was due to a periprosthetic joint infection, which was removed at 3 years. The other stem was aseptically loose and revised at 8 years. Stem survivorship was 93.7
