الكتب والنشرات العلمية

قائمة المقالات العلمية والنشرات الدورية الخاصة بالدكتور سميح الطرابيشي

  • Operative Procedure for Primary TKR, How to Increase ROM
  • .A unique pattern of Peri-Prosthetic Fracture Following Total Knee, Arthroplasty. The Insufficiency Fracture
  • Achieving Deep Flexion, After Primary Total Knee Arthroplasty
  • Anatomic tibial component design can increase tibial coverage and rotational alignment accuracy: a comparison of six contemporary designs
  • ?Can an Anterior Quadriceps Realise Improve Range of Motion in the stiff Arthritic Knee
  • .Importance of Full Flexion After Total Knee Replacement in Muslims Daily Lifestyle
  • .Knee Kinematics of High-Flexion Activates of Daily Living Performed by the Male Muslims in the Middle East
  • Primary Repair of latrogenic Medial Collateral Ligament Injury During TKA: A Modified Technique
  • Special Considerations in Asian Knee Arthroplasty
  • Special Considerations in Asian Knee Arthroplasty searchgate
  • Primary Repair of Iatrogenic Medial Collateral Ligament Injury During TKA: A Modified Technique
  • THINGS YOU SHOULD KNOW ABOUT ASIAN KNEE BEEORE DOING. TQIALKNEEREPLACEMENT
  • Tranexamic Acid to Reduce Blood Loss After Bilateral Total Knee Arthroplasty
  • Achieving Deep Flexion After Primary Total Knee Arthroplasty
  • Comparing the Effect of Tourniquet vs Tourniquet-Less in Simultaneous Bilateral Total Knee Arthroplasties
  • EVALUATION OF TIBIAL COMPONENT ROTATION IN PAINFUL TOTAL KNEE ARTHROPLASTIES BY MRI ENHANCED WITH METAL ARTIFACT REDUCTION TECHNIQUE
  • Excellent vs. Good Range of Motion after TKA, What Makes the Difference?
  • Posterior Cruciate Ligament Substituting Total Knee Arthroplasty
  • Hip and Knee Section, Prevention, Surgical Technique: Proceedings of International Consensus on Orthopedic Infections
  • Posterior stabilized total knee arthroplasty increases the risk of postoperative periprosthetic fractures
  • Posterolateral overhang affects patient quality of life after total knee arthroplasty
  • Response to Letter to the Editor on “Comparing the Effect of Tourniquet vs. Tourniquet-Less in Simultaneous Bilateral Total Knee Arthroplasties.“
  • SIMULTANEOUS BILATERAL TOTAL KNEE REPLACEMENT IS SAFE AND NECESSARY IN GROSS DEFORMITY
  • Soft Tissue Release for Varus Knees during Posterior Stabilized Total Knee Arthroplasty: A New Algorithm
Operative Procedure for Primary TKR, How to Increase ROM
Operative Procedure for Primary TKR: How to Increase ROM

Samih Tarabichi, Ahmed El-Naggar, and Mohamed Adi

Deep knee flexion is a real concern for Middle Eastern and Asian patients undergo- ing total knee replacement . Since many daily activities, such as praying, dining, or using the oriental toilet, and many social encounters such as attending the Shaikh’s majlis are carried out on the ground. It has been shown that during prayers, people routinely flex the knee between 150 and 165°, 20–30 times each day

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.A unique pattern of Peri-Prosthetic Fracture Following Total Knee, Arthroplasty. The Insufficiency Fracture
A Unique Pattern of Peri-Prosthetic Fracture Following Total Knee Arthroplasty: The Insufficiency Fracture

Alisina Shahi, MD a, Usama Hassan Saleh, MD a, Timothy L. Tan, MD b, Mohamed Elfekky, MD a, Samih Tarabichi, MD a

abstract

An isolated periprosthetic compression fracture following total knee arthroplasty has not been described in periprosthetic fracture classifications. Thus, the purpose is to describe this unique type of fracture based on clinical and radiographic analysis and identify the incidence and potential risk factors of this fracture. A retrospec- tive chart review was performed from a database of 5864 primary total knee. A total of 56 (0.9%) periprosthetic fractures were identified with 15 (26.8%) of them demonstrating an isolated lateral compression fracture. Patients exhibiting this fracture pattern had a mean preoperative varus deformity of 176.3° and had poor bone quality (T score: −2.1). It is important to recognize that a compression fracture is not an infrequent finding and that further workup maybe warranted when clinical suspicion is high

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Achieving Deep Flexion, After Primary Total Knee Arthroplasty

