Total knee arthroplasty (TKA) results in a high degree of patient satisfaction, as it provides patients with considerable medium- and long-term benefits in terms of quality of life, pain relief and function. Nevertheless, the literature reports that up to 30% of patients are dissatisfied. This dissatisfaction is directly related to the patients' quality of life, which they deem insufficient. Their quality of life depends on many physical, behavioural, social and psychological factors that are not taken into account by functional outcome scores. After describing the principles of quality of life evaluation after TKA, we will assess the effects of patient-related factors, the surgical technique and postoperative program through an exhaustive review of the literature. Patient expectations after TKA will then be outlined, particularly return to work and return to sports.

Quality of life after total knee arthroplasty.

Recently, there is a growing interest in surgical variables that are intraoperatively controlled by orthopaedic surgeons, including lower leg alignment, component positioning and soft tissues balancing. Since more tight control over these factors is associated with improved outcomes of unicompartmental knee arthroplasty and total knee arthroplasty (TKA), several computer navigation and robotic-assisted systems have been developed. Although mechanical axis accuracy and component positioning have been shown to improve with computer navigation, no superiority in functional outcomes has yet been shown. This could be explained by the fact that many differences exist between the number and type of surgical variables these systems control. Most systems control lower leg alignment and component positioning, while some in addition control soft tissue balancing. Finally, robotic-assisted systems have the additional advantage of improving surgical precision. A systematic search in PubMed, Embase and Cochrane Library resulted in 40 comparative studies and three registries on computer navigation reporting outcomes of 474,197 patients, and 21 basic science and clinical studies on robotic-assisted knee arthroplasty. Twenty-eight of these comparative computer navigation studies reported Knee Society Total scores in 3504 patients. Stratifying by type of surgical variables, no significant differences were noted in outcomes between surgery with computer-navigated TKA controlling for alignment and component positioning versus conventional TKA (p = 0.63). However, significantly better outcomes were noted following computer-navigated TKA that also controlled for soft tissue balancing versus conventional TKA (mean difference 4.84, 95 % Confidence Interval 1.61, 8.07, p = 0.003). A literature review of robotic systems showed that these systems can, similarly to computer navigation, reliably improve lower leg alignment, component positioning and soft tissues balancing. Furthermore, two studies comparing robotic-assisted with computer-navigated surgery reported superiority of robotic-assisted surgery in controlling these factors. Manually controlling all these surgical variables can be difficult for the orthopaedic surgeon. Findings in this study suggest that computer navigation or robotic assistance may help managing these multiple variables and could improve outcomes. Future studies assessing the role of soft tissue balancing in knee arthroplasty and long-term follow-up studies assessing the role of computer-navigated and robotic-assisted knee arthroplasty are needed.

Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis.

BACKGROUND There is interest in hallux valgus deformity correction using internal fixation with the minimally invasive chevron and Akin osteotomies (MICA) technique. The objective of this study was to assess the correction measured on postoperative radiographs and clinical outcomes, using validated outcome measures, at 2 years following third-generation MICA. METHODS This is a prospective single-surgeon case series of 333 consecutive feet that underwent MICA surgery between July 2014 and April 2018. The primary clinical outcome measures included the Manchester-Oxford Foot Questionnaire (MOXFQ), EuroQol-5 Dimensions-5 Level (EQ-5D-5L) Index, EuroQol-visual analogue scale (EQ-VAS), and a VAS for pain (VAS-pain). Secondary outcome measures included radiographic parameters and complication rates. RESULTS Preoperative and 2-year postoperative patient-reported outcome measures (PROMs) were collected for 292 feet (87.7%). At a minimum 2-year follow-up, the MOXFQ scores (mean ± standard deviation [SD]) had improved in each domain-i.e., reduced from 44.5 ± 21.0 preoperatively to 9.4 ± 15.8 postoperatively for pain (p < 0.001), from 38.7 ± 23.4 to 6.5 ± 14.6 for walking and standing (p < 0.001), and from 48.0 ± 22.3 to 6.6 ± 13.5 for social interaction (p < 0.001). The VAS-pain score improved from 31.4 ± 22.7 preoperatively to 8.4 ± 16.4 at the 2-year follow-up (p < 0.001), the 1-2 intermetatarsal angle was reduced from 15.3° ± 3.6° preoperatively to 5.7° ± 3.2° at the 2-year follow-up (p < 0.001), and the hallux valgus angle was reduced from 32.9° ± 10.2° to 8.7° ± 5.2° (p < 0.001). CONCLUSIONS The third-generation MICA provided significant improvement in clinical outcome measures at the 2-year follow-up and can be successfully used for correction of a range of hallux valgus deformities with a low rate of symptomatic recurrence. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Third-Generation Minimally Invasive Chevron and Akin Osteotomies (MICA) in Hallux Valgus Surgery: Two-Year Follow-up of 292 Cases.

