Patients found to have unfavourable pelvic mobility had limited lumbar flexion and more posterior standing pelvic tilt in both men and women, as well as increasing age in women. We recommend that patients undergo preoperative functional radiographic screening to determine specific parameters that can affect the functional orientation of the acetabular component. Cite this article: Bone Joint J 2018;100-B:845-52.

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Background Stiffness and pain from arthrofibrosis following total knee arthroplasty (TKA) is a challenging problem, and investigating methods to prevent or reduce the incidence of postoperative arthrofibrosis is critical. Studies have shown that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are efficacious at preventing fibrotic disorders in the lungs, liver, kidneys, and eyes. Our aim was to determine if ACEI or ARB use postoperatively reduces the incidence of arthrofibrosis in TKA patients. Methods In a retrospective review, we analyzed 141 consecutive TKAs performed at a single institution by a single surgeon from December 2010 to December 2014. Range of motion (ROM) in patients already taking ACEI, ARB, or neither medication was compared. Independent variables recorded were gender, age, BMI, presence of diabetes or preoperative opioid or statin use, preoperative ROM, and use of ACEIs or ARBs. Dependent variables recorded were postoperative knee flexion, extension, and total arc of motion. The primary outcome variable was success or failure of achieving 118o total arc of motion postoperatively, based on a study that found significant compromise of function in TKA patients who failed to obtain this goal. Secondary endpoints were postoperative knee flexion, extension, and total arc of motion. Results The use of neither ACEIs nor ARBs showed a significant difference in attaining greater than 118° of motion postoperatively compared to controls at 6 months. Significant predictors of obtaining > 118° motion were BMI (p < 0.05), preoperative flexion (p < 0.001), and preoperative total arc of motion (p < 0.002). Significant predictors of secondary ROM outcomes were preoperative ROM and BMI. Conclusions Our study demonstrated that the principle predictor of postoperative ROM is BMI and preoperative ROM. The use of ACEIs or ARBs did not result in a greater likelihood of obtaining satisfactory ROM postoperatively.

Introduction The most common incision for total knee arthroplasty is the anterior midline incision; however, it is commonly associated with lateral knee numbness, kneeling difficulties and restricted flexion range. We sought to review the literature regarding the neurovascular supply and angiosomes over the anterior knee, and evaluate the anterolateral incision as a viable alternative for knee arthroplasty. Methods A systematic review of the literature was performed searching PUBMED, MEDLINE and EMBASE to evaluate the incisions available for total knee arthroplasty with respect to neurological function, kneeling ability and complications. Results Ten studies were identified evaluating midline or anterolateral incisions for total knee arthroplasty, with a total of 664 knees for analysis. Mean patient age was 68 years (45–88), and average length of followup was 1 year. A total of 586 had an anterior midline incision and 78 had an anterolateral incision. A total of 62% of anterior midline incisions sustained altered sensation compared to 15% (12/78) of anterolateral incisions (p < 0.0001). Incision length was similar in both groups (19.8 cm midline vs. 20.8 cm anterolateral). Wound dehiscence was not significantly different between the two groups being 8.3% for midline incisions, and 2.5% for anterolateral incisions (p = 0.153). Kneeling ability was reported in two studies which reported an improved ability to kneel with an anterolateral incision. Conclusions The lateral parapatellar incision respects the neurovascular anatomy of the knee and offers a significant reduction in sensory changes, better kneeling ability and similar rates of wound problems to a standard midline incision and should be considered as a viable alternative for knee arthroplasty.

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