Achieving Deep Flexion
After Primary Total Knee Arthroplasty

Samih Tarabichi, MD, MS, FRCSC, FAAO, Yasir Tarabichi, and Marwan Hawari, MD

Abstract

Total knee arthroplasty patients often have difficulty performing activities involving flexion beyond 130°. The NexGen LPS Flex (Zimmer Inc, Warsaw, Ind) mobile bearing implant accommodates up to 155° of flexion. Two hundred eighteen total knee arthroplasties were performed using this implant on 125 patients over a 2-year period with a minimum of 5 years follow-up. All data were collected prospectively. Forty-four percent of preoperative cases had full flexion (ie, 140° active flexion and ability to kneel with thigh/calf contact for 1 minute). Five-year data showed an average flexion of 140° ± 11.5° and flexion greater than 140° in 103 knees (68%). There were no differences in patellofemoral pain levels, complications, or Knee Society scores despite our patients having, on average, an increase in flexion and function. Keywords: total knee arthroplasty, knee flexion, rotating platform, mobile bearing, posterior stabilized, deep flexion

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Anatomic tibial component design can increase tibial coverage and rotational alignment accuracy: a comparison of six contemporary designs

Anatomic tibial component design can increase tibial coverage and rotational alignment accuracy: a comparison of six contemporary designs

Yifei Dai · Giles R. Scuderi · Jeffrey E. Bischoff · Kim Bertin · Samih Tarabichi · Ashok Rajgopal

Abstract

Purpose The aim of this study was to comprehensively evaluate contemporary tibial component designs against global tibial anatomy. We hypothesized that anatomically designed tibial components offer increased morphological fit to the resected proximal tibia with increased alignment accuracy compared to symmetric and asymmetric designs. Methods Using a multi-ethnic bone dataset, six contem- porary tibial component designs were investigated, includ- ing anatomic, asymmetric, and symmetric design types. Investigations included (1) measurement of component conformity to the resected tibia using a comprehensive set of size and shape metrics;  assessment  of componentoverage on the resected tibia while ensuring clinically acceptable levels of rotation and overhang; and (3) evalu- ation of the incidence and severity of component downsiz- ing due to adherence to rotational alignment and overhang requirements, and the associated compromise in tibial cov- erage. Differences in coverage were statistically compared across designs and ethnicities, as well as between place- ments with or without enforcement of proper rotational alignment

Results Compared to non-anatomic designs investigated, the anatomic design exhibited better conformity to resected tibial morphology in size and shape, higher tibial coverage (92 % compared to 85–87 %), more cortical support (pos- teromedial region), lower incidence of downsizing (3 % compared to 39–60 %), and less compromise of tibial cov- erage (0.5 % compared to 4–6 %) when enforcing proper rotational alignment

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?Can an Anterior Quadriceps Realise Improve Range of Motion in the stiff Arthritic Knee

?Can an Anterior Quadriceps Release Improve Range of Motion in the Stiff Arthritic Knee

Samih Tarabichi, MD, MS, FRCSC,* and Yasir Tarabichi, MDy

Abstract

We hypothesize that tethering adhesions of the quadriceps muscle are the major pathological structures responsible for a limited range of motion in the stiff arthritic knee. Forty-two modified quadriceps muscle releases were performed on 24 patients with advanced osteoarthritis scheduled for total knee arthroplasty. The ranges of motion were documented intraoperatively both before and immediately after the release. Passive flexion improved significantly in all patients (mean, 32.4° of improvement, P b .001) following a modified quadriceps release, despite any presence of osteophytes or severe deformities. These results strongly implicate adhesions of the quadriceps muscle to the underlying femur, which prevent the distal excursion of the quadriceps tendon, as the restrictive pathology preventing deep flexion in patients with osteoarthritis. Keywords: quadriceps excursion, quadriceps, excursion, quadricepsplasty, quadriceps release, release, knee flexion, range of motion, osteoarthritis, total knee replacement.

.Importance of Full Flexion After Total Knee Replacement in Muslims Daily Lifestyle

Importance of Full Flexion After Total Knee Replacement in Muslims’ Daily Lifestyle

Samih Tarabichi MD FRCS, Yasir Tarabichi, Abdul Rahman Tarabishy MD, Marwan Hawari MD
American Hospital Dubai, Dubai, United Arab Emirates

Abstract

Previous studies show that total knee replacement (TKR) patients have difficulty performing cer- tain tasks involving deep knee flexion which are part of activities of daily living (ADL). Muslims’ lifestyles heavily depend on the ability to fully flex the knee, and many daily activities, such as praying, social encounters (attending the Sheikh’s majlis), dining or even using the hole bathroom, are carried out on the ground. The LPS Flex implant has been designed to accommodate this by giving up to 165 degrees of flexion. One-thousand and thirty-two (1032) TKRs were performed on patients diagnosed with osteoarthritis using the LPS Flex mobile bearing implant over a five year period with a minimum of 1 year post-operative follow up. The results were then compared to a series obtained from the Zimmer Feedback database which is man- aged independently by the Audit and Research Office, Department of Orthopaedic and Trauma Surgery, University of Dundee, Dundee, Scotland, United Kingdom. 44% of pre-op cases had full flexion as per our set criteria. There were no apparent differences in patello-femoral pain levels, complications or Knee Society score despite the fact that our patients had, on average, an increase in maximum flexion along with an increase in functional ability. The knee score failed to assess this improved functionality of patients who had full flexion; a new diagnostic method is therefore needed. The results indicate that the implant allows patients to maintain a high degree of flexion and function post-operatively, with few complications.

