Cases reported "Osteoarthritis, Knee"

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1/30. Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty.

    Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty (TKA) has not been well reported before. A 63-year-old man with osteoarthritis of the right knee underwent TKA with a New Jersey LCS Knee, with cementing on the tibia and patella but not on the femoral component. After 42 months, in addition to wearing of polyethylene of the tibia and patella, severe osteonecrosis of the medial femoral condyle was noted. osteonecrosis caused loss of osseous support of the medial flange of the femoral component, and the bone ingrowth of the central and lateral flange to the distal femur was so good that it overcame the yield stress of the metal of the femoral component and caused fracture of the femoral component. The osteolytic area was filled with autogenous iliac bone, and a new femoral component was inserted and cemented. The patient's condition became satisfactory with relief of pain. Although uncommon, fracture of the femoral component does occur associated with polyethylene wear and osteolysis.
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ranking = 1
keywords = tibia
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2/30. Nonunion of tibial stress fractures in patients with deformed arthritic knees. Treatment using modular total knee arthroplasty.

    In two years we treated four women with ununited stress fractures of their proximal tibial diaphyses. They all had arthritis and valgus deformity. The stress fractures had been treated elsewhere by non-operative means in three patients and by open reduction and internal fixation in one, but had failed to unite. After treatment with a modular total knee prosthesis with a long tibial stem extension, all the fractures united. A modular total knee prosthesis is suitable for the rare and difficult problem of ununited tibial stress fractures in patients with deformed arthritic knees since it corrects the deformity and the adverse biomechanics at the fracture site, stabilises the fracture and treats the arthritis.
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ranking = 3.5
keywords = tibia
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3/30. Total knee arthroplasty in a patient with chronic occlusion of the superficial femoral artery.

    In a 67-year-old patient with severe valgus gonarthrosis and chronic occlusion of the superficial femoral artery on the same side, total knee replacement was performed without preceding angioplasty because the collateral circulation was intact. No tourniquet was used. To leave the peripatellar arterial ring intact on one side in this case of lateral patellar maltracking, a lateral approach was used. In this approach, a lateral release forms part of the approach itself. To achieve gentle eversion of the patella, the tibial tubercle was osteotomized. One year postoperatively, the patient was satisfied with the outcome and showed no clinical signs of any vascular deterioration. It is concluded that total knee replacement may be possible in the presence of chronic occlusion of the superficial femoral artery provided that the collateral circulation is intact.
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ranking = 0.5
keywords = tibia
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4/30. Reversal of medial compartment osteoarthritic uptake pattern after high tibial osteotomy.

    Two cases of osteoarthritis of the knee are presented that illustrate the typical medial compartment pattern of scintigraphic uptake. In both cases the patients had significant medial joint pain. After high tibial osteotomy, the pattern of uptake was altered and paralleled the improvement in symptoms. These observations prompt several important issues regarding the cause of the uptake and may provide a way to monitor treatment response.
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ranking = 2.5
keywords = tibia
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5/30. Periprosthetic tibial fractures after cementless low contact stress total knee arthroplasty.

    periprosthetic fractures are a recognized complication of total knee arthroplasty. Fractures may occur intraoperatively or postoperatively, and risk factors have been identified that may predispose an individual to such a complication. We report 7 cases of periprosthetic tibial fractures after low contact stress total knee arthroplasty, a complication encountered by the senior author (D.E.B.) only after a change in practice from a cemented implant to a cementless one. In light of this previously unreported complication in our unit, we attempted to identify common features within this group of patients that may have contributed to fracture occurrence. Statistical analysis revealed a highly significant (P<.005) risk of periprosthetic tibial fracture in patients with a preoperative neutral or valgus knee. Age, gender, and diagnosis did not appear to increase the risk of fracture significantly. All patients displayed evidence of reduced bone mineral density in the lumbar spine and femoral neck regions on dual-energy x-ray absorptiometry scanning. patients with a preoperative neutral or valgus knee and local evidence of osteopenia represent a high-risk group, in whom particular care in alignment should be taken. In this group, it may be preferable to have the tibial component inserted with cement fixation.
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ranking = 3.5
keywords = tibia
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6/30. A case report: reconstruction of a damaged knee following treatment of giant cell tumor of the proximal tibia with cryosurgery and cementation.

