Transcutaneous Pulsed Radiofrequency Treatment in Patients With Painful Knee Awaiting Total Knee Joint Replacement Knee Arthroplasty With a Medially Conforming Ball-and-Socket Tibiofemoral Articulation Provides Better Function Treatment of complex tibial plateau fractures using the less invasive stabilization system plate: clinical experience and a laboratory comparison with double plating. Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. Kinematics of Three Variations of the Freeman-Samuelson Total Knee Prosthesis Dynamic Stabilization Time After Isokinetic and Functional Fatigue. Contact Kinematic Differences Between Gap Balanced vs Measured Resection Techniques for Single Radius Posterior-Stabilized Total Knee Arthroplasty. Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol The Bisurface Total Knee Replacement: A Unique Design for Flexion Four-to-Nine-Year Follow-up Study* Stress radiographical measurement of the anteroposterior, medial and lateral stability of the knee joint.
Objective Our study was design ed to determine if transcutaneous-pulsed radiofrequency treatment ( TCPRFT ) was able to reduce the pain experienced by patients awaiting total knee joint replacement ( TKJR ) . We conducted a r and omized , double-blinded , placebo controlled trial of TCPRFT in patients referred for TKJR to our hospital 's Orthopedic Outpatient Clinic . Methods Patients on the waiting list for assessment for TKJR were invited to participate and were examined in the clinic if they satisfied the inclusion criteria . Patients were r and omized to receive active or sham TCPRFT . The alteration in pain and function of the treated knee after a single TCPRFT was assessed at examination at 1 and 4 weeks using visual analog pain score ( VAS ) at rest and after 20 and 400 m walks . Results The results of 50 patients showed a statistically significant reduction in VAS at 1 and 4 weeks compared with baseline in the group who received active treatment . We also demonstrated what is considered a clinical ly significant improvement in this group that became more pronounced at week 4 compared with week 1 and also more after a 400 m walk compared with a 20 m walk . Maximum improvement observed in group data was 19/100 VAS . Patients receiving sham treatment showed no statistically significant improvement . Discussion We believe this to be the first report of a controlled study of TCPRFT . This pilot study shows a benefit of the technique that justifies future research Background A knee design with a ball- and -socket articulation of the medial compartment has a femoral rollback profile similar to the native knee . Compared to a conventional , posterior-stabilized knee design , it provides AP stability throughout the entire ROM . However , it is unclear whether this design difference translates to clinical and functional improvement . Questions / purpose sWe asked whether the medially conforming ball- and -socket design differences would be associated with ( 1 ) improved ROM ; and ( 2 ) improved American Knee Society , WOMAC , Oxford Knee , SF-36 , and Total Knee Function Question naire scores compared to a conventional , fixed-bearing posterior-stabilized TKA . Patients and Methods We enrolled 82 patients in a single-center , single-blinded , r and omized , controlled trial comparing the medially conforming ball- and -socket design knee prosthesis to a posterior-stabilized total knee prosthesis .  Our primary end point was ROM . Our secondary end points were American Knee Society , WOMAC , Oxford Knee , SF-36 , and Total Knee Function Question naire scores . All patients were followed at 1 and 2 years . Results The mean ROM was 100.1 ° and 114.9 ° in the posterior-stabilized and medially conforming ball- and -socket groups , respectively . The physical component scores of SF-36 and Total Knee Function Question naire were better in the medially conforming ball- and -socket group . We found no difference in American Knee Society , WOMAC , and Oxford Knee scores . Conclusions Both implant design s similarly relieved pain and improved function . The medially conforming ball- and -socket articulation provided better high-end function as reflected by the Total Knee Function Question naire . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence BACKGROUND Bicondylar tibial plateau fractures are complex injuries , historically associated with high complication rates . The purpose of this study was : 1 ) to evaluate the clinical use L.I.S.S plating system for stabilization of bicondylar tibial plateau fractures . 