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Nakano N, Tsubosaka M, Kamenaga T, Kuroda Y, Ishida K, Hayashi S, Kuroda R, Matsumoto T. What effect does preoperative flexion contracture have on the component angles in unicompartmental knee arthroplasty? Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03929-3. [PMID: 38573382 DOI: 10.1007/s00590-024-03929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE The indication for unicompartmental knee arthroplasty (UKA) has been extended to cases with some degree of preoperative knee flexion contracture recently. The purpose of this study was to clarify the effect of flexion contracture on component angles. MATERIALS AND METHODS Thirty-five fixed-bearing UKAs using the spacer block technique with preoperative flexion contracture (Group FC) and 35 UKAs using the same technique without preoperative flexion contracture (Group NC) were included. Using radiographs, the coronal femoral component angle, coronal tibial component angle, sagittal femoral component angle, and sagittal tibial component angle were determined. Also, extension and flexion angles of the knee as well as coronal Hip-Knee-Ankle (HKA) angles in long-leg standing radiographs were measured. The data about the thickness of the selected insert were also collected. The above results were compared between the two groups. RESULTS The femoral component tended to be placed in a more varus and flexed position in Group FC, while no significant difference was found about the tibial component angles. While there was no significant difference in pre- and postoperative knee flexion angles between the two groups, flexion contracture remained postoperatively in Group FC. Preoperative HKA angle was greater in Group FC while the difference was no longer significant postoperatively. Regarding the thickness of the selected insert, thicker inserts tended to be used in Group FC. CONCLUSIONS In fixed-bearing UKA with the spacer block technique, the femoral component tended to be placed in a flexed and varus position in the knees with preoperative flexion contracture.
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Affiliation(s)
- Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinoharakita-machi, Nada-ku, Kobe, Hyogo, 657-0068, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Yang X, Wang Q, Meng Z, Liu H, Wu H, Juma T, Pan L, Wang Y, Cao Y. A Femoral Neck Osteotomy for the Patients with Ankylosing Spondylitis and Thoracolumbar Kyphosis Combined with Hip Flexion Contracture. Orthop Surg 2024; 16:245-253. [PMID: 37975214 PMCID: PMC10782266 DOI: 10.1111/os.13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE The surgical treatment of patients with ankylosing spondylitis and severe thoracolumbar kyphosis combined with hip flexion contracture is very difficult for all the surgeons. The femoral neck osteotomy (FNO) is the first step to break the ice. The evaluation of a new modified FNO method is very important to improve the curative effect. METHODS Five male patients with nine bone-fused hips who underwent the new femoral neck osteotomy were included from October 2021 to March 2022. The FNO was designed that the saw blade was manipulated from the lateral femoral neck base to the inferior part of the femoral head, keeping Pauwels' angle less than 30° on the coronal plane. On the transverse plane, the angle between the saw blade and the coronal plane was more than 15°. On the sagittal plane, the saw blade cut through the femoral neck. They accepted pedicle subtraction osteotomy (PSO) after FNO according to the patient' recovery. Then, 2 weeks later, the patients underwent total hip arthroplasty (THA). The visual analogue scale (VAS), Harris hip score (HHS) and passive hip flexion-extension range of motion (ROM) were used to evaluate hip function. The data were analyzed by paired t-test. RESULTS The average operation time and blood loss of FNO, the average interval between FNO and THA were collected. The average angle of the trunk and lower limb (ATL) was 36.33° ± 16.36° pre-FNO, 82.89° ± 13.51° post-FNO and 175.22° ± 3.42° post-THA. The average VAS scores were 0 pre-FNO, 5 ± 1.58 post-FNO and 2.6 ± 0.55 post-THA. The average HHS was 43.56 ± 1.59 preoperatively and 83.89 ± 2.21 postoperatively. The average hip extension ROM was 23.89° ± 12.69° pre-FNO, -22.67° ± 14.18° post-FNO and - 3.33° ± 2.50 post-THA°. The average hip flexion ROM was 23.89° ± 12.69° pre-FNO, 35.56° ± 12.11° post-FNO and 104.44° ± 5.27° post-THA. The differences among them were significant (p < 0.05). Only one hip (11.11%) displaced completely after FNO. CONCLUSION A new modified FNO was developed, which can provide osteotomy with a certain degree of stability and greater ease for performing PSO and THA.
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Affiliation(s)
- Xin Yang
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Qiwei Wang
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Zhicao Meng
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Heng Liu
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Hao Wu
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Talante Juma
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Liping Pan
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Yu Wang
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Yongping Cao
- Department of OrthopaedicsPeking University First HospitalBeijingChina
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Lee JK, Oh CH, Oh J, Jeong S, Lim CK, Han SH. Surgical Treatment for Patients with Post-traumatic Flexion Contracture of Proximal Interphalangeal Joint: Analysis of Various Affecting Factors. J Hand Surg Asian Pac Vol 2023; 28:642-650. [PMID: 38073415 DOI: 10.1142/s2424835523500674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Background: A flexion contracture (FC) of the proximal interphalangeal (PIP) joint can have a profound negative influence on daily activity. The outcomes of surgical release of the PIP joint in literature are based on small sample size studies done several decades ago. The aim of this study is to report the outcomes of surgical treatment for post-traumatic FC of the PIP joint and to identify factors that affect these outcomes. Methods: This single institute retrospective study included patients from 2000 to 2020. We only included patients with post-traumatic FC of the PIP joint. We evaluated the demographic characteristics, cause of FC, surgical approaches and the various procedures conducted. We surveyed postoperative complications. During the study period, we asked about their current symptoms and evaluated their operative outcomes as excellent, good, fair or poor through the phone. Results: The average FC recovery angle was 37.3°. The small finger was the most affected, and the most common cause of FC was a tendon laceration. The volar plate complex release was the most frequently conducted procedure. The FC improvement was positively correlated to the degree of preoperative FC. The more severe preoperative flexion-extension arc was presented, the more FC recovery was achieved after operation. Patients who underwent multiple procedures had a higher degree of preoperative FC, and better correction was achieved with multiple procedures than with a single procedure. The most critical complication was recurrence. Conclusions: We were able to obtain average 37.3° of extension by surgical treatment. The more severe the FC presented before surgery, the greater the need for multiple procedures, however, this resulted in a significant increase in joint extension. Nevertheless, caution should be exercised regarding recurrence and could occur even with an experienced surgeon. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Jun-Ku Lee
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Chi Hoon Oh
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jongbeom Oh
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Simho Jeong
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Chae Kwang Lim
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Soo-Hong Han
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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Villa M, Farrar J, Larkin K, Satpathy J, Isaacs J, Patel N. Prophylactic Common Peroneal Nerve Release for Total Arthroplasty of the Valgus Knee: Surgical Technique and Early Outcomes. Arthroplast Today 2023; 23:101205. [PMID: 37649876 PMCID: PMC10463189 DOI: 10.1016/j.artd.2023.101205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/11/2023] [Accepted: 07/23/2023] [Indexed: 09/01/2023] Open
Abstract
Background Common peroneal nerve (CPN) palsy after primary total knee arthroplasty represents a relatively rare but serious complication. Recently, there has been a growing interest in prophylactic CPN decompression in high-risk patients with significant combined valgus and flexion deformity. This study aimed to examine outcomes at our institution in those undergoing prophylactic CPN decompression at the time of total knee arthroplasty. Methods A retrospective evaluation of a single-institution experience with selected patients at high risk for CPN palsy who underwent prophylactic nerve decompression through a separate incision at the time total knee arthroplasty was performed between July 1, 2018 and December 31, 2022. Patient demographics as well as perioperative and intraoperative clinical and radiographic measurements were collected and analyzed. Results A total of 14 patients (15 knees) met our inclusion criteria. The mean preoperative femorotibial angle was 18.6° of valgus (range 13°-22°). The mean preoperative flexion contracture was 4.3° (range 0°-25°). The patients with flexion contractures preoperatively had a mean combined valgus/flexion contracture deformity of 28.8° (range 23°-38°) . There was preservation of nerve function in all knees. No knees required subsequent operative intervention within 90 days of surgery. Conclusions Early experience with prophylactic CPN release in our high-risk population demonstrates preservation of nerve function in all patients and is reasonable to consider in patients with a large preoperative combined valgus/flexion deformity. Further studies with larger sample sizes would be beneficial in verification of the results with this technique, as well as determining an angular deformity threshold for which CPN release should be considered.
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Affiliation(s)
- Morgan Villa
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jacob Farrar
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Kevin Larkin
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Jibanananda Satpathy
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Jonathan Isaacs
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Nirav Patel
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
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Song SJ, Lee HW, Park CH. Predictors of Recurrent Flexion Contracture after Total Knee Arthroplasty in Osteoarthritic Knees with Greater Than 15° Flexion Contracture. Clin Orthop Surg 2023; 15:770-780. [PMID: 37811511 PMCID: PMC10551682 DOI: 10.4055/cios22207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/16/2022] [Accepted: 09/05/2022] [Indexed: 10/10/2023] Open
Abstract
Background This study aimed to analyze the risk factors that predict recurrent flexion contracture (FC) after total knee arthroplasty (TKA) in osteoarthritic knees with FC ≥ 15°. Methods Data from a consecutive cohort comprising 237 TKAs in 187 patients with degenerative osteoarthritis, preoperative FC ≥ 15°, and a minimum follow-up period of 2 years were retrospectively reviewed. Preoperative FC was corrected intraoperatively from 0° to 5°. The incidence of recurrent FC (FC ≥ 10°) at 2 years postoperatively was investigated. Potential risk factors predicting recurrent FC including age, sex, body mass index, unilateral TKA, severity of preoperative FC, 3-month postoperative residual FC, γ angle, change in posterior femoral offset ratio, and lumbar degenerative kyphosis (LDK) were analyzed using logistic regression analysis. The post-hoc powers for the identified factors were then determined. Results Forty-one knees (17.3%) with recurrent FC were identified. Risk factors with sufficient power for recurrent FC were unilateral TKA, severity of preoperative FC, residual FC at 3 months postoperatively, and LDK (odds ratios of 3.579, 1.115, 1.274, and 3.096, respectively; p < 0.05; power ≥ 86.1). Conclusions Recurrent FC can occur in TKAs with the risk factors including unilateral TKA, severe preoperative FC, residual FC at 3 months postoperative, and LDK despite appropriate intraoperative correction. Surgical strategies and rehabilitation protocols used in managing FC should be applied in TKA cases with risk factors for recurrent FC.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
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Inoue A, Arai Y, Nakagawa S, Yoshihara Y, Kobayashi M, Takahashi K. The clinical results of bi-cruciate vs posterior stabilized total knee arthroplasty for flexion contracture in osteoarthritic knee. J Orthop Surg (Hong Kong) 2023; 31:10225536231190524. [PMID: 37817454 DOI: 10.1177/10225536231190524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The improvement of flexion contracture is important in knee arthroplasty since residual flexion contracture postoperatively is associated with decreased quality of life and patient satisfaction. In this study, we investigated the effect of bi-cruciate stabilized (BCS)-type total knee arthroplasty (TKA) as compared to posterior stabilized (PS)-type TKA on osteoarthritic primary knees with flexion contractures. METHODS 59 TKAs from January 2014 to December 2020, of which 30 were PS-type TKAs (NexGen LPS-flexⓇ; 76.3 years, BMI 27.5) and 29 BCS-type TKAs (Journey IIⓇ; 72.5 years, BMI 28.6), were performed for knee osteoarthritis with preoperative flexion contracture of 15° or greater. Full extension was obtained intraoperatively during all TKAs. Clinical outcomes, radiological evaluations, and the amount of additional distal femoral osteotomy during TKA were evaluated in a retrospective study design. RESULTS The range of motion improved in the both groups. Postoperative flexion contracture was significantly improved in the BCS group. Knee Society Score improved significantly in both groups, with no difference between the two groups. The amount of additional distal femoral osteotomy was 2.5 ± 1.3 mm for the PS group, and 1.8 ± 1.5 mm for the BCS group, showing a significant difference (p = 0.04). DISCUSSION The BCS-type TKA significantly improved preoperative flexion contracture and reduced the amount of additional distal femoral osteotomy compared to PS-type TKA. This is attributed to the anterior cam in the BCS-type TKA, which leads to a smaller amount of protrusion of the posterior femoral condyle from the posterior margin of the tibial component in the BCS-type in knee extension, as compared to the PS-type.
