What a find! A truly brilliant article! Definitely going in the Library.
I specially liked these comments
the functional impact of disease upon the everyday life of the patient determines the appropriate timing of surgery.
in many cases, the plain rad*iographic findings will make MRI unnecessary.
Preoperative radiographic templating for knee arthroplasty, while not as crucial as for hip arthroplasty, does indicate the size and shape of the tibial bone to be removed and the component type and size that is likely to be required. It is particularly important in cases requiring the extremes of implant size to ensure that all likely sizes are available, in cases of severe deformity, and in cases where there is severe bone loss.
I'd also add explanation of this
“Pie crusting” of the iliotibial band
means multiple puncturing of the tendon to enable it to lengthen. This could be loosely compared to expanded aluminium mesh that has lines of short cuts in it which, when stretched out, makes a much wider sheet. A similar technique is used in skin grafting to make a small piece of skin larger and able to cover a bigger area. (all these examples have quite different reasons for using this technique)
Q angle correction. This is the angle between the quadriceps and the patella tendon and is a function of the positioning of the tibial, femoral, and, if used, patella component. In particular the femoral component requires appropriate positioning in all three planes to allow the patella to track correctly.
But these statistics are most interesting:
studies have confirm*ed clinical survival of the total condylar knee design of 94% at 15 years and be*tween 77% and 91% at 21 to 23 years.
The Anatomic Graduated Con*dy*lar (AGC) knee has a published survivorship rate of 98.9% in 4583 knees at 15 years and a rate of 97.8% in 7760 knees at 20 years—quite impressive survivorship.
Studies comparing the results of different design options manufactured by the same company are now also available: the 10-year Genesis knee results for the (posterior) cruciate retaining knee reveal 97% survival compared with the Genesis posterior stabilized knee, which has 96% survival—an insignificant difference.
It should be noted that statistics obtained from Joint Registries can be very misleading. At a conference recently, it was shown that in three different countries, UK, Sweden and Australia, two knee replacements (let's call them product A and product B) had very different results.
In the good results ratings, in the UK, A was rated the top product and B was about halfway down the list. In Sweden, B was in the middle and A in the lowest grading. In Australia, B was top and A was the lowest. It was figured that the only variable that could be responsible was the surgeon's skills! Go figure!
United Kingdom