    OBJECTIVE: Reconstruction of a knee damaged by cement packed to cure a giant-cell tumor is sometimes difficult. We reconstructed such a knee by removal of the cement, autologous bone transplantation and distraction osteogenesis using the Ilizarov apparatus. In this paper the results 29 months after the salvage surgery are given. PATIENT AND methods: We saw a 31-year-old woman's knee joint that showed osteoarthritic change after curettage, cryosurgery and cementation performed 4 years previously for a giant-cell tumor of the proximal tibia. We reconstructed the knee joint. This procedure included cement removal, alignment correction by tibial osteotomy, subchondral bone reconstruction by autologous bone transplantation, and filling the defect after removing the bone cement by elongating the diaphysis using the Ilizarov apparatus. RESULTS: Distraction was terminated 4 months later when 54 mm of elongation was performed. All devices were removed 12 months after the surgery. Seventeen months after the removal of the apparatus, the range of motion of the right knee was 0 degrees extension and 110 degrees flexion, and the patient was able to walk without pain. CONCLUSIONS: Although the treatment period is long and there may be some complications of Ilizarov lengthening and distraction osteogenesis, this procedure has numerous benefits. Bony defects can be soundly reconstructed and, at the same time, the alignment of the knee can be corrected. Also it is not necessary to reconstruct the ligaments because the insertions are intact. If osteoarthritis progresses, a surface type total knee replacement can be performed, not constrained type prosthesis, which would be used if the bony structure had not been reconstructed. This procedure may be one of the candidates for reconstructing such knee joints destroyed by bone cement.
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ranking = 3
keywords = tibia
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7/30. The influences of biomechanical factors on cartilage regeneration after high tibial osteotomy for knees with medial compartment osteoarthritis: clinical and arthroscopic observations.

    PURPOSE: A high tibial osteotomy (HTO) is often performed on knees with medial compartment osteoarthritis. However, in varus knees with medial compartment osteoarthritis, degeneration of the articular cartilage tends to progress due to medial deviation of the mechanical axis. This can result in eburnated bone. A widening of the medial joint space has been observed after HTO with a proper correction as a result of decreased stress on the load-bearing cartilage in the medial compartment. Researchers have reported obtaining a repair of the articular cartilage with both eburnation and clinical improvement using HTO in patients showing a medial deviation of the mechanical axis. However, which factors influence cartilage regeneration remain unclear. The purpose of this study was to quantitatively evaluate the influence of cartilage regeneration after a high tibial osteotomy for knees with medial compartment osteoarthritis. TYPE OF STUDY: Observational cohort study. methods: The study involved 58 knees in 47 patients. A modified Noyes classification was used for arthroscopic grading. The patients underwent a second look arthroscopic evaluation of the articular cartilage 18 months after surgery. The articular cartilage was classified as no regenerative change (grade 1), white scattering with fibrocartilage (grade 2), partial coverage with fibrocartilage (grade 3), and even coverage with fibrocartilage (grade 4). The functional results were evaluated according to the Japanese Orthopedic association score for osteoarthritic knees (JOA score), femorotibial angle (FTA), percentage of mechanical axis, and body mass index (BMI). RESULTS: Partial or even coverage with fibrocartilage (grade 3 and 4) was achieved on 55% of the femorotibial joint surfaces. A repair with white scattering with fibrocartilage (grade 2) was achieved in 34%, and 3 knees showed no regenerative change (grade 1). At follow up, significant differences were seen between grade 4 and grade 1 in JOA score and percentage of mechanical axis. CONCLUSIONS: This study demonstrates the correlation between the visible improvement of the articular surface, the functional score, and the degree of correction obtained with a lateral closing wedge HTO.
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ranking = 4
keywords = tibia
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8/30. Chronic lateral knee instability treated with a high tibial osteotomy.

    Published studies have recommended correction of osseous alignment in patients with chronic deficiencies of multiple knee ligaments and varus angulation. However, similar treatment for isolated chronic lateral collateral ligament deficiency has not been reported. We report such a case treated successfully with a medial high tibial osteotomy using a dynamic external fixator.
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ranking = 2.5
keywords = tibia
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9/30. Screw migration from total knee prostheses requiring subsequent surgery.

    Complications in total knee arthroplasty directly related to hardware failure other than polyethylene wear are rare. We report 2 cases of symptomatic screw migration into the joint space from total knee prostheses. In the first case, a screw disengaged from a constrained condylar knee prosthesis. arthroscopy using standard arthroscopy portals and a small arthrotomy were performed to remove the screw. In the second case, symptomatic screw disengagement and posterior migration from the tibial component of a posterior-stabilized prosthesis occurred. Revision with replacement of the polyethylene insert and locking screw was required.
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ranking = 0.5
keywords = tibia
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10/30. Common peroneal nerve palsy after lateral unicompartmental knee arthroplasty.

    Unicompartmental knee arthroplasty is now being used more commonly to treat single compartment disease of knee, with very encouraging results. We report on a rare case of common peroneal nerve palsy; 8 years after lateral unicompartmental knee arthroplasty. This palsy was caused by pressure on the common peroneal nerve, due to posterior migration of tibial component.
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ranking = 0.5
keywords = tibia
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