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Affiliation(s)
- Atsuo Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Orthopaedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasushi Yoshihara
- Department of Orthopaedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Masashi Kobayashi
- Department of Orthopaedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
- Kobayashi Orthopaedic Clinic, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Diebo BG, Balmaceno-Criss M, Daher M, Daniels AH. Bilateral psoas release for long standing hip-spine syndrome: surgical technique and case report. N Am Spine Soc J 2023; 15:100247. [PMID: 37636341 PMCID: PMC10458283 DOI: 10.1016/j.xnsj.2023.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/13/2023] [Accepted: 07/23/2023] [Indexed: 08/29/2023]
Abstract
Background Severe positive sagittal malalignment can potentially lead to shortening and contracture of the psoas and joint capsule in a flexed spinopelvic position. The utilization of bilateral psoas release to supplement sagittal spinal deformity correction in the same hospitalization was not reported in the literature. Case presentation A 66-year-old patient presented with a 5-year history of severe global spinal deformity (sagittal vertical axis 220 mm, 60° spinopelvic mismatch) that did not improve on supine radiographs, and a modified Thomas test with more than 30° flexion contracture of bilateral hips. A 3-stage operation utilizing posterior spinal column osteotomies, anterior lumbar interbody fusion, and bilateral psoas releases was performed. Outcome Her postoperative alignment significantly improved and she was pleased with her new posture and the ability to stand up straight. Conclusions This report is the first to demonstrate safe and substantial correction of severe spinal deformities associated with bilateral hip flexion contracture in 1 hospitalization.
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Affiliation(s)
- Bassel G. Diebo
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States
- Spine surgery division, University Orthopedics Inc, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States
- Spine surgery division, University Orthopedics Inc, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Mohammad Daher
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States
- Spine surgery division, University Orthopedics Inc, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Alan H. Daniels
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States
- Spine surgery division, University Orthopedics Inc, 1 Kettle Point Ave, East Providence, RI, 02914, United States
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Tate JP, Schneider AM, Brown NM. Femoral Component Fracture in a Total Knee Arthroplasty Patient With a Persistent Flexion Contracture. Arthroplast Today 2023; 22:101174. [PMID: 37521733 PMCID: PMC10374856 DOI: 10.1016/j.artd.2023.101174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023] Open
Abstract
This article reports a rare case of a total knee arthroplasty femoral component fracture. Fractures of early knee systems were attributed to design flaws. Modern design failures have been attributed to poor surgical technique or underlying osteolysis. Here, we report a fracture in the Vanguard prosthesis (Zimmer Biomet, Warsaw, IN) 12 years after implantation in a patient with a persistent flexion contracture. The fracture likely occurred due to fatigue failure of the anterior flange secondary to increased stress from a high riding patella. Although femoral component fractures are rare, they should be considered as a potential complication, especially in patients with special load considerations. For these patients, it is essential that the prosthesis be properly supported with clean cuts and an adequate cement mantle.
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Affiliation(s)
- Jackson P. Tate
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Andrew M. Schneider
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Nicholas M. Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
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Punsola-Izard V, Schultz KS, Ozaes-Lara E, Mendieta-Zamora J, Casado A, Llusà-Perez M. Case report illustrating use of serial elastic tension digital neoprene orthoses (ETDNO) protocol in the treatment of proximal interphalangeal joint flexion contracture. J Hand Ther 2023; 36:684-692. [PMID: 35909069 DOI: 10.1016/j.jht.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/19/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This case report details the application of a treatment regimen using a serial elastic tension digital neoprene orthosis (ETDNO) protocol for a patient with an eight-month-old finger crush injury who experienced recurrence of a 45º proximal interphalangeal joint (PIPJ) flexion contracture two months after arthrolysis. PURPOSE OF THE STUDY To illustrate how the application strategy of ETDNO can increase the daily total end range time (TERT) and modify finger stiffness. RESULTS The patient reached full extension following 15 weeks of ETDNO treatment. The six-month follow-up evaluation revealed that the PIPJ was stable with full flexion and extension. The joint did not require continued orthosis use. DISCUSSION The literature describes orthosis application as the treatment of choice for PIPJ flexion contracture, but no study has described an ideal program for use nor the full and stable resolution of the flexion contracture. The current literature describes a maximum daily total end range time (TERT) of 12 hours a per day. The serial ETDNO protocol that this study described increased the daily TERT to nearly 24 hour per day and demonstrated an excellent result in the treatment of PIPJ flexion contracture CONCLUSION: This outcome suggests that clinicians will want to consider this new orthosis design and management protocol as a novel option for the treatment of PIPJ flexion contracture. We need future research to better define the optimum number of hours of daily TERT for the effective treatment of PIPJ flexion contracture. In addition, we will also benefit from the exploration of the optimum orthosis design to enable the highest amount of TERT.
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Affiliation(s)
- Vicenç Punsola-Izard
- Hand Therapy Barcelona, Barcelona, Spain; Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain; Gimbernat University School of Physical Therapy, Barcelona, Spain.
| | - Karen S Schultz
- Senior Consulting Therapist: Karen Schultz Hand and Upper Limb Strategies (KSHULS); Senior Occupational Therapist/Hand and Upper limb service of the University of Colorado
| | | | - Judit Mendieta-Zamora
- Hand Therapy Barcelona, Barcelona, Spain; Gimbernat University School of Physical Therapy, Barcelona, Spain
| | - Aroa Casado
- Hand Therapy Barcelona, Barcelona, Spain; Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain; Gimbernat University School of Physical Therapy, Barcelona, Spain
| | - Manuel Llusà-Perez
- Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
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Shichman I, Ben-Ari E, Sissman E, Singh V, Hepinstall M, Schwarzkopf R. Total knee arthroplasty in patients with lumbar spinal fusion leads to significant changes in pelvic tilt and sacral slope. Arch Orthop Trauma Surg 2023; 143:2103-2110. [PMID: 35536355 DOI: 10.1007/s00402-022-04462-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The knee-hip-spine syndrome has been well elucidated in the literature in recent years. The aim of this study was to evaluate the effect of total knee arthroplasty (TKA) on spinopelvic sagittal alignment in patients with and without pre-TKA lumber spinal fusion. METHODS This is a retrospective cohort study of 113 patients who underwent TKA for primary osteoarthritis. Patients were stratified into the following three groups: (1) patients who had pre-TKA spinal fusion (SF, n = 19), (2) patients who had no spinal fusion but experienced pre-TKA flexion contracture (FC, n = 20), and (3) patients without flexion contracture or spinal fusion before TKA (no SF/FC, n = 74). Spinopelvic sagittal alignment parameters, including pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and plumb line-sacrum distance (SVA) were measured preoperatively and 3 months postoperatively on lateral standing full-body low-dose images. RESULTS TKA resulted in significant pre- to postoperative changes in pelvic tilt (average ∆ PT = - 8.6°, p = 0.018) and sacral slope (average ∆ SS = 8.6°, p = 0.037) in the spinal fusion (SF) group. Non-significant changes in spinopelvic sagittal alignment parameters (PT, SS, LL, TK, SVA) were noted postoperatively in all patients in the FC and the no SF/FC groups. CONCLUSIONS TKA can lead to meaningful changes in spinopelvic alignment in patients with prior lumbar fusion compared to those without spinal fusion. Patients with spinal fusion who are candidates for both hip and knee replacements should consider undergoing TKA first since changes in spinopelvic sagittal alignment can increase the risk of future complications. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Ittai Shichman
- NYU Langone Health, Division of Adult Reconstruction, Department of Orthopedic Surgery, Hospital of Joint Diseases, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Erel Ben-Ari
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Ramat Gan, Israel
| | - Ethan Sissman
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Ramat Gan, Israel
| | - Vivek Singh
- NYU Langone Health, Division of Adult Reconstruction, Department of Orthopedic Surgery, Hospital of Joint Diseases, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Matthew Hepinstall
- NYU Langone Health, Division of Adult Reconstruction, Department of Orthopedic Surgery, Hospital of Joint Diseases, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- NYU Langone Health, Division of Adult Reconstruction, Department of Orthopedic Surgery, Hospital of Joint Diseases, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA.
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Su PH, Hsu CE, Ho TY, Wei BH, Wang WC, Chiu YC. Mathematical analysis in the design of digital artery-based V-Y advancement flap in treating proximal interphalangeal joint flexion contracture. BMC Musculoskelet Disord 2023; 24:33. [PMID: 36650507 PMCID: PMC9843851 DOI: 10.1186/s12891-023-06158-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The digital artery-based V-Y advancement flap is a widely used flap for soft tissue coverage in the treatment of flexion contracture of the proximal interphalangeal (PIP) joint. A standard method for the flap design and a mathematical method to predict the advance distance have not been well established. In this study, we proposed a simplified method for the design of V-Y advancement flaps based on digital arteries and used a geometric model to predict the advance distance for the flexion contracture correction surgery. METHODS According to the general concept of hand flap design and law of cosine, we proposed three principles in the design of the digital artery-based V-Y advancement flap that should be followed. Since 2021 to 2022, finger geometric data of 120 fingers (index, middle, ring, and small fingers) from 30 healthy participants were collected and analysed to evaluate the necessary advance distance and flap tip angle for PIP flexion contracture correction of different fingers by our flap design method. RESULTS The middle finger needed a significantly longer advance distance compared to other fingers in the same degree flexion contracture correction. The ring finger had the largest length-to width ratio and smallest flap tip angle among the four fingers in the V-Y flap design. No vertical scar crossed the flexion creases and flap tip angle < 20° was found in the tentative V-Y flap design for the 120 fingers. CONCLUSIONS Our flap design method provides a proper advance distance and flap length-to-width ratio without common skin complications in the flap design for PIP flexion contracture of index, middle, ring and small fingers. This geometric model provides a mathematical basis for prediction of advance distance and flap tip angle in the design of a digital artery-based V-Y advancement flap.
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Affiliation(s)
- Po-Han Su
- grid.254145.30000 0001 0083 6092School of Medicine, China Medical University, Taichung City, 404 Taiwan ,Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, No. 2, Xueshi Rd, Taichung City, 404 Taiwan
| | - Cheng-En Hsu
- grid.265231.10000 0004 0532 1428Sports Recreation and Health Management Continuing Studies-Bachelor’s Degree Completion Program, Tunghai University, Taichung, 407 Taiwan ,grid.410764.00000 0004 0573 0731Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Tsung-Yu Ho
- grid.254145.30000 0001 0083 6092School of Medicine, China Medical University, Taichung City, 404 Taiwan ,Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, No. 2, Xueshi Rd, Taichung City, 404 Taiwan
| | - Bor-Han Wei
- Department of Orthopedic, Chung-Kang Branch, Cheng-Ching General Hospital, Taichung, Taiwan
| | - Wei-Chih Wang
- grid.254145.30000 0001 0083 6092School of Medicine, China Medical University, Taichung City, 404 Taiwan ,Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, No. 2, Xueshi Rd, Taichung City, 404 Taiwan
| | - Yung-Cheng Chiu
- grid.254145.30000 0001 0083 6092School of Medicine, China Medical University, Taichung City, 404 Taiwan ,Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, No. 2, Xueshi Rd, Taichung City, 404 Taiwan
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12
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Hardy WR, Landy DC, Chalmers BP, Sabatini FM, Duncan ST. Additional Distal Femoral Resection Minimally Improves Terminal Knee Extension: A Systematic Review and Meta-Regression Challenging the Dogma. Arthroplast Today 2023; 19:101083. [PMID: 36845290 DOI: 10.1016/j.artd.2022.101083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/11/2022] [Indexed: 01/13/2023] Open
Abstract
Background Additional distal femoral resection is a common technique to address a flexion contracture during primary total knee arthroplasty (TKA) but can lead to midflexion instability and patella baja. Prior reports regarding the magnitude of knee extension obtained with additional femoral resection have varied. This study sought to systematically review research describing the effect of femoral resection on knee extension and to perform meta-regression to estimate this relationship. Methods A systematic review was conducted using MEDLINE, PubMed, and Cochrane databases by combining the terms ("flexion contracture" OR "flexion deformity") AND ("knee arthroplasty" OR "knee replacement") to identify 481 abstracts. In total, 7 articles reporting change in knee extension after additional femoral resection or augmentation across 184 knees were included. The mean value for knee extension, its standard deviation, and the number of knees tested were recorded for each level. Meta-regression was performed using weighted mixed-effects linear regression. Results Meta-regression estimated that each 1mm resected from the joint line produced a 2.5° gain of extension (95% confidence interval, 1.7 to 3.2). Sensitivity analyses excluding outlying observations estimated each 1mm resected from the joint line produced a 2.0° gain of extension (95% confidence interval, 1.9 to 2.2). Conclusions Each millimeter of additional femoral resection is likely to produce only a 2° improvement in knee extension. Thus, an additional resection of 2 mm is likely to improve knee extension by less than 5°. Alternative techniques, including posterior capsular release and posterior osteophyte resection, should be considered in correcting a flexion contracture during TKA.
