Hee-Nee Pang

Purpose: The objective of this study was to compare the outcome of constrained and unconstrained primary total knee arthroplasty (TKA) in the management of the valgus deformity.Methods: This is a retrospective review of patients with type II valgus knee who underwent primary TKA from 1999 to 2011. There were fifty patients in Group 1 who underwent varus–valgus constrained TKA. They were matched with another fifty patients in Group 2 who underwent unconstrained TKA.Results: The mean joint line shift was significantly higher in Group 1 (+8 mm, SD 6 mm) than in Group 2 (+2 mm, SD 3 mm) (p = 0.03). At 2 years, there was no difference in anterior–posterior stability and mediolateral stability according to the Knee Society Score, and patients in Group 2 reported significantly better mean function score of 66.2 (SD 9.3) (mean 48, SD 7.1 in Group 1) (p = 0.002). Two patients (6 %) in Group 1 underwent revision surgery—one for a broken central peg and the other for aseptic loosening. Three patients (2 %) in Group 2 underwent revision surgery—two for global instability and one for poly wear. The estimated survivorship time was 8.3 years for constrained TKA and 12.0 for unconstrained TKA.Conclusion: Constrained TKA was associated with more significant joint line changes for the management of valgus arthritic knee, when compared with unconstrained TKA.Level of evidence: Retrospective study, Level III.

Purpose.: To report injury patterns and management of musculoskeletal injuries after an earthquake. Methods.: 94 male and 161 female patients aged 17 to 90 (mean, 53) years underwent surgery for musculoskeletal injuries. Their injury patterns, anaesthesia administered, surgeries undertaken, and development of postoperative complications were reviewed. Results.: Of the 255 patients, 155 sustained superficial lacerations with minor soft-tissue contusion, whereas 100 sustained injuries that necessitated surgery under anaesthesia. The injuries involved the tibia/ankle (n=90), the hand (n=48), the pelvis/femur (n=41), the radius/ulnar (n=36), the foot (n=20), the humerus (n=10), and the spine (n=10). 30 (12%) of the patients had multiple injuries. The most common procedure performed was debridement (n=58), followed by open reduction and internal fixation with plates and screws for closed fractures (n=20), Kirschner wiring (n=11), external fixation (n=8), and general surgery and others (n=6). Repeated debridements were performed for 19 open fractures; 10 involved the distal tibia. 63 procedures were carried out under anaesthesia or sedation. General anaesthesia involved 2 patients; one had a right hemi-colectomy for an ischaemic bowel and another had an appendicectomy. Regional anaesthesia included sub-arachnoid block for lower-limb surgeries (n=21), axillary brachial plexus block for upper-limb surgeries (n=11), and femoral and sciatic nerve blocks for a lower-limb surgery (n=1). The remaining 28 procedures involved conscious sedation. The mean number of debridements for open fractures was 2.8 (range, 2–5). The mean follow-up duration was 10.4 (range, 7–14) days. Only one patient developed a postoperative wound infection. Conclusion.: Our team was effective in managing orthopaedic injuries after an earthquake. The postoperative complication rate was low. Regional and spinal anaesthesia are relatively safe alternatives to general anaesthesia when carried out under such austere circumstances. The success of the mission depended on collaboration with the local health care workers and external agencies.

Purpose: The objective of this prospective study was to compare the functional outcome of conventional measured resection technique and computer‐assisted gap balancing technique in TKA.Methods: 140 patients were randomized into two groups. The conventional measured resection technique without computer navigation was performed in Group 1 and the computer‐assisted gap balancing technique in Group 2. Range of motion, clinical laxity assessment with KT‐1000 arthrometer, postoperative radiological films and various functional knee scores were documented at 6 months and 2 years.Results: At 2 years, there were significantly more patients (five patients, 7%) in the Group 1 with flexion contractures of more than 5° (P = 0.05). There were significantly more outliers in the Group 1 (eight patients, 11%), who demonstrated anterior tibial translation >5 mm, than Group 2 (two patients, 3%) (P = 0.041). The total excursion at 20° was significantly higher in Group 1 at 6 months (P = 0.012) and after 2 years (P = 0.031). Group 2 was able to demonstrate significantly better limb alignment with fewer outliers (more than 3° varus/valgus) than Group 1. At 6‐month follow‐up, Group 2 demonstrated better outcomes in Function Score (P = 0.040) and Total Oxford Score (P = 0.031). At 2‐year review, Group 2 had better outcome in the Total Oxford Score (0.030).Conclusion: Computer‐assisted gap balancing technique was able to achieve more precise soft tissue balance and restoration of limb alignment with better knee scores as compared to the conventional measured resection technique in total knee arthroplasty.Level of evidence: I.

We have performed a prospective double-blind, randomised controlled trial over two years to evaluate the efficacy and safety of an intra-operative peri-articular injection of triamcinolone acetonide in patients undergoing medial unicondylar knee replacement. We randomised 90 patients into two equal groups. The study group received an injection of triamcinolone acetonide, bupivacaine, and epinephrine into the peri-articular tissues at the end of the operation. The control group received the same injection mixture but without the addition of triamcinolone. The peri-operative analgesic regimen was standardised.The study group reported a significant reduction in pain (p = 0.014 at 12 hours, p = 0.031 at 18 hours and p = 0.031 at 24 hours) and had a better range of movement (p = 0.023 at three months). There was no significant difference in the rate of infection and no incidence of tendon rupture in either group.The addition of corticosteroid to the peri-articular injection after unicondylar knee replacement had both immediate and short-term benefits in terms of relief from pain, and rehabilitation with no increased risk of infection.

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