Personalized Hip and Knee Joint Replacement

The Scarf osteotomy has proven to be an effective intervention in the correction of various degrees of hallux valgus deformity Outcome compares favourably with other bunion surgeries such as the distal or proximal Chevron or crescentic osteotomy The Scarf osteotomy is a more extensive surgical procedure than other techniques and the technically demanding nature of the procedure requires experience to master This paper describes peri-operative complications during our early experience of Scarf osteotomy for hallux valgus A case note review was carried out for the first 100 Scarf osteotomy procedures completed by the senior author There were six patients (6%) with peri-operative complications Four of these were intra-operative complications including a split of the first metatarsal in three cases, and a shearing of the K wire in one case, and there were two cases of post-operative stress fracture These complications should be considered by those beginning to master the Scarf osteotomy procedure and by surgeons teaching surgical trainees

Peri-operative complications of the scarf osteotomy

This study sought to determine the medium-term
patient-reported and radiographic outcomes in patients undergoing
surgery for hallux valgus. A total of 118 patients (162 feet) underwent
surgery for hallux valgus between January 2008 and June 2009. The
Manchester-Oxford Foot Questionnaire (MOXFQ), a validated tool for
the assessment of outcome after surgery for hallux valgus, was used
and patient satisfaction was sought. The medical records and radiographs
were reviewed retrospectively. At a mean of 5.2 years (4.7 to 6.0)
post-operatively, the median combined MOXFQ score was 7.8 (IQR:0
to 32.8). The median domain scores for pain, walking/standing, and social
interaction were 10 (IQR: 0 to 45), 0 (IQR: 0 to 32.1) and 6.3 (IQR:
0 to 25) respectively. A total of 119 procedures (73.9%, in 90 patients)
were reported as satisfactory but only 53 feet (32.7%, in 43 patients)
were completely asymptomatic. The mean (SD) correction of hallux
valgus, intermetatarsal, and distal metatarsal articular angles was
18.5° (8.8°), 5.7° (3.3°), and 16.6° (8.8°), respectively. Multivariable
regression analysis identified that an American Association of Anesthesiologists
grade of >1 (Incident Rate Ratio (IRR) = 1.67, p-value = 0.011)
and recurrent deformity (IRR = 1.77, p-value = 0.003) were associated
with significantly worse MOXFQ scores. No correlation was found
between the severity of deformity, the type, or degree of surgical
correction and the outcome. When using a validated outcome score
for the assessment of outcome after surgery for hallux valgus, the
long-term results are worse than expected when compared with the
short- and mid-term outcomes, with 25.9% of patients dissatisfied
at a mean follow-up of 5.2 years. Cite this article: Bone Joint J 2015;97-B:208–14.

Surgery for the correction of hallux valgus: Minimum five-year results with a validated patient-reported outcome tool and regression analysis

Elbow fracture-dislocation combined with Galeazzi fracture in adult: A case report and literature review

Sports and High Tibial Osteotomy

and High Tibial

The incidence of anteroposterior overhang of the tibial component after TKA and its effect on clinical outcome were investigated, and the morphometric characteristics of the knees in which tibial baseplates were oversized were identified. 
One hundred and fourteen consecutive TKAs were retrospectively assessed. The dimensions of the tibia were measured on a pre-operative CT scan and were compared with those of the implanted tibial component. We analysed the effect of anteroposterior and mediolateral size variations on clinical outcomes 1 year after surgery. An anteroposterior overhang was observed in 87 % of cases on the lateral plateau, in 88 % on the central plateau and in 25 % on the medial tibial plateau. The mean post–pre-operative size differences were 3.2 ± 2.7, 2.8 ± 2.7 and −1.6 ± 2.3 mm, respectively. (Positive value means oversizing). A mediolateral overhang of the tibial component was found in 61 % of the patients. Oversizing was significantly greater and more frequent in females. Patients oversized in the anteroposterior dimension had lower post-operative pain scores. Patients with mediolateral oversizing had decreased flexion 1 year after surgery. Anteroposterior oversizing was observed more frequently in patients with asymmetric tibial plateaus, while mediolateral oversizing was observed more frequently in patients with small tibias. This study demonstrates that the incidence of oversized tibial plateau components is surprisingly high and that functional outcomes are lower in the case of mediolateral or anteroposterior oversizing. The risk of oversizing could be predicted as it occurs predominantly in patients with asymmetric proximal tibia and/or small tibia. IV.

https://link.springer.com/content/pdf/10.1007%2Fs00167-015-3512-0.pdf

Oversizing the tibial component in TKAs: incidence, consequences and risk factors.

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