2 ) To compare the biomechanics of this plating system with a double plate construct . METHODS AND MATERIAL S Thirty-eight patients who sustained a complex tibial plateau fracture ( OTA type 41C ) at one of three level-one trauma centers were stabilized using the Less Invasive Stabilization System ( L.I.S.S. ) . The cohort of patients was evaluated clinical ly and radiographically for outcomes at a mean 15 months . In phase 2 of this study a model of a bicondylar tibial plateau fractures was made in six matched pairs of embalmed , human tibia and r and omized to fixation with either a L.I.S.S plate or a st and ard double plate construct . The tibias were then subjected to an axial cyclic load of 500N for 10 cycles ( 3Hz ) to approximate 2 months in vivo and displacements measured . RESULTS Thirty-six of /38 ( 95 % ) patients united at 4 months after surgery with no loss of fixation nor infection . Two patients underwent prophylactic autogenous bone grafting for bone loss and united by 3 months postgrafting . Significant loss of knee range of motion ( < 90 ) was seen in five patients .Biomechanically , no differences in permanent inferior displacement of the medial fragment were found in initial axial loading and after 10 cycles between the two plate constructs . However , when loaded to 500N the L.I.S.S plate construct demonstrated almost twice the displacement of the medial fragment compared with the dual plate construct . No specimen lost fixation during cycling . CONCLUSION The L.I.S.S plating system provides stable fixation of complex bicondylar tibial plateau fractures allowing early range of knee motion with favorable clinical results Valgus high tibial osteotomy for osteoarthritis of the medial compartment of the knee can be performed using medial opening- and lateral closing-wedge techniques . The latter have been thought to offer greater initial stability . We measured and compared the stability of opening- and closing-wedge osteotomies fixed by TomoFix plates using radiostereometry in a series of 42 patients in a prospect i ve , r and omised clinical trial . There were no differences between the opening- and closing-wedge groups in the time to regain knee function and full weight-bearing . Pain and knee function were significantly improved in both groups without any differences between them . All the osteotomies united within one year . Radiostereometry showed no clinical ly relevant movement of bone or differences between either group . Medial opening-wedge high tibial osteotomy secured by a TomoFix plate offers equal stability to a lateral closing-wedge technique . Both give excellent initial stability and provide significantly improved knee function and reduction in pain , although the opening-wedge technique was more likely to produce the intended correction The effect of changes in the articulating surfaces on the kinematics of the Freeman-Samuelson total knee replacement was evaluated . Twenty-two patients ( 22 knees ) ( median age , 69 years ) were r and omized to a st and ard design with a fixed polyethylene bearing , a design with a mobile bearing , or a new design with a spherical medial femoral condyle with a fixed bearing . The patients were studied with radiostereometry and film-exchangers at 0 ° nonweightbearing and during active weightbearing extension from 45 ° to 15 ° . The center of the tibial tray with a mobile-bearing prosthesis occupied a more anterior position than observed in the design s with a fixed bearing . The medial femoral condyle center had a more posterior position in the st and ard design than in the design with a spherical medial condyle . From a distally displaced position at 45 ° , the medial condylar center displaced a mean of 1.8 mm proximally during extension in the st and ard design and had a constant position in the meniscal design . In the spherical design the medial condyle was displaced proximally at 45 ° and displaced a mean of 1.6 mm distally during extension . The reduced anteroposterior and proximodistal translations in the meniscal design are compatible with improved congruency between the components . The design with a spherical medial condyle stabilized anteroposterior motions , but showed more pronounced proximodistal displacement medially than did the other two design OBJECTIVE : To compare the effects of an isokinetic fatigue protocol and a functional fatigue protocol on time to stabilization ( TTS ) , ground reaction force ( GRF ) , and joint kinematics during a jump l and ing . DESIGN AND SETTING : Subjects were assessed on 2 occasions for TTS , GRF , and joint kinematics immediately before and after completing a fatigue protocol . One week separated the 2 sessions , and the order of fatigue protocol s was r and omly