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Knee Exam

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13001. Surface damage of patellar components used in total knee arthroplasty. (Abstract)

Surface damage of patellar components used in total knee arthroplasty. Patellofemoral complications are a common cause of failure of total knee replacement. In this study, we examined eighty-five patellar components that had been retrieved for a variety of reasons after a mean of 71.9 months in vivo. The objective of this study was to identify factors contributing to surface damage of patellar components in total knee replacements.The retrieved patellar components were of three primary designs (...) by others who examined retrieved tibial inserts. The results of this study suggest that the use of congruent patellar components may reduce damage.

2005 The Journal of Bone and Joint Surgery. American Volume

13002. Patient-reported outcome and survivorship after Kinemax total knee arthroplasty. (Abstract)

Patient-reported outcome and survivorship after Kinemax total knee arthroplasty. We examined the long-term survivorship and patient-reported outcomes at a minimum of ten years following primary total knee arthroplasty. We hypothesized (1) that the survival rate would be at least 90% at ten years; (2) that age, gender, body-mass index, and primary diagnosis would not affect the survival rate; and (3) that the functional status of patients would be comparable with that of an age and gender (...) -matched normal population.A total of 407 patients (523 knees) who had had primary total knee arthroplasty between January 1988 and April 1991 were identified. The mean age of the patients at the time of surgery was sixty-nine years, and 68% of the patients were women. At ten years, 165 patients (211 knees) had died; seven of these 211 knees had been revised before the time of death. Of the remaining 242 patients, 208 (86%) completed a questionnaire, which included the Western Ontario and McMaster

2004 The Journal of Bone and Joint Surgery. American Volume

13003. 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

2004 The Journal of Bone and Joint Surgery. American Volume

13004. Bilateral total knee arthroplasty increases the propensity to trip on an obstacle. (Abstract)

Bilateral total knee arthroplasty increases the propensity to trip on an obstacle. Tripping over an obstacle is the most frequent cause of falls. We examined the effects of total knee arthroplasty on obstacle avoidance success rates in older adults. Obstacle avoidance success rates, body mass index, visual acuity, contrast sensitivity, depth perception, and single-leg stance duration were evaluated in 29 subjects who had bilateral total knee arthroplasties (age range, 72.6 +/- 5.4 years) and 27 (...) age-matched healthy control subjects (age range, 70.6 +/- 5.5 years). The patients who had total knee arthroplasties had a lower obstacle avoidance success rate, lower single-leg stance duration, and greater body mass index than control subjects. Age, contrast sensitivity, and depth perception were not different between patients who had total knee arthroplasties and control subjects. Obstacle avoidance success rates decreased linearly as single-leg stance duration decreased in the control group

2005 Clinical Orthopaedics and Related Research

13005. Using self-assessed health to predict patient outcomes after total knee replacement. (Abstract)

Using self-assessed health to predict patient outcomes after total knee replacement. Self-assessed health status has been shown to be a powerful predictor of mortality, service use, and total cost of medical care treatment. We investigated the potential for self-assessed health to further serve as a predictor of improvement in health status after a clinical intervention. Using the five-category measure of self-assessed health (excellent, very good, good, fair, or poor), we examined patients (...) ' improvements in health status after total knee arthroplasty in each of the WOMAC-defined categories for health status in patients. The results indicate that the greater patients rated their preoperative health, the greater their postoperative improvement. The results suggest that a simple process of asking patients to rate their own health in a presurgery clinic could be a powerful tool in predicting patient outcome. This also suggests that by stratifying preoperative self-assessed health, potential

2005 Clinical Orthopaedics and Related Research

13006. Early failure of minimally invasive unicompartmental knee arthroplasty is associated with obesity. (Abstract)

Early failure of minimally invasive unicompartmental knee arthroplasty is associated with obesity. There has been increasing use of and expanding indications for unicompartmental knee arthroplasty using minimally invasive techniques. We sought to define contraindications by examining failures. We retrospectively reviewed the early results of a consecutive series of minimally invasive medial unicompartmental knee arthroplasty using two implant designs. Seventy-nine consecutive unicompartmental (...) knee arthroplasty cases (48 instrumented and 31 noninstrumented) with minimum 2-year followup were reviewed. Patients with radiographic involvement with or without pain referable to the lateral compartment or to the patellofemoral joint were not considered candidates. Failure was defined as revision or pending revision. The average followup was 40.2 months. There were 16 failures (six tibial loosening, three plateau fracture, four persistent medial pain, one progressive arthritis, and two sepsis

