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Abstract: Femoral component rollback and tibial rotation were evaluated using lateral radiographs taken during passive knee flexion under fluoroscopy in NexGen Legacy Posterior Stabilized Flex (Zimmer, Warsaw, Ind) total knee arthroplasties (TKAs; 30 with mobile insert and 26 with fixed insert). Measured maximal flexion angle demonstrated no significant differences. Femoral component rollback was observed predominantly in TKAs with fixed insert in more than 45° flexion and correlated with maximal flexion angle in each group. Tibial internal rotation was more significant in TKAs with mobile insert in maximal flexion. However, tibial internal rotation from 90° to maximal flexion, which demonstrated correlation with maximal flexion angle in each group, did not show significant difference. The kinematic differences between 2 inserts seemed to have little relevance to the maximal flexion angle. [Copyright &y& Elsevier]

Although total ankle replacement is routinely used for rheumatoid arthritis of the ankle, it has been hampered by early implant failures such as loosening and subsidence of the tibial component due to poor bone quality. To prevent this complication, total ankle replacement augmented by a specially designed hydroxyapatite coating was used in 14 patients (16 feet). Patients were reviewed after an average follow-up of 23.1 months, and the mean clinical rating scale significantly improved from 30.7/100 points preoperatively to 65.9/100 at final follow-up, especially with respect to pain relief. Radiographs taken immediately postoperatively and at final follow-up were analyzed for the position and sinking of the tibial component. The position was evaluated by measurement of the alpha and beta angles, formed by the tibial long axis and tibial component on anteroposterior and lateral radiographs, respectively. The mean alpha and beta angles were 87.4° and 79.3° postoperatively and 87.7° and 81.0° at final follow-up, respectively. No significant change was noted in either angle between the immediate postoperative views and at final follow-up, and no significant subsidence was noted. Radiographs were also assessed for the presence of a lucent zone: 1 case demonstrated a clear zone between hydroxyapatite and bone, 9 cases between hydroxyapatite and the tibial component, and 6 cases between the tibial component and bone. These results suggest that hydroxyapatite helps to secure implant fixation firmly to the bone, making it a useful augmentation for tibial bone atrophy in total ankle replacement for rheumatoid arthritis. [Copyright &y& Elsevier]

Background Current worldwide clinical practice guidelines recommend acetaminophen as the first option for the treatment of acute low back pain. However, there is no concrete evidence regarding whether acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) is more effective for treating acute low back pain (LBP) in Japan. The present study aimed to investigate whether acetaminophen treatment for acute musculoskeletal pain was comparable with loxoprofen (a traditional NSAID in Japan) treatment. Methods Of the 140 patients with acute LBP who visited out-patient hospitals, 127 were considered eligible and were randomly allocated to a group taking acetaminophen or one taking loxoprofen. As primary outcome measure, pain intensity was measured using a 0–10-numeric rating scale (NRS). Moreover, pain disability, pain catastrophizing, anxiety, depression, and quality of life, as well as adverse events, were assessed as secondary outcomes. The primary outcome was tested with a noninferiority margin (0.84 on changes in pain-NRS), and the secondary outcomes were compared using conventional statistical methods at week 2 and week 4. Results Seventy patients completed the study (acetaminophen: 35, loxoprofen: 35). The dropout rates showed no significant difference between the two medication-groups. We found that the mean differences of changes in pain-NRS from baseline to week 2 or 4 between the two medication groups were not statistically beyond the noninferiority margin (mean [95% confidence interval]: −0.51 [−1.70, 0.67], at week 2 and −0.80 [−2.08, 0.48] at week 4). There were no consistent differences between the two medication groups in terms of secondary outcomes. Conclusions The results suggest that acetaminophen has comparable analgesic effects on acute LBP, based on at least a noninferiority margin, compared with loxoprofen at 4 weeks. Acetaminophen seems to be a reasonable first-line option for patients with acute LBP in Japan. [ABSTRACT FROM AUTHOR]