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.Knee Kinematics of High-Flexion Activates of Daily Living Performed by the Male Muslims in the Middle East

Knee Kinematics of High-Flexion Activities of Daily Living Performed by Male Muslims in the Middle East

Stacey M. Acker, PhD,* Robert A. Cockburn, BSc Eng,* Janet Krevolin, PhD,* Rebecca M. Li, BSc Eng,* Samih Tarabichi, MD,y and Urs P. Wyss, PhDz

Abstract

Full flexion is critical for total knee arthroplasty (TKA) patients in the Middle East, where daily activities require a high range of motion in the lower limb. This study aimed to increase understanding of the knee kinematics of normal Muslim subjects during high-flexion activities of daily living, such as kneeling, Muslim prayer, sitting cross-legged, and squatting. The early postoperative kinematics for a select group of Muslim, high-flexion TKA patients are also reported. Mean curves were compared between the normal group and the TKA group. During kneeling, the average maximum flexion was 141.6° for the normal group and 140.2° for the TKA group. The normal group’s maximum and minimum knee angles (flexion, abduction, external rotation) were reported and, with the exception of maximum extension, were not significantly different from the TKA group, despite short postoperative times. Keywords: total knee arthroplasty, knee kinematics, high-flexion activities.

Primary Repair of latrogenic Medial Collateral Ligament Injury During TKA: A Modified Technique

Primary Repair of Iatrogenic Medial Collateral Ligament Injury During TKA: A Modified Technique

Alisina Shahi, MD a, Timothy L. Tan, MD b, Samih Tarabichi, MD a, Ahmed Maher, MD a, Craig Della Valle, MD c, Usama Hassan Saleh, MD

abstract

Intraoperative injury to the medial collateral ligament (MCL) is a rare but important complication of total knee arthroplasty (TKA). While described treatment methods are mainly primary repair and revision with a more constrained implant, a few studies have investigated the outcomes of primary repair without constrained implants. A retrospective study was performed to evaluate the prevalence of iatrogenic injury to the MCL during primary TKA and determine the clinical outcomes of MCL repair augmented with synthetic material without the use of a constrained device. The incidence of intraoperative tear of the MCL was 0.43% (15/3432). No patient demonstrated instability during the follow-up period. Primary repair of iatrogenic MCL injury without the use of constrained im- plants appears to be a potential alternative that warrants further investigation.

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Special Considerations in Asian Knee Arthroplasty

Special Considerations in Asian Knee Arthroplasty

Hamid Reza Seyyed Hosseinzadeh, Samih Tarabichi, Ali Sina Shahi, Mehrnoush Hassas Yeganeh
Usama Hassan Saleh, Gholam Reza Kazemian and Aidin Masoudi

Human body is a unique correlation between anatomy and physiology. It is mandatory to have adequate knowledge on this issue former to perform any kind of surgery. As in all parts of human body, there are several variations in human knee concerning middle-eastern and Asian ethnicity, which should be considered for performing total knee arthroplasty among these races. These differences involve both in anatomical and physiological features, causing variations in a wide spectrum from metabolic syndromes to morphology of knee components.

During total knee replacement, the accurate bone cutting, adequate balancing of the soft tis‐ sues and proper coverage of the resected surface were important factors for achieving a suc‐ cessful outcome. In recent years, many studies have identified shape differences in the knee within the Caucasian population. Total knee replacement is a precise procedure, requiring accurate soft tissue balancing and resection of bone thickness equal to the thickness of the implanted prosthetic component. Proper bone cuts for rotational alignment of the femur and tibia in the axial plane represents the key for a balanced flexion gap and proper patella tracking. Both represent important parameters for high flexion. [1] A properly shaped pros‐ thesis can provide the best coverage and avoid soft tissue impingement. Thus, it becomes important to obtain the anthropometric data to achieve the best stability and longevity for implant. Total knee prostheses based on the accurately morphologic data of knee, gender morphologic difference, and the morphologic correlations between tibia and femur may be expected to give better results.

