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Abstract Background The literature comparing the long-term outcomes and survivorship of computer navigation-assisted and conventional total knee replacement (TKR) is sparse. Moreover, of the available comparative studies with follow-up duration of more than 10 years, the results seem to be conflicting. The purpose of this long-term study was to compare the clinical and radiological outcomes, and implant survivorship, of TKR performed with and without computer navigation. Methods We retrospectively compared the results of 49 computer-navigated TKRs and 139 conventional TKRs. The mean age of the patients was 67.9 (range 52–81) years for the navigation group and 67.1 (range 50–80) years for the conventional TKR group. The mean duration of follow-up for the conventional and navigation TKR groups was 12.9 and 13.2 years, respectively. Clinical and radiographic follow-up examinations of the patients were performed at 2 weeks, 1 month, 3 months and 6 months post-operatively, and at 1-year intervals thereafter. Results There were no significant differences in the post-operative Knee Society knee and function score between the two groups. The mean overall deviation from neutral alignment and the radiological outliers were significantly higher in the conventional TKR group. The overall survival rates at 17 years were 92.9% for the navigation group and 95.6% for the conventional TKR group (p = 0.62). Conclusions Navigated TKR resulted in fewer radiological outliers; however, this did not translate to better long-term functional outcomes or implant survival.

Background: The literature comparing the long-term outcomes and survivorship of computer navigation-assisted and conventional total knee replacement (TKR) is sparse. Moreover, of the available comparative studies with followup duration of more than 10 years, the results seem to be conficting. The purpose of this long-term study was to compare the clinical and radiological outcomes, and implant survivorship, of TKR performed with and without com‑ puter navigation. Methods: We retrospectively compared the results of 49 computer-navigated TKRs and 139 conventional TKRs. The mean age of the patients was 67.9 (range 52–81) years for the navigation group and 67.1 (range 50–80) years for the conventional TKR group. The mean duration of follow-up for the conventional and navigation TKR groups was 12.9 and 13.2 years, respectively. Clinical and radiographic follow-up examinations of the patients were performed at 2 weeks, 1 month, 3 months and 6 months post-operatively, and at 1-year intervals thereafter. Results: There were no signifcant diferences in the post-operative Knee Society knee and function score between the two groups. The mean overall deviation from neutral alignment and the radiological outliers were signifcantly higher in the conventional TKR group. The overall survival rates at 17 years were 92.9% for the navigation group and 95.6% for the conventional TKR group (p=0.62). Conclusions: Navigated TKR resulted in fewer radiological outliers; however, this did not translate to better long-term functional outcomes or implant survival. [ABSTRACT FROM AUTHOR]

Background: Total knee arthroplasty (TKA) remains the surgical gold standard treatment for patients suffering from end‐stage osteoarthritis (OA) of the knee. However, due to the high demand and scarce medical resources, the waiting time for surgery is astoundingly lengthy. Controversies are shown in numerous studies, on whether physical functionality and mental status decline or remain stable over the waiting period. This study aims to evaluate the progression in patients suffering from end‐stage OA while on the waiting list for TKA. Methods: One hundred and twenty‐seven patients suffering from end‐stage OA who were on the TKA waiting list were prospectively recruited from our orthopaedics specialist clinic. They were assessed once a year for 2 years or until surgery. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC), SF‐36 self‐rated questionnaire and 15D health‐related quality of life (HRQoL) questionnaire were used as outcome measurements for functionality and disability assessment. Results: Patients on the waiting list for TKA showed a progressive increase in pain and disability level within the first year (P =.035). Those patients waiting for more than 2 years showed worsening HRQoL (P <.05) as time progressed. However, no significant difference was observed between the first and second years. Conclusions: A decline in functionality and increase in disability were shown in follow‐up assessments conducted every year. However, a plateau effect is observed with end‐stage disease. This emphasizes that more active conservative management programmes should be introduced and implemented while patients are enlisted on the TKA waiting list. Moreover, timely surgical intervention can improve patients' overall function. Trial registration: This study involved human participants and reports health‐related outcomes concerning the HRQoL in patients with end‐stage OA of the knee. Thus, it was registered, retrospectively, as a clinical trial under the U.S. National Library of Medicine ClinicalTrials.gov (https://clinicaltrials.gov/) on March 4, 2018. [ABSTRACT FROM AUTHOR]

Isolated femoral condyle fracture is an uncommon entity. It accounts for only 0.65% of all femoral fractures, with lateral condyle involvement three times more frequently than the medial condyle. In neglected cases, nonunion and malalignment may occur, which results in osteoarthritis of the knee due to uneven distribution of load across respective compartments. In treating such cases, both osteoarthritis and nonunion have to be tackled to reconstruct a stable, mobile, pain-free, and well-aligned knee joint. There are a number of surgical options, including excision of the nonunion fragment, fixation of the nonunion fragment with or without bone graft, and total knee arthroplasty with or without stem extension. In the following, we present a case of 40-year non union of the lateral condyle and our rationale of management for a relatively young lady. During the course of treatment, there was an unexpected success even though arthroplasty was not performed. A management strategy for this challenging condition was also suggested. [ABSTRACT FROM AUTHOR]

The article presents a case study of an old lady suffering from Asian size exeter femoral stem fracture. The patient suffered from bilateral hip dysplasia, for which she underwent bilateral total hip arthroplasties. She was having right proximal thigh pain that was affecting her ambulatory ability. The patient was put on touchdown walking exercise, followed by partial weight bear walking exercise. Physical examination showed her body weight to be 78 kg and body mass index of 31.6.

