Evaluation of the flexion gap by axial radiography of the distal femur

The shape of the flexion gap in 20 normal knees was evaluated by axial radiography of the distal femur, and the results compared with those obtained in a previous study by MRI. The observed asymmetry was reduced by 29% using radiography, with a mean value of 3.6° (1.5° to 6.3°) compared with that obtained by MRI of 5.1° (2.6° to 9.5°), a mean discrepancy of 1.49°. The results obtained by radiography and MRI showed a strong correlation (r = 0.78).

Axial radiography is acceptable for the evaluation of the flexion gap and is less expensive and more comfortable to perform than MRI. Additionally, no metallic artefact occurs when the radiological method is used for assessment after arthroplasty.

Axial radiography of the distal femur to assess rotational alignment in total knee arthroplasty

A method for taking an axial radiograph of the distal femur was developed to see the epicondyles and posterior condyles of the femur. It was hypothesized that these radiographs would be acceptable for evaluating rotational alignment in total knee arthroplasty with comparable reproducibility and good correlation to the results obtained with computed tomography images. Radiographs were obtained of 50 knees in 32 patients having total knee arthroplasty. The radiographs were taken while the patients were with the knee in 90 degrees flexion. The angle between the clinical epicondylar axis and the posterior condylar axis (twist angle) was measured and compared with the results obtained by conventional computed tomography. The interobserver variation in the axial radiography was less than or comparable to the computed tomography method. The mean discrepancy between the two methods (+/- standard deviation) was 0.5 degrees +/- 0.4 degrees (range, 0-1.9 degrees ), and a strong correlation was observed. This plain radiography is acceptable for evaluation of femoral component rotation with comparable reproducibility and correlation to the results with computed tomography. It has several advantages regarding cost, radiation dose, and lack of scatter when used for postoperative assessment.

Fluoroscopic analysis of knee arthroplasty kinematics during deep flexion kneeling

Achieving deep knee flexion >145 degrees is a goal of many patients receiving knee arthroplasty in Asia and the Middle East, yet it is unknown whether knees with implants move similar to the natural knee in these postures. We studied 18 of 36 consecutively operated knees that were able to flex >145 degrees using fluoroscopic analysis during kneeling to maximum flexion. An average of 9 degrees tibial internal rotation was observed in deep flexion. Posterior condylar translations were observed from 80 degrees to 120 degrees flexion, and the condyles translated forward in flexion beyond 120 degrees. Separation of the condyles from the tibial surface was observed in 9 knees at flexion >130 degrees. Very deep flexion can be achieved and is well accommodated using contemporary posterior-stabilized knee arthroplasty, but the kinematics differ from the intact natural knee.

The static and cyclic strength of a bone-cement bond

Four-point bending static and fatigue tests were carried out on bone-cement bonds. The effects of the pressurization and the washing of the bone joint face on the bond strength were investigated. The results are summarized as follows. When the bond surface of cancellous bone is washed prior to the application of the bone cement, both the static and fatigue strengths of the bond are increased relative to the corresponding properties of unwashed bone-cement bonds. From observations of bone-cement interfaces as well as the fracture surfaces of bone-cement specimens, it has been determined that bone cement was able to infiltrate into fine holes present in washed cancellous bone. However, such infiltration occurred to a much lesser degree in the case of unwashed cancellous bone. Increasing the molding pressure during the time of cement application to the bone from 39200 to 117600 Pa had a beneficial effect on the bending strength and fatigue properties, particularly in the case of washed bone cement specimens. An increase in molding pressure also resulted in a reduction in the amount of scatter in test results.

On fatigue lifetimes and fatigue crack growth behavior of bone cement

Bone cement is used to develop a mechanical bond between an artificial joint and the adjacent bone tissue, and any degradation of this bond is of serious concern since it can lead to loosening and eventually malfunction of the artificial joint. In the present study, the fatigue lives and fatigue crack propagation behavior of two bone cements, CMW Type 3 and Zimmer, were investigated, and it was found that the size and distribution of pores played a major role in influencing both the fatigue crack initiation and propagation processes. The fatigue lifetimes of CMW exceeded those of Zimmer because of a lesser density of large pores. When the fatigue lifetimes were plotted as a function of Klimax, the maximum initial stress intensity factor based upon the initiating pore size, the difference in fatigue lifetimes between CMW and Zimmer bone cements was greatly reduced. The fatigue crack growth behavior of both bone cements were similar. This is a further indication that the noted differences in fatigue lifetimes were related to the size of the pore at the crack initiating site.

The clamp fixation method in cemented total knee arthroplasty. Dynamic experimental and radiographic studies of the tibial baseplate clamper

The clamp fixation method using the Tibial Baseplate Clamper in total knee arthroplasty (TKA) is a superior procedure compared to conventional cement fixation methods. A dynamic experimental study and a radiographic study were performed to make sure the efficiency of the clamp fixation method was satisfactory. As a result, this procedure showed the large initial pressure force and a lack of variance in the force applied over time, and also it had a large depth of cement penetration compare to the pusher method. The clamp fixation method will help the surgeon achieve excellent cement fixation in TKAs because it has the many advantages of a gentle, yet strong, constant, and, most importantly, simple approach surgeons can use to reduce operating time while cementing all three prostheses simultaneously.

[A clinical study of arthroscopic cystectomy on popliteal cysts associated with rheumatoid arthritis]

PURPOSE

We performed a prospective study of arthroscopic cystectomy on popliteal cysts associated with rheumatoid arthritis.

MATERIALS

We performed arthroscopic cystectomy on three patients, four knees, and an open excision of a cyst on one patient, one knee, who had pain and swelling in the popliteal region. Of these five rheumatoid knees, three were grade I on the Larsen radiographic scale, one was II, and one was III. OPERATIVE METHOD: First, we performed synovectomy on the posterior compartment using a multi-portal approach. Second, we confirmed a small communication hole between the posterior compartment and the Popliteal cyst after the synovectomy with an angled arthroscope through the anterior compartment. Third, we enlarged the communication hole and performed a cystectomy (the excision of the membranous septum and the contents of the cyst) from the inside by using a motorized shaver. Finally, we performed a synovectomy on the anterior compartment. The follow-up period ranged from 1 year 6 months to 3 years, 4 months (the mean was 2 years, 4 months).

EVALUATION

We assessed the results using objective oriteria based on the evaluation of swelling, pain and subjective criteria based on the evaluation of the range of motion of the knee and confirmation of the disappearance of the cyst using MRI.

RESULT

We had good results in this study. All the four knees on which the arthroscopic cystectomy was performed had a reduction of pain and swelling right after the operation. The absence of the cyst was verified using MRI. We had no patient whose ROM was aggravated. However, synovitis and popliteal cysts reoccurred in one knee after the open excision (this case had the vasculitis, larsen grade III radiographically, and severe rheumatism).

DISCUSSION

The recurrence rate of the popliteal cyst was very high (over 50%) when a cyst was performed open exision using a posterior approach. Open synovectomy of an anterior compartment needed the manipulation in several cases because of limited knee movement. We had a reduction in pain and a disappearance of the cyst right after operation. Further more, there was no restriction in ROM resulting from this operative method.

CONCLUSION

Arthroscopic cystectomy is a superior procedure for treating the popliteal cysts associated with rheumatoid arthritis.