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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. [ABSTRACT FROM AUTHOR]

Objectives: Our aims were (a) to describe the prevalence and incidence of self-reported injuries and illnesses of amateur golfers over a 5-month period and (b) to investigate potential risk factors for injury., Methods: We recruited 910 amateur golfers (733 males [81%] and 177 females [19%]) from golf clubs in the USA and Switzerland. The median age was 60 (IQR: 47-67) and the median golfing handicap was 12 (IQR: 6-18). Participants' health was monitored weekly for 5 months using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Players also completed a baseline questionnaire on personal and golf-specific characteristics and their medical history., Results: We distributed 19 406 questionnaires and received 11 180 responses (57.6%). The prevalence of injuries was 11.3% (95% CI: 9.8 to 12.8) and of illnesses was 2% (95% CI 1.7 to 2.2). The incidence of injuries and illnesses was 3.79 (95% CI 3.54 to 4.06) and 0.94 (95% CI 0.81 to 1.07) per golfer per year, respectively. The injury regions with the highest burden of injury (time-loss days per player per year) were lumbosacral spine (5.93), shoulder (3.47) and knee (2.08). Injury risk was higher with increased age, osteoarthritis and previous injury., Conclusion: The prevalence and incidence of injury and illness in amateur golf were low compared with many other sports. To further reduce the burden of injury, future research attention should be directed towards the lumbosacral spine, knee and shoulder., Competing Interests: Dr AM receives remuneration from clinical and research services to professional golf organisations. Dr MLM is a deputy editor of BJSM and Dr BC is an associate editor for BJSM., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The primary aim was to describe the characteristics and prevalence of musculoskeletal complaints of a large group of non-professional golfers. Secondary aims were to compare golfers different in (A) skill-level, (B) presence of low back pain (LBP) and (C) performance of prevention exercises., Methods: A sample of 1170 male golfers (mean age 54.98, SD=13.3) were surveyed online on personal and golf-specific characteristics, medical history and complaints in the preceding 7 days. Subgroups (A) with different golfing handicap (0 to 5, >5 to 10, >10), (B) with and without LBP and (C) who performed versus did not perform injury prevention exercises were compared using analysis of variance and χ 2 test., Results: The prevalence and severity of musculoskeletal complaints was similar in everyday life and when playing golf. More than one-third of the golfers (n=436; 37.3%) reported LBP in the preceding 7 days, while other frequently affected body parts were the shoulder and knee. Golfers with different skill level differed in age and most golf-related characteristics but not in prevalence and severity of musculoskeletal complaints. Golfers with and without LBP were similar in almost all variables. Golfers who performed prevention exercises (n=371; 27.1%) were older and had a higher prevalence of complaints., Conclusion: The prevalence and severity of musculoskeletal complaints in golfers were similar to the wider population. It seems that injury prevention exercises were implemented after injury, rather than as primary prevention. Prospective studies looking at the epidemiology of injury, risk factors and interventions are required., Competing Interests: Competing interests: AM receives remuneration from clinical and research services to professional golf organisations., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Epidemiological studies of injury in elite and recreational golfers have lacked consistency in methods and definitions employed and this limits comparison of results across studies. In their sports-generic statement, the Consensus Group recruited by the IOC (2020) called for sport-specific consensus statements. On invitation by International Golf Federation, a group of international experts in sport and exercise medicine, golf research and sports injury/illness epidemiology was selected to prepare a golf-specific consensus statement. Methodological stages included literature review and initial drafting, online feedback from the consensus group, revision and second draft, virtual consensus meetings and completion of final version. This consensus statement provides golf-specific recommendations for data collection and research reporting including: (i) injury and illness definitions, and characteristics with golf-specific examples, (ii) definitions of golf-specific exposure measurements and recommendations for the calculation of prevalence and incidence, (iii) injury, illness and exposure report forms for medical staff and for golfers, and (iv) a baseline questionnaire. Implementation of the consensus methodology will enable comparison among golf studies and with other sports. It facilitates analysis of causative factors for injuries and illness in golf, and can also be used to evaluate the effects of prevention programmes to support the health of golfers., Competing Interests: Competing interests: Author affiliations are provided in Appendix 1. Francois Gazzano is Chief Executive Officer (CEO) and founder of FITSTATS. Robert Neal is the CEO and founder of Golf BioDynamics., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Performing total knee replacement, accurate alignment and neutral rotation of the femoral component are widely believed to be crucial for the ultimate success. Contrary to absolute bone referenced alignment, using a ligament balancing technique does not automatically rotate the femoral component parallel to the transepicondylar axis. In this context we established the hypothesis that rotational alignment of the femoral component parallel to the transepicondylar axis (0° ± 3°) results in better outcome than alignment outside of this range., Methods: We analysed 204 primary cemented mobile bearing total knee replacements five years postoperatively. Femoral component rotation was measured on axial radiographs using the condylar twist angle (CTA). Knee society score, range of motion as well as subjective rating documented outcome., Results: In 96 knees the femoral component rotation was within the range 0 ± 3° (neutral rotation group), and in 108 knees the five-year postoperative rotational alignment of the femoral component was outside of this range (outlier group). Postoperative CTA showed a mean of 2.8° (±3.4°) internal rotation (IR) with a range between 6° external rotation (ER) and 15° IR (CI 95). No difference with regard to subjective and objective outcome could be detected., Conclusion: The present work shows that there is a large given natural variability in optimal rotational orientation, in this study between 6° ER and 15° IR, with numerous co-factors determining correct positioning of the femoral component. Further studies substantiating pre- and postoperative determinants are required to complete the understanding of resulting biomechanics in primary TKA.

