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BACKGROUND: We aimed to evaluate the effect of vitamin D levels on the functional outcome of elderly women who underwent total knee arthroplasty (TKA). METHODS: Seven hundred and four patients (1013 knees) who underwent primary TKA were included in our retrospective study. Preoperative vitamin D levels were measured and the relationship analyzed between these and age, weight, height, body mass index, and bone mineral density. Two hundred and twenty patients (220 knees) who received unilateral TKA and were followed up for more than 1 year after operation were divided into two groups: Group 1, serum 25-hydroxyvitamin D3 (25(OH)D3) level < 20 ng/ml; and Group 2, 25(OH)D3 level ≥ 20 ng/ml. Both groups were evaluated for the relationship between vitamin D levels and postoperative Visual Analogue Scale (VAS) score, Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. RESULTS: The number of vitamin D-deficient patients (< 20 ng/ml of serum 25(OH)D3 level) was 556 (79.0%). In the correlation analysis, the vitamin D level was negatively correlated with weight only (p = 0.033). No significant differences were observed between the groups in terms of postoperative VAS score, KSKS, KSFS, and WOMAC score. CONCLUSIONS: Vitamin D deficiency was highly prevalent in patients who underwent TKA. Vitamin D levels negatively correlated with weight. Low vitamin D level was not a risk factor for unsatisfactory TKA outcome in elderly women.
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Pigmented villonodular synovitis (PVNS) is a proliferative disease that develops in the synovium of joints, especially the knee joints. A 52-year-old man visited our hospital with left knee pain, swelling and symptoms of collapse. Twenty-one years earlier, he had undergone anterior cruciate ligament (ACL) reconstruction using an active bioprosthetic composite (ABC) as an artificial ligament. T1 and T2 weighted magnetic resonance imaging of the knee joint showed rupture of the ABC ligament and low signal intensity of hyperplastic synovium. Arthroscopic total synovectomy without ACL reconstruction was performed and the lesion was histopathologically diagnosed as diffuse PVNS. Clinical outcomes included good pain relief and no recurrence of the disease after 5 years of follow-up.
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Articulação do Joelho/patologia , Sinovite Pigmentada Vilonodular/diagnóstico , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Próteses e Implantes/efeitos adversos , Sinovectomia , Sinovite Pigmentada Vilonodular/cirurgiaRESUMO
PURPOSE: To evaluate the radiographic and clinical follow-up results of iatrogenic medial collateral ligament (MCL) injuries caused by valgus stress during arthroscopic surgery of the knee. METHODS: This study retrospectively evaluated 15 knees in 15 patients (8 female and 7 male patients), with a mean age of 58 years (range, 45-66 years), with iatrogenic MCL injuries caused by valgus stress during arthroscopic surgery of the knee. All patients were treated conservatively without an immobilizer or brace. The mean follow-up period was 24 months (range, 18-51 months). Evaluations included magnetic resonance imaging immediately postoperatively, as well as physical examinations and valgus stress radiographs (at 0° and 30° of knee flexion) 6 weeks after surgery and at final follow-up. RESULTS: Postoperative magnetic resonance imaging in all patients showed increased signal intensity, swelling, and partial loss of continuity at the meniscofemoral portion of the MCL. Physical examination showed mild tenderness in only 1 patient after 6 weeks and none at final follow-up. Valgus stress tests and valgus stress radiographs showed no significant differences between the injured and uninjured knees at 6 weeks postoperatively and at final follow-up (P > .05). CONCLUSIONS: Iatrogenic MCL injuries during arthroscopic knee surgery could be treated successfully without a splint or brace. LEVEL OF EVIDENCE: Level IV, prognostic case series.
