Purpose Studies have shown that up to 25 % of TKA patients are dissatisfied with the implanted knee, even if registry data shows ten-year revision rates below 5 %. It has been the question of our study, if it would be possible to identify those patients at risk for dissatisfaction pre-operatively. Methods The data of 1,121 consecutive TKA patients with a follow-up between one and six years have been analysed retrospectively. Demographic, radiologic and perioperative variables have been recorded and all patients were asked by questionnaire for satisfaction with the implanted knee. Logistic regression models have been used to identify significant risk factors. Results The data of 996 patients (89 %) were complete, 849 (85.2 %) reported satisfaction and 147 (14.8 %) dissatisfaction. Patients' satisfaction was independent of the time after operation (p=0.285). The only factor which influenced patients' satisfaction was the osteoarthritic severity. In comparison to severe arthritis Kellgren Lawrence IV°, the risk for dissatisfaction was 2.556-fold elevated for arthritis grade III°(p<0.001) and 2.956-fold higher for grade II°(p=0.001). Conclusions Patients suffering from mild or moderate osteoarthritis are at risk for dissatisfaction after TKA. The TKA indication in those patients should therefore be critically proven. Furthermore, to adjust patients' expectations, the elevated dissatisfaction risk in case of mild or moderate osteoarthritis should be included into patients' pre-operative information.

No abstract

Selective colonic manipulation initiates a distant inflammatory response in the small intestinal muscularis that contributes to postoperative ileus. The data provide evidence that gut-derived bacterial products are mechanistically involved in the initiation of this remote inflammatory cascade.

Femoral malrotation in total knee arthroplasty causes flexion gap instability. Conventional instruments mostly reference the posterior condylar angle (PCA). The aim of this study was to verify whether the computernavigated flexion gap (GAP) method produces a rectangular flexion gap and if a balanced flexion gap could also be achieved by referencing the PCA. A total of 100 knee prostheses were analysed using the navigated GAP method, and flexion gap symmetry along with femoral rotation were recorded. The GAP technique resulted in a rectangular flexion gap with adequate femoral rotational alignment. If the PCA technique had been used, only 51% of the femoral components would have been implanted in correct femoral rotation; the remaining 49% would have implanted with flexion gap instability. The GAP technique produces a rectangular flexion gap. The referencing of the PCA was shown to be less reliable. Thus, modern knee prosthesis instrumentation should not base femoral rotation solely on the PCA.Résumé Les anomalies de rotations fémorales peuvent être à l'origine d'instabilité dans les prothèses totales du genou. Le matériel ancillaire conventionnel a pour référence l'angle postérieur des condyles (PCA). Le but de cette étude est de vérifier grâce à la navigation (GAP) si l'on peut avoir une meilleure balance ligamentaire et un meilleur équilibrage qu'en faisant référence à la PCA. Matériel et méthode: 100 prothèses de genou ont été analysées en utilisant la navigation de type GAP et les anomalies de l'espace en flexion et rotation ont été rapportées. Résultats: la technique utilisant la navigation de type GAP permet d'avoir un bon alignement en rotation alors que la technique conventionnelle faisant référence au condyle postérieur ne permet d'avoir une bonne implantation que dans 34% des cas, les 66% de cas restant présentent une instabilité. En conclusion: la technique avec navigation permet d'avoir un espace en flexion parfaitement rectangulaire, la référence au condyle postérieur est moins fiable. Le matériel ancillaire moderne des prothèses du genou ne doit plus se baser uniquement sur les condyles postérieurs en flexion.

Background-Inflammatory events within the intestinal muscularis, including macrophage activation and leukocyte recruitment, have been demonstrated to participate in causing postoperative ileus. Recently, glycine has gained attention due to its beneficial immunomodulatory effects in transplantation, shock and sepsis.