2005 Clinical Orthopaedics and Related Research

13007. Implications of the pivot shift in the ACL-deficient knee. (Abstract)

Implications of the pivot shift in the ACL-deficient knee. The Losee repair controls rotational subluxation of the lateral femoral condyle, or pivot shift, but does not reliably eliminate Lachman laxity. Despite this surgical limitation, many patients who were operated on continued to do high-demand activities at the last followup. We hypothesized that Lachman findings alone did not predict poor surgical outcome or progression to osteoarthritis. We report on 87 patients evaluated at an average (...) of 9 years (range, 5-21 years) postoperatively. Prospectively collected examinations and radiographic, subjective, and objective outcome measures were recorded and statistically evaluated. The presence of a postoperative pivot shift or residual varus laxity correlated with poor patient subjective evaluations and poor scoring outcomes. Lachman laxity with an absent pivot shift had no correlation with the outcome measures or onset of radiographic progression to osteoarthritis. Meniscectomy

2005 Clinical Orthopaedics and Related Research

13008. Flexion instability without dislocation after posterior stabilized total knees. (Abstract)

Flexion instability without dislocation after posterior stabilized total knees. Flexion instability after cruciate-retaining total knee arthroplasty has been well documented. We identified an analogous patient group with symptomatic flexion instability without dislocation after primary posterior stabilized total knee arthroplasty. We sought to determine the typical symptoms and exam findings that lead to the diagnosis, to assess the reliability of revision total knee arthroplasty as a treatment (...) , and to assess the technical difficulties encountered during revision total knee arthroplasty. Between 1995 and 2001, 10 patients had revision of a well-fixed posterior stabilized total knee arthroplasty for isolated symptomatic flexion instability. The typical constellation of symptoms and physical findings included a sense of instability without giving way, recurrent knee effusions, multiple areas of soft tissue tenderness about the knee, and substantial anterior tibial translation at 90 degrees of flexion

2005 Clinical Orthopaedics and Related Research

13009. Tibial component failure mechanisms in total knee arthroplasty. (Abstract)

Tibial component failure mechanisms in total knee arthroplasty. The purpose of this study was to examine the failure mechanisms and factors associated with failure of a nonmodular metal backed cemented tibial component. Out of 3152 total knee replacements done for osteoarthritis, 41 tibial components had been revised (1.3%). Four distinct failure mechanisms were identified: 20 knees were revised for medial bone collapse, 13 for ligamentous imbalance, 6 for progressive radiolucencies, and 2 (...) for pain. Factors associated with medial bone collapse were varus tibial component alignment more than 3.0 degrees , Body Mass Index higher than 33.7, and overall postoperative varus limb alignment. Ligamentous imbalance was more prevalent in knees with preoperative valgus deformity. There were no knees revised for tibial component polyethylene wear or osteolysis. We conclude that the dominant failure mechanisms for this component design are related to preoperative deformity, technical factors

2004 Clinical Orthopaedics and Related Research

13010. Clinical significance of gelatinases in septic arthritis of native and replaced knees. (Abstract)

Clinical significance of gelatinases in septic arthritis of native and replaced knees. We hypothesized that more gelatinases appear in effusions of septic arthritis than aseptic arthritis. This study examined the laboratory variables of inflammation and the levels of gelatinase A and B (matrix metalloproteinases-2 and -9) in 75 effusions from the knees of 37 patients with inflammatory arthritis and compared them with effusions of septic and aseptic arthritis. Gelatin zymography revealed (...) that the levels of the latent matrix metalloproteinase-9 were higher in 24 effusions of septic arthritis than in 51 effusions of aseptic arthritis. The latent matrix metalloproteinase-9 levels of septic arthritis also correlated with the neutrophil counts in effusions. Significantly more activated matrix metalloproteinases-2 and -9 appeared in effusions of septic arthritis in native and replaced knees than in effusions of aseptic arthritis. A high matrix metalloproteinase-9 level and the appearance

2004 Clinical Orthopaedics and Related Research

13011. Long-term outcome of meniscal degeneration in the knee: poor association between MRI and symptoms in 45 patients followed more than 4 years. Full Text available with Trip Pro

Long-term outcome of meniscal degeneration in the knee: poor association between MRI and symptoms in 45 patients followed more than 4 years. Knee joint-related symptoms are frequent and the use of MRI as a diagnostic tool is common. About 25% of MRIs show meniscal degeneration (MD). As the natural history of MD has not been well described, we studied the long-term outcome of 50 MDs. 45 patients were initially evaluated by a MRI, and clinical examination and later by another MRI. After 5 years (...) , 38 of the MDs were unchanged, 8 had progressed and 4 regressed. Progression of MD was associated with age over 40 years, trauma during the follow-up period and/or other knee lesions, such as osteoarthrosis and ligament rupture. The clinical findings were consistent with MDs only in 8 cases.