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Artroscopia/efeitos adversos , Articulação do Joelho/cirurgia , Ligamento Colateral Médio do Joelho/lesões , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Artroscopia/métodos , Braquetes , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Ligamento Colateral Médio do Joelho/diagnóstico por imagem , Ligamento Colateral Médio do Joelho/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Prognóstico , Radiografia , Estudos Retrospectivos , Estresse Mecânico , Procedimentos Desnecessários , Adulto JovemRESUMO
PURPOSE: This study assessed the levels of soluble tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and matrix metalloproteinase 1 (MMP-1) in the synovial fluid from osteoarthritic knees to determine their role as well as the relationship between these levels and the severity of osteoarthritis (OA). METHODS: Synovial fluid was obtained from 44 knees of 40 patients. The Kellgren-Lawrence (KL) grade was measured using radiograph. The concentration of TWEAK and MMP-1 in the synovial fluid was assessed by enzyme-linked immunosorbent assay. The underlying inflammatory factors (erythrocyte sedimentation rate and C-reactive protein) were also measured. We analyzed the correlation between the factors measured. In addition, the samples were subdivided into three groups according to OA severity using the KL grade, and the differences in TWEAK and MMP-1 levels between groups were analyzed. RESULTS: The TWEAK and MMP-1 levels in the synovial fluid showed a positive correlation with each other. The TWEAK and MMP-1 levels were compared between the three groups according to the KL grade, and the levels showed a significant difference. A post hoc test demonstrated that the group with advanced OA showed a lower concentration of both factors when compared to groups with early OA. CONCLUSION: The concentration of TWEAK and MMP-1 in the synovial fluid were relatively high in the early stage of OA, and the levels decreased as the OA progressed.
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Citocina TWEAK/metabolismo , Metaloproteinase 1 da Matriz/metabolismo , Osteoartrite do Joelho/metabolismo , Líquido Sinovial/metabolismo , Biomarcadores/metabolismo , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: The purpose of this study was to evaluate the association between posterior tibial slope (PTS) and anterior cruciate ligament (ACL) graft rupture in patients who have undergone ACL reconstruction by comparing results in patients who experienced graft rupture and a matched control group. METHODS: The study included 64 knees of 64 patients (58 men and 6 women), of mean age 31 years (range, 18-60 years) who underwent revision ACL reconstruction for ACL graft rupture, as well as a control group without ACL graft rupture matched for age, sex, body mass index (BMI), and left or right side. The mean time to failure in study group was 48.5 months, and after revision surgeries, the mean follow-up period was 37.7 months. The graft used for the primary surgery was autograft in 3 patients (4.7%) and allograft in 49 patients (76.6%). The type of graft could not be confirmed in the remaining 12 patients (18.7%). PTS was measured on plain radiographs and compared in the 2 groups. RESULTS: Mean PTS was significantly higher in patients with (13.2° ± 2.5°; range, 8.5°-18.2°) than without (10.9° ± 3.1°; range, 4.9°-13.6°) rerupture (P < .01). When mean PTS was compared in the 37 patients who underwent primary surgery by the same surgeon, it was significantly higher in patients with (13.5° ± 2.5°; range, 8.5°-18.2°) than without (11.1° ± 2.9°; range, 5.1°-13.6°) rerupture (P < .01). PTS in patients with rerupture was not significantly associated with age, gender, BMI, and right or left side. The odds ratio of ACL graft rupture in knees with PTS ≥12° was 4.52 (P < .001). CONCLUSIONS: This study showed that mean PTS was significantly greater in patients with than without noncontact ACL graft rerupture (13.2° vs 10.9°, P < .01). The failure of ACL reconstruction appears to be associated with increased PTS, with PTS ≥12° a risk factor for the failure of ACL reconstruction. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
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Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Ruptura/etiologia , Tíbia/cirurgia , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Ruptura/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Adulto JovemRESUMO
To overcome the limitation of short-term efficacy of virtual reality (VR), an enhanced reality (ER) analgesia, (combination of the VR, real-time motion capture, mirror therapy [MT]) involving a high degree of patients' presence or embodiment was explored. Patients, who underwent unilateral total knee arthroplasty (TKA), received ER analgesia. The duration was 5 times a week, for 2 weeks for one group and 5 times a week, for 1 week in the other. Visual Analogue Scale (VAS) at rest and during movement, active knee range of motion (ROM) for flexion and extension were measured repeatedly. After screening 157 patients, 60 were included. Pre-interventional evaluation was performed at 6.7 days and ER was initiated at 12.4 days after surgery. Evaluation was performed at 5, 12, 33 days after the initiation of ER. Analgesia in the 2 week therapy group was effective until the third evaluation (p = 0.000), whereas in the other group, it was effective only until the second evaluation (p = 0.010). Improvement in ROM in the 2 week group was also maintained until the third evaluation (p = 0.037, p = 0.009). It could lay the foundations for the development of safe and long-lasting analgesic tools.