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13
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Okamoto Y, Wakama H, Matsuyama J, Nakamura K, Otsuki S, Neo M. The significance of the pelvic incidence measurement as a possible predictor of TKA outcome. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07224-8. [PMID: 36352242 DOI: 10.1007/s00167-022-07224-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the association between the sagittal alignment of the pelvis and residual knee flexion contracture after total knee arthroplasty (TKA). This is important as a flexion contraction can be associated with the risk of poor outcomes and patient satisfaction after TKA. METHODS This was a retrospective, case-control, study of 200 osteoarthritic knees, contributed by 200 patients, over a mean follow-up of 2.4 years. The following factors were compared between patients 'with' (46 knees) and 'without' (154 knees) a residual flexion contracture ≥ 10° after TKA: age, sex, pelvic incidence (PI), anterior femoral bowing, femoral component flexion angle (FFA), and patient-reported outcomes. Logistic regression and receiver operating characteristic curve analyses were used to identify predictive factors. RESULTS The following factors were predictive of a residual flexion contracture ≥ 10°: a pelvic incidence ≥ 55° (odds ratio, 1.29; 95% confidence interval, 1.05-1.59; P = 0.031) and the FFA (odds ratio, 1.08; 95% confidence interval, 1.03-1.14; P = 0.044). A pelvic incidence cutoff of 55° yielded a significant between-group difference, with a sensitivity of 78.4% and specificity of 89.9% to differentiate a residual knee flexion contracture ≥ 10° (P = 0.001), patient satisfaction (P = 0.029), EuroQol 5-Dimension score (P = 0.028), anterior femoral curvature (P = 0.031), and Knee Injury and Osteoarthritis Outcome Score-Joint Replacement score (P = 0.046). CONCLUSION A pelvic incidence > 55° is associated with a residual knee flexion contracture ≥ 10° after TKA. The significance of the pelvic incidence measurement as a possible predictor of TKA outcome was highlighted, including its impact on patient satisfaction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
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14
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Supreeth S, Yukata K, Suetomi Y, Yamazaki K, Sakai T, Fujii H. Optimal intraoperative medial joint gap in extension to prevent flexion contracture following total knee arthroplasty using modified gap balancing technique. J Clin Orthop Trauma 2022; 33:101992. [PMID: 36089993 PMCID: PMC9450135 DOI: 10.1016/j.jcot.2022.101992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Primary aim to identify the ideal medial joint gap in extension needed to prevent post-operative flexion contracture following total knee arthroplasty (TKA) in varus osteoarthritic knees by the modified gap balancing technique. A secondary aim was to analyze multiple factors that influence knee extension in TKA by modified gap balancing. Methods This is a prospective cohort study of 150 patients diagnosed with osteoarthritic varus knee who underwent TKA using the modified gap balancing technique. Operative and clinical records were assessed to determine factors including age, BMI (Body mass index), pre-operative extension angle and the medial extension laxity. Patients were followed for 6-months post-operatively and reviewed for knee extension angle. Results Six months final follow-up information was available for 148 patients with an average age of 75.5 years. Pre-operative knee extension and BMI were significantly associated with post-operative knee extension. Post-operative flexion contracture of ≧ 100 was not seen in any of 34 patients with a medial extension laxity ≧ 0 mm who had no pre-existing flexion contracture, and in 1/9 (11.1%) patients with a medial extension laxity ≧ 1 mm who had pre-existing flexion contracture. Conclusions Pre-operative extension angle and BMI significantly influence the post-operative knee extension angle in TKA using the modified gap balancing technique. A medial extension laxity of at least 1 mm is ideally needed to prevent post-operative flexion contracture in patients with a pre-existing contracture ≧ 100. Level of evidence Level II; Prospective cohort study.
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Affiliation(s)
- Sam Supreeth
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori Daiichi General Hospital, 839-1 Ogori-shimogo, Yamaguchi, 754-0002, Japan
| | - Kiminori Yukata
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori Daiichi General Hospital, 839-1 Ogori-shimogo, Yamaguchi, 754-0002, Japan
| | - Yutaka Suetomi
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori Daiichi General Hospital, 839-1 Ogori-shimogo, Yamaguchi, 754-0002, Japan
| | - Kazuhizo Yamazaki
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori Daiichi General Hospital, 839-1 Ogori-shimogo, Yamaguchi, 754-0002, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroshi Fujii
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori Daiichi General Hospital, 839-1 Ogori-shimogo, Yamaguchi, 754-0002, Japan
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Rocco J, Putzer D, Nogler M, Rocco A, Maitino P, Thaler M. The effect of gastrocnemius resection on knee flexion in a total knee arthroplasty model. Arch Orthop Trauma Surg 2022; 142:2503-2511. [PMID: 33772361 DOI: 10.1007/s00402-020-03695-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/03/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Flexion contracture in knee arthritis and total knee arthroplasty (TKA) is a common and significant problem. An improvement in knee extension in patients with TKA and mild flexion contractures has been observed clinically when a gastrocnemius recession was performed for other concomitant conditions. The goal of this study was to quantify the effect of gastrocnemius recession on knee flexion in TKA cadaver model. MATERIALS AND METHODS Range of motion (ROM) of 23 cadaveric knees was determined with a navigation system before and after performing TKA using a medial parapetallar approach and after performing a gastrocnemius recession. Varus-valgus, flexion-extension, and internal-external rotation angles of the knee joint were recorded with leg in full extension and in 90°of knee flexion. Extension and flexion gaps were measured using a gap tensioning device. Dorsiflexion of the foot was measured with a goniometer when a torque moment of 10 Nm was applied to the ankle joint. RESULTS A statistically significant improvement of 5° in knee extension was observed following gastrocnemius recession (P = 0.015). Varus and valgus angles, internal, and external rotation were unaffected by gastrocnemius recession. Ankle dorsiflexion increased by 9° following gastrocnemius recession (P ≤ 0.001). CONCLUSIONS Performing a gastrocnemius recession improves the knee extension in TKA knees with flexion contractures. Gastrocnemius recession may be a useful technique to improve terminal extension in TKA.
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Affiliation(s)
- Jeffrey Rocco
- Utah Orthopaedics, 5782 Adams Avenue Parkway, Ogden, UT, 84405, USA.
| | - David Putzer
- Department of Orthopaedics-Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria
| | - Michael Nogler
- Department of Orthopaedics-Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria
| | - Alexandra Rocco
- Utah Orthopaedics, 5782 Adams Avenue Parkway, Ogden, UT, 84405, USA
| | - Paul Maitino
- Joint Reconstructive Specialists, Inc., 3110 SW 89th Street Suite 200D, Oklahoma City, OK, 73159, USA
| | - Martin Thaler
- Department of Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria
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Rahyussalim AJ, Zufar MLL, Kurniwati T. A holistic approach for severe flexion contracture of bilateral hip, knee, and ankle joints in a neglected patient with prolonged knee-chest positioning on extreme undernourishment: a case report and review of the literature. J Med Case Rep 2022; 16:225. [PMID: 35610728 PMCID: PMC9128234 DOI: 10.1186/s13256-022-03439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Flexion contracture in the lower extremity is a common finding in the patient with neuromusculoskeletal disorders. However, severe cases due to prolonged immobilization in knee–chest position are rarely established and remain underreported. This condition is associated with high morbidity and reduced quality of life, especially when it comes to neglected cases with missed injury and late presentation for adequate primary care and rehabilitative program. It remains a difficult challenge to treat, with no established treatment protocol. In addition, other factors related to psychological and socioeconomic conditions may interfere and aggravate the health state of such patients. Case presentation A 19-year-old Javanese man presented with flexion contracture of bilateral hip, knee, and ankle joints due to prolonged immobilization in knee–chest position for almost 2 years following a traffic accident and falling in the bathroom. The condition had persisted for the last 3 years due to irrecoverable condition and lack of awareness. In addition, the patient also presented with paraplegia at level L2–S1, dermatitis neglecta, multiple pressure ulcers, community-acquired pneumonia, and severe malnutrition. Prolonged and sustained passive stretching with serial plastering were performed in the patient. By the time of discharge, patient was able to move and ambulate using wheelchair. Progressive improvement of range of motion and good sitting balance were observed by 3-month follow-up. Conclusion A combination of surgery and rehabilitative care is required in the setting of severe flexion contracture. Passive prolonged stretching showed a better outcome and efficacy in the management of flexion contracture, whether the patient undergoes surgery or not. However, evaluation of residual muscle strength, changes in bone density and characteristic, and the patient’s general and comorbid conditions must always be considered when determining the best treatment of choice for each patient to achieve good outcome and result. A holistic approach with comprehensive assessment is important when treating such patients.
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Affiliation(s)
- Ahmad Jabir Rahyussalim
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National Central General Hospital and Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, RW.5, Kenari, Kec. Senen, Kota Jakarta Pusat, Daerah Khusus Ibukota, Jakarta, 10310, Indonesia.
| | - Muhammad Luqman Labib Zufar
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National Central General Hospital and Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, RW.5, Kenari, Kec. Senen, Kota Jakarta Pusat, Daerah Khusus Ibukota, Jakarta, 10310, Indonesia
| | - Tri Kurniwati
- Stem Cell and Tissue Engineering, IMERI Universitas, Jakarta, Indonesia
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Lee HW, Park CH, Bae DK, Song SJ. How much preoperative flexion contracture is a predictor for residual flexion contracture after total knee arthroplasty in hemophilic arthropathy and rheumatoid arthritis? Knee Surg Relat Res 2022; 34:20. [PMID: 35395934 PMCID: PMC8994339 DOI: 10.1186/s43019-022-00146-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Although total knee arthroplasty (TKA) in hemophilic arthropathy (HA) or rheumatoid arthritis (RA) can improve functional ability, the postoperative range of motion (ROM) and prosthesis durability are reduced compared with those in osteoarthritic patients. Aim We aimed to compare (1) the pre- and postoperative flexion contracture after TKA in HA and RA, (2) the threshold of preoperative flexion contracture as a predictor of residual contracture > 15° after TKA, and (3) the survival rate. Methods Data from a consecutive cohort comprising 48 TKAs in HA and 92 TKAs in RA were retrospectively reviewed. The degree of flexion contracture was analyzed. Through receiver operating characteristics analysis, we aimed to determine the cutoff value of preoperative flexion contracture that increases the risk of residual contracture > 15° after TKA and compare the cutoff value in HA and RA. The survival rate was evaluated based on life table analysis and the Kaplan–Meier method. Results The degree of preoperative flexion contracture was not significantly different. The degree of postoperative residual flexion contracture was 5.6° in the HA group and 1.4° in the RA group, respectively (p < 0.001). The cutoff value of preoperative flexion contracture for residual contracture of > 15° at last-follow up was 25.0° in the HA group and 32.5° in the RA group. The 5- and 12-year survival rates were 96% and 87% in the HA and 99% and 95% in the RA group, respectively (n.s.). Conclusions The postoperative residual flexion contracture was greater and the cutoff value of preoperative flexion contracture for residual contracture was smaller in the HA group than the RA group. Appropriate intra- and postoperative care to avoid postoperative residual contracture is required in HA patients. Level of evidence III.
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Affiliation(s)
- Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-702, Korea.
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Ebisz M, Mostowy M, Góralczyk A, Hirschmann MT, Skowronek P, LaPrade RF, Malinowski K. Both arthroscopic and open posterior knee capsulotomy are effective in terms of extension recovery and functional improvement-systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:1443-1452. [PMID: 34117895 DOI: 10.1007/s00167-021-06634-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the recovery of extension and improvement in functional scores after an arthroscopic or open posterior knee capsulotomy in the setting of an extension deficit. METHODS A systematic search of articles published between 1980 and 2020 was performed in the MEDLINE/PubMed database, EMBASE/Ovid database and Web of Science database. The inclusion criteria consisted of patients with primary extension deficits > 5° who underwent an arthroscopic or open posterior knee capsulotomy. The assessed outcomes were preoperative and postoperative range of motion and functional outcome scores. Randomized controlled trials, cohort studies and case series with a follow-up longer than 6 months were included. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for case series. The certainty of evidence was assessed using the GRADE approach. RESULTS Of 226 records identified through database searching, 7 studies were included in the final analysis. The outcomes of 107 patients with a mean age of 34.1 (range 15-63) years were available. In all the included studies, a posterior capsulotomy resulted in the restoration of knee extension to normal or nearly normal values (mean postoperative extension deficit: 0.4-4.2 degrees) with a significant increase in functional outcome scores. No neurovascular complications were reported within the studies. Due to the diverse methodology of studies, the direct comparison of arthroscopic versus open approaches was not possible. Concerning the risk of bias assessment, the greatest concerns raised the selection of participants among the included studies and the methods of outcome measurement. The certainty of evidence was very low according to the GRADE. CONCLUSIONS Both arthroscopic and open posterior capsulotomy of the knee results in restoration of normal or nearly normal knee extension and significant improvement in functional outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Michał Ebisz
- Artromedical Orthopaedic Clinic, Antracytowa 1, 97-400, Belchatow, Poland
| | - Marcin Mostowy
- Orthopedic and Trauma Department, Veteran's Memorial Teaching Hospital in Lodz, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland
| | | | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland.,University of Basel, CH-4051, Basel, Switzerland
| | - Paweł Skowronek
- Department of Orthopaedic, Trauma Surgery S. Zeromski Hospital, Os. Na Skarpie 66, 31-913, Krakow, Poland
| | - Robert F LaPrade
- Twin Cities Orthopedics, 4010 W 65th St Edina, Minnesota, 55435, USA
| | - Konrad Malinowski
- Artromedical Orthopaedic Clinic, Antracytowa 1, 97-400, Belchatow, Poland.
