PS high-flexion TKA provided greater weight-bearing maximal flexion and posterior femoral roll-back than CR high-flexion TKA, although no difference in clinical outcomes was observed between the two prosthesis designs.

III.

Painful plantar callosities under the lesser metatarsals in patients with hallux valgus deformity can be improved by hallux valgus correction alone without lesser metatarsal osteotomy.

BackgroundAchieving neutral limb alignment during total knee arthroplasty (TKA) has been considered an important determinant in the long-term prosthesis survival. The purpose of this study was to evaluate the association between the immediate postoperative mechanical alignment of the lower limb and the rate of revision TKA by comparing an acceptable mechanical axis group (within ± 3° from neutral alignment) and an outlier group (> 3° deviation from neutral alignment).MethodsBetween 2000 and 2006, clinical and radiographic data of 334 primary TKAs were retrospectively reviewed to determine the 10-year Kaplan-Meier survival rate. Patients were divided into acceptable and outlier groups according to the mechanical axis checked postoperatively within a month. Clinical outcomes were assessed using Hospital for Special Surgery, Knee Society Score, and Western Ontario and McMaster Universities Osteoarthritis Index score preoperatively and at the final follow-up. Postoperative complications and revision rates were also evaluated.ResultsThe mean change in mechanical axis between the immediate postoperative examination and the last follow-up was greater in the outlier group (1.6 ± 2.7) than in the acceptable group (0.8 ± 2.4). The revision rates were significantly different between the two groups (p = 0.04). At the last follow-up, clinical scores were all improved in both groups compared to each preoperative condition. There were no significant differences in clinical scores between the two groups at the last follow-up. The 10-year Kaplan-Meier survival analysis showed a tendency towards better survival with restoration of neutral mechanical axis. However, the difference was not statistically significant (p = 0.25).ConclusionsRestoration of neutral limb alignment is a factor that can result in a lower revision rate and higher longevity in TKA. However, there were no significant differences in clinical outcomes between the two groups.

This study was done to evaluate the change of medial-lateral gap in flexion and extension after posterior cruciate ligament (PCL) release in severely deformed knees and to determine how PCL release affects bone resection, rotation, and size of the femoral component and polyethylene thickness in converting to a PCL-sacrificed design. Thirty primary osteoarthritis patients with severe varus deformity or flexion contracture were enrolled. After releasing the PCL, the medial gap in extension increased by 1.2 mm, the lateral gap in extension increased by 0.3 mm, the medial gap in flexion increased by 4.5 mm, and the lateral gap in flexion increased by 3.4 mm. Compared with PCL-retained prostheses, the mean external rotation of the femoral component decreased by 1.6 degrees in the PCL-sacrificed type. Polyethylene thickness increased by 1.2 mm. In 12 cases, a larger femoral component was needed. In 8 knees, the size of the femoral component and the thickness of polyethylene did not change; however, posterior femoral resection could be decreased. In 8 knees, thicker polyethylene was planned with slightly increased distal femoral resection. After PCL cutting, flexion gap increased significantly compared with extension gap; however, correction of varus deformity was not significant. Conversion to PCL-sacrificed design resulted in a decrease in external rotation of the femoral component and increased the size of the femoral component or the thickness of the polyethylene insert.