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Knee Exam

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12981. Osteoarthritis development in novel experimental mouse models induced by knee joint instability. Full Text available with Trip Pro

Osteoarthritis development in novel experimental mouse models induced by knee joint instability. Although osteoarthritis (OA) is induced by accumulated mechanical stress to joints, little is known about the underlying molecular mechanism. To apply approaches from mouse genomics, this study created experimental mouse OA models by producing instability in the knee joints.The models were of four types: severe, moderate, mild, and medial, depending on the severity and direction of instability (...) imposed by combinations of ligament transection and menisectomy. OA development was evaluated by X-ray and histology by Safranin-O staining, and quantified using our original gradings. Expressions of type II, IX and X collagens and matrix metalloproteinase (MMP)-2, -3, -9 and -13 were further examined by immunohistochemistry and in situ hybridization (ISH).The severe, moderate and mild models exhibited OA development in the posterior tibial cartilage. The severe model showed cartilage destruction at 2

2005 Osteoarthritis and Cartilage

12982. Factors predicting complication rates following total knee replacement. (Abstract)

Factors predicting complication rates following total knee replacement. The purpose of this investigation was to expand on previous studies by more fully examining the role of a variety of patient and hospital characteristics in determining adverse outcomes following total knee replacement.With use of data from all hospital admissions in California from 1991 through 2001, multiple logistic regression was performed on the information regarding patients treated with total knee replacement. Rates (...) and the Charlson comorbidity index on the baseline probability of adverse outcomes following total knee replacement were shown to be similar to or greater than the effect of hospital volume. This study elucidates and compares the relative importance of the effects of several different factors on outcome. This information is important when considering the conclusions and implications of this type of policy-relevant outcomes research.

2006 The Journal of Bone and Joint Surgery. American Volume

12983. Osteolysis after total knee arthroplasty: influence of tibial baseplate surface finish and sterilization of polyethylene insert. Findings at five to ten years postoperatively. (Abstract)

. Two arthroplasty specialists independently examined the radiographs for evidence of osteolysis (defined as any nonlinear region of cancellous bone loss with delineable margins).Osteolysis was identified in 34% (eighty-two) of 242 knees treated with an insert that had been gamma-irradiated in air and affixed to a rough baseplate surface, and it was identified in 9% (nine) of ninety-eight knees treated with an insert that had been gamma-irradiated in an inert gas, or had not been irradiated (...) Osteolysis after total knee arthroplasty: influence of tibial baseplate surface finish and sterilization of polyethylene insert. Findings at five to ten years postoperatively. Debris displaced from the articular and backside surfaces of the polyethylene inserts of modular tibial components is considered a chief cause of osteolysis at the sites of total knee arthroplasties. One design of total knee replacement featured changes, over time, in the proximal surface roughness of the tibial baseplate

2005 The Journal of Bone and Joint Surgery. American Volume

12984. Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee. (Abstract)

metaphyseal osteosarcoma around the knee who had transepiphyseal resection and reconstruction with an intercalary allograft were retrospectively reviewed at a mean of sixty-three months. Complications, disease-free survival of the patient, final preservation of the limb and epiphysis, and functional results according to the Musculoskeletal Tumor Society scoring system were documented at the time of the latest follow-up.At the final follow-up examination, eleven of the thirteen patients continued (...) of these patients. At the latest follow-up examination, twelve patients were alive with preserved limbs. In one patient, the epiphysis, which originally had been preserved, was resected because of a metaphyseal fracture, and the limb was reconstructed with an osteoarticular allograft. The patients with a preserved epiphysis had an average functional score of 27 points (maximum, 30 points).Preservation of the epiphysis in high-grade metaphyseal osteosarcoma at the knee is an alternative in carefully selected

2005 The Journal of Bone and Joint Surgery. American Volume

12985. Patellectomy after total knee arthroplasty. (Abstract)

points (range, 69-97 points) and 49 points (range, 10-100 points) for pain and function, respectively. Knee scores after patellectomy were 81 (range, 20-97) and 28 (range, 0-80) for pain and function, respectively. The average range of motion before and after patellectomy was 0 degrees to 104 degrees and 2 degrees to 106 degrees , respectively. Four patients had mild extensor lags at final examination, but all were less than 10 degrees . Two patients were unable to use stairs. Two patients had (...) Patellectomy after total knee arthroplasty. We retrospectively reviewed nine patients who had condylar TKA and subsequently had a patellectomy between 1969 and 2003. One patient was lost to followup, but the remaining eight patients were followed up for an average of 49 months after patellectomy. All patellectomies were done after comminuted patellar fractures at an average of 21 months (range, 4-88 months) after the initial arthroplasty. Knee scores after the initial arthroplasty were 83

