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Infections are rare and poorly studied complications of unicompartmental knee arthroplasty (UKA) surgery. They are significantly less common compared to infections after total knee arthroplasties (TKAs). Optimal management of periprosthetic joint infections (PJIs) after a UKA is not clearly defined in the literature. This article presents the results of the largest multicentre clinical study of UKA PJIs treated with Debridement, Antibiotics and Implant Retention (DAIR). In this retrospective case series, patients presenting between January 2016 and December 2019 with early UKA infection were identified at three specialist centres using the Musculoskeletal Infection Society (MSIS) criteria. All patients underwent a standardized treatment protocol consisting of the DAIR procedure and antibiotic therapy comprising two weeks of intravenous (IV) antibiotics followed by six weeks of oral therapy. The main outcome measure was overall survivorship free from reoperation for infection. A total of 3225 UKAs (2793 (86.2%) medial and 432 (13.8%) lateral UKAs) were performed between January 2016 and December 2019. Nineteen patients had early infections necessitating DAIR. The mean follow-up period was 32.5 months. DAIR showed an overall survivorship free from septic reoperation of 84.2%, with overall survivorship free from all-cause reoperation of 78.95%. The most common bacteria were Coagulase-negative Staphylococci, Staphylococcus aureus and Group B Streptococci. Three patients required a second DAIR procedure but remained free from re-infection at follow-up obviating the need for more demanding, staged revision surgery. In infected UKAs, the DAIR procedure produces a high rate of success, with a high survivorship of the implant. Debridement, Antibiotics and Implant Retention (DAIR) is a successful and minimally invasive surgical option for the management of periprosthetic joint infections (PJIs) after UKA. The surface area available for bacteria to colonise is much smaller in UKAs compared to total knee arthroplasties (TKAs), and this may account for the higher success rates of the DAIR procedure in infected UKAs versus infected TKAs. A second DAIR procedure can be considered in the management of the early recurrence of PJIs with a well-fixed UKA. [ABSTRACT FROM AUTHOR]

Purpose: Cruciate-retaining and posterior-stabilised implant designs are available for primary total knee arthroplasty. However, whether the implant design is associated with a difference in the level of activity still remains unclear. This clinical trial compared posterior-stabilised and cruciate-retaining implants in sport-related patient-reported outcome measures, range of motion, rate of return to sport, and weekly time dedicated to sport in active adults. It was also hypothesised that in young and active patients both implants lead to a similar rate of return to sport in terms of hours per week, type of sport, and joint mobility. Methods: All patients were evaluated preoperatively and for a minimum of 36 months follow-up. The University of California Los Angeles activity scores, High-Activity Arthroplasty Score, and Visual Analogue Scale were administered preoperatively and at the last follow-up. The range of motion was investigated at admission and the last follow-up. Data concerning the hours per week dedicated to sports and the type of sport practiced were also collected at admission and at the last follow-up. The Kaplan–Meier Curve was performed to compare implant survivorship. Results: Data from 227 procedures (cruciate-retaining: 109, posterior-stabilised: 118) were prospectively collected. At the last follow-up, no difference was reported in The University of California Los Angeles activity scores (p = 0.6), High-Activity Arthroplasty Score (p = 0.1), Visual Analogue Scale (p = 0.9), flexion (p = 0.7) and extension (p = 0.4). No difference was found in the rate of return (p = 0.1) and weekly hours dedicated to sport (p = 0.3). The Kaplan–Meier curve evidenced no statistically significant difference in implant survivorship (p = 0.6). Conclusions: At approximately five years of follow-up, no difference was reported between cruciate-retaining and posterior-stabilised implants in active adults in sport-related patient-reported outcomes measures, range of motion, pain, weekly time dedicated to sport, rate of return to sport, and implant survivorship. Level of evidence: Level II, prospective study. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions Level of Evidence This work developed a novel preclinical test of total knee replacements (TKRs) in order to explain TKR instability linked to patient dissatisfaction. It was hypothesized that stability tests on the isolated moving prostheses would provide novel comparative data on the stability and kinematics among TKR designs.Three TKR designs, DePuy Synthes Attune MS, Stryker Triathlon and Zimmer Biomet Persona MC, were assessed using a robotic arm while flexing–extending 0–140°. Tests imposed 710 N body weight combined with three tibial loads: no anterior–posterior (AP) force, 90 N anterior or 90 N posterior force. Other load effects were minimized and the kinematics was recorded. Each implant was tested six times to investigate the repeatability of the method. Data were analysed using statistical parametric mapping with one‐way analysis of variance (ANOVA). If significance was found (p < 0.05), post hoc t tests with Bonferroni correction were used to contrast groups.Significant differences were found throughout flexion–extension. Femoral rollback, AP stability, coupled internal–external rotation and AP position (roll‐back) were all influenced by implant design. AP stability of the TKRs reduced with flexion reaching Attune 15 mm, Persona 13 mm and Triathlon 21 mm at 140° flexion. Tractive rolling significantly affected kinematics in the less congruent Triathlon design, with 6 mm different paths between flexion and extension motion (p < 0.05 across 5–100°). Paradoxical anterior femoral sliding in early flexion (0–40°) occurred in Persona and Triathlon designs.The novel testing technique provides, for the first time, comparative data on the inherent stability and kinematics of the TKR implants themselves across the arc of flexion–extension, independent of variables including soft tissue behaviour and surgical technique. The data show how much each prosthesis can contribute to the stability and motion of the implanted knee. Similar data from a wider range of designs will enable more informed decisions regarding implant design choice, aiming to reduce the prevalence of TKR instability in patients.Controlled laboratory study. [ABSTRACT FROM AUTHOR]

