Diabetes and increased body mass index are two of the most associated comorbidities in patients undergoing total knee arthroplasty. With the number of patients undergoing knee arthroplasty increasing and with the incidence of diabetes and increased BMI, we can expect that in the coming decades the association of the two comorbidities will be frequent. An ethical issue arises when the patients who are refused for total knee arthroplasty are instructed to change the risk factors, and they fail either because of a mental problem or because of a physical problem. This study analyzes the effects of controlled, uncontrolled, uncomplicated and complicated diabetes on the rates of post- knee arthroplasty complications. The study proposes to evaluate obese patients in terms of functional outcomes and postoperative complications after total knee arthroplasty.
In an attempt to standardize the X-ray analysis and to create relevant correlations between it and the functional results, we present a pilot model of an artificial neural network based on a Bayesian belief network (BNN) designed for the automatic analysis of anteroposterior X-ray of the knee following total knee arthroplasty and more precisely the analysis of the tibial component. A prospective analysis was conducted in which 30 patients were analyzed and two groups resulted: the first was made up of 12 cases considered “normal” by the examiners (optimal positioning and cementation) and the second one, which was considered “pathological” (incorrect positioning or cementation) and included 16 cases. Based on 22 points established on the tibial component several geometric sizes (calculated parameters) were computed. Several parameters were compared and the results were up to 75% accuracy, 81.25% sensitivity, and 66.7% specificity. BBNs can be a solution for X-ray evaluation of total knee arthroplasty and can improve the understanding of its evolution. It needs confirmation in time, its accuracy rising with the number of patients introduced in the analysis algorithm.
Rotational malalignment complication following TKA, is common but can be avoided with proper surgical technique. This paper reviews the literature regarding rotational alignment during TKA, femoral and tibial rotation, and highlights the techniques prior in obtaining proper rotational positioning, nevertheless correct positioning in all three planes is important. Proper femoral component positioning in the axial plane is done using as landmarks the posterior condylar line (PCL), surgical transepicondylar axis (sTEA), anatomical transepicondylar axis and the trochlear anteroposterior (AP) axis. The paper describes the angular relationships between these landmarks and the distal femur. Axial tibial positioning is done when using intraarticular landmarks, the combination of more than one landmark could be a solution for solving this problem. The consensus is that femoral component should be positioned according to TEA but the interobserver variability of this land mark is very high. The rotation of the tibial component remains an open subject, most studies suggesting a point between half of the distance of patellar ligament and 1/3 of the internal tuberosity as optimal landmark.