2005 Clinical Orthopaedics and Related Research

12986. Clinical correlation with the PA/plasmin system in septic arthritis of the knee. (Abstract)

Clinical correlation with the PA/plasmin system in septic arthritis of the knee. Substantially more gelatinases appear in effusions of septic arthritis than in effusions of aseptic arthritis. We hypothesized there is greater plasminogen activator/plasmin activity in effusions of septic arthritis than aseptic arthritis. We examined the antigenic values of urokinase-type plasminogen activator and plasminogen activator inhibitor Type-1, cell counts, and levels of matrix metalloproteinase-2 (...) and metalloproteinase-9 in 135 knee effusions from 80 patients with septic arthritis, rheumatoid arthritis, gouty arthritis, and osteoarthritis. Urokinase-type plasminogen activator and plasminogen activator inhibitor Type-1 antigenic values in effusions of septic arthritis were greater than those in effusions of aseptic arthritis. The increases of urokinase-type plasminogen activator and plasminogen activator inhibitor Type-1 antigenic values in effusions were associated with increased levels

2006 Clinical Orthopaedics and Related Research

12987. Agreement about indications for total knee arthroplasty. (Abstract)

Agreement about indications for total knee arthroplasty. Total knee arthroplasty is an effective and cost efficient procedure that improves the quality of life for patients with end stage knee arthritis. With the prevalence of arthritis expected to increase with the aging of the population, the demand for total knee arthroplasty will increase substantially. We examined current indications for total knee arthroplasty by reviewing articles extracted from a comprehensive Med-line search. We (...) studied the indications for proceeding with a total knee arthroplasty, the indications for referring a patient for a total knee arthroplasty, and the contraindications among orthopaedic surgeons, rheumatologists, and primary care providers. We evaluated 27-42 different patient factors. "Pain not responsive to drug therapy" was the only factor with consensus for total knee arthroplasty. "Major psychiatric disorder, including dementia" was the only contraindication to total knee arthroplasty that had

2006 Clinical Orthopaedics and Related Research

12988. Flexion and extension gap balancing in revision total knee arthroplasty. Full Text available with Trip Pro

femoral augments, and then balanced the flexion gap using different sized femoral components. We retrospectively analyzed 45 patients who had revision total knee replacement with an average of 4 years followup. These patients had a mean flexion of 105 degrees and none had signs of instability in flexion or extension or on clinical exam. Despite the complex nature of revision knee arthroplasty, cases utilizing an algorithm to balance the extension and flexion gaps, with increased implant constraint (...) Flexion and extension gap balancing in revision total knee arthroplasty. Revision total knee arthroplasty presents a unique set of problems when attempting to balance flexion and extension gaps. Loss of soft tissue support and established deformity can make balancing difficult. One needs to balance the flexion and extension gap heights as well as medial and lateral symmetry, which may not always be attainable. We used a set of stepwise techniques to reestablish the joint line in extension using

2006 Clinical Orthopaedics and Related Research

12989. Report of a group developing a virtual reality simulator for arthroscopic surgery of the knee joint. (Abstract)

of Medicine and incorporates active force-feedback haptic technology. Our premise is that postgraduate year 2 residents completing a formal virtual education program who are trained to reach a proficiency standard in the techniques and protocol for an arthroscopic knee examination will complete a diagnostic arthroscopy on an actual patient in less time with greater accuracy, less iteration of movement of the arthroscope, and less damage to the patient's tissue compared with residents in the control group (...) learning and practicing the arthroscopic knee examination procedures through the residency program's established education and training program. The validation study, done at eight orthopaedic residency programs, will commence in early 2006 and will take one year to complete. We anticipate that proficiency obtained on the simulator will transfer to surgical skills in the operating room.

2006 Clinical Orthopaedics and Related Research

12990. Rotational changes at the knee after ACL injury cause cartilage thinning. (Abstract)

Rotational changes at the knee after ACL injury cause cartilage thinning. We examined the relationship between specific gait changes after anterior cruciate ligament injury and the progression of osteoarthritis at the knee. The study was done using a finite-element model derived from subject specific three-dimensional cartilage volumes created from magnetic resonance images. Cartilage thinning was predicted using an iterative algorithm based on the octahedral shear stress. Simulations were done (...) for a knee with normal alignment and for a knee with an internal tibial rotation offset, as associated with anterior cruciate ligament deficiency. For the healthy knee, the model predicted patterns of cartilage thinning consistent with a previous clinical report of idiopathic osteoarthritis. For the ACL-deficient scenario the model predicted a more rapid rate of cartilage thinning throughout the knee, especially in the medial compartment. The results suggest that the progression of osteoarthritis after