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Corain M, Lando M, Pantaleoni F, Pozza P, Giardini M, Adani R. Surgical Treatment of Camptodactyly with Malek Cutaneous Approach and Stepwise Release: A Retrospective Multi-centre Study. J Hand Surg Asian Pac Vol 2022; 27:233-241. [PMID: 35404199 DOI: 10.1142/s2424835522500308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Clinical manifestations of camptodactyly are varied and no official consensus on the etiopathogenesis or best treatment is available. Conservative treatment is generally preferred and, in refractory patients, surgery might be considered. However, reported results of surgery are often unsatisfactory and it is difficult to compare outcomes as different classification systems are adopted. We reported the outcomes of surgical treatment of camptodactyly with the Malek cutaneous approach and stepwise release, assessed using the Siegert classification. Methods: A retrospective analysis of paediatric patients (≥1 and ≤18 years) with congenital camptodactyly refractory to conservative management (flexion contracture >30°), treated with Malek cutaneous approach and stepwise release surgery between June 2009 and June 2019 with at least 1 year of follow-up was performed. Pre- and post-operative clinical and radiographic assessments were evaluated for degrees of flexion contractures and early (<30 days) or late (>30 days) complications were recorded. Results: A total of 59 patients underwent surgery, of whom 38 (64%), including 42 fingers, were enrolled; mean patient age was 8 years (range 1-18). Post-operative mean flexion contracture was significantly improved (p > 0.001) and no infections were recorded. Mean follow-up was 6 years (range 1-10) and proximal interphalangeal joint extension deficits were rated according to Siegert classification as excellent (69%), good (12%), or fair (9.5%) and poor (9.5%). Conclusions: The Malek cutaneous approach and stepwise release of the retracting soft tissues allow prompt evaluation of the anatomical structures involved in the deformity and seem to be an effective surgical correction in the long term. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Massimo Corain
- Hand Surgery and Microsurgery Department, Azienda Ospedaliero Universitaria Integrata di Verona, Italy
| | - Mario Lando
- Hand Surgery and Microsurgery Department, Azienda Ospedaliero Universitaria di Modena, Italy
| | - Filippo Pantaleoni
- Hand Surgery and Microsurgery Department, Azienda Ospedaliero Universitaria di Modena, Italy
| | - Paolo Pozza
- Hand Surgery and Microsurgery Department, Azienda Ospedaliero Universitaria Integrata di Verona, Italy
| | - Mattia Giardini
- Hand Surgery and Microsurgery Department, Azienda Ospedaliero Universitaria Integrata di Verona, Italy
| | - Roberto Adani
- Hand Surgery and Microsurgery Department, Azienda Ospedaliero Universitaria di Modena, Italy
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Minamimoto K, Ozawa J, Kaneguchi A, Yamaoka K. A rat model of hip joint contracture induced by mono-articular hip joint immobilization. Clin Biomech (Bristol, Avon) 2021; 90:105487. [PMID: 34597915 DOI: 10.1016/j.clinbiomech.2021.105487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/20/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To elucidate the formation process and therapeutic targets of hip flexion contracture, we developed a rat model of hip flexion contracture induced by hip mono-articular immobilization. METHODS Kirschner wires inserted into the femur and hip bone were anchored at the hip in a flexed position in the immobilization groups and unanchored in the sham groups for up to four weeks. Age-matched untreated rats were used as controls. Hip extension range of motion (RoM) was measured at three different extension moments (7.5, 15, and 22.5 N•mm) in each successive myotomy step as follows: before myotomy, after sequential myotomy of the tensor fascia lata, quadriceps muscle, iliopsoas muscle, and after myotomy of all residual muscles (the gluteus medius and adductor muscles). Histological analysis of the hip joint was also performed. FINDINGS After four weeks of immobilization, the RoM before myotomy at 22.5 N•mm was significantly decreased by 29° compared with controls, and this value was unaltered in the sham group. Analyses following serial myotomy suggested that the structures responsible for myogenic contracture were the tensor fascia lata, iliopsoas, gluteus medius, and adductor muscles because the RoMs were increased by these myotomies. Unexpectedly, arthrogenic contracture was not detected at moments other than at 7.5 N•mm, even after four weeks of immobilization. Histological analysis confirmed that pathological changes were not apparent in the anterior capsule of the hip joint. INTERPRETATION The present findings suggest that myogenic contracture may be an important therapeutic target for immobilization-induced hip flexion contracture.
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Affiliation(s)
- Kengo Minamimoto
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan.
| | - Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Kaoru Yamaoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
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Kinoshita T, Hino K, Kutsuna T, Watamori K, Tsuda T, Miura H. Efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty. J Exp Orthop 2021; 8:102. [PMID: 34735661 PMCID: PMC8568746 DOI: 10.1186/s40634-021-00422-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose Posterior capsular contracture causes stiffness during knee extension in knee osteoarthritis. Furthermore, in posterior-stabilized total knee arthroplasty (PS-TKA), a unique design such as the cam mechanism could conflict with the posterior capsule (PC) causing flexion contracture (FC). However, few studies have focused on the anatomical aspects of the PC. This study aimed to investigate the anatomical site and forms of posterior capsular attachment to the femoral cortex, and to evaluate the efficacy of posterior capsular release for FC by assessing changes in knee extension angles using a navigation system. Methods Attachment sites of the PC were investigated in 10 cadaveric knees using computed tomography. PS-TKA was performed in six cadaveric knees using a navigation system to evaluate the efficacy of posterior capsular release for FC. Posterior capsular release was performed stepwise at each part of the femoral condyle. Results The gastrocnemius tendon and PC were integrally attached to the femoral cortex at the medial and lateral condyles, whereas the PC at the intercondylar fossa was independently attached directly to the femoral cortex. Moreover, the PC at the intercondylar fossa was attached most distally among each femoral condyle. Posterior capsular release at the intercondylar fossa allowed 11.4° ± 2.8° improvement in knee extension. This angle was further improved by 5.5° ± 1.3°, after subsequent capsular release at the medial and lateral condyles. Conclusion The forms and sites of posterior capsular attachment differed based on the part of the femoral condyle. Stepwise posterior capsular release was effective for FC in PS-TKA. Level of evidence III.
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Affiliation(s)
- Tomofumi Kinoshita
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kazunori Hino
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Tatsuhiko Kutsuna
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kunihiko Watamori
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takashi Tsuda
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Song JH, Bin SI, Kim JM, Lee BS, Choe JS, Cho HK. Flexion contracture can be relieved by concurrent notchplasty in medial open wedge high tibial osteotomy. Orthop Traumatol Surg Res 2021; 107:103020. [PMID: 34314903 DOI: 10.1016/j.otsr.2021.103020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Given that medial open wedge high tibial osteotomy (OWHTO) not only delays the progression of osteoarthritis but also alleviates the resulting pain, surgical outcomes would be improved if limited ROM can also be managed. In this regard, the effect of concurrent notchplasty on flexion contracture has not been evaluated. HYPOTHESIS (1) Concurrent notchplasty in OWHTO would relieve flexion contracture regardless of the severity of osteoarthritis and this effect would be maintained over time, and (2) concurrent notchplasty would not cause any added complications compared to the same procedure without notchplasty. PATIENTS AND METHODS In total, 107 patients who underwent OWHTO between 2011 and 2017 with a mean follow-up period of 46.6months (range: 24-102months) were reviewed. ROM was measured at three time points as follows: before surgery, at 6-12months postoperatively, and at the latest follow-up. The measurements were analyzed using a linear mixed model in terms of notchplasty and other factors, including age, sex, body mass index, preoperative hip-knee-ankle angle, lateral distal femoral angle, medial proximal tibial angle, correction angle, concurrent meniscectomy, postoperative posterior slope, and Kellgren-Lawrence grade. Then, ROMs at the three time points were compared between the notchplasty and non-notchplasty groups. RESULTS Of the 107 patients, 47 underwent concurrent notchplasty. The linear mixed model regarding flexion contracture showed a significant notchplasty-by-time interaction (p<0.001). When comparing preoperative flexion contractures between the two groups, a significant difference was found (p<0.001). At 6-12months postoperatively, flexion contractures were relieved regardless of notchplasty; however, the difference between the groups was decreased (p=0.026). At the latest follow-up, flexion contractures were partly aggravated in both groups, but no significant difference was found between the groups (p=0.461). Comparison of flexion contracture between before surgery and at the latest follow-up in each group revealed a significant difference only in the notchplasty group (p<0.001, with notchplasty; p=0.197, without notchplasty). The linear mixed model regarding maximal flexion did not show any factor having a significant interaction with time. There were no surgical complications such as infection, thromboembolic events, and hemarthrosis, in both notchplasty and non-notchplasty groups. CONCLUSION The preoperative difference in flexion contracture was overcome by adding notchplasty to OWHTO, and this improvement was maintained over time. No added complications were noted in the notchplasty group. The results should be interpreted with caution, considering measurement error of ROM. However, concurrent notchplasty in OWHTO deserves further study to validate its efficacy. LEVEL OF EVIDENCE III, retrospective cohort study. IRB INFORMATION Project No. S2020-0081, AMC IRB SOP.
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Kinoshita T, Hino K, Kutsuna T, Watamori K, Tsuda T, Miura H. Gender-specific difference in the recurrence of flexion contracture after total knee arthroplasty. J Exp Orthop 2021; 8:87. [PMID: 34617136 PMCID: PMC8494879 DOI: 10.1186/s40634-021-00409-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Range of motion after total knee arthroplasty (TKA) can impact patients’ daily lives. Nevertheless, flexion contracture (FC) often recurs after TKA, even upon achieving full extension intraoperatively. This study aimed to evaluate the relationship among preoperative, intraoperative, and postoperative knee extension angles, and clarify the risk factor for postoperative FC. Methods One hundred forty-seven knees undergoing TKA using a navigation system were evaluated. We measured the pre- and postoperative (6 months after TKA) extension angles using a goniometer, and intraoperative (before and after TKA) extension angle using a navigation system; the correlation between these angles at each time point was evaluated. Results The mean preoperative, intraoperative (before and after TKA) and postoperative extension angles were -9.9°, -6.8°, -0.1°, and -2.0°. Regarding intraoperative extension angle after TKA, 58 knees showed ≤ 5° hyperextension and six knees showed > 5° hyperextension. At 6 months, no cases showed hyperextension and 105 knees showed full extension. The mean intraoperative extension angle after TKA in the postoperative full extension group was 0.4°. A significant correlation was found among extension angles at each point (p<0.01, respectively). However, the intraoperative extension angle after TKA correlated with the postoperative extension angle only in females. Contrarily, the recurrence rate of FC was significantly higher in males than in females (p<0.01). Conclusion Intraoperative extension angles significantly correlated with pre- and postoperative extension angles in TKA. Moreover, intraoperative mild (≤ 5°) hyperextension is acceptable for postoperative full extension. There was a gender-specific difference in correlation between intra- and postoperative knee extension angles. Level of evidence III.
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Affiliation(s)
- Tomofumi Kinoshita
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kazunori Hino
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Tatsuhiko Kutsuna
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kunihiko Watamori
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takashi Tsuda
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Abstract
Controversy still exists whether conservative treatment may be a useful option for the treatment of pediatric trigger thumbs. We reviewed a random sample patient cohort with regard to success rates depending on whether flexible or fixed trigger thumbs were present. We performed a pilot study of 13 children (15 thumbs), who received a standardized treatment protocol including a custom-made thermoplastic splint for use during sleeping hours for a minimum of 3 months. Splinting was of only minor value for moderate and severe cases was but was beneficial for the majority of patients showing triggering symptoms only. It may thus be a reasonable option to delay surgery in infants with mild/flexible cases.
