No abstract

Total knee arthroplasty (TKA) alignment is one of the most important factors in long-term prosthesis survival. Minimally invasive surgical (MIS) procedures are becoming more common. There may be an increased overall complication rate, especially component malpositioning, due to poor visualisation. The disadvantage of restricted visualisation in the less invasive technique can be compensated by a navigation system. This combined procedure is described in this paper. A total of 40 Search Evolution TKAs were implanted using OrthoPilot navigation in the standard manner, and 40 TKAs were implanted using MIS via a subvastus approach. Primary osteoarthritis of the third or fourth degree, without severe valgus deformity, was the indication. These patients were then selected at random as they came to the institution. The results were evaluated radiologically and clinically.Pain, range of motion, gait and function, and the entire clinical score 10 days after the operation were significantly better in the MIS-group. At 6 and 12 weeks postoperatively, these results were no longer statistically significant. Ideal radiological results were obtained in all cases. No differences in limb axis and component alignment were found after the operation between the navigated groups. MIS is technically very demanding. That is why it should be used only in carefully selected cases. Its advantages occur in the first weeks after the surgery. The long-term results must still be determined.

The computer-assisted open-wedge high tibial osteotomy with tricortical grafts stabilized by LCP fixation gives exact and reproducible results without loss of correction.

The presence of a massive full-thickness osteochondral defect in the knee of young and active individuals is an unsolved problem in orthopedic surgery, especially in post-traumatic large bone defects. Fresh massive osteochondral allografts have been used for many years but mostly in oncology but not in post-traumatic cases. This case report describes a 20-year-old right leg-dominant woman, who, at age 19, sustained open Gustilo-Anderson type III comminuted fractures of the left patella and lateral femoral condyle in a motorbike accident. Initial treatment included immediate débridement and patellectomy with lavage. The large defect of the femoral condyle was reconstructed with a massive osteochondral allograft 1 year after the injury. The graft was obtained from our institutional tissue bank. The damaged bearing part of the condyle was resected to bleeding bone to create the nearly rectangular defect. The central condyle wall remained intact. The graft was trimmed to fit the defect and fixed with three cancellous 6.5-mm screws. The meniscus was not damaged. Partial weight bearing was permitted at 8 weeks and full weight bearing at 16 weeks after the surgery. At the last follow-up control 10 years after the surgery, no evidence of tibiofemoral arthrosis was present. The allograft-host interface was not visible. The radiodensity of the graft was nearly identical to the host bone. The Lysholm score and clinical findings were identical (100 points) to those 18 months after the surgery. The patient was extremely satisfied without complaints at 30 years of age.