2006 Clinical Orthopaedics and Related Research

12991. Patellofemoral instability after total knee arthroplasty. (Abstract)

Patellofemoral instability after total knee arthroplasty. Despite advances in surgical technique and implant design, complications involving the extensor mechanism and patellofemoral joint after total knee arthroplasty (TKA) continue to be the most common cause of pain and the most commonly cited reason for revision TKA surgery. A thorough understanding of the etiologies of patellofemoral instability, careful preoperative planning, and meticulous surgical techniques will optimize clinical (...) outcome. Evaluation of patellofemoral stability should begin in the operating room. Postoperatively, thorough history, physical examination, and dedicated radiographic studies should be obtained. Computed tomography scan is the most accurate and reliable way to assess component positioning. Treatment of patellofemoral instability is directed by its etiology. Revision of one or both components is indicated if malpositioning is present. If the components are determined to be in satisfactory positions

2006 Clinical Orthopaedics and Related Research

12992. Response shift in outcome assessment in patients undergoing total knee arthroplasty. (Abstract)

Response shift in outcome assessment in patients undergoing total knee arthroplasty. A response shift is a psychological change in one's perception of the quality of life following a change in health status. This phenomenon initially was recognized in patients with terminal diseases who, despite a worsening of the physical condition, did not necessarily report deterioration in quality of life. The purpose of the present study was to examine the role of response shift in patients undergoing (...) total knee replacement surgery.Consecutive candidates undergoing total knee replacement for the treatment of degenerative arthritis completed a Western Ontario and McMaster Universities Osteoarthritis questionnaire preoperatively (Pre-Test). At six months postoperatively, the patients completed two questionnaires: one on how they felt currently (Post-Test), and one on how they perceived themselves to have been prior to surgery (Then-Test). The study cohort comprised 125 subjects, including ninety

2006 The Journal of Bone and Joint Surgery. American Volume

12993. The influence of income and race on total knee arthroplasty in the United States. Full Text available with Trip Pro

, zip (postal) code income, and region (n = 27.5 million) and (2) the National Health and Nutrition Examination Survey (NHANES III) for individuals with an age of sixty years or more (n = 1926) with radiographic and clinical evidence of osteoarthritis. Logistic regression methods were used to adjust for covariates.At the national level, age-adjusted rates of total knee arthroplasty in the high-income quintile were no higher than those in the low-income group (odds ratio, 0.98; 95% confidence (...) The influence of income and race on total knee arthroplasty in the United States. The associations among income, total knee arthroplasty, and underlying rates of knee osteoarthritis are not well understood. We studied whether high-income Medicare recipients are more likely to have a knee arthroplasty and less likely to suffer from knee osteoarthritis.Two data sources were used: (1) the 2000 United States Medicare claims data measuring the incidence of total knee arthroplasty by race, ethnicity

2006 The Journal of Bone and Joint Surgery. American Volume

12994. Magnetic resonance imaging appearance of cartilage repair in the knee. (Abstract)

Magnetic resonance imaging appearance of cartilage repair in the knee. Assessment of surgically repaired cartilage lesions with standardized cartilage sensitive magnetic resonance imaging was done to evaluate the integrity, morphologic features, and signal of the articular surface, thereby obtaining information about the natural history of these procedures in the knee. Magnetic resonance imaging also assessed the interface between the repaired and native cartilage, changes in the subchondral (...) bone, and the appearance of cartilage over the opposite and adjacent (native) surfaces. One hundred eighty magnetic resonance imaging examinations were obtained in 112 patients who had cartilage-resurfacing procedures, including 86 microfractures and 35 autologous chondrocyte implantations, at a mean of 15 and 13 months after surgery, respectively. Autologous chondrocyte implantations showed consistently better fill of the defects at all times compared with microfracture. The graft hypertrophied

2004 Clinical Orthopaedics and Related Research

12995. The optimum knee flexion angle for skyline radiography is thirty degrees. (Abstract)

the radiograph taken at 90 degrees knee flexion. In terms of detecting abnormality of the parameters measured, the radiographs taken at 30 degrees and 50 degrees were similar. The radiograph taken at 90 degrees knee flexion detected the fewest abnormalities. Skyline radiographic examination of the patellofemoral joint should be a mandatory part of the investigation of all knee problems. One radiograph, ideally taken at 30 degrees knee flexion, offers the best means of assessing the patellofemoral joint (...) The optimum knee flexion angle for skyline radiography is thirty degrees. There is wide variation in practice among orthopaedic surgeons regarding the use of skyline tangential patellar radiographs of the patellofemoral joint in patients with anterior knee pain. Various techniques are available for taking such radiographs and numerous radiologic parameters can be measured from them. There is no information as to which knee flexion angle is superior when taking skyline radiographs. The purpose