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Affiliation(s)
- Sebastian Farr
- Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Speisingerstraße 109, 1130, Vienna, Austria.
| | - Doris Taurok
- Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital Speising, Vienna, Austria
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Liawrungrueang W, Tangtrakulwanich B, Yuenyongviwat V. Soft tissue releasing and serial casting for management of flexion contracture after primary total knee arthroplasty in a patient with hemophilia. Int J Surg Case Rep 2021; 83:105995. [PMID: 34049178 PMCID: PMC8170162 DOI: 10.1016/j.ijscr.2021.105995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Flexion contracture following total knee arthroplasty (TKA) in patients with hemophilia is not uncommon, and this complication reduces knee range of motion and produces morbidity for the patient. This report states the success of treatment of flexion contracture after primary TKA in a patient with hemophilia; by open soft tissue contracture releasing and serial casting. CASE PRESENTATION A 20-year-old-man presented with hemophilia type A. He had undergone TKA for treatment of secondary osteoarthritis, following chronic hemophilic arthropathy of his right knee. After surgery, the patient had progressive flexion contracture posture, until he had 45 degrees of knee flexion contracture at his 3 month follow up. The patient received open soft tissue releasing, then serial casting for 6 weeks. After this, the cast was removed and he continued with a home rehabilitation program. At 1 year follow, his knee flexion contraction contracture had improved up to 10 degrees. The patients function had recovered and he was satisfied with this treatment. CLINICAL DISCUSSION The complications after TKA in patients with hemophilia are very challenging in there management; with flexion contracture after TKA being a common complication in patients with hemophilia. CONCLUSION In severe flexion contracture following TKA, soft tissue releasing combined with serial casting is effective, and might be an option that is less invasive than revising all of the TKA components.
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Affiliation(s)
- Wongthawat Liawrungrueang
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Boonsin Tangtrakulwanich
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
| | - Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
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Sénès FM, Nucci AM, Valore A, Catena N. Corrective Procedure for Flexion Contracture of the Elbow in Neonatal Palsy Sequelae: Long-term Follow-up. Indian J Orthop 2021; 55:452-459. [PMID: 34306560 PMCID: PMC8275703 DOI: 10.1007/s43465-020-00316-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/16/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Aim of this paper is to validate a procedure for correcting elbow flexion contracture in patients suffering from brachial plexus neonatal palsy sequelae during their teens. Elbow flexion contracture represents an unsolved problem in the natural history of obstetric brachial plexus palsy (OBPP) because of the consistent deformity recurrence. Following a previous paper, in which an original technique was proposed in a small sample of patients, the authors show the possible correction of the deformity in a larger group of patients. METHODS The procedure includes a combination of a posterior approach to the elbow with olecranon tip section and an anterior one with capsulotomy and soft tissue release to improve elbow range of motion. A series of 26 patients, who underwent the procedure, were checked out in medium and long term. Collected data were age, type of brachial plexus palsy, length of hospitalization, duration of surgery, preoperative and postoperative elbow range of motion, preoperative and postoperative DASH scores and satisfaction scores. Explaining further details about the procedure, the Authors report their results, including a statistical analysis. RESULTS At the final follow-up, the mean increase of elbow extension was about 22°. Functional outcomes were successful as well, with a mean increase of 10 points of DASH score. Over 75% of patients were fully satisfied with their outcome. CONCLUSIONS The outcome has confirmed the good efficacy of the procedure in increasing elbow extension but also in improving cosmetic appearance in adolescents suffering from flexed elbow in OBPP sequelae.
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Affiliation(s)
- Filippo Maria Sénès
- grid.419504.d0000 0004 1760 0109Hand Surgery and Reconstructive Microsurgery Unit, IRCSS Giannina Gaslini Institute, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Anna Maria Nucci
- Traumatology and Orthopedics Unit, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56125 Pisa, Italy
| | - Annalisa Valore
- grid.419504.d0000 0004 1760 0109Hand Surgery and Reconstructive Microsurgery Unit, IRCSS Giannina Gaslini Institute, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Nunzio Catena
- Pediatric Orthopedic and Traumatology Unit, Children’s Hospital, AON SS Antonio E Biagio E Cesare Arrigo, Spalto Marengo 46, 15121 Alessandria, Italy
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Elmasry SS, Chalmers BP, Kahlenberg CA, Mayman DJ, Wright TM, Westrich GH, Cross MB, Sculco PK, Imhauser CW. Simulation of preoperative flexion contracture in a computational model of total knee arthroplasty: Development and evaluation. J Biomech 2021; 120:110367. [PMID: 33887615 PMCID: PMC8183383 DOI: 10.1016/j.jbiomech.2021.110367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/29/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
Preoperative flexion contracture is a risk factor for patient dissatisfaction following primary total knee arthroplasty (TKA). Previous studies utilizing surgical navigation technology and cadaveric models attempted to identify operative techniques to correct knees with flexion contracture and minimize undesirable outcomes such as knee instability. However, no consensus has emerged on a surgical strategy to treat this clinical condition. Therefore, the purpose of this study was to develop and evaluate a computational model of TKA with flexion contracture that can be used to devise surgical strategies that restore knee extension and to understand factors that cause negative outcomes. We developed six computational models of knees implanted with a posteriorly stabilized TKA using a measured resection technique. We incorporated tensions in the collateral ligaments representative of those achieved in TKA using reference data from a cadaveric experiment and determined tensions in the posterior capsule elements in knees with flexion contracture by simulating a passive extension exam. Subject-specific extension moments were calculated and used to evaluate the amount of knee extension that would be restored after incrementally resecting the distal femur. Model predictions of the extension angle after resecting the distal femur by 2 and 4 mm were within 1.2° (p ≥ 0.32) and 1.6° (p ≥ 0.25), respectively, of previous studies. Accordingly, the presented computational method could be a credible surrogate to study the mechanical impact of flexion contracture in TKA and to evaluate its surgical treatment.
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Affiliation(s)
- Shady S Elmasry
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA; Department of Mechanical Design and Production, Faculty of Engineering, Cairo University, Egypt.
| | - Brian P Chalmers
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Cynthia A Kahlenberg
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - David J Mayman
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Michael B Cross
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
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Ngoie M, Degez F, Sané-Diatta I, Diamé-Seydi Y, Gueye M, Coulibaly-Ndiaye NF. Wrist opener splint: An effective way to treat chronic wrist flexion contracture. Hand Surg Rehabil 2020; 39:256-260. [PMID: 32070794 DOI: 10.1016/j.hansur.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/13/2019] [Accepted: 02/09/2020] [Indexed: 11/29/2022]
Abstract
In Senegal, patients are seen an average of 16 months after their injury in a specialized hand and upper limb surgery department. Because of this lengthy delay, these patients have severe functional sequelae, such as wrist flexion contracture, averaging 45 degrees in our case series (range, 35 to 90 degrees). After reviewing the literature, we did not find any splint that was well suited to these patients. Inspired by the general splinting rules set out by Schultz, MacConaill and Brand, we constructed a volar/dorsal splint to reduce these contractures. We have been using this serial static splint for 2 years. We performed a prospective study of 17 wrists to evaluate its therapeutic benefit, describe its use and outline its optimal application.
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Affiliation(s)
- M Ngoie
- Service d'orthopédie-traumatologie, Hôpital Aristide-Le-Dantec, 30, avenue Pasteur, B.P. 3001, Dakar, Senegal.
| | - F Degez
- Centre de la Main, Village Santé Angers Loire, 47, rue de la Foucaudière, 49800 Trélazé, France.
| | - I Sané-Diatta
- Service d'orthopédie-traumatologie, Hôpital Aristide-Le-Dantec, 30, avenue Pasteur, B.P. 3001, Dakar, Senegal.
| | - Y Diamé-Seydi
- Service d'orthopédie-traumatologie, Hôpital Aristide-Le-Dantec, 30, avenue Pasteur, B.P. 3001, Dakar, Senegal.
| | - M Gueye
- Service d'orthopédie-traumatologie, Hôpital Aristide-Le-Dantec, 30, avenue Pasteur, B.P. 3001, Dakar, Senegal.
| | - N F Coulibaly-Ndiaye
- Service d'orthopédie-traumatologie, Hôpital Aristide-Le-Dantec, 30, avenue Pasteur, B.P. 3001, Dakar, Senegal.
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Alsaadi Y, Alhassan TS, Alfawzan MF, Aldekhayel S, Almeshal OM. A successful surgical treatment of a closed rupture of flexor digitorum superficialis in surgeon's hand. A case report and review of literature. Int J Surg Case Rep 2020; 67:235-238. [PMID: 32070817 PMCID: PMC7025954 DOI: 10.1016/j.ijscr.2020.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/25/2020] [Accepted: 01/30/2020] [Indexed: 11/24/2022] Open
Abstract
Isolated closed rupture or avulsion of flexor digitorum superficialis tendon is a rare pathology. Early diagnosis and managment can prevent irreversible disabilities. In our case we demonstrate the clinical presentation and surgical management of a closed ruptured flexor digitorum superficialis.
Introduction Isolated closed rupture or avulsion of the flexor digitomm superficialis (FDS) tendon at its insertion is a rare diagnosis. It can be related to a pathology such as rheumatoid arthritis, bony abnormalities, tenosynovitis, fractures, or tuberculosis. A review of the literature identified only few cases of closed avulsion or rupture of FDS tendons nonpathologically. We hope this report will help to gather more experience for the surgical intervention in a delayed presentation of ruptured flexor digitorm superficialis tendon. The work has been reported in line with the SCARE criteria. Presentation of case We report a case of 48-year-old surgeon who sustained a trauma to her left middle finger. The patient presented three months after injury with complaints of pain and decreased range of motion of involved digit. Patient was treated conservatively and after failure of conservative treatment surgical intervention was done with complete tendon excision and capsulotomy of Proximal interphalangeal joint. Patient retained full range of motion and pain subsided. Discussion Isolated closed avulsions or rupture of the FDS tendon is a challenging entity in hand surgery in diagnosis and treatment. Nonsurgical treatment with splinting and physiotherapy might help to prevent flexion deformity. The surgical treatment include tenolysis, flexor digitorum superficialis tendon excision, and in selected patients capsulotomies of involved joints. Conclusion A review of the literature identified only few cases of closed avulsion of FDS tendons nonpathologically. Early diagnosis and intervention can prevent sequel of flexion contracture.
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Affiliation(s)
- Yazeed Alsaadi
- Department of Plastic Surgery, King Abdulaziz Medical City-Riyadh, Riyadh 11426, P.O. Box 22490, Saudi Arabia.
| | - Turki S Alhassan
- Department of Plastic Surgery, King Abdulaziz Medical City-Riyadh, Riyadh 11426, P.O. Box 22490, Saudi Arabia
| | - Mohammed F Alfawzan
- Department of Plastic Surgery, King Abdulaziz Medical City-Riyadh, Riyadh 11426, P.O. Box 22490, Saudi Arabia
| | - Salah Aldekhayel
- Department of Plastic Surgery, King Abdulaziz Medical City-Riyadh, Riyadh 11426, P.O. Box 22490, Saudi Arabia
| | - Obaid M Almeshal
- Department of Plastic Surgery, King Abdulaziz Medical City-Riyadh, Riyadh 11426, P.O. Box 22490, Saudi Arabia
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Leie MA, Klasan A, Oshima T, Putnis SE, Yeo WW, Luk L, Coolican M. Large osteophyte removal from the posterior femoral condyle significantly improves extension at the time of surgery in a total knee arthroplasty. J Orthop 2020; 19:76-83. [PMID: 32021042 DOI: 10.1016/j.jor.2019.10.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/30/2019] [Accepted: 10/30/2019] [Indexed: 02/03/2023] Open
Abstract
Removing osteophytes from the posterior compartment of the femur eliminates the tenting effects on the joint capsule and consequently increases the extension gap in total knee arthroplasty. However, there is no clear association with the size of osteophytes removed and the potential degree of additional extension achieved at time of surgery. Aims Correlate the size of posterior osteophytes removed with the degree of extension gained intraoperatively in total knee arthroplasty and develop a radiological classification system to grade these osteophytes. Methods Patients who underwent a TKA had pre and post operative sagittal radiographs assessed and classified according to 4 different categories of a proposed classification system. Knee extension was then assessed by a computer navigated system before incision and after implant insertion. Confounding factors were controlled and considered on the analysis. The study was done retrospectively. Results 147 patients were included in the study. Ninety-three (63.2%) patients had osteophytes on the posterior aspect of the femur completely removed and fifty-four patients (36.8%) did not have radiological evidence of osteophytes on the posterior aspect of the femur. There was a positive and linear correlation (Pearson correlation 0.327, p .005) between osteophyte size and degree of extension corrected at time of surgery. On Multivariate Logistic Regression Analysis, we found that small osteophytes (Grade 1) did not seem to affect the extension, while removing Grade 2 or Grade 3 osteophytes lead to a gain in extension of 2.7 and 4.5° respectively. Conclusion Removing large osteophytes (Grade 2 and Grade 3) from the posterior femoral compartment can be used as an adjuvant strategy to ensure that intraoperative extension is optimal. However removing small osteophytes (Grade 1) should not be expected to affect extension at the time of surgery in TKA and could increase intra-operative time and morbidity.