assigned and counterbalanced . SUBJECTS : Twenty healthy male ( n = 8 , age = 21.8 + /- 1.4 years , height = 180.6 + /- 7.6 cm , and mass = 74.1 + /- 13.0 kg ) and female ( n = 12 , age = 22.2 + /- 2.1 years , height = 169.3 + /- 9.8 cm , and mass = 62.5 + /- 10.1 kg ) subjects volunteered to participate . MEASUREMENTS : Subjects performed 2-legged jumps equivalent to 50 % of maximum jump height , followed by a single-leg l and ing onto the center of a forceplate 70 cm from the starting position . Peak vertical GRF and vertical , medial-lateral , and anterior-posterior TTS were obtained from forceplate recordings . Maximum ankle dorsiflexion , knee-flexion , and knee-valgum angles were determined using 3-dimensional motion analysis . RESULTS : A 2-way analysis of variance with repeated measures revealed no significant differences when comparing TTS , GRF , and joint kinematics after isokinetic and functional fatigue protocol s. CONCLUSIONS : No difference was noted between isokinetic and functional fatigue protocol s relative to dynamic stability when l and ing from a jump BACKGROUND Measured resection ( MR ) and gap balancing ( GB ) are common surgical techniques for total knee arthroplasty ( TKA ) . Controversy has arisen as each conceptually differs in how the knee is balanced through bone and soft tissue management . The objective of the present study was to compare both the frequency of condylar liftoff and the location of femorotibial contact from extension through midflexion between patients undergoing GB or MR TKA . METHODS A total of 24 knees ( 23 patients ) were r and omly assigned at referral to either a surgeon performing MR or GB TKA  with the same single radius , posterior-stabilized implant ( 12 per cohort ) . At 1-year postoperation , patients underwent biplanar radiographic imaging at 0 ° , 20 ° , 40 ° , and 60 ° of flexion  . Condylar liftoff , contact location , and magnitude of excursion on each condyle were measured . Preoperative and postoperative clinical outcome scores were also collected . RESULTS There was no difference ( P = .41 ) in the frequency of liftoff between cohorts . The MR cohort had more posterior contact on the medial condyle ( P < .01 ) and more anterior contact on the lateral condyle ( P < .01 ) throughout flexion . Motion patterns were similar between cohorts , with similar medial ( P = .48 ) and lateral ( P = .44 ) excursion , which was equal in magnitude between condyles for both MR ( P = .48 ) and GB ( P = .73 ) . There was no difference in clinical outcome scores between groups . CONCLUSION For this particular implant system , GB and MR appear to produce similar kinematic and patient-reported outcome results Background Osteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people , giving rise to pain and loss of function . Many people experience progressive worsening of the disease over time , particularly those with varus malalignment and increased medial knee joint load . Therefore , interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression . Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load . A neuromuscular exercise program , emphasising optimal alignment of the trunk and lower limb joints relative to one another , as well as quality of movement performance , while dynamically and functionally strengthening the lower limb muscles , may be able to reduce medial knee load . Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature . This r and omised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading , pain and function in individuals with medial knee joint osteoarthritis . We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program . Methods / Design 100 people with medial knee pain , radiographic medial compartment osteoarthritis and varus malalignment will be recruited and r and omly allocated to one of two 12-week exercise programs : quadriceps strengthening or neuromuscular exercise . Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home . The primary outcomes are medial knee load during walking ( the peak external knee adduction moment from 3D gait analysis ) , pain , and self-reported physical function measured at baseline and immediately following the program . Secondary outcomes include the external knee adduction moment angular impulse , electromyographic muscle activation patterns , knee and hip muscle strength , balance , functional ability , and quality -of-life . Discussion The findings will help determine whether neuromuscular exercise is superior to traditional quadriceps strengthening regarding effects on knee load , pain and physical function in people with medial knee osteoarthritis and