Ortho One

This study aimed to identify the key factors influencing post-operative range of motion after total knee arthroplasty. The primary determinants investigated were preoperative range of motion, intra-operative posterior condylar offset (PCO), posterior condylar offset ratio (PCOR), posterior tibial slope (PTS), and joint line height (JLH).

This prospective study enrolled 68 patients. PCO, PCOR, PTS, and JLH were assessed radiologically in both pre-operative and post-operative X-rays. The knee range of motion and Oxford Knee Score (OKS) were assessed at 2-year follow-up. Statistical analysis, including Student's t test and correlation analysis, was employed to compare and correlate pre-operative and post-operative parameters.

Pre-operative range of motion correlated with post-operative range of motion (p = 0.001). The study did not find a significant correlation when post-operative range of motion was correlated with PCO (p = 0.923), PCOR (p = 0.278), PTS (p = 0.604), and JLH (p = 0.488). Post-operative changes in PCO (p = 0.001) and PTS (p = 0.001) when compared to pre-operative values were significant. PCOR (p = 0.468) and JLH (p = 0.108) had no significant correlation with their respective pre-operative values. Pre-operative OKS: 18.23 ± 8.53, Post-operative OKS: 40.92 ± 4.0 (p = 0.001). Pre-operative maximum flexion: 93.31° ± 7.73°, post-operative maximum flexion angle: 111.83° ± 9.69° (p = 0.001).

Amongst the measured parameters, pre-operative range of motion was the primary factor influencing the range of motion attained after total knee arthroplasty (TKA).

Accurate restoration of the joint line is critical in revision total knee arthroplasty (r-TKA) to ensure proper ligament tension and optimize functional outcomes.

To determine the adductor ratio in the Indian population and assess its reliability for restoring the joint line in primary total knee arthroplasty (TKA).

The study consisted of two parts. In the first part, 93 young, non-arthritic individuals were evaluated radiologically to estimate the adductor ratio. In the second part, 47 patients with grade IV osteoarthritis undergoing primary TKA were included. Pre-operative radiographic and intraoperative calliper measurements of the adductor tubercle to joint line distance (ATJL) and femoral width (FW) were taken. Pearson correlation was estimated between FW and ATJL, and Bland-Altman analysis was used to assess the agreement between pre-operative and intra-operative measurements. The error in using a standard adductor ratio was estimated.

The mean adductor ratio in the non-arthritic population was 0.542, with a strong correlation between ATJL and FW (r = 0.81, p < 0.001). In the second part, the mean adductor ratio was consistent pre-operatively (0.53) and intra-operatively (0.54), with a bias of 0.001 and 95 % limits of agreement from -0.062 to 0.065. The estimated ATJL was within 5 mm of the actual measurement in 95 % of cases.

The adductor ratio of 0.54 is a reliable indicator for joint line restoration in the Indian population. Documentation of ATJL and FW during primary TKA is recommended for enhancing accuracy in joint line reconstruction in revision scenarios.

The recent advances in surgical techniques have resulted in increasing number of knee preservation surgeries including ligament reconstructions/repairs which adds to the financial burden in healthcare. Important hurdles in doing arthroscopic surgery are high cost and lack of sophisticated options like allografts. To overcome these, we have developed some simple yet effective implant-minimizing techniques (IMTs) which help minimize implants use and allografts for ligament reconstruction around knee.

IMTs help us in minimizing the cost burden by reducing the amount of implants used in multiligament surgeries of knee. There are 4 IMTs that bypass implants for graft fixation. They include 1. Confluent tunnel technique for combined ACL, LCL reconstruction, combined PCL, MCL reconstruction, and combined ACL, ALL reconstruction; 2. bone bridge technique for the combined ACL reconstruction and meniscal root repair, combined ACL, and ALL reconstruction, and tibial MCL repair; 3. suture bridge technique for MPFL reconstruction; and 4. cinch knot technique for LCL reconstruction. The cost- effectiveness between two techniques were analyzed.

Our methods proved to be cost effective with a percentage difference in cost of more than 60 percentage when compared to standard methods of fixation. Patients showed good-to-excellent functional outcomes, with no major complications.

IMTs helped us minimize cost by 60 percentage when compared to standard techniques. They also helped us minimize graft usage, preserve bone stock and avoid tunnel convergence particularly useful in smaller Indian knees. These techniques can be followed without special instrumentation.