Gunnar Adalberth

Postoperative drainage of knee arthroplasty is not necessary. A randomized study of 90 patients.

We studied the management of postoperative drainage after total knee replacement (TKR). 90 primary total knee joint arthroplasties were prospectively randomized into 3 groups: a) no drain, b) an autotransfusion system, c) a standard disposable closed suction drainage system. We monitored hemoglobin and hematocrit values, drainage volume and transfusions (homologous and autologous), range of knee motion, knee swelling and hospital stay. Parameters were recorded preoperatively, days 0-8 and 4 months postoperatively. No significant differences were seen between the groups in any of the parameters measured. The results show no benefit from using postoperative drainage systems in knee arthroplasties. Savings of SEK 400 (USD 55) per patient would have resulted if drains had not been used at all.

The Wagner revision stem for severe osteolysis: 31 hips followed for 1.5-5 years

We used the Wagner (1989) method in 31 hip revisions because of loosening with pronounced scalloping, which made a conventional revision unsuitable. The radiographs showed that within a few months new bone developed in the defects. In 5 cases, a new revision was necessary at an early stage, because of dislocation and/or subsidence. At follow-up after 3 (1.5-5) years, 21 of the remaining 26 hips were pain-free and 23 had almost full range of motion.

Cortisone injection with anesthetic additives for radial epicondylalgia (tennis elbow).

In a prospective, randomized, double-blind study of radial epicondylalgia (tennis elbow), 109 patients with an average symptom duration of 8 months were considered for treatment with a single 1-mL injection of the steroid triamcinolone combined with either lidocaine or bupivacaine. The patients received clinical examinations at regular intervals for 1 year, and followup included visual analog pain scale and questionnaires. The 2 groups were comparable and for many factors distributed completely evenly with respect to gender, age, symptom duration, side dominance, type of pain onset, earlier treatment, and occupational loading. The only difference between the groups receiving lidocaine or bupivacaine was found at 2 weeks, when the bupivacaine additive yielded a better outcome for patients who had not been treated in any way before, for those with a short history of epicondylalgia, or both. The steroid injection treatment, regardless of which local anesthetic was given, presented a typical pattern, with symptoms relieved quickly by 2 weeks and then deterioration for many patients at 3 months, indicating a tendency to recurrence. A considerable loss of patients to other treatments at the 1-year followup indicated an equivocal long-term result. Patients who had not been treated earlier in any way had a more favorable prognosis, as did those with a history of epicondylalgia to 3 months.

All-polyethylene versus metal-backed and stemmed tibial components in cemented total knee arthroplasty: A PROSPECTIVE, RANDOMISED RSA STUDY

We studied the quality of fixation of the tibial component using radiostereometric analysis (RSA) in 40 patients who had undergone a cemented Freeman-Samuelson total knee arthroplasty. They were prospectively randomised to either a stemmed metal-backed (MB) or non-stemmed all-polyethylene (AP) tibial component. The articulating geometry of the implants was identical, as was the operative technique and the postoperative regime. The study showed no complications of fixation using AP tibial components, and the migration was the same as that of their metal-backed counterparts. There was no bony collapse or increased subsidence of any part of the tibial component or increased incidence of radiolucent lines in the knees with AP components. Most AP implants were stable between one and two years after surgery, a finding known to be of positive prognostic significance when predicting future aseptic loosening.

Knee joint moments in work-related situations

Circumstantial evidence in the literature points towards a relationship between heavy labour and arthrosis of the knee. The aim of this study was to demonstrate which occupational activities yield the greatest knee moments and thus indicate possible gonarthrosis-inducing occupational hazards. Twelve healthy and uninjured medical students were studied in set occupational situations in a laboratory for gait analysis, using a force plate with video display of force vectors and knee joints (VIFOR). With normal walking as a baseline for moment it was found that activities involving knee flexion, such as lifting objects from one level to the other, climbing stairs and ladders, and jumping down, revealed a significant increase in moment. On the other hand, carrying objects in one or both hands did not yield significant increase in knee moment compared with normal walking. Flexed knee lifting had significantly lower moment than jumping down from a height of 0.5 m on to one or both feet. Three levels of knee moment could thus be identified, i.e., normal walking, flexed knee lifting and jumping down.

All-polyethylene versus metal-backed and stemmed tibial components in cemented total knee arthroplasty

We studied the quality of fixation of the tibial component using radiostereometric analysis (RSA) in 40 patients who had undergone a cemented Freeman-Samuelson total knee arthroplasty. They were prospectively randomised to either a stemmed metal-backed (MB) or non-stemmed all-polyethylene (AP) tibial component. The articulating geometry of the implants was identical, as was the operative technique and the postoperative regime.The study showed no complications of fixation using AP tibial components, and the migration was the same as that of their metal-backed counterparts. There was no bony collapse or increased subsidence of any part of the tibial component or increased incidence of radiolucent lines in the knees with AP components. Most AP implants were stable between one and two years after surgery, a finding known to be of positive prognostic significance when predicting future aseptic loosening.

Tibial component rotation around the transverse axis measured by radiostereometry predicts aseptic loosening better than maximal total point motion: A follow-up of 116 total knee arthroplasties after at least 15 years

Background and purpose — Maximal total point motion (MTPM) measured by radiostereometry (RSA) is widely used as a predictor of total knee arthroplasty (TKA) loosening. We compared the ability of different RSA measurements at different time points to predict loosening of tibial TKA components in the long term. Patients and methods — 116 TKAs in 116 patients were included in our analysis. 16 (14.8–17.4) years after surgery, 5 tibial components had been revised due to aseptic loosening. Receiver operating characteristic curves were calculated in order to investigate the specificity and sensitivity of different RSA parameters at different thresholds. Results — Rotation around the transverse (x-) axis measured 2 years postoperatively had the best predictive value of all parameters, with an area under the curve (AUC) of 80%. Using a threshold of 0.8 degrees, a specificity of 85% and a sensitivity of 50% were reached. The AUC for tibial component distal translation was 79% and it was 77% for proximal translation, whereas it was only 68% for MTPM. Interpretation — Rotation of the cemented tibial component around the transverse axis, proximal translation, and distal translation are slightly better at predicting aseptic loosening than MTPM, and tibial component migration measured after 2 years gives a good prediction of aseptic loosening up to 15 years.