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  • Author: Konstantīns Kalnbērzs x
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Open access

Sergejs Zadorožnijs and Konstantīns Kalnbērzs

Abstract

Published studies on the accuracy of digital templating in total knee replacement (TKR) have employed standard knee, but not hip-to-ankle radiographs. A retrospective study was conducted in our hospital on patients undergoing TKR due to osteoarthritis in a period of six consecutive months. Templating was performed using a calibrating 25 mm metallic ball and Agfa Orthopaedic Tools software by a surgeon not involved with the operation. The surgeon performing the templating was blinded to the size of the implants inserted. Postoperative knee anteroposterior and lateral radiographs were then checked for the presence of prosthetic overhang of ≥ 3 mm. In total, 132 Caucasian adults were included in the study. Femoral overhang occurred in 33%, whereas tibial overhang in only 6% of cases. The exclusion of prosthetic overhang cases significantly improved the accuracy of size detection; exact match for femur increased from 55% to 69%, and for tibia from 70% to 73%. All implants were predicted to within one size in all cases. Digital templating using a calibrating 25 mm metallic ball, Agfa Orthopaedic Tools software and hip-to-ankle and knee lateral radiographs is an accurate method of predicting the knee implant to within one size. Ignoring this procedure leads to prosthetic overhang.

Open access

Sergejs Zadorožnijs and Konstantins Kalnberzs

Summary

Introduction. Osteoarthritis of the knee is a common and frequently symptomatic illness. Total knee replacement (TKR) has evolved as an accepted, cost-effective and efficacious treatment modality for osteoarthritis and other forms of arthritic conditions of the knee joint. Preoperative planning is an important part of the surgical procedure. The inability to accurately determine the magnification factor of the radiograph is one of the major problems in analog preoperative planning of TKR. With the use of calibration objects, the digital images can be corrected for the magnification factor.

Aim of the Study. We aimed to determine the reliability and accuracy of digital templating in the pre-operative work-up for TKR.

Materials and Methods. A retrospective study was done in 105 caucasian adults, who had osteoarthritis of the knee. Digital templating was performed using a calibrating 25-mm metallic ball and Agfa Orthopaedic Tools digital software package by a surgeon not involved with the operation, who was blinded to the size of the implant inserted. The Press Fit Condylar Sigma Knee system was used in all the patients. Digital anteroposterior and lateral radiographs of the knee were used in measuring the implant size. The results from digital images were compared with the size of actual femoral and tibial implants used at the time of surgery.

Results. The correct size of the implant was predicted in 73 of 105 (69,5%) of the femoral and 70 of 105 (66,7%) of the tibial components. The correct size of the whole system was predicted in 58 of 105 (55,2%) cases. The digital preoperative planning predicted 104 of 105 (99,0%) femoral and tibial implants and 103 of 105 (98,1%) whole systems to within one size.

Conclusions. We conclude that digital templating using a calibrating 25-mm metallic ball and Agfa Orthopaedic Tools digital software is a reliable method of predicting the implant to within one size.

Open access

Silvestris Zebolds, Valdis Goncars, Ints Zommers and Konstantins Kalnberzs

Both Knee Re-revision Operations with Different Types of Endoprosthesis after Septic Complications

We report about the patient who underwent seven replacement operations in both knees during twelve years period. Different types of implants were used due to clinical situation and septic complications.

Open access

Silvestris Zebolds, Valdis Goncars, Ints Zommers and Konstantins Kalnberzs

Summary

Introduction. Total knee replacement (TKR) is still a challenging procedure for severe gonarthrosis patients. Deformities of knee joint (varus, valgus - more than 30 degrees), insufficiency of collateral ligaments and extensive bone loss could be a difficult problem to solve with standard knee endoprosthesis. Also in cases of revision - TKR the restoration of bone loss and regaining of stability of the joint could be a problem.

Aim of the Study. The aim of our study was to analyse the results with Rotating - Hinge prosthesis after severe primary and revision TKR.

Materials and Methods. 34 patients (27 female, 7 male) were treated with Rotating - Hinge prosthesis during 12 years (first in 1997). Mean age of patients were 69 years. 17 operations were primary total knee arthroplasties and also 17 were revisions of the knee prosthesis. The Oxford Knee score was used for evaluation of patients satisfaction rate. The Knee Society Score was used to get objective functional results. For radiological analysis X-rays of knee joint in two projections were performed.

Results. 34 Oxford Knee score questionnaires were sent to patients, response we got from 27 patients (79%). Mean result from Oxford Knee score was 32 which is good. The same number of patients (34) were invited for examination using Knee Society score. The response were from 20 patients (59%). Mean result from Knee Society score was 83, which means excellent.

Conclusions. Rotating-Hinge prosthesis allows to achieve good and excellent functional results and high patients satisfaction rate after severe primary and revision TKR. The biological age, general health condition, insufficiency of ligaments and previous infection in patients history have to be considered for choosing the tactics for each case.

Open access

Valdis Gončars, Konstantīns Kalnbērzs, Ēriks Jākobsons, Ieva Briede, Kristaps Blūms, Kristaps Ērglis, Mārtiņš Ērglis, Liene Patetko, Indriķis Muižnieks and Andrejs Ērglis

Abstract

The clinical effects on knee osteoarthritis (OA) symptoms and tissue structure were evaluated after bone marrow-derived mononuclear cell intraarticular injection. A group of 32 patients with 34 knee joints in stage II–III osteoarthritis were treated by intraarticular injection of mononuclear cell suspension. Clinical results were obtained by KOOS (Knee Osteoarthritis Outcome Score) and KSS (Knee Society Score) scores during a 12 months follow-up period. Radiological evaluation was performed using magnetic resonance imaging. A comparison with a control group of 28 patients treated with routinely used three hyaluronic acid intra-articular injections was made. No adverse effects were observed after the bone marrow derived mononuclear cells (BM-MNC) injection. At the end point of the follow up all score results had improved, compared to those at to the starting point. 65% of patients maintained minimal perceptible clinical improvement of the score results. The Whole Organ Magnetic Resonance Imaging Score showed improvement from 44.31 to 42.93 points (p < 0.05) during a 6–7 month period. Comparing score results to the control group, a statistically significant (p < 0.05) improvement in the KOOS pain subscale score at the 6 and 12 months was observed in the mononuclear cell group. BM-MNC injection leads to a decrease of knee OA symptoms and slows changes in structure of the degenerative joint tissue.