Background Since the medial parapatellar (MPP) approach in conventional TKA can cause patellar maltracking and anterior knee pain, some orthopaedic surgeons use the midvastus (MV) approach instead of the MPP approach to reduce patellar maltracking. Minimally invasive surgical (MIS) TKA has been developed to limit the damage to the surrounding muscle and reduce the necessity of patellar eversion during surgery. Thus, MIS TKA might be associated with proper patellar tracking and a low incidence of anterior knee pain. However, this presumption has not been confirmed. Questions/purposes We asked whether the incidence of patellar maltracking and anterior knee pain differed with the MV and MPP in association with MIS TKA. Methods We prospectively followed 59 patients (60 knees)

No abstract

No abstract

In the past, medial osteoarthritis (OA) knee with symptomatic patellofemoral (PF) arthritis has not been recommended for a unicompartmental knee arthroplasty (UKA). However, recent studies have reported that UKA has shown good results in patients with medial OA of the knee, including those with PF arthritis. The purpose of this study is to compare the results between patients with medial OA knees; those with severe arthritis of the lateral facet of the patella and patients without severe arthritis of the lateral facet of the patella following mobile bearing UKA. We have prospectively evaluated 104 patients (114 knees) who had undergone an Oxford mobile bearing UKA. The mean follow-up was 19.05 months (range 12.30–29.70 months). The patients were divided into two groups: group I consisted of eighty patients (88 knees) who did not have severe arthritis of the lateral facet (Outerbridge grade 0–2) and group II had twenty-four patients (26 knees) who had severe arthritis of the lateral facet (Outerbridge grade 3, 4). We recorded the incidence of anterior knee pain, knee scores, pain scores, and functional scores in comparison of the two groups. The visual analog scale (VAS) and incidence of post-operative anterior knee pain had not shown any significant differences. The VAS for post-operative anterior knee pain was 0.11 (SD 0.56, range 0–3 point) versus 0.12 (SD 0.59, range 0–3 point) for group I and group II patients, respectively (P = 0.98). The incidence of post-operative anterior knee pain was 4.5 versus 3.8 % for group I and group II patients, respectively (P = 0.88). The pain scores and functional scores had not exhibited any differences. However, the knee scores of patients with severe arthritis of the lateral facet of the patella was worse than those seen in patients without severe arthritis of the lateral facet of the patella with a statistical significance. It was scored as 96.78 (SD 4.56, range 85–100) versus 94.43 (SD 4.50, range 81–100) for group I and group II patients, respectively (P = 0.02). Anterior knee pain, pain scores, and functional scores were not different between the two groups following a medial Oxford UKA. However, the knee scores of patients with severe arthritis of the lateral facet were worse than those in patients without severe arthritis of the lateral facet of the patella.

BackgroundLittle is known about differences in amounts of antioxidants or oxidative stress at different stages of knee osteoarthritis. This study investigated the relationship between concentrations of antioxidants, iron and lipid peroxidation in synovial fluid and levels of severity of primary knee osteoarthritis.Materials and methodsFrom 2011 to 2013, 23 patients (mean age, 66.7 ± 7.6 years) with primary knee osteoarthritis were recruited. Patients were divided into 2 groups based on pre-treatment knee society scores (KSS): n = 9, severe KSS ≤46; and n = 14, mild-moderate KSS >46. Synovial fluid was analyzed to determine levels of antioxidants, iron concentrations and lipid peroxidation (thiobarbituric acid reactive substances [TBARs]). Baseline data, including Kellgren- Lawrence radiographic grade, were collected for all patients.ResultsMean KSS was 49.1 ± 10.8. Total mean concentrations of antioxidants were 2.29 ± 1.71 ng/mL vitamin E and 0.47 ± 0.51 nmol/mL glutathione (GSH). Total mean levels of TBARs and iron were 1.20 ± 0.37 nmol/mL and 2.13 ± 0.82 μg/mL, respectively. The mean concentration of vitamin E was inversely related to severity of knee osteoarthritis (mild-moderate > severe, p = 0.006). There were no significant differences between the two groups in terms of GSH (p = 0.90), TBARs (p = 0.84) or iron levels (p = 0.27). There was a significant positive correlation between KSS and vitamin E concentration (r = 0.43, p = 0.04). No significant correlations were shown between KSS and GSH (r = -0.01, p = 0.97), TBARs (r = -0.06, p = 0.81) or iron level (r = 0.28, p = 0.20).ConclusionUsing synovial fluid profiles, vitamin E concentration is an essential prognostic factor in primary knee osteoarthritis and may act as a basis for treatment directions. The concentration of vitamin E decreased as the clinical severity of primary knee osteoarthritis increased.