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Analgesia/métodos , Artroplastia do Joelho/efeitos adversos , Dor Pós-Operatória/terapia , Terapia de Exposição à Realidade Virtual , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Resultado do TratamentoRESUMO
Hypoplasia of the meniscus is a very rare congenital abnormality, with only a few cases reported to date. A 9-year-old girl visited our hospital due to lateral knee pain following a hyperextension injury to the left knee. Magnetic resonance imaging showed hypoplasia of the medial and lateral menisci, as well as a posterior horn tear of the lateral meniscus, in both knee joints. To our knowledge, this is the first report of a patient with hypoplasia of the medial and lateral menisci in both knee joints.
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PURPOSE: To investigate the patterns of medial meniscus (MM) tears in patients with varus knee osteoarthritis who underwent total knee arthroplasty and analyze the factors that could affect MM tears. MATERIALS AND METHODS: The patients (365 knees, 268 patients) were classified into three groups; group I with MM posterior horn (PH) tear only; group II with MM root tear only; and group III with MMPH plus root tear. The following factors were evaluated: age, gender, body mass index, varus deviation of the mechanical axis, medial proximal tibial angle, posterior tibial slope (PTS), and anterior cruciate ligament (ACL) integrity (normal, degeneration, and tear or absence). RESULTS: MM tears were identified in all knees. The patterns of the combined MMPH tears in group III were less complex than those in group I. Varus deviation and PTS were significantly greater in group III than groups I and II. In group III, there were significantly more cases of ACL tear or absence than groups I and II. The others showed no differences among three groups. CONCLUSIONS: Severe varus knee osteoarthritis was always accompanied by MM tears. Risk factors for MMPH plus root tears were severe varus deformity, great PTS, and ACL tear or absence.
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BACKGROUND: We evaluated the effectiveness of postoperative pain management using intraoperative periarticular injection (PAI) and/or electromyography-guided preoperative femoral nerve block (FNB) in knees undergoing total knee arthroplasty (TKA). METHODS: This study included 90 patients (90 knees) who underwent primary TKA. Thirty patients received a single injection of electromyography-guided FNB, 30 received intraoperative PAI, and 30 received both. Pain at rest and while moving was evaluated by a visual analog scale (VAS) at 0, 4, 8, 24, and 48 hours. Postoperative range of motion, time to walking, amount of opioid consumption, and complications were analyzed. RESULTS: VAS immediately after surgery was significantly higher in the FNB group than in the PAI and combined groups, but did not differ significantly in the latter 2 groups. VAS after 4 and 8 hours showed similar results. VAS after 24 hours was significantly higher in the PAI than in the FNB and combined groups. After 48 hours, there were no differences among the 3 groups. Total opioid consumption was lower in the combined than in the FNB and PAI groups. Postoperative range of motion and time to walking were similar in the 3 groups. CONCLUSION: PAI was more effective than FNB during the early (0-8 hours) postoperative period after TKA. Patients treated with PAI, however, experienced rebound pain at 24 hours. The combination of PAI and FNB may provide greater postoperative pain management than either alone for the first 24 hours after TKA.