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Winston BA, Jones J, Ries MD. Flexion contracture due to cyclops lesion after bicruciate-retaining total knee arthroplasty. Arthroplast Today 2019; 5:442-445. [PMID: 31886387 PMCID: PMC6920727 DOI: 10.1016/j.artd.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022] Open
Abstract
Flexion contracture may develop after total knee arthroplasty (TKA) and is usually associated with soft tissue contracture in the posterior compartment or hamstrings. A cyclops lesion is a soft tissue mass which can form in the anterior compartment usually after anterior cruciate ligament reconstruction and has been observed after bicruciate-retaining TKA. We have treated a patient who developed progressive loss of full extension from 0° to 20° after bicruciate-retaining TKA. A large fibrous tissue mass (cyclops lesion) was identified in the anterior compartment during arthrotomy 1 year after TKA. Excision of the mass resulted in complete resolution of the flexion contracture.
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Affiliation(s)
| | - Jackson Jones
- Department of Orthopedics, Reno Orthopedic Clinic, Reno, NV, USA
| | - Michael D Ries
- Department of Orthopedics, Reno Orthopedic Clinic, Reno, NV, USA
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Lee SS, Kim JH, Heo JW, Moon YW. Gradual change in knee extension following total knee arthroplasty using ultracongruent inserts. Knee 2019; 26:905-913. [PMID: 31229289 DOI: 10.1016/j.knee.2019.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/07/2019] [Accepted: 06/01/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) using an ultracongruent (UC) insert is widely performed. Lack of the posterior cruciate ligament or post-cam mechanism is a concern in terms of range of motion. The flexion angle of UC TKA had been well investigated; however, natural history and correlation factors of the postoperative extension angle have not been well documented. This study aimed to investigate time-dependent changes in extension after TKA using UC inserts, and to evaluate factors that correlated with the postoperative extension angle. METHODS This study reviewed 388 gap-balanced UC TKAs (331 patients) without hyperextension at navigation and performed between November 2010 and December 2014. The extension angle (a positive number indicates hyperextension) was measured on full-extension lateral radiographs. The extension angles from five days post-operation to final follow-up were investigated. Factors correlated with the postoperative extension angle were evaluated using multiple regression analysis. RESULTS Mean follow-up duration was 46.2 months. Until two years, the extension angle gradually increased; mean angles at five days/six months/one year/two years/and final follow-up were: -9.2°/-2.6°/0.6°/1.0°/1.0°, respectively. Female sex (β = -0.15, P = 0.002) and pre-operative hyperextension (β = 0.31, P < 0.001) were associated with postoperative hyperextension deformity. CONCLUSIONS Following UC TKA, knees became gradually more extended until two years post-operation. Sex and pre-operative extension angle were predictive factors for the postoperative extension angle following UC TKA. LEVEL OF EVIDENCE Level 4, Case series.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, South Korea
| | - Joo Hwan Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae-Won Heo
- Department of Orthopedic Surgery, Bareunsesang Hospital, Seongnamsi, Gyeonggido, South Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Tajika T, Kuboi T, Mieda T, Oya N, Endo F, Nakazawa T, Chikuda H. Digital flexion contracture caused by tophaceous gout in flexor tendon. SAGE Open Med Case Rep 2019; 7:2050313X19844708. [PMID: 31041105 PMCID: PMC6477753 DOI: 10.1177/2050313x19844708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/27/2019] [Indexed: 02/05/2023] Open
Abstract
Gouty tophus is an unusual cause of digital flexion contracture. Awareness of
this pathophysiology will lead to more confidence in proper treatment and
surgical management of this rare condition. This report describes a case of
digital flexion contracture by tophaceous gout distinguished between trigger
finger and locking of the metacarpophalangeal joint. We found the flexor tendon
with a deposited chalky white substance suggestive of gouty tophus
intraoperatively. We performed tenosynovectomy and removed the chalky white
substance to the greatest degree possible. Histological findings confirmed the
diagnosis of gout. Postoperatively, the patient recovered nearly to a full range
of motion of the affected digits. When meeting with the patient who has had
hyperuricemia and who is unable to extend the affected digits suddenly, one must
keep in mind digital flexion contracture caused by tophaceous gout.
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Affiliation(s)
- Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takuro Kuboi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tokue Mieda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Noboru Oya
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Fumitaka Endo
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takuro Nakazawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
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Song MH, Lee TJ, Song JH, Song HR. Sustained hip flexion contracture after femoral lengthening in patients with achondroplasia. BMC Musculoskelet Disord 2018; 19:417. [PMID: 30497473 PMCID: PMC6267876 DOI: 10.1186/s12891-018-2344-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 11/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Hip flexion contracture often occurs after femoral lengthening in patients with achondroplasia, but few studies have investigated its development in these patients. The purpose of this study was to analyze sustained hip flexion contracture in achondroplasia patients who underwent femoral lengthening and to identify contributing factors. Methods This study included 34 patients with achondroplasia who underwent femoral lengthening (mean age at operation, 11.1 years). Sustained hip flexion was defined as flexion contracture lasting > 6 months postoperatively despite physiotherapy. Demographic data, spinopelvic parameters (pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, and sagittal vertical axis), and quantitative assessments of femoral lengthening were investigated. The associations among these factors and the development of sustained hip flexion contracture were assessed. Results Sustained hip flexion contracture developed in 13 (38%) of 34 achondroplasia patients after femoral lengthening. Eight (62%) of these 13 patients concomitantly exhibited limitation of knee flexion. Excessive femoral lengthening (odds ratio [OR], 1.450; 95% confidence interval [CI], 1.064 to 1.975; p = 0.019) and forward sagittal vertical axis tilt (OR, 1.062; 95% CI, 1.001 to 1.127; p = 0.047) contributed to sustained hip flexion contracture. Conclusions Sustained hip flexion contracture frequently occurs after femoral lengthening in achondroplasia patients. Both excessive femoral lengthening and preoperative forward SVA tilt may contribute to the development of sustained hip flexion contracture in these patients.
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Affiliation(s)
- Mi Hyun Song
- Department of Orthopaedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 152-703, Republic of Korea
| | - Tae-Jin Lee
- Department of Orthopaedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 152-703, Republic of Korea
| | - Jong Hyeop Song
- Department of Orthopaedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 152-703, Republic of Korea
| | - Hae-Ryong Song
- Department of Orthopaedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 152-703, Republic of Korea.
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Abstract
Upper extremity contractures in the spastic patient may result from muscle spasticity, secondary muscle contracture, or joint contracture. Knowledge of the underlying cause is critical in planning successful treatment. Initial management consists of physical therapy and splinting. Botulinum toxin can be helpful, as a therapeutic treatment in relieving spasticity and as a diagnostic tool in determining the underlying cause of the contracture. Surgical management options include release or lengthening of the causative muscle/tendon unit and joint capsular release, as required. Postoperative splinting is important to maintain the improved range of motion and protect any associated tendon lengthening or transfer.
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Affiliation(s)
- Kristi S Wood
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, 5th Floor, New York, NY 10021, USA
| | - Aaron Daluiski
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, 5th Floor, New York, NY 10021, USA; Department of Hand and Upper Extremity, Hospital for Special Surgery, 523 East 72nd Street, 4th Floor, New York, NY 10021, USA.
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Kubeš R, Salaj P, Hromádka R, Včelák J, Kuběna AA, Frydrychová M, Magerský Š, Burian M, Ošťádal M, Vaculik J. Range of motion after total knee arthroplasty in hemophilic arthropathy. BMC Musculoskelet Disord 2018; 19:162. [PMID: 29788949 PMCID: PMC5964921 DOI: 10.1186/s12891-018-2080-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/07/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Outcomes of total knee replacement in cases of hemophilic patients are worse than in patients who undergo operations due to osteoarthritis. Previous publications have reported varying rates of complications in hemophilic patients, such as infection and an unsatisfactory range of motion, which have influenced the survival of prostheses. Our retrospective study evaluated the data of hemophilic patients regarding changes in the development of the range of motion. METHODS The data and clinical outcomes of 72 total knee replacements in 45 patients with hemophilia types A and B were reviewed retrospectively. Patients were operated between 1998 and 2013. All of the patients were systematically followed up to record the range of motion and other parameters before and after surgery. RESULTS The mean preoperative flexion contracture was 17° ± 11° (range, 0°-40°), and it was 7° ± 12° (range, 0°-60°) postoperatively. The mean flexion of the knee was 73° ± 30° (range, 5°-135°) before the operation and 80° ± 19° (range, 30°-110°) at the last follow-up. The mean range of motion was 56° ± 34° (range, 0°-130°) before the operation and 73° ± 24° (range, 10°-110°) at the last follow-up. CONCLUSIONS Statistical analysis suggested that the range of motion could be improved until the 9th postoperative week. The patient should be operated on until the flexion contracture reaches 22° to obtain a contracture < 15° postoperatively or until the contracture reaches 12° to obtain less than 5°. The operation generally does not change the flexion of the knee in cases of hemophilic patients, but it reduces the flexion contracture and therefore improves the range.
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Affiliation(s)
- Radovan Kubeš
- Department of Orthopaedics, 1st Faculty of Medicine, Charles University and Na Bulovce Hospital, Budínova 2, 180 81, Prague 8, Czech Republic.
| | - Peter Salaj
- Institute of Clinical and Experimental Hematology, First Faculty of Medicine, Charles University and Institute of Hematology and Blood Transfusion, U Nemocnice 1, 12802, Prague 2, Czech Republic
| | - Rastislav Hromádka
- Department of Orthopaedics, 1st Faculty of Medicine, Charles University and Motol University Hospital, Úvalu 84, 15006, Prague 5, Czech Republic
| | - Josef Včelák
- Department of Orthopaedics, 1st Faculty of Medicine, Charles University and Na Bulovce Hospital, Budínova 2, 180 81, Prague 8, Czech Republic
| | - Aleš Antonín Kuběna
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, Akademika Heyrovského 1203, 500 05, Hradec Králové, Czech Republic
| | - Monika Frydrychová
- Department of Orthopaedics, 1st Faculty of Medicine, Charles University and Na Bulovce Hospital, Budínova 2, 180 81, Prague 8, Czech Republic
| | - Štěpán Magerský
- Department of Orthopaedics, 1st Faculty of Medicine, Charles University and Na Bulovce Hospital, Budínova 2, 180 81, Prague 8, Czech Republic
| | - Michal Burian
- Department of Orthopaedics, 1st Faculty of Medicine, Charles University and Na Bulovce Hospital, Budínova 2, 180 81, Prague 8, Czech Republic
| | - Martin Ošťádal
- Department of Orthopaedics, 1st Faculty of Medicine, Charles University and Na Bulovce Hospital, Budínova 2, 180 81, Prague 8, Czech Republic
| | - Jan Vaculik
- Department of Orthopaedics, 1st Faculty of Medicine, Charles University and Na Bulovce Hospital, Budínova 2, 180 81, Prague 8, Czech Republic
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Ohmori T, Kabata T, Kajino Y, Inoue D, Taga T, Yamamoto T, Takagi T, Yoshitani J, Ueno T, Ueoka K, Tsuchiya H. Three-dimensional limb lengthening after total knee arthroplasty in a simulation study. Mod Rheumatol 2018; 28:1029-1034. [PMID: 29385865 DOI: 10.1080/14397595.2018.1436119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Limb lengthening after total knee arthroplasty (TKA) has been reported in some cases, all of which were evaluated using two-dimensional images. To our knowledge, no case has been evaluated using three-dimensional (3D) images. We investigated 3D limb lengthening after TKA. METHODS We simulated 100 varus knees using 3D templating software. Virtual TKA was performed to maintain the original joint line by conducting a measured-resection technique. We examined the relationships of 3D distance between the femoral head center and ankle center before and after TKA, degree of hip-knee-ankle angle (HKA) improvement, and degree of flexion contracture angle improvement. RESULTS All cases showed limb lengthening (average, 9.4 ± 6.0 mm). The coefficients of correlation with limb lengthening and the degree of HKA improvement and the degree of flexion contracture angle improvement were good (0.730 and 0.751, respectively). The correlation between the degree of total improvement (the degree of HKA improvement + the degree of flexion contracture angle improvement) and limb lengthening was strong (r = 0.896). CONCLUSION The expected limb lengthening when performing measured-resection TKA is expressed as 0.58 × (the degree of HKA improvement + the degree of flexion contracture angle improvement) mm and is a useful index.
