Patients with excessive preoperative alignment (>8° of varus or >11° of valgus) have a greater risk of failure (2.3%). Neutral postoperative alignment (2.5° through 7.4° of valgus) improves (1.9% for preoperatively deformed knees) but does not completely eliminate the risk of failure (0.5% for knees that were neutral both preoperatively and postoperatively). Careful attention should be paid to knee alignment during total knee arthroplasty, especially for patients with severe preoperative deformities.

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Aim:The aim of this study was to describe the surgical management, outcomes and risk of malignancy of presacral tailgut cysts. Method:A retrospective analysis of all patients who underwent resection of tailgut cyst at Mayo Clinic in Arizona, Florida and Minnesota between 2008 and 2020 was performed.Demographics, presentation, evaluation, surgical approach, postoperative complications, pathology and recurrence rates were reviewed.Results: Seventy-three patients were identified (81% female) with a mean age of 45 years. Thirty-nine patients (53%) were symptomatic, most commonly with pelvic pain (26 patients). Digital rectal examination identified a palpable mass in 68%. Mean tumour size was 6 cm. Resection was primarily performed through a posterior approach (77%, n = 56), followed by a transabdominal approach (18%, n = 13) and a combined approach (5%, n = 4). Six patients underwent a minimally invasive resection (laparoscopic/robotic).Coccygectomy or distal sacrectomy was performed in 41 patients (56%). Complete resection was achieved in 94% of patients. Thirty-day morbidity occurred in 18% and was most commonly wound related; there was no mortality. Malignancy was identified in six patients (8%). For the 30 patients with follow-up greater than 1 year, the median follow-up was 39 months (range 1.0-11.1 years). Local recurrence was identified in three patients and distant metastatic disease in one patient. Conclusion:The rate of malignancy in presacral tailgut cysts based on this current review was 8%. Overall recurrence was 5% at a median of 24 months.

The under-tray method for taking radiographs may produce films of at least equivalent quality to the standard method. Since the standard method involves handling with potential desaturation and bradycardia, this technique should cease.