Showing papers by "Gautam M. Shetty published in 2009"

Computer-Assisted Total Knee Arthroplasty for Arthritis With Extra-articular Deformity

Abstract: Forty extra-articular deformities (22 femoral and 18 tibial) in 34 patients (mean age, 63.1 years) were studied. Mean coronal extra-articular deformity was 9.3 degrees ; mean preoperative limb alignment was 166.7 degrees . Three limbs underwent simultaneous corrective osteotomy; the rest were treated with intra-articular correction during computer-assisted total knee arthroplasty (TKA). Mean postoperative limb alignment was 179.1 degrees . At a mean follow-up of 26.4 months, the Knee Society knee score improved from a mean preoperative score of 49.7 to 90.4 points postoperatively; function score improved from 47.3 to 84.9 points. Computer-assisted TKA is a useful alternative to conventional TKA for knee arthritis with extra-articular deformity where accurate restoration of limb alignment may be challenging because of the presence of a deformed tibia or femur or in the presence of hardware.

Effect of Repair of Radial Tears at the Root of the Posterior Horn of the Medial Meniscus With the Pullout Suture Technique: A Biomechanical Study Using Porcine Knees

Abstract: Purpose Our purpose was to evaluate the result of radial tears at the root of the posterior horn of the medial meniscus (PHMM) in terms of tibiofemoral contact mechanics and the effectiveness of pullout sutures for such tears. Methods Eleven mature pig knees each underwent 15 different testing conditions with an intact, simulated (incised) radial tear at the root of the PHMM and placement of pullout sutures in the radial tears of the medial meniscus at 5 different angles of flexion (0°, 15°, 30°, 60°, and 90°) under a 1,500-N axial load. A K-Scan pressure sensor (Tekscan, Boston, MA) was used to measure medial tibiofemoral contact area and peak tibiofemoral contact pressure. Data were analyzed to assess the difference in medial contact area and tibiofemoral peak contact pressure among the 3 meniscal conditions at various degrees of knee flexion. Results The mean contact area was significantly lower, and the peak tibiofemoral contact pressure was significantly high in knees with simulated radial tears at all angles of knee flexion compared with knees with intact menisci ( P P Conclusions Radial tears at the root of the PHMM in a porcine model significantly increased medial tibiofemoral contact pressure and decreased contact area. Although repair of tears of the PHMM with the pullout suture technique aids in significantly reducing tibiofemoral peak contact pressure between 30° and 90°, it remains significantly high at 0° and 15° of flexion. Clinical Relevance Pullout sutures for radial tears at the root of the PHMM may lead to an increase in peak medial tibiofemoral contact pressure and may be prone to mechanical failure, especially during the stance (loading) phase of gait (mean, 15° of flexion).

Computer-assisted TKA: greater precision, doubtful clinical efficacy: opposes.

Abstract: Despite improved precision of component placement and consistent and accurate restoration of neutral limb alignment, controversy persists regarding the clinical benefits of computer-assisted total knee arthroplasty (TKA). Computer-assisted TKA provides excellent information regarding gap equality and symmetry throughout the knee range of motion and allows precise, quantitative soft tissue release for deformities, especially in knees with severe flexion contractures and severe rigid valgus deformities. Hence accurate restoration of gap balance, joint line, and posterior femoral offset consequently improves functional results. Knee arthritis with complex extra-articular deformities and in situ hardware can be tackled appropriately using computer navigation where conventional techniques may be inadequate. It also allows intra-articular correction for extra-articular deformities due to malunions and facilitates extra-articular correction in cases with severe extra-articular tibial deformities. In obese patients, where the alignment of the limb is difficult to assess, computer navigation improves accuracy and reduces the number of outliers. The ability to quantify the precise amount of bone cuts and soft tissue releases needed to equalize gaps and restore alignment, reduced blood loss, and incidence of systemic emboli improves the safety of the procedure and hastens functional recovery of the patient. Hence, computer-assisted TKA not only provides greater precision, but also greater clinical benefit.

Anterolateral incision in total knee arthroplasty: is there a role for a longer incision in this day-and-age of minimal invasive surgery?

Abstract: Prospective randomised study on the early clinical outcome of anterior midline versus anterolateral incision for total knee arthroplasty (TKA). To assess the early clinical outcome of anterior midline versus anterolateral incision for TKA in terms of wound dehiscence, time for wound healing, lateral flap numbness and knee range of movements. A total of 40 consecutive patients randomly received either anterior midline (midline group; 20 patients, 25 TKAs) or anterolateral skin incision (anterolateral group; 20 patients, 24 TKAs) followed by anteromedial arthrotomy. Postoperatively, the patients were assessed for wound dehiscence, time for wound healing, lateral flap numbness and range of movements. Midline group demonstrated more wound dehiscence, longer healing time and lateral flap numbness compared to anterolateral group. Although the incision was shorter in midline group(P < 0.0001), better flexion was achieved in anterolateral (P < 0.0001). Anterolateral incision may be superior in terms of wound healing, lateral flap numbness and knee range of movements and may be a good alternative to the routine anterior midline incision especially in patients who want to kneel, for religious reasons, in the early postoperative period.

Localized pigmented villonodular synovitis of the posterior capsule of the knee.

Abstract: Localized pigmented villonodular synovitis involving the posterior intra-articular structures of the knee joint is rare. We report a case of localized pigmented villonodular synovitis arising from the posterior capsule of the knee joint in a patient who presented with a history of repeated joint effusions and loss of terminal knee flexion. After successful, complete removal of the mass through the posteromedial portal, the patient was asymptomatic, with no evidence of recurrence during the 26-month follow-up period.

Central Popliteal Mass Due to Communicating Posterior Cruciate Ligament Cyst: An Indication for a Combined Approach

Abstract: An isolated symptomatic posterior cruciate ligament cyst is uncommon, and extra-articular communication of this cyst is extremely rare. We report a case of a symptomatic communicating posterior cruciate ligament cyst presenting as a central popliteal mass. In view of the large extra-articular extension of this cyst and its close proximity to the popliteal neurovascular structures, we successfully treated this cyst with a combined arthroscopic and open approach.

Arthroscopic view of transient synovitis of the hip joint: a case report.

Abstract: We present a case of a 13-year-old male patient with hip pain and limp. Inconclusive investigations and persistent symptoms resulted in the patient undergoing hip arthroscopy. At arthroscopy, a large focal cartilaginous defect of the femoral head with synovitis was seen and synovial biopsy confirmed the diagnosis. Arthroscopic debridement of the lesion, synovectomy and non-weight bearing for 6 weeks resulted in relief of symptoms. Transient synovitis is a common diagnosis in young children, but the extent of damage to the femoral head has not been previously described. Transient synovitis may not always respond to symptomatic treatment and hip arthroscopy may be useful in detecting the actual lesion and plan the treatment.