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Affiliation(s)
- Takaaki Ohmori
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Tamon Kabata
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Yoshitomo Kajino
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Daisuke Inoue
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Tadashi Taga
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Takashi Yamamoto
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Tomoharu Takagi
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Junya Yoshitani
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Takuro Ueno
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Ken Ueoka
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Hiroyuki Tsuchiya
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
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Kim SH, Lim JW, Jung HJ, Lee HJ. Influence of soft tissue balancing and distal femoral resection on flexion contracture in navigated total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:3501-7. [PMID: 27539400 DOI: 10.1007/s00167-016-4269-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the influence of intra-operative soft tissue balancing and distal femoral cutting on flexion contracture in navigated TKA. METHODS This was a prospective cohort study. Fifty-nine patients of primary navigation-assisted TKA were included with over 15° of flexion contracture and excluded valgus knees. Among the cases, 43 cases were performed with soft tissue balancing procedures only, and 16 cases were performed with soft tissue balancing and additional distal femoral bone cutting. The mean preoperative flexion contracture was 17.5° ± 2.7°. The angles of flexion contracture were recorded at each surgical step with navigation. RESULTS The mean difference in flexion contracture angle between initial angle and angle after medial release was 5.2° ± 2.8°. The mean difference in flexion contracture angle between medial release step and after posterior cruciate ligament (PCL) release was 2.5° ± 2.2°. The mean difference in flexion contracture angle between PCL release step and after routine bone cutting was 3.1° ± 3.2°. The mean difference in flexion contracture angle between after trial insertion and after posterior clearing procedure was 2.7° ± 1.9°. Among the cases, TKA with 2 mm additional bone cutting were performed in 16 cases. The mean difference in flexion contracture angle after additional femoral bone cutting was 4.8° ± 2.1°. CONCLUSION The medial release and 2 mm additional bone cutting could correct flexion contracture by 5°. The appropriate soft tissue balancing and bone cutting could correct flexion contracture intra-operatively up to 5° in each step. LEVEL OF EVIDENCE II.
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39
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Ashraf M, Priyavadhana S, Sambandam SN, Mounasamy V, Sharma OP. Total Knee Arthroplasty In Patients With Parkinson's Disease- A Critical Analysis of Available Evidence. Open Orthop J 2017; 11:1087-1093. [PMID: 29152001 PMCID: PMC5676002 DOI: 10.2174/1874325001711011087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/16/2017] [Accepted: 07/18/2017] [Indexed: 01/26/2023] Open
Abstract
Background: In this era of modern medicine, there is an increase in life expectancy and thereby an ageing population. Among this group one of the most common neurological disorder is Parkinson disease and one of the most common operation done in elderly population is a total joint arthroplasty. But total joint arthroplasty in Parkinson disease is a relatively uncommon entity. There is sparse literature available with regards to total knee arthroplasty (TKA) in Parkinson disease. This review focusses on the necessity, complications and previous experiences on TKA in PD based on the literature available. Method: The review was conducted after a series of advanced search in the following medical databases; Pub med, Biomed central, Cochrane and Google scholar for articles related to total knee replacement in patients with Parkinson’s disease. The following keywords were used; Total knee arthroplasty, Parkinson’s disease, Hoehn and Yahr, Flexion Contracture. Results: The review indicates that the functional outcome is comparable to that of controls in immediate post-operative phase, one year and three-year phase, but the long term functional outcome seems to deteriorate significantly. Conclusion: Total knee arthroplasty can serve as an effective tool in alleviating pain in short term as well as long term periods, whereas the functional outcome seems to deteriorate post operatively on a long-term basis. Nevertheless, TKA in PD is a challenging situation, thereby necessitating a holistic approach with the efforts from various specialists needed at each stage to ensure a successful operation.
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Affiliation(s)
- Munis Ashraf
- Department of Orthopaedics, K.G. Hospital and Postgraduate Medical Institute, Arts College Road, Coimbatore 641018, Tamil Nadu, India
| | | | - Senthil Nathan Sambandam
- Department of Orthopaedics, K.G. Hospital and Postgraduate Medical Institute, Arts College Road, Coimbatore 641018, Tamil Nadu, India
| | - Varatharaj Mounasamy
- VCU Medical Center Ambulatory Care Center, 417 North 11th Street, Richmond, Virginia, USA
| | - Om Prakash Sharma
- Orthopedic surgeon Essentia Health St.Mary's Detroit Lakes Clinic, Minnesota, USA
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Van Beeck A, Van den Broek M, Michielsen M, Didden K, Vuylsteke K, Verstreken F. Efficacy and safety of collagenase treatment for Dupuytren's disease: 2-year follow-up results. Hand Surg Rehabil 2017; 36:346-349. [PMID: 28732844 DOI: 10.1016/j.hansur.2017.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 06/01/2017] [Accepted: 06/13/2017] [Indexed: 01/24/2023]
Abstract
Dupuytren's contracture is a common hand problem that affects the palmar fascia. Several treatment options exist, but none are curative and recurrence is common. Bacterial collagenase has recently been proven beneficial for treating Dupuytren's disease, cleaving the collagen fibers at different sites, with weakening and eventually rupture of the fibrous cords after manipulation. An independent prospective follow-up study was organized on 87 patients, treated with one or more collagenase injections. Inclusion criteria were a contracture of at least 20° at the metacarpophalangeal (MCP) or the proximal interphalangeal (PIP) joint. The most diseased joint was taken into consideration for follow-up evaluation. The resulting extension deficit was measured at 1 month, 1 year and 2 years and was graded as "clinical success", "clinical improvement" or "clinical failure". The mean contracture improved from 45° (39° for MCP and 54° for PIP joints) before treatment to 5° (2° for MCP and 9° for PIP joints) 4 weeks after treatment. No serious complications occurred. After 2 years, 68 joints were evaluated; 61.5% of the MCP joints and 34.5% of the PIP joints had a contracture of ≤20°. When compared with the 4-week evaluation, 28.2% of MCP joints and 62.1% of PIP joints had a recurrence (20° or greater worsening) or had received additional treatment. Collagenase injection is a safe and effective treatment option for Dupuytren disease, but recurrence is common especially for the PIP joint.
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Affiliation(s)
- A Van Beeck
- Orthopedic department, Monica hospital, 68, Harmoniestraat, 2018 Antwerp, Belgium.
| | - M Van den Broek
- Orthopedic department, Monica hospital, 68, Harmoniestraat, 2018 Antwerp, Belgium
| | - M Michielsen
- Orthopedic department, Monica hospital, 68, Harmoniestraat, 2018 Antwerp, Belgium
| | - K Didden
- Orthopedic department, Monica hospital, 68, Harmoniestraat, 2018 Antwerp, Belgium
| | - K Vuylsteke
- Orthopedic department, Monica hospital, 68, Harmoniestraat, 2018 Antwerp, Belgium
| | - F Verstreken
- Orthopedic department, Monica hospital, 68, Harmoniestraat, 2018 Antwerp, Belgium
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Mousavi H, Mir B, Safaei A. Evaluation of Thompson's quadricepsplasty results in patients with knee stiffness resulted from femoral fracture. J Res Med Sci 2017; 22:50. [PMID: 28567069 PMCID: PMC5426090 DOI: 10.4103/1735-1995.205237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/17/2016] [Accepted: 01/29/2017] [Indexed: 11/08/2022]
Abstract
Background: Posttraumatic and/or postsurgical knee stiffness is one of the orthopedic complications which is difficult to be treated and can affect individual's life negatively. The aim of this study is to investigate the results of quadricepsplasty in patients with knee stiffness resulted from femoral fracture. Materials and Methods: This is a cross-sectional study on all patients with femoral fracture which has caused knee flexion limitation referred to Kashani and Al-Zahra Hospitals in Isfahan from January 2010 to March 2013. The type and site of fracture, joint extension, and fracture fixation technique were recorded. Moreover, the range of motion (ROM) before surgery, under general anesthesia, and 3- and 6-month postoperation were measured. Results: Among the patients, 13 had a simple fracture (48%) and 14 had a segmental fracture (51.9%). Considering the fracture site, 11, 10, and 6 patients had femoral (40.74%), supracondylar (37.3%), and femoral supracondylar (22.2%) fractures, respectively. The fracture fixation was performed by the plate, external, and Wagner fixation techniques for 24 (88.9%), 2 (7.4%), and 1 (3.7%) patients, respectively. The mean ROM before operation, under general anesthesia, and 3- and 6-month postoperation were determined to be 33.15° ± 24.73°, 122.60° ± 10.22°, 99.63° ± 16.52°, and 100.74° ± 15.67°, respectively. The mean ROM value at various stages was not similar (P < 0.001). The mean changes in the ROM were 79.2° ± 24.6° and 62.1° ± 19.7° in the cases with simple and segmental fractures, respectively. The mean changes in the knee ROM were significantly higher in simple fractures in comparison with the segmental femoral fracture (P = 0.03). Conclusion: We found Thompson's quadricepsplasty may successfully increase the range of knee flexion in knee fracture and also regardless of quadriceps time.
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Affiliation(s)
- Hamid Mousavi
- Department of Orthopedics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrouz Mir
- Department of Orthopedics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Safaei
- Isfahan Medical School Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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42
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Wierer G, Runer A, Gföller P, Fink C, Hoser C. Extension deficit after anterior cruciate ligament reconstruction: Is arthroscopic posterior release a safe and effective procedure? Knee 2017; 24:49-54. [PMID: 27742158 DOI: 10.1016/j.knee.2016.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/15/2016] [Accepted: 09/20/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postoperative extension deficits following anterior cruciate ligament (ACL) reconstruction can cause major limitation during daily life. The purpose of this study was to evaluate the efficiency of an all-arthroscopic approach and posterior capsule release for the treatment of persistent knee extension deficits following ACL reconstruction. METHODS Between 2009 and 2013 a total of 10 patients with knee flexion contractures after ACL reconstruction were assessed following an all-arthroscopic approach and posterior capsulotomy. The clinical outcomes were reviewed using the range of motion (ROM), Tegner Activity Level, Lysholm score and visual analogue pain scale (VAS). RESULTS Four women and six men with a median age of 34years (range: 17 to 49years) were included in the study. The median follow-up period was 25months (range: 14 to 69months). The median preoperative extension deficit was 15° (range: 10 to 20°) compared to the normal contralateral knee. Postoperatively at final follow-up the median extension deficit was one degree (range: 0 to five degrees) (P<0.01). The median preoperative Lysholm score improved from 52 (range: 32 to 67) to 92 (range: 84 to 100) postoperatively (P<0.01), while the median Tegner Activity Level improved from three (range: two to six) to six (range: three to seven) respectively (P<0.02). The median VAS status for pain decreased from five (range: one to 10) to one (range: 0 to three) (P<0.01). No complications were observed. CONCLUSIONS Arthroscopic posterior capsulotomy is a safe and effective additional procedure in the treatment of persistent knee extension deficits following ACL reconstruction with excellent results regarding ROM and subjective outcomes. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Guido Wierer
- Department of Traumatology and Sports Injuries, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; Gelenkpunkt - Center for Sports and Joint Surgery, Olympiastraße 39, 6020 Innsbruck, Austria.
| | - Armin Runer
- Gelenkpunkt - Center for Sports and Joint Surgery, Olympiastraße 39, 6020 Innsbruck, Austria; Medical University Innsbruck, 6020 Innsbruck, Austria.
| | - Peter Gföller
- Gelenkpunkt - Center for Sports and Joint Surgery, Olympiastraße 39, 6020 Innsbruck, Austria.
| | - Christian Fink
- Gelenkpunkt - Center for Sports and Joint Surgery, Olympiastraße 39, 6020 Innsbruck, Austria; Research Unit for OSMI, UMIT/ISAG, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria.
| | - Christian Hoser
- Gelenkpunkt - Center for Sports and Joint Surgery, Olympiastraße 39, 6020 Innsbruck, Austria.
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Hwang YS, Moon KP, Kim KT, Kim JW, Park WS. Total Knee Arthroplasty for Severe Flexion Contracture in Rheumatoid Arthritis Knees. Knee Surg Relat Res 2016; 28:325-329. [PMID: 27894181 PMCID: PMC5134793 DOI: 10.5792/ksrr.16.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 10/31/2022] Open
Abstract
Flexion contracture deformities, as well as severe varus and valgus deformities of the knee joint, accompany osteoarthritis or rheumatoid arthritis (RA). In particular, severe flexion contracture deformity of the knee joint is often found in patients with RA, which renders them nonambulatory. This report describes a 26-year-old female patient diagnosed with RA 10 years ago. She had chronic joint pain, severe flexion contracture, valgus deformity in both knees, and limited range of motion in both knees and became nonambulatory. She underwent a total knee arthroplasty (TKA) and serial casting and physical therapy to restore stable joint movement and correct knee joint deformity. Her pain was successfully relieved, and she was able to walk after surgery. Here, we report the excellent results of TKA in this RA patient with severe flexion contracture of both knees.