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Special Considerations in Asian Knee Arthroplasty searchgate

Special Considerations in Asian Knee

Arthroplasty

 Introduction

Human body is a unique correlation between anatomy and physiology. It is mandatory to have adequate knowledge on this issue former to perform any kind of surgery. As in all parts of human body, there are several variations in human knee concerning middle-eastern and Asian ethnicity, which should be considered for performing total knee arthroplasty among these races. These differences involve both in anatomical and physiological features, causing variations in a wide spectrum from metabolic syndromes to morphology of knee components

During total knee replacement, the accurate bone cutting, adequate balancing of the soft tis‐ sues and proper coverage of the resected surface were important factors for achieving a suc‐ cessful outcome. In recent years, many studies have identified shape differences in the knee within the Caucasian population. Total knee replacement is a precise procedure, requiring accurate soft tissue balancing and resection of bone thickness equal to the thickness of the implanted prosthetic component. Proper bone cuts for rotational alignment of the femur and tibia in the axial plane represents the key for a balanced flexion gap and proper patella tracking. Both represent important parameters for high flexion. [1] A properly shaped pros‐ thesis can provide the best coverage and avoid soft tissue impingement. Thus, it becomes important to obtain the anthropometric data to achieve the best stability and longevity for implant. Total knee prostheses based on the accurately morphologic data of knee, gender morphologic difference, and the morphologic correlations between tibia and femur may be expected to give better results

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Primary Repair of Iatrogenic Medial Collateral Ligament Injury During TKA: A Modified Technique

Primary Repair of Iatrogenic Medial Collateral Ligament Injury During TKA: A Modified Technique

Alisina Shahi, MD a, Timothy L. Tan, MD b, Samih Tarabichi, MD a, Ahmed Maher, MD a, Craig Della Valle, MD c, Usama Hassan Saleh, MD a

Intraoperative injury to the medial collateral ligament (MCL) is a rare but important complication of total knee arthroplasty (TKA). While described treatment methods are mainly primary repair and revision with a more constrained implant, a few studies have investigated the outcomes of primary repair without constrained implants. A retrospective study was performed to evaluate the prevalence of iatrogenic injury to the MCL during primary TKA and determine the clinical outcomes of MCL repair augmented with synthetic material without the use of a constrained device. The incidence of intraoperative tear of the MCL was 0.43% (15/3432). No patient demonstrated instability during the follow-up period. Primary repair of iatrogenic MCL injury without the use of constrained im- plants appears to be a potential alternative that warrants further investigation.

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THINGS YOU SHOULD KNOW ABOUT ASIAN KNEE BEEORE DOING. TQIALKNEEREPLACEMENT

Medical literatures has documented some unique features of the Asian knee. These features need to be addressed when performing TKA on Asians. The senior writer of this paper has performed over 3,000 TKA on Americans and over 5000 TKA on Asians. This enabled us to document specific anatomical, systemic, functional and revision surgery features. The objective of this exhibit is to introduce surgeons to these features and recommend specific modifications for each feature to improve clinical outcome.

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Tranexamic Acid to Reduce Blood Loss After Bilateral Total Knee Arthroplasty

Tranexamic Acid to Reduce Blood Loss After Bilateral Total Knee Arthroplasty

A Prospective, Randomized Double Blind Study Robin G. MacGillivray, FCA(SA),* Samih B. Tarabichi, MD,y

Marwan F. Hawari, MD,y and Nayzak T. Raoof, FRCA*

Abstract

The effects of 2-dosage regimens of tranexamic acid (10 mg/kg and 15 mg/kg) on blood loss and transfusion requirement were compared to saline placebo in 60 patients undergoing concurrent bilateral total knee arthroplasty, with additional reinfusion autotransfu- sion from intraarticular drains. Mean blood loss was 462 mL in 15 mL/kg group, 678 mL in 10 mg/kg group, and 918 mL in controls (P b .01 vs 15 mg/kg). Blood available for autotransfusion was greatest in controls and least in 15 mg/kg group. Combined autologous and allogenic transfusion volumes were similar in the treatment groups and significantly less than controls (P b .01). With use of an autologous reinfusion strategy, the lower dose is sufficient to lead to a lesser allogenic transfusion requirement. Keywords: bilateral total knee arthroplasty, blood loss, transfusion, tranexamic acid.

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Achieving Deep Flexion After Primary Total Knee Arthroplasty

Achieving Deep Flexion After Primary Total Knee Arthroplasty

Samih Tarabichi, MD, MS, FRCSC, FAAO, Yasir Tarabichi, and Marwan Hawari, MD

Abstract

Abstract: Total knee arthroplasty patients often have difficulty performing activities involving
flexion beyond 130°. The NexGen LPS Flex (Zimmer Inc, Warsaw, Ind) mobile bearing implant
accommodates up to 155° of flexion. Two hundred eighteen total knee arthroplasties were
performed using this implant on 125 patients over a 2-year period with a minimum of 5 years
follow-up. All data were collected prospectively. Forty-four percent of preoperative cases had
full flexion (ie, 140° active flexion and ability to kneel with thigh/calf contact for 1 minute).
Five-year data showed an average flexion of 140° ± 11.5° and flexion greater than 140° in 103
knees (68%). There were no differences in patellofemoral pain levels, complications, or Knee
Society scores despite our patients having, on average, an increase in flexion and function.
Keywords: total knee arthroplasty, knee flexion, rotating platform, mobile bearing, posterior
stabilized, deep flexion.
© 2010 Elsevier Inc. All rights reserved.