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Artroplastia do Joelho , Nervo Femoral , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Analgésicos Opioides/administração & dosagem , Eletromiografia , Feminino , Humanos , Injeções Intra-Articulares/efeitos adversos , Masculino , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Período Pós-Operatório , Estudos Prospectivos , Amplitude de Movimento Articular , CaminhadaRESUMO
PURPOSE: The purpose was to analyze the relationship between posterior tibial slope (PTS) and mucoid degeneration of the anterior cruciate ligament (ACL) in patients with total knee arthroplasty. MATERIALS AND METHODS: Four hundred and twenty-four patients (24 males and 400 females; 636 knees) who received total knee arthroplasty for osteoarthritis were included. Their mean age was 68.9 years (range, 48 to 88 years). The patients were classified into three groups according to the status of ACL; normal ACL group (group I), mucoid degeneration of ACL group (group II) and ruptured or absent ACL group (group III). Plain lateral radiographs were used to measure the PTS and the values were compared among groups. RESULTS: There were no significant differences with regard to gender, age and left-to-right side ratio among groups (p>0.05). The mean PTS was 9.9° (range, 0.6° to 20.1°) in group I (161 knees), 10.8° (range, 0.2° to 21.8°) in group II (342 knees) and 12.3° (range, 2° to 22.2°) in group III (133 knees), which showed significant differences (p<0.001). CONCLUSIONS: The patients with mucoid degeneration of the ACL and those with ruptured or absent ACL had greater PTS than those with normal ACL. These findings suggest that an increased PTS may be one of the causative factors for mucoid degeneration of the ACL.
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BACKGROUND: Although several studies have compared a conventional transtibial technique with an anteromedial (AM) portal technique for single-bundle (SB) anterior cruciate ligament (ACL) reconstruction, no study to date has investigated whether the modified transtibial technique results in the femoral tunnel being in a similar anatomic position and produces similar clinical outcomes with those of the AM portal technique. PURPOSE: To compare the clinical outcomes and femoral tunnel position of SB ACL reconstruction using a modified transtibial technique (creating a femoral tunnel with varus and internal rotation of the tibia as well as modification of the tibial tunnel orientation) with those of SB ACL reconstruction using an AM portal technique. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 40 patients (40 knees) who underwent arthroscopic SB ACL reconstruction were included in this study. Patients were randomized using a computer-generated sequence into 2 groups: 20 patients by the modified transtibial technique (group 1) and 20 patients by the AM portal technique (group 2). Clinical evaluations included the 2000 International Knee Documentation Committee (IKDC) subjective knee score, Lysholm knee score, Tegner activity scale, Lachman test, pivot-shift test, 2000 IKDC knee examination, and KT-1000 arthrometer measurement. Three-dimensional computed tomography scans were analyzed according to the quadrant method, and the obliquity of the femoral tunnels in the coronal and sagittal planes and the size of the tunnel orifice were measured. RESULTS: All clinical parameters improved significantly after SB ACL reconstruction, with no between-group differences. The mean distance of the femoral tunnel center location from the posterior condylar surface (0.8% difference; P = .167) and from the Blumensaat line (2.1% difference; P = .067) was similar in groups 1 and 2. The mean coronal obliquity of the femoral tunnel was significantly lower in group 1 than in group 2 (42.5° ± 6.1° vs 49.3° ± 7.2°, respectively; P = .001), but the mean sagittal obliquity was similar between the 2 groups (41.9° ± 6.1° vs 43.3° ± 5.4°, respectively; P = .303). The mean area of the tunnel orifice was significantly greater in group 1 than in group 2 (11.6 ± 1.4 × 9.2 ± 1.6 mm vs 10.3 ± 1.1 × 9.1 ± 1.4 mm, respectively; P = .013). CONCLUSION: The modified transtibial technique for SB ACL reconstruction showed good clinical results and anatomic placement of the femoral tunnel, similar with those of the AM portal technique.