The clinical and radiographic results of 174 female and 86 male Innex (Zimmer, Warsaw, Indiana) mobile bearing total knee arthroplasty systems (245 patients) were evaluated, with particular emphasis on gender-related differences at five-year follow-up. Pre-operative Knee Society (KS) function and total scores were lower in women than in men. All KS scores showed a significant improvement at follow-up, but women still obtained lower KS function scores than men. Self-reported function was significantly better for male knees. No gender differences were observed for component alignment, while the occurrence of radiolucent lines, endosteal cavitations, and wear was significantly greater in male knees. Male Innex mobile bearing knees exhibited better clinical function and satisfaction than their female peers at five-year follow-up, despite inferior radiographic findings and higher revision rates.

Introduction: Unicompartmental knee arthroplasty (UKA) has gained in popularity during the last years. However, the body mass index (BMI) of patients undergoing UKA is controversially discussed in the literature. There is, moreover, a paucity of information available concerning the association of BMI with early clinical outcomes after UKA., Materials and Methods: We retrospectively reviewed the clinical data of 83 consecutive UKA, 2 years after surgery, and investigated the potential association of BMI and the outcome variables Knee Society Score (KSS), University of California at Los Angeles (UCLA) activity levels, anterior knee pain (AKP), range of motion, and implant failure., Results: The KSS and UCLA significantly increased from 132 and 4.7 preoperatively to 187.5 and 7.1, respectively, after surgery. Knee flexion significantly improved from 123.7 to 128.4 degrees and the prevalence of extension deficiencies significantly decreased from 28.9 to 15.7%. Three knees (3.6%) failed and were converted to total knee arthroplasty. Failures were not associated with increased BMI (P = 0.387). The BMI had no significant association with KSS values, UCLA levels, and implant failure. We found a weak negative correlation between BMI and postoperative knee flexion (r = -0.285, P = 0.009) and a moderate positive correlation between BMI and the intensity of AKP (r = 0.525, P < 0.001)., Conclusion: The results of the present study suggest that the BMI of patients undergoing UKA has no major impact on the early clinical outcome 2 years after surgery. There was, however, a definite correlation between the BMI and AKP. Longer follow-up is necessary to determine if overweight and obesity may increase revision rates after UKA.