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Comparing the Effect of Tourniquet vs Tourniquet-Less in Simultaneous Bilateral Total Knee Arthroplasties

Comparing the Effect of Tourniquet vs Tourniquet-Less in
Simultaneous Bilateral Total Knee Arthroplasties

Mohamed Shaher Hasanain, MD a, Dragos Apostu, MD b, *, Attaallh Alrefaee, MD a, Samih Tarabichi, MD

Abstract

Background: Total knee arthroplasty (TKA) is a commonly performed procedure worldwide for the
treatment of knee joint disease. Tourniquet is frequently used during the entire procedure to reduce
blood loss and increase surgical comfort. On the other hand, tourniquet-related complications exist, and
there are still controversies whether benefits outweigh the risks.
Methods: Patients undergoing simultaneous TKAs had one knee assigned to group A (use of tourniquet
during the entire procedure) and the other knee assigned to group B (use of tourniquet only during
cementation). Blood loss, intraoperative complications, implant alignment, soft tissue swelling, pain
score, and range of motion were analyzed.
Results: Fifty-four patients undergoing 108 TKAs were included in the study. Total blood loss was almost
2 times higher in group B knees compared with group A. No difference was observed between groups in
implant alignment, soft tissue swelling, pain, range of motion, or other early postoperative complications.
Conclusion: Tourniquet use in TKAs during the entire surgical procedure reduces total blood loss, without
an increase in early postoperative complications.

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EVALUATION OF TIBIAL COMPONENT ROTATION IN PAINFUL TOTAL KNEE ARTHROPLASTIES BY MRI ENHANCED WITH METAL ARTIFACT REDUCTION TECHNIQUE

EVALUATION OF TIBIAL COMPONENT ROTATION IN PAINFUL TOTAL KNEE ARTHROPLASTIES BY MRI ENHANCED WITH METAL ARTIFACT REDUCTION
TECHNIQUE

Mohamed Elkabbani,†,§ , Amr Osman† , Mohamed Helaly‡ and Samih Tarabichi†

Abstract

Background: Tibial component malrotation is one of the commonest causes of pain and stiffness
following total knee arthroplasties, however, the assessment of tibial component malrotation on imaging is not clear-cut. The objective of this study was to assess tibial component rotation in cases with
pain following total knee replacement using MRI with metal artifact reduction technique.
Methods: In 15 consecutive patients presented in our clinic | a high-volume arthroplasty institution | between January 2017 and June 2017 with persistent unexplained moderate to severe
pain for at least 6 months following total knee arthroplasties, which were ALL done outside our
institution, after exclusion of infection and loosening (tibial or femoral), MRI evaluation of tibial
component rotation using metal artifact reduction for orthopedic implants (O-MAR) technique | to
improve visualization of soft tissue and bone by reducing artifacts caused by metal implants | was done according to the technique of Berger et al. [Malrotation causing patellofemoral complications
after total knee arthroplasty. Clin Orthop Relat Res 144–153, 1998].
Results: Eleven cases showed an internal rotation of tibial components (73.3%), four cases showed a
neutral or external rotation of tibial components (26.6%), however, with the presence of abnormal
intraarticular fibrous bands in two of them.
Conclusions: Two main conclusions are obtained from this study: Firstly, internal rotation of tibial
component must be excluded in all cases of persistent pain following total knee replacement. Secondly,
magnetic resonance imaging with the newly developed metal artifact reduction techniques is a very
useful tool in evaluating cases of unexplained pain following total knee replacement.
Keywords: Total knee arthroplasty; Tibial component; Malrotation; MRI; Metal artifact.

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Excellent vs. Good Range of Motion after TKA, What Makes the Difference?

Excellent vs. Good Range of Motion after TKA, What Makes the Difference

Attaallh Alrefaee 1*, Samih Tarabichi1, Mohammad Alfeqqy2 and Dragos Apostu3

Abstract

Background: Achieving full range of motion (ROM) is one of the most important goals in total knee replacement (TKA). The aim of this study was to identify surgical-dependent factors that are correlated to a full ROM.
Methods: Between August 2013 and July 2014, on 227 total knee replacements (132 patients), who were assessed for range of motion at least one month postoperatively, x-ray measurements were performed. We have included patient demographics (sex, age, body mass index and preoperative range of motion), type of TKA, as well as radiographic measurements including patella length, patellar height, Insall-Salvati
Ratio, joint line to patella distance, joint line to tibial tubercle distance, joint line to fibula distance, joint line to medial epicondyle distance and other ratios. The total knee replacements were divided into two groups, an excellent ROM group (more than 130 degrees) and a good ROM group (between 110 and 129 degrees). The parameters were statistically analyzed.
Results: We found a statistically significant result in joint line to fibula head distance (p=0.01) with an average of 18.8 mm in excellent ROM group compared to 17.5 mm in the good ROM group. Also patellar length / joint line to tibial tubercle ratio difference between the two groups proved statistically significant (p=0.032). Other results included the ranges of all measurements associated with an excellent and
good ROM.
Conclusion: Better range of motion after TKA is associated with a good control of joint line to fibula head distance and patellar length / joint line to tibial tubercle ratio. Many parameters can withstand a wide range without affecting ROM outcome.
Keywords: Knee; TKA; Arthroplasty; Range of Motion; X-Ray Measurements

