The patella clunk syndrome is not an uncommon complication, particularly after posterior-stabilized (PS) total knee arthroplasty. The present study was a consecutive unselected series comparing the incidence of the patella clunk syndrome amongst two comparable groups of elderly patients with knee arthritis implanted with the Insall-Burstein (IB II) total knee system and the newer NexGen Legacy total knee prosthesis. While 7.5% of patients in the PS IB II group developed patella clunk syndrome, none occurred in the NexGen group (P=0.05). We believe the difference is due mainly to a change in the design of the prosthesis, especially the more posterior intercondylar box and femoral cam of the NexGen femoral component.Résumé Le ressaut patellaire audible (clunk syndrome) n'est pas une complication rare en particulier après arthroplastie total du genou postéro -stabilisée (PS). La présente étude est celle d'une série consécutive de patients non sélectionnés comparant la fréquence de ce syndrome parmi deux groupes comparables de malades âgés avec arthrose du genou traités par prothèse de Insall-Bustein (IB II) ou par prothèse NexGen Legacy. Pendant que 7.5% de malades avaient un «clunk syndrome» dans le groupe IB II, aucun ne s'est produit dans le groupe NexGen (P=0.05). Nous croyons que la différence est principalement due à un changement dans le dessin de la prothèse, notamment un boitier intercondylien et une came fémorale plus postérieurs pour la prothèse Nexgen.
Purpose. To assess treatment outcomes of young patients with medial epicondylar fracture of the elbow using standard operative protocols. Methods. 24 consecutive patients with medial humeral epicondylar fracture underwent surgery by one of the 3 methods: (1) 2 parallel Kirschner wires, (2) 2 parallel Kirschner wires plus a tension-band wire, and (3) a screw plus an anti-rotation Kirschner wire. Fractures displaced less than 5 mm were treated conservatively (casting for 3 weeks). Outcome was assessed clinically and radiologically. The Mayo Clinic Elbow Performance Index was measured. Results. The 3 patients with undisplaced fractures had good radiological results and scores. One patient with a displaced fracture refused surgery and subsequently developed pseudarthrosis and cubitus valgus. All operatively treated patients had good scores, but 2 treated with 2 parallel Kirschner wires alone developed pseudarthrosis. Surgery 2007;15(2):170-3 this group needed longer rehabilitation to attain a functional range of movement than those in other groups (treated together with a tension-band wire or screw). Conclusion. Surgery is recommended for children with displaced medial epicondylar fractures of more than 5 mm. The use of a tension-band wire, instead of a screw, together with Kirschner wires is the preferred treatment for younger children. Journal of Orthopaedic
Background: Although the majority of total knee arthroplasty cases have good outcome and survival, some arthroplasty eventually required revision. While early outcomes of revision knee arthroplasty are well reported, there is relatively fewer literatures reporting on the longer term outcome of revision knee arthroplasty. This study aims to review the outcome of revision knee arthroplasty for a longer term, and also make comparison between the two common indications for revision arthroplasty of infection and aseptic loosening. Methods: This study reviews all total knee arthroplasty revision performed at a single center over a 11 year period. Of the 48 cases found, 35 cases not lost to follow-up had a mean follow-up duration of 10.6 years (SD 2.9) for aseptic loosening, and 10.1 years (SD 2.6) for infection. Data of initial arthroplasty, revision arthroplasty, demographics, follow-up outcome were obtained, analyzed and compared. Results: Revision arthroplasty due to infection had more cases that required use of varus/valgus constraints (p ∼ 0.008) and extensile surgical exposure of quadriceps snip (p ∼ 0.005) compared to aseptic loosening. The survival at 10 years for this study is 91% overall (aseptic loosening 93.3%, infection 89.3%). Infection cases had significant initial improvement for range of motion (p ∼ 0.001) and use of walking aid (p ∼ 0.04) at post-operation 1 year, but no significant differences between the infection and aseptic loosening cases at 5 years and 10 years follow-up. Comparison between the two groups on other factors including initial arthroplasty, operative details, demographics, post-operative details and X-rays showed no statistically significant difference.
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