2004 Acta Orthopaedica Scandinavica

13012. Impact of psychological distress on pain and function following knee arthroplasty. (Abstract)

Impact of psychological distress on pain and function following knee arthroplasty. Preoperative psychological distress has been reported to be an important risk factor for poor outcome following lower-extremity arthroplasty. We determined the independent impact of preoperative psychological distress on three, twelve, and twenty-four-month WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain and function scores and on change scores over those time periods.Data were (...) preoperative and three, twelve, and twenty-four-month WOMAC pain and function scores and general linear models were used to derive change scores for patients with and without psychological distress after adjustment for covariates.Psychological distress, when examined on a continuous scale, was found to predict pain and function at all time-points. WOMAC pain scores for psychologically distressed patients were 3 to 5 points lower, depending on the time-frame, than the scores for the non-distressed patients

2007 The Journal of Bone and Joint Surgery. American Volume

13013. Patellofemoral overstuff and its relationship to flexion after total knee arthroplasty. (Abstract)

constraints may increase trochlear groove height in the anterior compartment, increase the arc that the extensor mechanism must travel, and thereby decrease passive flexion. We determined the trochlear groove height change in 55 patients after primary total knee arthroplasties. The thickness of the replaced lateral and medial anterior flanges increased by 1.1 +/- 2.6 mm and 0.5 +/- 2.2 mm, respectively, whereas the change in trochlear groove thickness was 0 +/- 1.1 mm. We examined varying amounts (...) Patellofemoral overstuff and its relationship to flexion after total knee arthroplasty. Flexion is an important outcome variable after total knee arthroplasty. Traditionally, matched implant-bone resections of the distal and posterior aspects of the femur are used to prevent loss of knee flexion or extension. However, given limited implant sizes, resection of these portions of the femur may affect the shape of the knee. Variations in the anterior aspects of the femur along with implant size

2006 Clinical Orthopaedics and Related Research

13014. The Chitranjan Ranawat Award: Long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties. (Abstract)

The Chitranjan Ranawat Award: Long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties. We examined factors affecting survivorship, and reasons for reoperation and revision of a cemented modular condylar total knee arthroplasty (TKA). One thousand and eight consecutive primary cemented cruciate-retaining TKAs performed at one institution were studied. At the time of review, 411 patients (562 knees) had died, 43 patients (45 knees) had their knee components (...) revised or removed, and 47 patients (62 knees) were lost to followup. Mean followup of living patients with their TKA components in situ (244 patients, 331 knees) was 15.7 years. Survivorship at 15 years for revision for any reason, revision for mechanical failure, and revision for aseptic loosening were 95.9%, 97.0%, and 98.8% respectively. Survivorship was poorer among patients aged less than 60. Forty-five knees had components removed or revised; approximately one-third were removed for infection

2006 Clinical Orthopaedics and Related Research

13015. The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty. (Abstract)

completed a self-administered, validated "Knee Function Questionnaire," which examined each patient's participation in a broad range of activities involving the knee, their level of satisfaction, and the extent to which TKR had fulfilled their expectations. The association between function, expectation and satisfaction was examined using univariate and multivariate logistic regression. Seventy-five percent of patients were either "satisfied" or "very satisfied" with their knee replacement, while 14 (...) The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty. Satisfaction with the outcome of total knee arthroplasty is highly variable, with a small but significant percentage of patients reporting dissatisfaction with the procedure. The purpose of this study was to determine which factors contribute to patient satisfaction with total knee replacement (TKR), and their relative importance. At a minimum of 1 year post unilateral primary TKR, 253 patients

2006 Clinical Orthopaedics and Related Research

13016. Internet promotion of MIS and CAOS in TKA By Knee Society members. (Abstract)

Internet promotion of MIS and CAOS in TKA By Knee Society members. Minimally invasive surgery (MIS) and computer-assisted orthopaedic surgery (CAOS) options for total knee arthroplasty (TKA) have become increasingly popular. However, few controlled studies document their efficacy and safety. We examined the Internet for Knee Society members' websites to evaluate the level of promotion for these procedures in terms of direct (surgeon endorsed) and indirect (surgeon associated) information. On 92

