Unicompartmental knee arthroplasty (UKA) is a successful procedure for medial compartment osteoarthritis (OA). Recent studies using the same implant report a revision rate of 2.9%. Other centers have reported revision rates as high as 10.3%. The purpose of this study was to retrospectively review the clinical results of Oxford Phase 3 UKA's performed in the setting of isolated medial compartment OA and to compare our results to the previous mid-term studies. Our secondary goal was to determine reasons for revision and evaluate selected independent predictors of failure. A retrospective review of 465 Oxford Phase 3 medial UKA's performed on 386 patients (222 female; 164 male) with isolated medial compartment OA. The average age at surgery was 69.5 years (40–88). Outcome measures included: Knee Society Scores(KSS), Oxford Knee Scores(OKS), SF-12, WOMAC, revision rates, and patient satisfaction. We evaluated independently predictors of failure including: gender, body mass index(BMI), number of previous surgeries, implant sizes, cement technique (simultaneous vs staged), cement type. Revision rates based upon the polyethylene thickness (defined as thin 3–4 mm; medium 5–6 mm; thick 7–9 mm). The need for stems and augments and the degree of constraint required at revision to a total knee arthroplasty (TKA) were evaluated.Introduction
Methods
Clubfoot is a complex three-dimensional deformity that is difficult to assess by clinical examination and conventional radiography. Pedobarography has been established as a useful technique for measuring pressure profiles of the foot, however its utility in the clubfoot population has not been established. The purpose of the present study is to describe the pedobarographic profiles of children with clubfeet and to establish the significant variables when compared with aged-matched controls. Pedobarographic profiles were obtained using the Tekscan HR Mat Pressure Measurement System and data was analyzed using a custom built LabView program. Clubfoot patients aged 18 months to four years (n = 190) were tested and compared to aged matched controls (n = 82). Each foot was divided into five segments (heel, medial and lateral midfoot, medial and lateral forefoot) and each segment was analyzed for timing of initiation of force, timing of termination of force, force distribution, and impulse. The mean and standard deviation were calculated for each variable. Clubfoot pedobarographic means were compared to the aged matched controls and significant variables were identified using Student’s paired t-test (p <
.05). Nine of twenty-five variables were found to be significantly different in the clubfoot population. The heel showed a reduced force and impulse. The lateral mid-foot showed an increased force and impulse with an earlier initiation and later termination of forces. The medial forefoot showed a decrease force and impulse with a later initiation of force. Pedobarography has been found to be a useful tool in the evaluation of foot pathology, but its utility in the clubfoot population has yet to be established. In this study, we describe the pedobarographic profiles of children with clubfeet and have noted significant differences when compared to age-matched controls.
To determine if immediate closure of open wounds is safe, we examined our results over a five year period. Of the two hundred and ninety-seven open fractures, two hundred and fifty-five (86 %) were closed immediately. Grade III open fractures accounted for 24.2% of cases. The superficial infection rate was 10.9%. The combined deep infection and osteomyelitis rate was 4.7%. Neither region of injury, Gustilo grade, velocity of trauma, nor time to primary closure had a significant influence on the incidence of infection. Primary closure may be a safe practice and could be accepted as a viable treatment plan in the care of most open fractures. The purpose of this study was to determine if immediate primary closure of open fracture wounds is a safe practice without increased deep infections and delayed/ nonunions? There was neither an increase in deep infection nor delayed union/non-union. Benefits include a decreased requirement for repeat debridements and soft tissue procedures, minimized surgical morbidity, hospital stay, and cost of treatment. Primary closure may be a safe practice in the care of most open fractures. The standard of care has been to leave traumatic wounds open after initial emergent surgical debridement. Due to orthopedic advancements and current resource limitations, treatment at our institution has evolved to immediate closure of all open wounds after adequate irrigation and debridement. Of the two hundred and ninety-seven open fractures, two hundred and fifty-five (86 %) were closed immediately after irrigation and debridement. Grades 3a, 3b and 3c open fractures accounted for 24.2% of cases. The superficial infection rate of primary closure was 10.9 %. All cases resolved with oral antibiotics. The combined deep infection and osteomyelitis rate was 4.7%. Neither region of injury, Gustilo grade, velocity of trauma, nor time to primary closure had a significant influence on the incidence of infection. The study reviewed all open fractures presenting to a Level One Trauma center over a five-year study period. Patients were followed until fracture union or complication resolution. Multiple variables were examined including patient demographics, injury mechanism, fracture location, Gustilo classification, time to antibiotic administration, surgical debridement and wound closure, and method of wound closure. Outcome measurement included infection or union problems.