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Posterior Cruciate Ligament Substituting Total Knee Arthroplasty

Posterior Cruciate Ligament Substituting Total Knee Arthroplasty

Sam Tarabichi, Majd Tarabichi

Abstract

The goals of total knee arthroplasty (TKA) have always remained the same as pertains to restoring the native anatomy, relieving pain, and bringing patients back to an earlier level of functioning. However, different populations with variations in anatomy, physiology, and functional needs necessitate a different approach. These characteristics must be taken into account when performing TKA in Middle Eastern patients, and can be divided into systemic features, local anatomic features, severity of disease, and activities of daily living. We should stress that Asian and Middle Eastern patients are very similar because of culture and lifestyle, as well as anatomic features. We found that the features that we reported in our scientific exhibit at the American academy of orthopedic surgeons 2012 annual meeting were endorsed by our Asian colleagues’ literature.27,47 We will also describe perioperative management of Middle Eastern
patients. Our approach is based on the authors’ experience of practicing both in the United States and the Middle East, as well as data from our registry of more than 8000 total knee replacements (TKRs). We will focus on our results with the posterior stabilized prosthesis because the demands of the Middle Eastern knee are better served by a posterior stabilized implant, and this is for multiple reasons. First of all, the activities of patients in the Middle East involve a great deal of kneeling. Komistek et al. demonstrated in a kinematic study that posterior stabilized knees exhibited greater roll­back of the femur on the tibia,26 which plays a crucial role in facilitating high flexion in the knee. In contrast, the cruciate ­retaining knee implants showed a “paradoxical movement” whereby the tibia rolls forward on the femur in high flexion. The femoral roll­back mechanism increases the leverage of the patellar tendon, allowing the patient to place greater
forces on the patellar tendon and thus enabling him or her to tolerate more of the activities of daily living (Fig. 141.1 ). This principle was the driving force behind John Insall’s design of the NexGen LPS Flex (Zimmer Biomet, Warsaw, Indiana) knee prosthesis designed to accommodate greater flexion at the knee because he believed that posterior stabilized prostheses would provide more physiologic roll­back and accommodate deeper flexion. Furthermore, flexion Varus deformity, which is extremely common in the Middle East, results in a contracted posterior cruciate ligament (PCL), and thus PCL resection is needed, especially with flexion deformity of greater than 20 degrees. A contracted PCL is dysfunctional, and this is observable intraoperatively with subluxation of the tibia despite an intact PCL. This is the rationale behind our extensive use of posterior stabilized prostheses in Middle Eastern patients.

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Hip and Knee Section, Prevention, Surgical Technique: Proceedings of International Consensus on Orthopedic Infections

Hip and Knee Section, Prevention, Surgical Technique: Proceedings of International Consensus on Orthopedic Infections

Giovanni Balato 2 , Katarina Barbaric 3, Goran Bicanic 3, Stefano Bini 1, Jiying Chen 4,Kresimir Crnogaca 3, Eustathios Kenanidis 1, Nicholas Giori 2, Rahul Goel 3,Michael Hirschmann 2, Maurilio Marcacci 5, Carles Amat Mateu 4, Denis Nam 5,Hongyi Shao 5, Bin Shen 3, Majd Tarabichi 1, Samih Tarabichi 4, Eleftherios Tsiridis 1,Anastasios-Nektarios Tzavellas 1

Abstract

The literature is inconclusive regarding the use of tourniquet during total knee arthroplasty and its potential to increase the risks for surgical site infections/periprosthetic joint infections(SSIs/PJIs) in TKAs. Tourniquet times and pressures should be minimized to reduce this risk.
Level of Evidence: Limited Delegate Vote: Agree: 89%, Disagree: 9%, Abstain: 2% (Super Majority, Strong Consensus) Rationale:
The use of a pneumatic tourniquet during total knee arthroplasty (TKA) has long been a standard for this procedure. However, concerns have arisen over the ischemic injury that can occur from tourniquet use. This has prompted many authors to conduct studies evaluating the use and nonuse of a tourniquet and its effect on perioperative blood loss, postoperative pain and function, and postoperative complications [1e7]. However, many of these studies are small, randomized, controlled trials that lack the power to
definitively state the influence of tourniquet use of surgical site infections (SSIs) and periprosthetic joint infections (PJIs). Liu et al [8] showed in a randomized controlled trial of 52 patients undergoing simultaneous bilateral TKA that tourniquet use was associated with greater wound ooze and blistering, as well as the only deep infection in the cohort occurring in a TKA case that had been performed while using a tourniquet. In a 31-patient randomized controlled trial, Clarke et al [9] demonstrated that increased tourniquet pressures led to sustained wound hypoxia up to 1 week after surgery. A meta-analysis by Yi et al [6] evaluated 13 randomized controlled trials of tourniquet use comprising 859 patients. Of these 13 studies, 3 evaluated infection risk, SSI, and PJI together, and they found that tourniquet use was significantly associated with an increased risk of infection. A meta-analysis by Zhang et al [10] found a similar pooled result with tourniquet use associated with a greater risk of nonthrombotic complications, infection included.
Longer tourniquet times, and by virtue longer surgical times, have been associated with an increased risk for both SSI and PJI [11e13]. Willis-Owen et al [11] in a series of 3449 consecutive TKA found that patients who went on to have a SSI/PJI had significantly

