MS Orthopaedics, DNB Orthopaedics
Trauma, Arthroplasty, Spinal Surgeries
Haroon Manzil, Shah Basheer Colony, Hadi Nagar, Dhorra, Aligarh-202002
- Limb length discrepancy after total knee arthroplasty: Unilateral versus bilateral, a comparative study at tertiary centre Download PDF
total knee arthroplsty in unilateral and bilateral total knee arthroplasty (TKA) because few literature is available
regarding limb length discrepancy in TKA in comparison to total hip arthroplasty. Limb length discrepancy (LLD)
may lead to low back pain and gait abnormalities.
Material and methods: We divided 58 patients into two groups: Group A (28 patients) includes patients who underwent
unilateral TKA and Group B (30 patients) includes patients who underwent bilateral TKA. We assessed
the patients clinico-radiologically in terms of limb length (supine position), deformity, Sagital-flexion deformity/
extensor lag, coronal - varus/valgus, range of motion, knee stability, patellar tracking and Hip-knee-ankle angle
preoperatively and postoperatively.
Results: In group A, mean limb length difference (operated limb gained length as compared to unoperated limb)
was 1.11 cm. Out of 22 patients (78%) in whom limb length discrepancy was present, only 7 patients (31%) having
limb length discrepancy perceived it. In group B, mean limb length difference was 1.03 cm. Fourteen patients
(47%) in group B had LLD but none of them perceived it. Clinically 22 patients (78%) in group A and 14 patients
(47%) in group B had LLD. Radiologically 25 patients (89%) in group A and 22 patients (73%) in group B had
LLD. Out of the 7 patients who perceived LLD, all had LLD radiologically too.
Conclusion: We reckoned that limb length discrepancy is more common in unilateral TKA. Limb length discrepancy
of 2 cm or more is perceived by the patients operated for unilateral TKA. But in bilateral TKA, none of the
patient perceived LLD because in this group LLD was less than 2 cm. Limb length discrepancy may leads to dissatisfaction
of the patients and poor functional outcome.
- Proximal Fibular Osteotomy: Is it Really an Option for Medial Compartmental Osteoarthritis Knee? Our Experience at Tertiary Centre Download PDF
Introduction The medial compartment is commonly involved in age-related osteoarthritis knee because weight-bearing axis
passes close to the medial condyle and its large surface area. Various treatments have been proposed ranging from conservative
to total knee arthroplasty which is an expensive and complex treatment. Recently, proximal fibular osteotomy (PFO)
for medial compartment knee osteoarthritis became popular as a treatment modality. Although, the mechanism of PFO is
not clear. So, we conducted a prospective study to assess the clinico-radiological outcome of proximal fibular osteotomy in
medial compartment osteoarthritis knee.
Materials and methods We conducted a prospective study from November 2017 to November 2019 on 32 (47 knees) patients
with degenerative medial compartmental osteoarthritis knee, varus deformity < 15 and Kellgren and Lawrence grade II and
grade III (K–L Grade). We recorded the visual analogue score (VAS) and knee society score (KSS) pre-operatively and
post-operatively of all patients. We got weight bearing anterio-posterior and lateral radiograph of knee done. We assessed
joint space ratio and lateral tibio-femoral angle (FTA) pre-operatively, post-operatively and at each follow-up.
Results Mean age was 48.4 (35–65) years and the mean follow-up was 18 months. Mean duration for unilateral PFO was
37 min and for bilateral, 55 min. The VAS was improved from 7.33 ± 0.72 to 7.13 ± 1.64 at 3 months and remained the same
at final follow-up (p > 0.05). The mean pre-operative clinical and functional KSS was statistical insignificantly improved at
3 months and final follow-up (p > 0.05). The mean pre-operative lateral and mean pre-operative joint space ratio was also
improved statistically insignificant (p > 0.05). Extensor hallucis longus (EHL) weakness was documented in five knees
(10.6%) and paraesthesia was documented in seven (14.8%) knees.
Conclusion Although, PFO is a simple, less invasive and affordable procedure, we could not reproduce the favourable results
in medial compartmental osteoarthritis knee. This procedure is also associated with reversible but noticeable complications.
So, we would not consider PFO as an alternative option in the treatment of medial compartmental osteoarthritis knee.
Keywords Proximal fibular osteotomy · Medial compartmental osteoarthritis · Peroneal nerve palsy · VAS · Lateral FTA