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Reconstrução do Ligamento Cruzado Anterior/métodos , Fêmur/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Tendão do Calcâneo/transplante , Adulto , Artroscopia , Feminino , Fêmur/cirurgia , Humanos , Imageamento Tridimensional , Masculino , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos , Tíbia/cirurgia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To evaluate minimum 5-year follow-up clinical and radiological results of total knee arthroplasty (TKA) using a posterior cruciate ligament sacrificing (PS), non-substituting Advance Medial Pivot Knee. MATERIALS AND METHODS: One hundred and twenty knees in 80 patients who could be followed up for more than 5 years after TKA using the PS Advance Medial Pivot Knee were evaluated retrospectively. The evaluations included the preoperative and postoperative range of motion (ROM), tibiofemoral angle, Knee Society (KS) knee and function scores, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. The Kaplan-Meier method was used for survival analysis. RESULTS: The ROM increased from a preoperative mean flexion contracture of 7.6° and further flexion of 115.1° to a postoperative mean flexion contracture of 1.5° and further flexion of 120.5°. The tibiofemoral angle was changed from 4.6° varus preoperatively to 5.8° valgus postoperatively. The KS knee and function scores as well as WOMAC score significantly improved after surgery (p<0.05). Complications developed in 4 cases (3.3%): 2 cases of periprosthetic patellar fracture (1.7%) and 2 cases of aseptic loosening (1.7%). The seven-year survival rate was 98.1% in the Kaplan-Meier survival analysis. CONCLUSIONS: The minimum 5-year follow-up results of TKA using the PS Medial Pivot Knee were satisfactory.
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INTRODUCTION: We analyzed the location of femoral and tibial tunnels by three-dimensional (3D) CT reconstruction images after modified transtibial single bundle (SB) anterior cruciate ligament (ACL) reconstruction, creating a femoral tunnel with varus and internal rotation of the tibia. MATERIAL AND METHODS: Data from 50 patients (50 knees) analyzed by 3D CT after modified transtibial SB ACL reconstructions were evaluated. 3D CT images were analyzed according to the quadrant method by Bernard at the femur and the technique of Forsythe at the tibia. RESULTS: The mean distance of the femoral tunnel center locations parallel to the Blumensaat's line was 29.6%±1.9% along line t measured from the posterior condylar surface. The mean distances perpendicular to the Blumensaat's line were 37.9%±2.5% along line h measured from the Blumensaat's line. At the tibia, the mean anterior-to-posterior distance for the tunnel center location was 37.8%±1.2% and the mean medial-to-lateral distance was 50.4%±0.9%. DISCUSSION: The femoral and tibial tunnels after modified transtibial SB ACL reconstruction creating a femoral tunnel with varus and internal rotation of the tibia (figure-of-4 position) were located between the anatomical anteromedial and posterolateral footprints.
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Reconstrução do Ligamento Cruzado Anterior/métodos , Fêmur/diagnóstico por imagem , Imageamento Tridimensional , Tíbia/diagnóstico por imagem , Adolescente , Adulto , Aloenxertos , Artroscopia , Feminino , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tendões/transplante , Tíbia/cirurgia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
PURPOSE: Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. The aim of this study was to detail the clinical, radiological, arthroscopic and pathological findings of this condition and to report clinical outcomes following arthroscopic partial excision of the ACL. METHODS: Between 1999 and 2009, 80 knees in 78 patients were diagnosed as having mucoid degeneration of the ACL based on MRI and clinical findings, and subsequently underwent arthroscopic treatment. Of these, 68 knees in 66 patients, with a median age of 51 years (range, 35-75 years), were followed-up for at least one year. RESULTS: All patients had insidious onset of knee pain, while 56 knees (82 %) had associated extension deficits and 36 knees (53 %) had restricted flexion. MRI findings typically showed diffuse thickening and increased signal intensity of the ACL. Arthroscopic examination revealed notch impingement and bulging of hypertrophied ACL into lateral compartments. Associated lesions included meniscal tears in 33 knees and chondral lesions of at least Outerbridge grade 2 in 56 knees. All knees underwent arthroscopic partial excision of the hypertrophied ACL, with three undergoing preoperative and 30 undergoing concomitant meniscectomies. Pain relief was achieved in 58 of 62 knees (94 %) following partial excision of the ACL. Extension deficits were normalized in 49 of 56 knees (88 %), and restricted flexion was normalized in 33 of 36 affected knees (92 %). Four knees of four patients had postoperative symptoms of anterior instability. CONCLUSIONS: Pain and limitation of motion due to mucoid degeneration of the ACL can be improved by arthroscopic partial excision of the ACL with or without notchplasty. However, one potential complication is the development of postoperative symptoms of anterior instability. LEVEL OF EVIDENCE: Retrospective study, Level IV.
