We treated 14 patients having knee instability and varus alignment with tibial osteotomy with or without ligament reconstruction. Five patients with varus angulated anterior cruciate deficiency (double varus) were treated with single-stage closed-wedge tibial osteotomy and anterior cruciate ligament reconstruction. The remaining nine patients had varying amount of posterior cruciate and postero-lateral corner ligament injuries with varus angulation (triple varus); six of these patients had a ligament reconstruction using the Ligament Advanced Reconstruction System ligament with tibial osteotomy (intra-articular--posterior cruciate ligament/extra-articular--postero-lateral corner reconstruction), while the remaining three had a tibial osteotomy without a ligament reconstruction. Four of the nine patients with triple varus had open-wedge tibial osteotomy, and the remaining five had closed-wedge tibial osteotomy. The mean time interval between injury and index surgery of an osteotomy and ligament surgery was 8.3 years (range 1-20 years). At a mean follow-up of 2.8 years after tibial osteotomy, 12 knees (86%) were stable and eliminated of giving way while the remaining 2 were unstable. In one of these patients the result was compromised with severe infection, while in another there was combined cruciate ligament deficiency with postero-lateral corner ligament deficiency. Thirteen (93%) of the patients were able to participate in light recreational activities. None of these patients could return to competitive sports. Five (35%) continued to have pain of varying degree. The mean Cincinnati Knee Score improved from a mean preoperative of 53 (range 40-58) to a mean postoperative of 74 (range 58-82). Accordingly, there were two poor, four fair and eight good results. In-patients with triple-varus, open-wedge tibial osteotomy had better scores than those with closed-wedge procedure. The results of this series are encouraging, and we recommend a high tibial osteotomy along with ligament reconstruction in these complex injuries with varus alignment.
Results: The mean kyphosis correction obtained was 62.5% with the mean post-operative kyphosis angle reducing to 24.1 (range 5 ± 60). At a mean follow-up of 5.8 years (4 ± 7 years) the mean kyphosis angle loss was 3.28 (range 0 ± 58). Of the 23 patients with neurological de®cit, recovery was seen in 21 cases (91.3%) while deterioration was seen in one case (4.3%). The remaining ®ve patients were neurologically intact pre-operatively. Bony fusion was seen in all cases at 9 months. One patient with subpulmonary function died post-operatively (mortality 3.5%).
Conclusion:The results of our series are encouraging. However single stage decompression with fusion and kyphosis correction is a very demanding surgery and should be performed after taking into account the risks and bene®ts involved. This surgery perhaps prevents progression of neurological de®cit and recurrence of late onset paraplegia in these complex cases in developing countries. Spinal Cord (2001) 39, 429 ± 436
This paper reports a case of fatigue fracture of the femoral component in a cruciate-retaining cemented total knee arthroplasty (TKA). A 64-year-old man had undergone a primary TKA for osteoarthritis 10 years previously at another institution using the PFC-Sigma prosthesis. The patient recovered fully and was back to his regular activities. He presented with a history of sudden onset pain and locking of the left knee since the preceding three months. There was no history of trauma, and the patient was mobilizing with difficulty using crutches. Radiographs revealed fracture of the posterior condyle of the femoral prosthesis. Revision surgery was performed as an elective procedure revealing the broken prosthesis. The TC3RP-PFC revision prosthesis was used with a medial parapatellar approach. The patient recovered fully without any squeal. Mechanical failure of the knee arthroplasty prosthesis is rare, and nontraumatic fracture of the femoral metallic component has not been reported before.
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