2004 Clinical Orthopaedics and Related Research

12996. Ankle arthroplasties generate wear particles similar to knee arthroplasties. (Abstract)

Ankle arthroplasties generate wear particles similar to knee arthroplasties. Second-generation total ankle arthroplasties have encouraging medium-term results, but the wear of the joint materials is of concern. The aim of the current study was to examine and compare the size, shape, and concentration of polyethylene particles in synovial fluid with total ankle arthroplasties and established posterior-stabilized total knee arthroplasties. Synovial fluid was obtained from 15 patients with well (...) -functioning total ankle arthroplasties and 11 patients with posterior-stabilized total knee arthroplasties at least 6 months after surgery. Polyethylene particles were isolated and analyzed using scanning electron microscopy. Particle size (equivalent circle diameter) in ankles was 0.81 +/- 0.09 microm (mean +/- standard error) and in knees was 0.78 +/- 0.08 microm. Particle shape (aspect ratio) in ankles was 1.57 +/- 0.04 and in knees was 2.30 +/- 0.22. The particle concentration was 1.02 +/- 0.43 x 10

2004 Clinical Orthopaedics and Related Research

12997. Magnetic resonance imaging of the knee in children and adolescents. Its role in clinical decision-making. (Abstract)

tear, lateral meniscal tear, medial meniscal tear, osteochondritis dissecans, discoid lateral meniscus, and osteochondral fracture. The preoperative diagnosis of the surgeon was determined by integrating the history and the findings on the clinical examination, plain radiographs, and magnetic resonance imaging scans (including the radiologist's interpretation).Ninety-six patients with ninety-six abnormal knees were included. The mean age was 14.6 years at the time of surgery. Relative to operative (...) Magnetic resonance imaging of the knee in children and adolescents. Its role in clinical decision-making. Recent studies have questioned the utility of magnetic resonance imaging in the diagnosis of pediatric knee disorders because of the morphologic changes during growth and the low accuracy of the formal interpretation of the magnetic resonance imaging scan by a radiologist. The purpose of this study was twofold: (1) to report the accuracy of formal interpretations of magnetic resonance

2005 The Journal of Bone and Joint Surgery. American Volume

12998. Modular fixed-bearing total knee arthroplasty with retention of the posterior cruciate ligament. A study of patients followed for a minimum of fifteen years. (Abstract)

surgeon using a nonconforming posterior cruciate-retaining prosthesis, was followed for fifteen years or longer. Forty-five patients (fifty-nine knees) were examined at a minimum of fifteen years postoperatively, fifty-seven patients (seventy knees) had died, five patients (eight knees) were too ill to return for assessment, and two patients (two knees) were considered lost to follow-up. The patients were assessed clinically with use of the Knee Society clinical rating system, and the knees were (...) Modular fixed-bearing total knee arthroplasty with retention of the posterior cruciate ligament. A study of patients followed for a minimum of fifteen years. There have been a limited number of studies of total knee arthroplasties with durations of follow-up of fifteen years, but we are not aware of any involving modular fixed-bearing posterior cruciate-retaining prostheses.A consecutive series of 139 total knee arthroplasties in 109 patients (average age, sixty-seven years), performed by one

2005 The Journal of Bone and Joint Surgery. American Volume

12999. Knee injury in patients experiencing a high-energy traumatic ipsilateral hip dislocation. (Abstract)

a traumatic hip dislocation on the basis of a standardized history, physical examination, and magnetic resonance imaging.Twenty-one (75%) of the twenty-eight knees were painful. Twenty-five (89%) of the twenty-eight knees had visible evidence of soft-tissue injury on inspection. Magnetic resonance imaging revealed evidence of some abnormality in twenty-five (93%) of twenty-seven knees, with effusion (37%), bone bruise (33%), and meniscal tear (30%) being the most common findings.The present study provides (...) evidence of a high rate of associated ipsilateral knee injuries in patients with a traumatic hip dislocation. Bone bruises may provide a plausible explanation for persistent knee pain following a traumatic hip dislocation. The liberal use of magnetic resonance imaging is recommended for the evaluation of these patients in order to detect injuries that may not be discoverable on the basis of a history and physical examination alone.

2005 The Journal of Bone and Joint Surgery. American Volume

13000. Epidemiology of total knee replacement in the United States Medicare population. (Abstract)

among United States Medicare beneficiaries in the year 2000. Poisson regression was used to assess the relationships between demographic characteristics and the incidence rates of primary and revision knee replacement. Proportional hazards models were used to examine the relationships between the ninety-day rates of complications and demographic and clinical factors.The rate of primary knee replacement was lower in blacks than in whites and in those qualifying for Medicaid supplementation than (...) Epidemiology of total knee replacement in the United States Medicare population. There are limited population-based data on the utilization and outcomes of total knee replacement. The aim of the present study was to describe the rates of primary and revision total knee replacement and selected outcomes in persons older than sixty-five years of age in the United States.Using Medicare claims, we computed annual incidence rates of unilateral elective primary and revision total knee replacement

2005 The Journal of Bone and Joint Surgery. American Volume

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