Background: The gold standard treatment for infected total knee arthroplasty (TKA) is two-stage revision. The first stage involves a temporary antibiotic spacer, which can be static or articulating; it remains unclear which is best. We aimed to compare 5-year outcomes between static and dynamic spacers. Methods: One hundred and seventy-six patients with infected TKA requiring two-stage revision were enrolled. Patients were organized based on the type of spacer used during the first-stage revision. One hundred and four patients received articulating spacers, and 72 received static spacers. At 5 years, postoperative range of motion (ROM), Short Form 12 (SF-12), Knee Society Score (KSS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded. Reinfection and revisions were also tracked. Results: Eradication of infection was similar in both groups, with 83.7% in the articulating group and 86.1% in the nonarticulating spacer group (P ¼ .234). Articulating spacers resulted in significantly improved ROM (111 vs 82 degrees, P < .001), SF-12 physical component score (35.2 vs 31.0, P ¼ .01), KSS (145.2 vs 113.7, P < .001), and WOMAC function scores (60.1 vs 51.1, P ¼ .03) as compared to the static spacer group. Conclusions: Treatment with an articulating spacer as opposed to a static spacer resulted in improved ROM, SF-12 physical component score, KSS, and WOMAC function scores at the final follow-up visit. There was no significant difference in reinfection rates. Patients requiring staged revision for infected TKA may benefit from an articulating spacer.

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Objectives:To investigate patient demographics, injury characteristics, radiographic outcomes, and identify risk factors for developing posttraumatic arthritis in high-energy transsyndesmotic ankle fracture dislocations or “logsplitter” injuries.Design:Retrospective cohort study.Setting:Academic level one trauma center.Patients/Participants:Twenty-seven adult patients with logsplitter injuries.Intervention:All patients were treated with open reduction internal fixation, with possible addition of syndesmosis screw(s) and deltoid repair.Main Outcome Measurements:The rate of posttraumatic arthritis at one year along with rate and reasons for reoperation.Results:Twenty-seven patients were included with a mean follow-up of 14.5 ± 12.5 months. At one-year postoperative, 14 of the 20 patients (70%) demonstrated posttraumatic arthritis. Two patients (7.4%) went onto fusion. The reoperation rate was 51.9%. There was no significant difference in the arthritis rate with the number of syndesmosis screws used, quality of reduction, or addition of deltoid repair.Conclusions:The logsplitter injury is one with devastating outcomes and high rates of arthritis; it should be considered separately from conventional ankle fractures. The role of deltoid repair remains unclear. Further study of this injury pattern is required.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Introduction Trialling is a key step in total knee arthroplasty (TKA) and helps the surgeon assess for adequate balancing, range of motion, and stability. Despite this, there are no studies investigating knee kinematics when using trial versus final polyethylene tibial inserts. Materials and Methods Fourteen fresh frozen cadaveric specimens were cycled in a VIVO joint motion simulator. Using both simple compression and simulated muscle loads, joints were tested after TKA with a trial insert or a final tibial poly insert. Anterior/posterior (AP), internal/external (IE), and varus/valgus (VV) kinematics and laxities were analyzed. Results Knees with trial poly inserts had significantly greater AP hysteresis (difference between flexion and extension motion) than those with final poly inserts (p=0.001). There was no significant difference in IE (p=0.563) or VV (p=0.580) hysteresis. There was no difference in AP, IE, or VV motion or laxities when considering the flexion path alone. Prosthetic joints followed different paths in flexion versus extension. Conclusion While trial tibial inserts impart valuable information, they may not accurately reproduce the same joint kinematics as final inserts. Balancing of the knee at specific degrees of flexion may depend on the path taken to get there.

Does surgical approach affect patient outcomes of total knee arthroplasty?Background: Surgical approaches for total knee arthroplasty (TKA) include the medial parapatellar (MPA), subvastus (SV), midvastus (MV), and lateral parapatellar approach (LPA); it remains unclear which approach is superior.Methods: Patients having undergone TKA at our institution were retrospectively organized into matched groups according to surgical approach (MPA, MV, SV, or LPA). Outcomes between the groups were compared using the Short-Form 12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and range of motion (ROM) up to 2 years postoperative.Results: Sixty-eight MV patients, 8 SV patients, and 4 LPA patients were matched with groups of MPA patients. There was no difference in outcomes between the MPA and MV groups up to 2 years. The SV group had significantly higher SF-12 Physical Composite Score (PCS; p = 0.036) and WOMAC stiffness score (p = 0.014) at 2 years, but significantly lower flexion at 1 year (p = 0.022) than the MPA group. The LPA group had significantly lower SF-12 PCS (p = 0.011) and WOMAC function scores (p = 0.022) at 1 year than the MPA group. Conclusion:There was no significant difference between the MPA and MV approach. The SV approach had some improved long-term outcomes over the MPA aproach (SF-12 and WOMAC), but had significantly lower flexion at 1 year. The LPA group showed inferior outcomes than the MPA group but had more severe valgus preoperative deformity (p = 0.024). Further studies are required to investigate the potential benefit of quadriceps-sparing approaches.Contexte : Les voies chirurgicales d'arthroplastie totale du genou (ATG) sont les suivantes : parapatellaire interne (PI), subvastus (SV), midvastus (MV), et parapatellaire externe (PE); il n'est pas clair quelle voie est supérieure.Méthodes : Les patients qui ont subi une ATG dans notre établissement ont été classés rétrospectivement en groupes appariés selon la voie chirurgicale (PI, MV, SV ou PE). Les résultats des différents groupes ont été comparés au moyen du Short-Form 12 (SF-12), de l'indice Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), du score de la Knee Society (KSS) et de l'amplitude du mouvement jusqu'à 2 ans après l'opération.Résultats : Au total, 68 patients traités par voie MV, 8 par voie SV et 4 par voie PE ont été appariés avec des groupes de patients traités par voie PI. Il n'y avait aucune différence dans les résultats entre les groupes PI et MV jusqu'à 2 ans. Comparativement au groupe PI, le groupe SV avait des résultats significativement plus élevés pour le score physique fonctionnel (PCS) du SF-12 (p = 0,036) et le score de raideur de l'indice WOMAC (p = 0,014) après 2 ans, mais une flexion significativement plus faible après 1 an (p = 0,022). Encore comparativement au groupe PI, le groupe PE avait des résultats significativement plus faibles pour le PCS du SF-12 (p = 0,011) et les scores fonctionnels de l'indice WOMAC (p = 0,022) après 1 a...