Introduction: Balancing the patellofemoral joint (PFJ) in total knee arthroplasty (TKA) involves avoiding over-stuffing. The purpose of this study was to assess how often a strategy of recreating the anterior space of the trochlea (full extension) led to the trochlea depth being recreated in both mid-flexion (30-40°) and deep flexion (80-90°)., Methods: One hundred and twenty two consecutive patients undergoing robotic-assisted TKA had femoral components placed according to functional alignment principals and were assessed. The femoral component was sized and positioned in order to ensure that the anterior flange was within 2 ​mm of the native anatomy, corresponding to a patella position of full extension (0° flexion). Trochlea depth restoration in 3 positions along the floor of the trochlea groove was compared and measured. The trochlea was defined as balanced if the prosthesis was within 2 ​mm of the native anatomy. Patients were divided into over-stuffed (prosthesis >2 ​mm above the native anatomy) or under-stuffed (prosthesis >2 ​mm beneath the native anatomy)., Results: All patients 122/122 (100%) had a balanced trochlea in full extension. In total 54 TKA were over or under-stuffed at either mid-flexion or deep flexion. In mid-flexion, 3/122 (2.5%) trochlea were over-stuffed and 39/122 (32%) trochlea were under-stuffed. In deep flexion, 25/122 (20.5%) of trochlea's were overstuffed and 30/122 (24.6%) were under-stuffed. In mid-flexion, balanced trochlea components were more externally rotated relative to the posterior condylar axis compared to unbalanced components (2.35° external rotation vs 1.21°, p=0.004). There were no other significant differences observed between the balanced and unbalanced trochlea groups in mid or deep flexion., Conclusion: Over 40% of TKA over or under-stuff the trochlea in deeper flexion despite the anterior flange being positioned within 2 ​mm of the native anatomy in full extension. The rate of over or under-stuffing in mid and deep flexion was similar (>40%); however, in mid-flexion, under-stuffing of the native trochlea was more common. The concept of PFJ over or under-stuffing in TKA needs to be redefined to consider the full arc of flexion of the trochlea groove, and the biomechanical and clinical consequences of under-stuffing the trochlea investigated further., Evidence: Level IV., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jobe Shatrov reports a relationship with Smith and Nephew Inc that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Sebastien Lustig reports a relationship with Smith and Nephew Inc that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Jobe Shatrov reports a relationship with Stryker Orthopaedics that includes: speaking and lecture fees and travel reimbursement. Sebastien Lustig reports a relationship with Stryker Orthopaedics that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Cécile Batailler reports a relationship with Stryker Orthopaedics that includes: consulting or advisory and speaking and lecture fees. Cécile Batailler reports a relationship with Smith and Nephew Inc that includes: consulting or advisory and speaking and lecture fees. William Walter reports a relationship with Johnson and Johnson Ltd that includes: consulting or advisory, equity or stocks, speaking and lecture fees, and travel reimbursement. William Walter reports a relationship with Smith and Nephew Inc that includes: consulting or advisory, equity or stocks, and speaking and lecture fees. William Walter reports a relationship with Mathys Orthopaedics Ptd Ltd that includes: consulting or advisory, equity or stocks, speaking and lecture fees, and travel reimbursement. William Walter reports a relationship with MicroPort Orthopedics Inc that includes: consulting or advisory and equity or stocks. William Walter reports a relationship with Navbit Holdings Pty Ltd that includes: board membership, consulting or advisory, equity or stocks, speaking and lecture fees, and travel reimbursement. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

The most common elbow lesions found in pediatric practice are supracondylar fractures. We compared two groups of 34 patients each with a supracondylar humerus fracture grade III (Gartland classification). The first group was treated with percutaneous pinning with Kirschner wires, with patients in a supine position, sometimes preceded by transkeletal traction. The second group was treated with percutaneous pinning with Kirschner wires, with patients in a prone position, within 6 h of the trauma. No statistically significant differences with regard to clinical outcomes and neurovascular complications were revealed in the comparison. Therefore, we can state that both treatment techniques used are valid., (© 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.)