Introduction: High tibial osteotomy (HTO) is a treatment of choice for active adult with knee osteoarthritis. With advancement in CT imaging with three-dimensional (3D) model reconstruction, virtual planning and 3D printing, patient-specific instrumentation (PSI) in form of cutting jigs is employed to improve surgical accuracy and outcome of HTO. The aim of this randomised controlled trial (RCT) is to explore the surgical outcomes of HTO for the treatment of medial compartment knee osteoarthritis with or without a 3D printed patient-specific jig., Methods and Analysis: A double-blind RCT will be conducted with patients and outcome assessors blinded to treatment allocation. This meant that neither the patients nor the outcome assessors would know the actual treatment allocated during the trial. Thirty-six patients with symptomatic medial compartment knee osteoarthritis fulfilling our inclusion criteria will be invited to participate the study. Participants will be randomly allocated to one of two groups (1:1 ratio): operation with 3D printed patient-specific jig or operation without jig. Measurements will be taken before surgery (baseline) and at postoperatively (6, 12 and 24 months). The primary outcome includes radiological accuracy of osteotomy. Secondary outcomes include a change in knee function from baseline to postoperatively as measured by three questionnaires: Knee Society Scores (Knee Scores and Functional Scores), Oxford Knee Scores and pain visual analogue scale (VAS) score., Ethics and Dissemination: Ethical approval has been obtained from the Joint Chinese University of Hong Kong - New Territories East Cluster Clinical Research Ethics Committee (CREC no. 2019.050), in accordance with the Declaration of Helsinki. The results will be presented at international scientific meetings and through publications in peer-reviewed journals., Trial Registration Number: NCT04000672; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: This prospective cohort study was designed to evaluate the survivorship and functional outcomes associated with long-term results of medial open-wedge high tibial osteotomy (MOWHTO) for the treatment of medial compartment knee osteoarthritis in the Chinese population. Although MOWHTO is a well-established procedure in the management of medial osteoarthritis of the knee, the long-term outcome in the Chinese population has not been reported in current literature. We hypothesised that MOWHTO would result in long-term preservation of knee function in Chinese, similar to that reported in the Caucasian population., Methods: A cohort of 22 young adult patients (age < 55 years old) undergoing MOWHTO for the treatment of symptomatic medial compartment knee osteoarthritis between 2002 and 2008 was retrospectively surveyed with a minimum follow-up of 10 years. Kaplan-Meier survival analysis was performed, and the failure modes were investigated. The outcomes on survival (not requiring arthroplasty), clinical outcome (Knee Society Knee Score and Knee Society Function Score) and range of motion (numeric rating scale) at preoperative, 1-year postoperative follow-up and at last follow-up (>10 years) were evaluated. In addition, the mechanical tibiofemoral angle was also measured. The Wilcoxon signed-rank test was used for statistical evaluation of nonparametric data in these related samples., Result: A total of 31 knees in these 22 cases were included. The follow-up rate was 100% at 13.4 ± 1.9 years (11-17). Mean age at time of surgery was 45.8 ± 9.5 years (18-53). At 10-year follow-up, four knees converted to require total knee arthroplasty (survival: 87.1%). Preoperative varus alignment with mechanical tibiofemoral angle of -9.26 ± 2.83 was corrected to 2.58 ± 2.46 after surgery and remained 2.01 ± 3.52 at the latest follow-up. Knee Society Knee Score increased significantly from 53.7 ± 11.1 preoperatively to 93.8 ± 6.8 at 1-year follow-up and 91.8 ± 9.7 at latest follow-up. Similarly, the functional score also increased significantly from 67.4 ± 21.0 preoperatively to 86.3 ± 14.5 at 1-year follow-up and 82.1 ± 16.6 at latest follow-up ( p  < 0.01). Whereas, the range of motion significantly decreased from 122.7 ± 6.6 preoperatively to 116.1 ± 15.5 at the latest follow-up., Conclusion: Even in cases of severe medial osteoarthritis and varus malalignment, MOWHTO would be a good treatment option for management in active Chinese population less than 55 years. Although t he long-term survival and functional outcome after MOWHTO was proven to be satisfactory in our cohort during the 10-year follow-up, a larger cohort to illustrate the long-term functional outcome is still warranted., Translational Potential: The finding in this study indicated MOWHTO is a feasible treatment option for young adult patients with osteoarthritis to achieve long-term satisfactory results., Competing Interests: The authors have no conflicts of interest to disclose in relation to this article., (© 2020 The Author(s).)

Osteoradionecrosis is a rare complication of radiation therapy. The pelvic and facial bones are those most likely to be affected when radiotherapy is used to manage gynaecological or nasopharyngeal malignancies. We report a 78-year-old woman with osteoradionecrosis of the acetabulum in a total hip arthroplasty 4 years after radiotherapy for a carcinoma of the vagina. Osteolysis of the acetabulum with pelvic discontinuity was noted on radiographs, but the patient was asymptomatic.