No abstract

The aim of this study was to determine whether primary repair for intraoperative injury of the medial collateral ligament (MCL) can achieve satisfactory clinical results when compared to the clinical results of patients with no MCL injury. Simultaneously, we sought to determine the differences between 2 methods of primary repair (anchor suture and staple) in terms of their clinical outcomes.In our institute, 3897 total-knee arthroplasties (TKAs) were performed between 2003 and 2014. Sixty-five patients who suffered an MCL injury during the TKA procedure and in whom the injury was repaired with a suture anchor or staple (suture anchor: 36 vs staple: 29) were studied. A matched group of 65 patients without an MCL injury was selected to serve as the control group. Subjective feelings of instability and functional outcomes were assessed using the knee society (KS) score and the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Objective stability was evaluated by the measurement of opening angles in extension and at 30° of knee flexion on valgus stress radiographs. The clinical outcomes and stability results were compared between the suture anchor and staple methods.The KS and WOMAC scores in patients who received primary repair of MCL injury during TKA improved from 50.6 ± 13.1 to 87.3 ± 7.3 (P < .001) and 65.9 ± 14.4 to 17.7 ± 6.6 (P < .001), respectively. However, there were no statistically significant differences in the KS (P = .84) and WOMAC (P = .71) scores when comparing the group that received primary repair to the control group. Radiographic stability also showed no differences between the repair and control groups in extension and at 30° of flexion (P = .48 and P = .11, respectively). In the subgroups, there were no significant differences between the suture anchor and staple repair methods in terms of stability and clinical outcomes.Primary repair of an MCL injury during TKA may have clinical outcomes comparable to that in the no MCL injury group. Both staple and suture anchor repair methods could provide excellent clinical and stability outcomes in these types of cases, although a further cohort study is required to validate our results.

Patellar tendon rupture after total knee arthroplasty is a rare, but often catastrophic complication. In addition, infection is also a dreaded complication after total knee arthroplasty. We report an 84-year-old female that has late infected total knee arthroplasty with patellar tendon rupture treated with resection arthroplasty and then subsequent arthrodesis with retrograde intramedullary nail. Objective: Periprosthetic joint infection (PJI) of the hip due to methicillin-resistant bacteria is difficult to treat and remain a challenge for arthroplasty surgeon. Methods: Retrospective review was done to the patients who received two-stage revisions with antibiotic loaded cement-spacer for PJI of the hip between January 2010 to June 2015. We found 65 patients (65 hips) with positive culture findings. Eight patients were lost to followup and excluded from the study. Among the rest of the 57 patients, methicillin-resistant infection (MR Group) was found in 28 cases. For comparison, we also evaluated the 29 other cases that caused by other pathogen (Non-Methicillin resistant group/Non-MR group). We compared all of the relevant medical records and the treatment outcomes between the two groups. Results: The mean of follow-up period was 33.7 months in the methicillin-resistant group and 28.4 months in the nonmethicillin-resistant group (p = 0.27). The causal pathogens in the methicillin-resistant group were: Methicillin-resistant Staphylococcus aureus (MRSA) in 10 cases, Methicillin-resistant Staphylococcus epidermidis (MRSE) in 16 cases and Methicillin-resistant coagulase-negative Staphylococcus (MRCNS) in 2 cases. The reimplantation rate was 92.8% and 89.6% in the methicillin-resistant and nonmethicillinresistant groups, respectively (p= 0.66). The rates of recurrent infection after reimplantation were 23.1% (6/26) in the methicillin-resistant group and 7.6% (2/26) in the nonmethicillinresistant group (p= 0.12). The overall infection control rate was 71.4% (20/28) and 89.6% (26/29) in the methicillin-resistant and nonmethicillin-resistant groups, respectively (p = 0.08). Both group showed comparable baseline data on mean age, BMI, gender distribution, preoperative ESR/CRP/WBC and comorbidities. Conclusion: Two-stage revision still resulted a higher recurrency rate and lower infection control rate for the treatment of periprosthetic joint infection (PJI) of the hip due to methicillin-resistant infection compared to nonmethicillin-resistant infection.