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Affiliation(s)
- Youn Soo Hwang
- Department of Orthopaedic Surgery, Dong-Eui Medical Center, Busan, Korea
| | - Kyu Pill Moon
- Department of Orthopaedic Surgery, Dong-Eui Medical Center, Busan, Korea
| | - Kyung Taek Kim
- Department of Orthopaedic Surgery, Dong-Eui Medical Center, Busan, Korea
| | - Jin Wan Kim
- Department of Orthopaedic Surgery, Dong-Eui Medical Center, Busan, Korea
| | - Won Seok Park
- Department of Orthopaedic Surgery, Dong-Eui Medical Center, Busan, Korea
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Uğurlu Ü, Özdoğan H. Effects of serial casting in the treatment of flexion contractures of proximal interphalangeal joints in patients with rheumatoid arthritis and juvenile idiopathic arthritis: A retrospective study. J Hand Ther 2016; 29:41-50; quiz 50. [PMID: 26847319 DOI: 10.1016/j.jht.2015.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/16/2015] [Accepted: 11/16/2015] [Indexed: 02/03/2023]
Abstract
AIM To analyze the effects of serial casting (SC) in the treatment of proximal interphalangeal (PIP) joint flexion contractures in patients with rheumatoid arthritis and juvenile idiopathic arthritis. STUDY DESIGN Retrospective case-series. METHODS The data of 18 patients treated with SC were obtained from their patient records. The angular changes in the finger joints were analyzed and compared statistically using t-tests. RESULTS A total of 49 fingers were serially casted with plaster of Paris over a 14-year period. The SC resulted in significant (26.8°; p < 0.001) reduction in the PIP joint extension loss. Small, but statistically significant, losses in flexion were associated with these gains. (p < 0.001). Angular changes were also observed in the other finger joints. The magnitude of the initial extension loss was the only factor to explain the amount of motion gained (p < 0.001; R2 = 0.38). CONCLUSION SC is an effective method to correct flexion contractures in PIP joints in selected patients with arthritis. The gain is partially related to the magnitude of initial extension loss.
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Smith EB, Shafi KA, Greis AC, Maltenfort MG, Chen AF. Decreased flexion contracture after total knee arthroplasty using Botulinum toxin A: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2016; 24:3229-3234. [PMID: 27515301 DOI: 10.1007/s00167-016-4277-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Flexion contracture after total knee arthroplasty (TKA) can cause significant dissatisfaction. Botulinum toxin A has shown improved extension in patients with spastic flexion contractures after TKA. The purpose of this study was to evaluate whether Botulinum toxin A improves knee extension for any patient with flexion contractures following TKA. METHODS A prospective, double-blinded, randomized controlled trial was conducted. Fourteen patients (15 knees), with a flexion contracture (≥10°) one month postoperatively, were randomized to receive either Botulinum toxin A or saline placebo to the affected hamstrings. The subject, surgeon, and administering physiatrist were blinded to the treatment group throughout the study. Subject range of motion (ROM) was evaluated at 1, 6, and 12 months following injection. Differences were tested using mixed-effects regression to control for multiple measurements. RESULTS The initial post-operative flexion contracture averaged 19° ± 6° in the Botulinum toxin A group and 13° ± 3° in the saline group. Injections were performed 53 and 57 days after TKA in the Botulinum toxin A and saline groups, respectively. Post-injection extension improved to an average of 8, 5, and 1 degrees for BTX and 4, 2, and 1 degrees for SAL, at 1, 6, and 12 months, respectively, compared to pre-injection extension (p < 0.0001). Improvement in knee extension at 1 year improved 18° ± 7.5° for Botulinum toxin A and 12° ± 2° for saline (p = 0.04). No complications resulted from either injection. CONCLUSION Patients who received Botulinum toxin A or placebo were able to achieve near full extension one year after surgery. There was a statistically significant improvement in the amount of extension achieved at 1 year with Botulinum toxin A, but this may be of little clinical significance. Since achieving full extension is important for patient function and satisfaction, novel techniques to address this issue deserve special attention. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Eric B Smith
- Rothman Institute, 1118 West Baltimore Pike Health Center 4, 3rd Floor Media, Philadelphia, PA, 19063, USA.
| | - Karim A Shafi
- Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ari C Greis
- Rothman Institute, 1118 West Baltimore Pike Health Center 4, 3rd Floor Media, Philadelphia, PA, 19063, USA
| | - Mitchell G Maltenfort
- Rothman Institute, 1118 West Baltimore Pike Health Center 4, 3rd Floor Media, Philadelphia, PA, 19063, USA
| | - Antonia F Chen
- Rothman Institute, 1118 West Baltimore Pike Health Center 4, 3rd Floor Media, Philadelphia, PA, 19063, USA
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Nakagawa S, Arai Y, Inoue H, Kan H, Hino M, Ichimaru S, Ikoma K, Fujiwara H, Amaya F, Sawa T, Kubo T. Comparative Effects of Periarticular Multimodal Drug Injection and Single-Shot Femoral Nerve Block on Pain Following Total Knee Arthroplasty and Factors Influencing Their Effectiveness. Knee Surg Relat Res 2016; 28:233-8. [PMID: 27595078 PMCID: PMC5009049 DOI: 10.5792/ksrr.2016.28.3.233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/14/2016] [Accepted: 03/27/2016] [Indexed: 11/04/2022] Open
Abstract
Purpose This study compared the analgesic effects of local infiltration analgesia (LIA) and femoral nerve block (FNB) after total knee arthroplasty (TKA) and assessed factors associated with analgesia obtained by these two methods. Materials and Methods Study subjects included 66 patients (72 knees) who underwent TKA for osteoarthritis of the knee. Pain visual analogue scale (VAS), the amount of analgesics used, number of days to achieve 90° of flexion of the knee joint, date of initiating parallel-bar walking, range of motion of the knee joint at discharge, and adverse events were investigated. Results The VAS scores did not differ significantly between two groups, whereas the amount of analgesics used was significantly lower in the LIA group. Preoperative flexion contracture was significantly more severe in the LIA group with high VAS compared with low VAS. No serious adverse event occurred in the LIA or FNB group. Conclusions The lower analgesic usage in the LIA group than the FNB group indicates that the analgesic effect of LIA was greater than that of singleshot FNB after TKA. There were no serious complications in either group. The postoperative analgesic effect of LIA was smaller in patients with severe than less severe preoperative flexion contracture.
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Affiliation(s)
- Shuji Nakagawa
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Arai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroaki Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroyuki Kan
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Manabu Hino
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shohei Ichimaru
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumimasa Amaya
- Department of Anesthesiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Okamoto Y, Nakajima M, Jotoku T, Otsuki S, Neo M. Capsular release around the intercondylar notch increases the extension gap in posterior-stabilized rotating-platform total knee arthroplasty. Knee 2016; 23:730-5. [PMID: 27174384 DOI: 10.1016/j.knee.2015.11.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/26/2015] [Accepted: 11/29/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND In posterior-stabilized (PS) total knee arthroplasty (TKA), various post-cam designs can be used. A larger cam of the femoral component may tighten the extension gap. Few studies have investigated the relationship between capsular release around the intercondylar notch and the extension gap. The aim of this study was to assess the effect of capsular release around the intercondylar notch on the extension gap. METHODS Forty-eight patients (54 knees) who underwent PS rotating-platform TKA (PFC Sigma RP-F) were enrolled retrospectively. We measured the extension gap with and without a femoral trial using a knee balancer, applying a joint distraction force of 44lb. When an intraoperative flexion contracture of >5° persisted, we performed a capsular release approximately 10mm cranial to the intercondylar notch. After full knee extension was achieved, the extension gap was measured again. RESULTS Thirty knees required capsular release. With a trial, the medial and lateral differences between the extension gaps before and after capsular release were 1.7mm (p<0.0001) and 2.3mm (p<0.0001), respectively. Without a trial, the gaps were enlarged by 0.4mm (p=0.0452) and 0.6mm (p=0.0215), respectively. Twenty-four knees did not require release. No significant differences were noted in the range of motion at one-year follow-up between the two cohorts. CONCLUSIONS With PS rotating-platform TKA, capsular release around the intercondylar notch is found to increase the extension gap and may prevent postoperative flexion contracture. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan.
| | - Mikio Nakajima
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Tsuyoshi Jotoku
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
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Ishida K, Shibanuma N, Matsumoto T, Sasaki H, Takayama K, Matsuzaki T, Tei K, Kuroda R, Kurosaka M. Navigation-based femorotibial rotation pattern correlated with flexion angle after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:89-95. [PMID: 25261225 DOI: 10.1007/s00167-014-3340-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate whether intraoperative kinematics obtained by navigation systems can be divided into several kinematic patterns and to assess the correlation between the intraoperative kinematics with maximum flexion angles before and after total knee arthroplasty (TKA). METHOD Fifty-four posterior-stabilised (PS) TKA implanted using an image-free navigation system were evaluated. At registration and after implantation, tibial internal rotation angles at maximum extension, 30°, 45°, 60°, 90°, and maximum flexion were collected. The rotational patterns were divided into four groups and were examined the correlation with maximum flexion before and after operation. RESULTS Tibial internal rotation from 90° of flexion to maximum flexion at registration was correlated with maximum flexion angles pre- and postoperatively. The four groups showed statistically different kinematic patterns. The group with tibial external rotation up to 90° of flexion, following tibial internal rotation at registration, achieved better flexion angles, compared to those of another groups (126.7° ± 12.0°, p < 0.05). The group with tibial external rotation showed the worst flexion angles (80.0° ± 40.4°, p < 0.05). Furthermore, the group with limited extension showed worse flexion angles (111.6° ± 8.9°, p < 0.05). CONCLUSION Navigation-based kinematic patterns found at registration predict postoperative maximum flexion angle in PS TKA. Navigation-based kinematics can be useful information during TKA surgery. LEVEL OF EVIDENCE Diagnostic studies, development of diagnostic criteria in a consecutive series of patients and a universally applied "gold" standard, Level II.
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Abstract
Paraplegic flexion contracture of hip joints beyond 90° is a difficult condition to treat for any orthopedic surgeon. There is no fixed protocol of treatment described, by and large it is individualized. A 20 year old female presented with paraplegia for last 15 years due to irrecoverable spinal cord disease with complete sensory and motor loss of both lower extremities and was admitted with acute flexion contracture of both hip joints with trunk resting on thighs. She underwent bilateral proximal femoral resection. Both hip joints were straight immediately after surgery and patient could lie on her back. In a course of time, she started sitting on her buttocks, led a comfortable wheelchair life with a sitting balance. Proximal femoral resection is an effective method to treat long standing irrecoverable paraplegic acute flexion deformity of the hip joint.
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Affiliation(s)
- Sailendra Bhattacharyya
- Department of Orthopaedics, Bhattacharyya Orthopaedics and Related Research Centre, Narayanpur, Kolkata, West Bengal, India,Address for correspondence: Dr. Sailendra Bhattacharyya, Bhattacharyya Orthopaedics and Related Research Centre, Narayanpur, P.O Rajarhat-Gopalpur, Kolkata - 700 136, West Bengal, India. E-mail:
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Harada Y, Fukiage K, Nishikomori R, Suzuki S, Futami T. CINCA syndrome with surgical intervention for valgus deformity and flexion contracture of the knee joint: A case report. Mod Rheumatol 2015; 27:1098-1100. [PMID: 25867226 DOI: 10.3109/14397595.2015.1040609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chronic infantile neurological, cutaneous, and articular (CINCA) syndrome is a systemic autoinflammatory disease caused by increased production of interleukin (IL)-1β. We present a case of CINCA syndrome followed up to skeletal maturity. Joint contracture and valgus deformity of the knee had developed before diagnosis. Surgical interventions by soft tissue release and hemiepiphysiodesis improved the contracture and the deformity, and IL-1 receptor antagonist dramatically controlled systemic inflammation, and the patient lives without any disabilities.
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Affiliation(s)
- Yuki Harada
- a Department of Pediatric Orthopaedics , Shiga Medical Center for Children , Shiga , Japan
| | - Kenichi Fukiage
- a Department of Pediatric Orthopaedics , Shiga Medical Center for Children , Shiga , Japan
| | - Ryuta Nishikomori
- b Department of Pediatrics , Kyoto University Hospital , Shiga , Japan
| | - Shigeo Suzuki
- c Department of Pediatric Orthopaedics , Mizuno Memorial Hospital , Shiga , Japan
| | - Tohru Futami
- b Department of Pediatrics , Kyoto University Hospital , Shiga , Japan
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