2006 Clinical Orthopaedics and Related Research

13017. Morselized bone grafting in revision arthroplasty of the knee: a retrospective analysis of 34 reconstructions after 2-9 years. Full Text available with Trip Pro

) with a mean age of 63 (34-81) years who, between 1994 and 2002, underwent revision arthroplasty of the knee using hinge or rotational knee prostheses (Link) and impaction bone grafting. The average follow-up was 4 (2-9) years and included a questionnaire, a clinical examination, and standardized radiographs.25 patients were satisfied with their results. 10 patients reported no impairment in their activities of daily living attributed to their operation and did not need any walking support. In 5 patients (...) Morselized bone grafting in revision arthroplasty of the knee: a retrospective analysis of 34 reconstructions after 2-9 years. Loosening of a total knee replacement may lead to loss of bone, requiring biological reconstruction at revision arthroplasty. Good results have been reported from revision arthroplasty of the hip using impaction bone grafting. We report our results of revision total knee arthroplasty using the same technique.We retrospectively analyzed 30 patients (involving 34 knees

2008 Acta Orthopaedica

13018. Reproductive history, hormonal factors and the incidence of hip and knee replacement for osteoarthritis in middle-aged women. (Abstract)

Reproductive history, hormonal factors and the incidence of hip and knee replacement for osteoarthritis in middle-aged women. To examine the effect of reproductive history and use of hormonal therapies on the risk of hip and knee joint replacement for osteoarthritis.A prospective study of 1.3 million women aged on average 56 years at recruitment and followed-up through linkage to routinely collected hospital admission records was conducted. The adjusted relative risk (RR) of hip and knee (...) replacement for osteoarthritis was examined in relation to parity, age at menarche, menopausal status, age at menopause and use of hormonal therapies.Over a mean of 6.1 person-years of follow-up, 12 124 women had a hip replacement and 9977 a knee replacement. The risk of joint replacement increased with increasing parity and the effect was greater for the knee than the hip: increase in RR of 2% (95% CI 1 to 4%) per birth for hip replacement and 8% (95% CI 6 to 10%) for knee replacement. An early age

2008 Annals of the Rheumatic Diseases

13019. The effects of total knee arthroplasty on physical functioning in the older population. (Abstract)

of physical functioning in a national sample of older adults.Data were obtained from the Medicare Current Beneficiary Survey from 1992 to 2003. Medicare claims data identified participants with osteoarthritis of the knee who received TKA (n=259) or no TKA (n=1,816). Propensity scores were used to match treatment and no-treatment groups according to demographic characteristics, comorbid conditions, and baseline functioning. Three levels of physical functioning were examined as outcomes of TKA. These levels (...) The effects of total knee arthroplasty on physical functioning in the older population. Clinical research provides convincing evidence that total knee arthroplasty (TKA) is safe and improves joint-specific outcomes. However, higher-level functioning associated with self care and independent living has not been studied. Furthermore, most previous studies of the effects of TKA relied on relatively small clinical samples. We undertook this study to estimate the effects of TKA on 3 levels

2008 Arthritis and Rheumatism

13020. Change in MRI-Detected subchondral bone marrow lesions is associated with cartilage loss - the MOST study A longitudinal multicenter study of knee osteoarthritis. Full Text available with Trip Pro

Change in MRI-Detected subchondral bone marrow lesions is associated with cartilage loss - the MOST study A longitudinal multicenter study of knee osteoarthritis. To describe the natural history of subchondral bone marrow lesions (BMLs) in a sample of subjects with knee osteoarthritis (OA) or at risk of developing it. Additionally, to examine the association of change in BMLs from baseline to 30-month follow-up with the risk of cartilage loss in the same subregion at follow-up.1.0 T MRI (...) was performed using proton density-weighted, fat-suppressed sequences. BML size and cartilage status were scored in the same subregions according to the WORMS system. Subregions were categorised based on comparison of baseline and follow-up BML status. A logistic regression model was used to assess the association of change in BML status with cartilage loss over 30 months using stable BMLs as the reference group.395 knees were included. 66% of prevalent BMLs changed in size; 50% showed either regression

2008 Annals of the Rheumatic Diseases

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