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Posterior stabilized total knee arthroplasty increases the risk of postoperative periprosthetic fractures

Posterior stabilized total knee arthroplasty increases the risk of postoperative periprosthetic fractures

Mohamed Elkabbani1,2 , Feras Haidar2 , Amr Osman2 , Yosra Adie2 , Apostu Dragos3 and Samih Tarabichi2

Abstract

Background: The Insall-Burstein posterior-stabilized knee design was first developed in 1978 by adding a central cam mechanism to the articular surface geometry of the total condylar prosthesis to correct its problems being not “rolling back”. Since then, the use of posterior-stabilized (PS) implants in total knee arthroplasty (TKA) is becoming increasingly popular. However, one of the main disadvantages of PS designs is related to the amount of bone removed during femoral box osteotomy to create the housing of the PS mechanism, the clinical value of removing more or less bone during primary TKA remains to be fully established. The objective of this study was to compare the incidence of early postoperative periprosthetic fractures in the cruciate retaining (CR) and posterior stabilized (PS) knee prosthesis. Methods: An institutional high volume arthroplasty unit database was reviewed to identify all patients who sustained a postoperative periprosthetic fracture following primary TKA between January 2014 and May 2018. A retrospective chart review was performed to collect clinical, radiographic, and operative report data. A total of 352 patients with 600 primary TKAs were identified. (300 cases of cruciate retaining TKAs from 178 patients and 300 cases of posterior stabilized TKAs from 174 patients) were retrospectively reviewed. Results: Eleven patients (1.83%) sustained periprosthetic fractures in the postoperative setting following primary TKA. All of the fractures were located on the femur and were treated surgically. Only one knee (one
patient) from the CR group sustained a periprosthetic fracture, while 10 knees (from 10 patients) from the PS group sustained a fracture. The relative risk of sustaining a fracture in the CR group was 0.10 times relative to the PS group (RR = 0.10, 95% CI 0.0129 – 0.776). Conclusion: Posterior stabilized total knee arthroplasties (TKAs) significantly increase the risk of periprosthetic fractures in obese Asian patients compared to cruciate retaining TKAs.

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Posterolateral overhang affects patient quality of life after total knee arthroplasty

Posterolateral overhang affects patient quality of life after total knee arthroplasty

Mehmet Emin Simsek1 · Mustafa Akkaya1 · Safa Gursoy1· Cetin Isik2· Akos Zahar3· Samih Tarabichi4 ·Murat Bozkurt2

Abstract

Purpose To investigate the appropriate mediolateral placement of symmetrical tibial components and the amount of overhang expected from the posterolateral of tibial components implanted to give ideal coverage and the subsequent incidence of residual knee pain and reduction in functional capacity.
Method A retrospective evaluation was made of 146 consecutive total knee arthroplasties. The posterolateral overhang, rotational alignment and coverage of the tibial component were measured on a post-operative CT scan and the effect of posterolateral overhang on clinical outcomes was analyzed 3 years after surgery.
Results Complaints of local pain in the posterolateral corner were determined in 76 (52.1%) patients. At the Posterolateral corner, overhang was determined in 111 (76%) patients, in the cortical border in 11 (7.6%) patients and underhang in 24 (16.4%) patients. In 71 (48.6%) patients, pain was determined together with oversize and in the evaluation of the overhang of the tibial component in the posterolateral region and the rotation status, there was determined to be overhang in 75 (96.2%) patients where the tibial component was placed in ideal rotation, in 25 (100%) where placement was in external rotation and in 11 (25.6%) where placement was in internal rotation. The mean KSS, KSS-F and WOMAC-P scores were 83.9±6.3,
83.3±7.8 and 4.6±2.9, respectively, in those with posterolateral overhang of the tibial component .The mean KSS, KSS-F and WOMAC-P scores were 86.6±8.4, 89.5±7.8 and 2.8±2.1, respectively, in those with no overhang and the difference was determined to be statistically significant. The amount of overhang was determined as mean 3.6±2.0 mm in those with posterolateral pain and 0.02±3.4 mm in those without pain and the difference was statistically significant.
Conclusions This study demonstrated that overhang in the posterolateral region is surprisingly high and negatively affects the clinical results following TKA, thereby presenting a danger to the success of TKA. The risk of posterolateral oversizing can increase with placement of the tibial component in external rotation.
Keywords Knee arthroplasty · Posterolateral overhang · Tibial baseplate · Knee pain