varus malalignment . Trial Registration Australian New Zeal and Clinical Trials Registry reference : Background : The Bisurface knee prosthesis was design ed in 1989 to improve knee flexion without affecting the durability of the prosthesis . The prosthesis has a unique ball- and -socket joint in the midposterior portion of the femoral and tibial components , which functions as a posterior stabilizing cam mechanism and causes femoral rollback . The femoral component was made of alumina ceramic . The purpose of this study was to review the clinical results of the first 223 arthroplasties performed with this prosthesis in order to assess whether this new implant had achieved its design objectives . Methods : From December 1989 to May 1994 , all patients who were scheduled for primary total knee arthroplasty were enrolled in a prospect i ve study of the Bisurface knee . The patients were evaluated clinical ly according to The Hospital for Special Surgery knee-rating system and with a self-administered question naire , and they were evaluated radiographically according to the system of the Knee Society . Kaplan-Meier survivorship analysis was performed with revision of the knee or recommendation for revision as the end point . Results : One hundred and sixty-six patients treated with a total of 223 consecutive primary total knee arthroplasties were enrolled in the study , and 182 knees were followed for 3.9 to 9.0 years ( mean , 5.8 years ) . Preoperatively , the mean Hospital for Special Surgery knee score was 44.5 points . At the time of latest follow-up , the mean knee score was 86.3 points . The mean preoperative and postoperative ranges of flexion were 119 and 124 degrees , respectively . The patients , even those with a good preoperative range of motion , rarely lost deep flexion of the knee after the procedure . A revision operation was performed in eight knees ( because of infection in five , instability in two , and breakage of the peg of the patellar component in one ) . Two knees had recurrent medial-lateral subluxations of the femorotibial articulation , which were treated nonoperatively . No prosthesis had loosened aseptically and no alumina ceramic femoral component had broken by the time of latest follow-up . The rate of survival of the implant was 94 percent ( 95 percent confidence interval , 90 to 98 percent ) at six years . According to the patient question naires , 20 percent of the knees sometimes felt loose in daily living activities , which prompted us to improve the intrinsic stability of the prosthesis by improving the congruity of the ball- and -socket joint . Conclusions : Total knee arthroplasty with the Bisurface prosthesis result ed in an excellent range of motion and a high level of satisfaction with the operation ; the durability of the prosthesis is promising A hydraulically operated machine for applying well-defined forces to the knee joint is described . The measurement of anteroposterior as well as lateral and medial stability in the knee joint is based upon roentgenograms exposed while the forces are being exerted on the patient . The advantage of the radiological measuring method over methods using external measurements is the elimination of inaccuracies due to displacements of the soft tissues of the limb . The accuracy was evaluated by test/retest examination of 50 healthy subjects . The radiographs were measured at r and om after cessation of examinations in the gonylaxometer . The accuracy is + /- 1.2 nm for medial/lateral , + /- 2.4 nm for drawer sign . Diagnostically the difference between the two knees must exceed 2.0 nm ( collateral instability ) or 3.1 nm ( drawer ) to exceed st and ard values . The st and ard values for the different ligament laxities are given . The applied force to be used for evaluation of medial/lateral stability is recommended to be 9 kg , and for anteroposterior stability between 20 and 30 kg
Conclusion Based on the small number of studies with appropriate statistical analysis , we are unable to reach a clear conclusion in the clinical performance of medial stabilized knee replacement construct .
Background Medial stabilized  total knee joint replacement ( TKJR ) construct is design ed to closely replicate the kinematics of the knee .
Little is known regarding comparison of clinical functional outcomes of patients utilising vali date d patient reported outcome measures ( PROM ) after medial stabilized TKJR and other construct design s. Purpose To perform a systematic review of the available literature related to the assessment of clinical functional outcomes following a  TKJR  employing a medial stabilized construct design .