Background: There is a lack of detailed information concerning patients' sports and recreational activities after unicompartmental knee arthroplasty., Hypothesis: Patients treated by unicompartmental knee arthroplasty will be able to return to sports and activity., Study Design: Case series; Level of evidence, 4., Methods: The authors surveyed 83 patients by postal questionnaires to determine their sporting and recreational activities at a mean follow-up of 18 +/- 4.6 months (range, 12-28) after unicompartmental knee arthroplasty. For data analysis, patients were divided into groups of women and men, and older and younger patients (those above and below the median age of the group). The authors also assessed the state of general health (SF-36) of the patients at the time of the survey and compared the results with those of a matched (for age and side-diagnoses) reference population., Results: Before surgery, 77 of 83 patients were engaged in an average of 5.0 sports and recreational disciplines; postoperatively, 73 (88%) participated in an average of 3.1 different sports disciplines, resulting in a return to activity rate of 95%. The frequency of activities (sessions per week) was 2.9 preoperatively and remained constant at the time of survey (2.8). The group of older patients (mean age 73.0 y) revealed a significantly higher frequency than the group of younger patients (mean age 57.8 y). The minimum session length decreased from 66 minutes before surgery to 55 minutes after surgery. The most common activities after surgery were hiking, cycling, and swimming. Several high-impact activities, as well as the winter disciplines of downhill- and cross-country skiing had a significant decrease in participating patients. The majority of the patients (90.3%) stated that surgery had maintained or improved their ability to participate in sports or recreational activities. The patients generally scored very high on the SF-36 compared with the matched reference population. Higher SF-36 values in the physical-related domains correlated with an increased level of activity (r = 0.425). The preoperative body mass index showed a weak, negative correlation with the postoperative extent of activities (r = -0.282)., Conclusion: The majority of patients returned to sports and recreational activity after unicompartmental knee arthroplasty. However, the numbers of different disciplines patients were engaged in decreased as well as the extent of activities. The activities in which most patients participated were primarily low- or midimpact. The patients scored higher on the SF-36 than age-related norms, which might be due to the patient-selection process for unicompartmental knee arthroplasty and geographical differences.

Study Design: Case report of a professional ice hockey goaltender who underwent an arthroscopically assisted lateral meniscus repair., Background: Rehabilitation of isolated meniscal repairs is not well documented in the literature. There is little knowledge about the healing time and the choice of rehabilitation exercises to be applied to a repaired meniscus. The objective of this case report is to describe a criterion-based, supervised, sport-specific rehabilitation protocol for a high-level athlete with a lateral meniscus repair from the first postoperative day until return to competitive sport, including a 5-year follow-up., Case Description: The criterion-based protocol used with this athlete was based on a sport-specific neuromuscular rehabilitation approach. Data collected included range of motion, strength, neuromuscular control, and magnetic resonance images., Outcomes: This high-level athlete was able to return to sport 103 days after surgery and no reinjury of the lateral meniscus occurred up to 5 years after surgery., Discussion: The sport-specific, criterion-based, supervised rehabilitation program described in this case report showed a safe return to sport and a good long-term outcome.

Early follow-up (15.8 months;1-48) of 230 knee replacements with an LCS A/P Glide component indicated an increased occurrence of anterior knee pain due to a fat-pad impingement, necessitating early revision surgery. Unsatisfactory results were observed in 28 knees (12.2%). Thirteen knees (5.7%) were revised on finding the fat-pad impingement, and four knees (1.7%) were scheduled for later revision surgery; the remaining 11 subjects (4.8%) had revision surgery for a different reason. Twenty-six subjects (11.3%) complained about milder but typical symptoms of a fat-pad impingement, and 22 subjects (9.6%) had unspecific mild symptoms. 151 knees (65.7%) were free of pain and demonstrated an excellent result. The total revision rate of 10.4% (24 knees) is higher than described for other implant systems. However, the revision needed to treat the fat-pad impingement (5.7%) consisted of minor surgery only, such as exchange of the mobile bearing or reduction of the fat pad by arthroscopy. The femoral and tibial components were able to be left untouched. Resection of the Hoffa's fat pad is recommended when such an implant system is used, and possible impingement should be investigated intraoperatively before closure.

Seven cases of total knee arthroplasty (TKA) after formal knee fusion were reviewed at a mean follow-up of 56 months (range, 12-161 months). The mean modified Hospital for Special Surgery score improved from 54 (range, 16-65) preoperatively to 68 (range, 57-80) at the latest follow-up. Mean range of motion was 74 degrees (range, 55-90 degrees ). Patient subjective rating was excellent or satisfied in 5 of 7 cases. Two patients underwent secondary refusion (1 for chronic infection, 1 for ligamentous instability). Six patients (86%) had to undergo reoperation for postoperative complications: 3 patients had open arthrolysis for adhesion and arthrofibrosis, 2 patients had a gastrocnemius flap for skin necrosis, and 1 patient had neurolysis of the peroneal nerve for painful paresis. Despite the presence of increased postoperative pain while walking, all 5 patients with the TKA still in place declared that they would undergo the same procedure again. The procedure of TKA in fused knees is technically demanding and has a considerable complication rate. Renewed mobility of the fused knee joint appears to correlate with increased pain on walking in this group of patients. Four types of postoperative problems were noted in the evaluation: skin necrosis, extensor mechanism contracture, insufficient collateral ligaments, and adhesion and arthrofibrosis. Takedown of a formal knee fusion with TKA should be performed only in carefully selected cases and in highly motivated patients with realistic expectations.