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Response to Letter to the Editor on “Comparing the Effect of Tourniquet vs. Tourniquet-Less in Simultaneous Bilateral Total Knee Arthroplasties.“

Response to Letter to the Editor on “Comparing the Effect of Tourniquet vs.
Tourniquet-Less in Simultaneous Bilateral Total Knee Arthroplasties.

Mohamed Shaher Hasanain, Dragos Apostu, Ph.D., Attaallh Alrefaee, Samih Tarabichi

Abstract

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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SIMULTANEOUS BILATERAL TOTAL KNEE REPLACEMENT IS SAFE AND NECESSARY IN GROSS DEFORMITY

SIMULTANEOUS BILATERAL TOTAL KNEE REPLACEMENT IS SAFE AND NECESSARY IN GROSS DEFORMITY

Samih Tarabichi, MD

Abstract

Simultaneous BTKR is still somewhat controversial. Although with severe deformity it is important to
perform a Simultaneous BTKR in order to correct deformity in both legs. The purpose of this scientific
exhibit is to review recent literature about Simultaneous BTKR and to share our experience with
simultaneous bilateral knee replacement for over 4500 cases that we have performed. Also the purpose
of this exhibit is to show surgeons how to set hospital and medical team and establish the proper
protocols in order to avoid higher complication rates.

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Soft Tissue Release for Varus Knees during Posterior Stabilized Total Knee Arthroplasty: A New Algorithm

Soft Tissue Release for Varus Knees during Posterior Stabilized Total Knee Arthroplasty: A New Algorithm

Mohamed Elkabbani1, 2* , Kamel Youssef1, Mohamed Ragab2 , Omar Ibrahim2 , Amr Osman2 , Apost  Dragos3 , Samih Tarabichi2

Abstract

Introduction: Total Knee Replacement (TKA) surgeries are frequently performed surgeries used to treat knee osteoarthritis. Several methods of medial soft tissue balancing in the varus knee during total knee replacement surgeries have been reported. Traditionally, they included releasing the superficial Medial Collateral Ligament (sMCL) in severe varus cases by several methods. However, this release can create instability in the knee. The aim of this study was to create an algorithm for soft tissue release in varus osteoarthritic knees and to evaluate its efficacy in achieving intraoperative gap balancing without releasing the superficial MCL. Materials and Methods: One hundred and five varus osteoarthritic knees who received primary posterior stabilized total knee arthroplasties between October 2015 and January 2016 were included in this study. Varus deformities ranged between 10 to 40 degrees. Sequential balancing was done into 5 steps: step 1 – releasing of deep MCL, step 2 – excision of osteophytes, step 3 – excision of scarred tissue in the posteromedial corner, step 4 – excision of the posteromedial capsule and step 5 – release of semimembranosus. The V-STAT® Variable Soft Tissue Alignment Tensor was used to ensure a balanced medial and lateral gap following each step. Once the gaps were balanced, no further soft tissue release were carried out. Results: All knees were balanced without releasing the superficial MCL ligament. The
maximum release step necessary was: step 1 (0 cases), step 2 (31 cases), step 3 (35 cases), step 4 (25 cases) and step 5 (14 cases). Conclusion: Superficial medial collateral ligament should not be released during intraoperative varus knees soft tissue balancing in posterior stabilized total knee arthroplasties. Preserving the superficial MCL is beneficial in maintaining implant stability without any increase in the constraint level of the implant even in cases with severe deformity.

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مركز الدكتور سميح الطرابيشي

مرحبا بكم في مركز الدكتور سميح الطرابيشي لعلاج ألام المفاصل والخشونة، نحن فريق ديناميكي من المتخصصين في الرعاية الصحية هدفنا تقديم الرعاية الصحية الأفضل عالميا.
تأسس المركز عام 2000 ويعتبر من المراكز المتميزة القليلة المتخصصة بعلاج المفاصل وإصابات العظام.
نسعى جاهدين لتوفير أفضل رعاية لجميع مرضانا، مع وجود مركز للعلاج الطبيعي وإعادة التأهيل مجهز بأحدث الأجهزة ومدعوم بأفضل الطواقم الطبية المدربة بشكل كبير في هذا المجال.
نحرص باستمرار في مركزنا على التعليم المستمر, كي نستفيد من الخبرات العالمية ونبقى على إطلاع على أفضل الطرق العالمية لتقديم الأفضل لمرضانا.

جميع الحقوق محفوظة – Bold Themes 2019