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Background: Aim of this study was to compare functional results within 36 months following primary total knee arthroplasty (TKA) using a conventional prosthesis Multigen Plus CR and a new Physica KR implant. Our hypothesis was that the use of the Kinematics-Retaining design of an TKA implant leads to a significantly greater improvement in the active range of motion and better functional results (KSS 1, KSS 2 and WOMAC score) than the conventional CR implant at short-term follow-up., Materials and Methods: We retrospectively analysed data of 234 patients who underwent primary TKA at our hospital from April 2010 to August 2015 with the CR type of implant and from July 2014 to August 2015 with the KR implant due to advanced knee arthrosis of IIIrd and IVth grade of Kellgren-Lawrence classification, with no major ligamentous instability. Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, Knee Society Scores 1 (KSS 1) and 2 (KSS 2) and flexion (AROM) were recorded preoperatively and at 6, 12 and 36 months after surgery., Results: Our study showed a statistically significant difference in functional results at three years with better KSS 1 score, a tendency to higher values in the KSS 2 score, as well as a statistically significant overall improvement in AROM in favour of the new KR design over the conventional CR implant with a post-hoc power analysis of 83.8%. We found that there was no statistically significant difference between groups when comparing WOMAC score and complications at short-term follow-up., Conclusions: Our study provided more favourable clinical results for using Kinematics-Retaining implant in primary TKA. Further studies should focus on radiological and functional outcomes from mid- to long-term follow-up., (© 2021. The Author(s).)

Introduction: Total knee replacement is one of the most common surgical methods in diagnosis of end staged osteoarthritis. In this retrospective analysis, we focus on comparison of functional and clinical outcome in patients undergoing unilateral and bilateral replacement within a single surgical procedure., Methods: 54 patients (bilateral 19, unilateral 35) underwent total knee replacement in our clinic participated in the current study. The length of hospital stay was monitored in all patients. Assessment of functional results was based on the WOMAC score, KSS 1, KSS2, range of motion and presence of complications in both groups., Results: Both groups of patients were homogeneous with age, body mass index and sex. The length of hospital stay in the unilateral group was 4.7±1.3 and 5.6±2.0 in the bilateral group. Patients operated on unilaterally achieved flexion of 114.9±9.3 after one year, bilateral group 112.6±8.6, the difference was insignificant. In both groups, there is a significant improvement one year postoperatively at WOMAC, KSS1 and KSS2. Comparing WOMAC, KSS1 and KSS2 between the unilateral and bilateral groups 3, 6, 12 months postoperatively, the differences are insignificant. The revision of implants in two-year follow-up reached 1.5% in unilateral group and 1.4% in bilateral group., Conclusion: Unilateral and bilateral knee joint endoprosthesis implantation is a successful surgical method in orthopedic practice. With conscious selection of patients, bilateral implantation may be more advantageous alternative, as the patient undergoes one operation and the associated risks.

PURPOSE OF THE STUDY Evaluation of short-term functional results in patients undergoing one-stage surgery involving sequential bilateral total knee arthroplasty (TKA) and comparison with the results of patients after unilateral TKA. MATERIAL AND METHODS The group with bilateral TKA consisted of 171 patients with 342 total knee replacements treated between 2009 and 2013. The control group included 50 patients with 50 TKAs operated on in the years 2010 to 2012. The indications to bilateral knee replacement included bilateral gonarthrosis, grade III or more in patients who were in good health and had a stable knee joint with axis deviation up to 20 degrees. A cemented TKA was used and the posterior cruciate ligament was preserved. Assessment of functional results was based on the Womac score, Knee Society Score (KSS 1, 2) range of motion and presence of specific complications in both groups. The follow-up lasted three years. RESULTS The average results in the bilateral vs the control group were as follows: the Womac score, 39.4/42.2 pre-operatively, 87.2/71.0 at 3 years; KSS 1, 48.5 / 44.8 pre-operatively, 87.4 / 79.9 at 3 years; KSS 2, 44.1 / 50.6 pre-operatively, 86.1 / 72.8 at 3 years; motion-flexion, 105.2° / 105.7° preoperatively, 114.0° / 100.2° at 3 years. In the bilateral group, infection was recorded in one patient. DISCUSSION Bilateral total knee replacement is a controversial issue. A higher risk of non-specific complications has been reported. Functional outcomes are good. The key problem is to set the correct indication to this procedure after an individual assessment of the patient's general health condition and the state of his/her knee joints. CONCLUSIONS The patients undergoing bilateral TKA at one-stage surgery showed functional results comparable (range of motion was even better) with the results of the unilateral TKA group. The number of specific complications was low. Every patient should be carefully assessed. Key words: total knee arthroplasty, bilateral implantation, functional results.

Introduction: In the literature, there are only few articles about urologic complications after total knee arthroplasty. We have evaluated our group of patients focusing on urethral catheter as a risk factor for urologic complications after the replacement., Material and Method: We have evaluated a group of 236 patients (143 female and 93 male subjects) aged 71.3 years on average, after primary total knee arthroplasty in 2008-2009, focusing on urologic complications of the patients. Permanent catheter was introduced in all the subjects after the operation. The group of patients was evaluated at end of 2010. We have evaluated urologic complications, the period of time the catheter was in place and analyzed the risk factors one year after the operation., Results: The incidence of urologic complications is 19.4% in men and 6.3% in women. The average duration of catheterization was 4 days, and 7 days in patients with complications. 126 patients (53.4%) had their catheter introduced for up to 4 days, out of whom complications occured in 5 (4%) patients. 110 patients (46.4%) were catheterized for over 4 days, and in this subgroup, complication occured in 23 (21%) subjects. IPSS is 8, on average, in complications 12/35, on average. A total of 5 patients were unsatisfied (2.1%). The combination of male gender with catheterization for over 4 days, is the main risk factor for urologic complications., Conclusion: In the literature the authors found only several articles related to urologic complications after the knee arthroplasty focused on postoperative urinary retention and the catheter. The risk factor is increased duration of catheterization, male gender and, partially, positive urologic anamnesis. There is a posibility to use ,,safe catheter" in the risky patients in future.

Joint dislocation after total knee arthroplasty is a rare complication. It is described as the result of ligamentous instability. Here we report the case of an 82-year-old women who underwent primary total knee arthroplasty (TKA) for advanced primary grade III gonarthrosis. At 3 post-operative months the joint was stable and painless, with radiographic evidence of good TKA alignment and integration. At 4 months the patient suffered injury to the ankle involving a bimalleolar fracture and damage to knee soft tissues. The fracture was surgically treated. Subsequently, dorsal tibial dislocation was manifested. This was managed by individual intramedullary nail arthrodesis. At 8 months following the operation, the knee condition was satisfactory, with rigid arthrodesis and leg shortening of 4 cm. The patient was satisfied because she was free of pain and able to walk. Arthrodesis of the knee joint with an individual nail is an option for a definitive treatment of TKA instability. When other joints, such as ankle or hip joints, are injured, it is recommended to pay attention also to any TKA implanted previously because of potential development of instability or infection.