Kurt Kolstad

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.

Isometric Strength and Endurance in Patients with Severe Rheumatoid Arthritis or Osteoarthrosis in the Knee Joints

Maximum isometric muscle strength on extension and flexion of the knee joints and endurance on extension has been studied in patients with rheumatoid arthritis (RA) and osteoarthrosis (OA), with such severe degeneration of the knees that arthroplasty was indicated. This material was compared with a group of healthy volunteers. The reduction in muscle strength was most pronounced in the RA group, which had 30-45% of the strength of the healthy volunteers. In the OA group the strength, similarly compared, was 55-70%. The difference is explained by the effect of the rheumatic disease on the muscles. The results indicate that in therapeutic measures due to trauma or in joint surgery, methods that contribute to a further decrease in muscle strength, e.g. immobilization with casts, bandages, or traction treatment, should be avoided.

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.

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.

The cone hip stem: a prospective study of 13 patients followed for 5 years with RSA.

We operated on 13 patients (14 hips) with dysplastic hips, mean age 42 (28-58) years, with a cementless Cone stem and followed them for 5 years, using the Merle d´Aubigné clinical score, conventional radiography and repeated radiostereometry analyses. The clinical scores improved markedly at 4 months and still more throughout the study. None of the patients complained of thigh pain. No stem showed radiographic subsidence, but 3 stems had radiolucent zones probably indicating fibrous ingrowth. Micromigration was measured at 4 months, 1, 2 and 5 years. The mean subsidence after 5 years was 0.27 mm and the mean posterior micromigration of the head was 0.74 mm. Most of the micromigration took place within the first 4 months. We conclude that the uncemented Cone stem used in dysplastic hips has shown a good clinical outcome so far and was found to be stable on conventional radiographs and using RSA technique.

Gastric carcinoma metastasis to a knee with a newly inserted prosthesis: A case report

About 3 months after arthroplasty of the knee, the 75-year-old patient returned with severe pain and swelling in the knee. A metastasis from an asymptomatic poorly differentiated mucinous adenocarcinoma of the stomach was found.

Isometric Muscle Strength and Endurance After Knee Arthroplasty with the Modular Knee in Patients with Osteoarthrosis and Rheumatoid Arthritis

Maximum isometric muscle strength and endurance were used in an investigation of knee extension and knee flexion in patients with rheumatoid arthritis (RA) and osteoarthrosis (OA) with such severe changes of the joint that arthroplasty with the Modular prosthesis was performed. The measurements were done preoperatively and 3, 12, 24 and 36 months postoperatively. Muscle strength preoperatively was very weak compared with that of a group of healthy persons. The muscle strength 3 months postoperatively remained unchanged, which could mean a very slight trauma from the operation, very good pain relief and efficient physiotherapy. During the first 2 years the maximum isometric muscle strength was significantly increased both in patients with RA and in those with OA. Thereafter there was no increase in the RA patients, whereas in women with OA there was an improvement up to 3 years postoperatively. The improvement in the flexion strength was greater than that of the extension strength, thus indicating the importance of postoperative training of extension strength. Isometric muscle strength measurements show that there is an equalization between the non-diseased knee and the one operated with the Modular knee.

Formation of New Menisci after Polycentric Knee Arthroplasty: Report of Four Cases, One with a Bucket Handle Tear

This paper presents four patients with polycentric artificial knee joints in whom reoperation revealed new menisci interposed between the artificial joint surfaces. One of the menisci had a bucket handle tear and was excised. Histological examination showed a fibrocartilage structure with the appearance of a newly formed meniscus. The artificial knees functioned well and the reoperations were performed because of trauma in one patient, because of femoro-patellar problems in one knee, and for conversion of a hemi-arthroplasty to an arthroplasty including all the compartments of the knee joint in two patients.

Gait Analysis with an Angle Diagram Technique: Application in Healthy Persons and in Studies of Marmor Knee Arthroplasties

Normal step dimension data were obtained from six healthy subjects by recording step length and step frequency at different walking speeds. In addition, an externally applied goniometer system was used to measure the sagittal knee and hip joint movements in eleven persons with healthy joints. The movements were recorded on an oscilloscope in the form of a so-called angle diagram during walking. In seven patients undergoing Marmor knee arthroplasty the same gait analysis as in the healthy subjects was performed before and after operation. The results were compared by a clinical scoring system for pain and walking ability and by measurement of passive knee mobility and passive extension deficit. The angle diagram permitted recording of functional sagittal mobility and functional extension deficit during walking. The functional knee mobility during walking was found to be pain-dependent; thus increasing pain is accompanied by a gradual decrease in functional mobility despite good passive knee joint motion. In several patients the functional extension deficit during walking was increased compared with the extension deficit on passive movement. The clinical improvements after knee arthroplasty corresponded very well to the increased functional knee mobility during walking measured on the angle diagram.

Extension Deficit and Lateral Instability in Degenerative Disease of the Knee

During the period October 1975-June 1977, 70 Marmor knee arthroplasties were performed. The operative procedure provided a good opportunity to study the anatomical conditions in vivo. The causes of extension deficit and lateral instability of the knees were analysed in a prospective investigation. Thirty-seven out of 69 knees had an extension deficit exceeding 10 degrees preoperatively. At operation a bony impediment to extension was found in 32 of these 37 knees, and by removal of this obstruction the extension deficit was relieved in 31 of the knees. At radiography a bony impediment was demonstrated preoperatively as a cause of an extension deficit in 29 of the 32 knees. No false positive diagnosis was made radiographyically. Varus or valgus instability exceeding 5 degrees was observed preoperatively in 42 of the the 70 knees. Lateral stability was achieved in all knees at operation by compensating for the intra-articular loss of cartilage and bone with the Marmor module system. Macroscopically intact collateral ligaments were found in all knee joints even in those severely affected by rheumatoid arthritis. All knees except three showed lateral stability 1 year postoperatively.