Purpose: This study was conducted to determine the importance of age as a limiting factor as well as to assess the role of age in combination with cartilage damage or osteoarthritis as predicting factors for the outcome after arthroscopic partial meniscectomy., Type of Study: Case series., Methods: We reviewed 97 patients over 70 years of age who underwent an arthroscopic partial meniscectomy between 1992 and 1996. At the time of evaluation, 5 patients had died and 1 patient was unavailable, leaving 91 patients (95 knees) suitable for assessment. There were 56 women and 35 men. The average age at time of surgery was 74 years (range, 70 to 84 years). The mean follow-up period was 4 years (range, 2 to 6 years). Assessment of the cases by 1 investigator included medical records and preoperative radiographs of the knee joint, with the main interest focused on evidence of osteoarthritis using the classification of Kellgren and Lawrence. Evaluation of cartilage damage was performed on surgical videotapes according to Outerbridge. All 91 patients were personally interviewed by telephone. The questionnaire included influence of the operation on knee pain, quality and duration of satisfaction, requirement of further surgery, and whether the patient would undergo the same operation again., Results: According to the Kellgren and Lawrence classification, 80% of patients had radiographic evidence of osteoarthritis grade 0-2, and 20% had grade 3-4. According to Outerbridge, 43% of the patients had cartilage damage grade 0-2 and 57% had grade 3-4; 81% of the patients with osteoarthritis grade 0-2 and 83% of the patients with cartilage damage grade 0-2 had a satisfactory outcome when followed-up for more than 2 years. Among the patients with osteoarthritis grade 3-4 or cartilage damage grade 3-4, 55% and 69%, respectively, were satisfied when followed-up for more than 2 years; 45% and 37%, respectively, required a further surgery after 1 to 4 years. The grade of osteoarthritis had significant influence on satisfaction (P <.01), on whether the patients would have the operation done again (P =.01), and on whether they required further surgery (P =.04). The severity of cartilage damage only had a significant influence on whether the patients would undergo the operation again (P =.01)., Conclusions: Pre-existing degenerative changes appeared to affect the outcome more than the patient's age. However, arthroscopic partial meniscectomy was followed by satisfactory results in more than two thirds of our cases even if performed in the presence of moderate degenerative changes. But two thirds does not correspond with the good results usually obtained in a younger population. Therefore, the indication for surgery and the expected outcome have to be evaluated carefully in elderly patients.

The Zweymüller shaft for uncemented total hip arthroplasty was developed in the early 1970s. Encouraged by the clinical results with this stem, which was mainly used in primary arthroplasty, longer fitting stems were added to the line to accommodate bony defects and to allow for an optimal load transfer from proximal to distal. The principal of the design is to allow an optimal distal fixation while allowing the bone to remodel in the proximal part. This study reports on 89 patients who underwent revision surgery of the hip for mostly aseptic loosening. The results after a median follow-up of 36 months show an increase of the modified Harris hip score from 52 points pre- to 82 points postoperatively. Radiographic subsidence was found in nine cases, with eight having progressed for more then 3 mm. Postoperative complications occurred in 11.2%, with seven dislocations. Open revision became necessary in two cases. The stem reviewed here seems to achieve predictable results in cases where a proximal cone is still present to facilitate load transfer, while at the same time the quadrangular stem provides solid distal fixation and ensures rotary stability.

We report on three patients with a symptomatic inguinal mass as a late complication of repetitive arthroplastic hip surgery. In one case, there was a false aneurysm and in two cases a so-called "synovial cyst". A synovial cyst is usually an enlarged iliopsoas bursa in communication with the capsule of the hip joint. Hypersecretion in arthritic joints may cause expansion of this bursa. Compression of the common femoral and external iliac veins may lead to outflow obstruction and leg swelling. The most important diagnostic tools are plain films of the hip joint and ultrasound of the groin including colour-coded assessment of the femoral vessels. Symptomatic cysts usually need removing by an anterior approach. Loose arthroplastic components can be causative and should be replaced.