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Ligamento Cruzado Anterior/patologia , Artropatias/patologia , Articulação do Joelho , Adulto , Idoso , Ligamento Cruzado Anterior/cirurgia , Feminino , Humanos , Artropatias/diagnóstico , Masculino , Pessoa de Meia-IdadeRESUMO
Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). A 48-year-old-male patient presented with knee pain and limitation of motion. The patient's magnetic resonance imaging, arthroscopic findings, and pathologic diagnosis confirmed a clinical diagnosis of mucoid degeneration of both the ACL and the PCL. The symptoms disappeared after arthroscopic partial excision of the ACL and PCL.
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Ligamento Cruzado Anterior/patologia , Artropatias/patologia , Articulação do Joelho/patologia , Ligamento Cruzado Posterior/patologia , Ligamento Cruzado Anterior/diagnóstico por imagem , Artralgia/etiologia , Humanos , Artropatias/diagnóstico , Artropatias/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ligamento Cruzado Posterior/diagnóstico por imagem , RadiografiaRESUMO
PURPOSE: The purpose was to analyze the association between posterior tibial slope (PTS) and mucoid degeneration of the anterior cruciate ligament (ACL). METHODS: From October 1999 to May 2010, 84 arthroscopies were performed in 82 patients (18 men and 64 women) with mucoid degeneration of the ACL. The mean patient age was 53 years (range, 25 to 75 years). In addition to this patient group (group I), the study included a control group without mucoid degeneration of the ACL that was randomly matched for age, sex, body mass index, left or right side, and associated lesions (group II). For each group, the diagnosis was made by use of magnetic resonance imaging and arthroscopy, and a plain lateral radiograph was used to measure the PTS. RESULTS: The mean PTS was 13.5° ± 2.6° (range, 8.2° to 19.5°) in group I and 9.4° ± 2.5° (range, 4.8° to 15.5°) in group II. The mean PTS in group I was significantly greater than that in group II (P < .001). For group I, the mean PTS of the involved knee was significantly greater than that of the uninvolved contralateral knee (P = .044). There were no differences according to age, sex, left or right side, body weight, and body mass index (P > .05). CONCLUSIONS: Mucoid degeneration of the ACL was found to be associated with an increased PTS. The patients with mucoid degeneration of the ACL had a greater mean PTS than matched control patients (13.5° v. 9.4°, P < .001). LEVEL OF EVIDENCE: Level III, diagnostic study of nonconsecutive patients without consistently applied gold standard.
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Ligamento Cruzado Anterior/patologia , Artralgia/etiologia , Articulação do Joelho/patologia , Tíbia/fisiopatologia , Adulto , Idoso , Ligamento Cruzado Anterior/fisiopatologia , Artralgia/patologia , Artralgia/fisiopatologia , Artroscopia , Estudos de Casos e Controles , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Método Simples-Cego , Tíbia/diagnóstico por imagemRESUMO
PURPOSE: We evaluated 3- to 6-year clinical and radiological follow-up results after NexGen® LPS-flex total knee arthroplasty (TKA). METHODS: A retrospective evaluation was undertaken of 218 knees in 166 patients (22 males, 144 females) who were followed up for more than 3 years after TKA. Evaluations included preoperative and postoperative range of motion (ROM) measurement, Knee Society (KS) Score, tibiofemoral angle and assessment of postoperative complications. RESULTS: TKA resulted in a significant ROM increase from a mean flexion contracture of 9° (range 0°-20°) and further flexion of 117° (range 80°-155°) to a mean flexion contracture of 2° (range 0°-10°) and a further flexion of 131° (range 95°-155°). KS knee and function scores significantly improved from 52 and 38 before surgery to 87 and 82 after surgery, respectively. The tibiofemoral angle significantly improved from varus 5.7° to valgus 5.4°. Progressive radiolucent lines around the femoral component on radiographs were observed in 30 knees (13.8%, 27 patients), and more of those knees, could squat than non-radiolucent knees (76.7 vs. 20.2%; P<0.05). Seven knees (3.2%, 6 patients) were revised at a mean 49 months after the index operation. CONCLUSIONS: While NexGen® LPS-flex TKA satisfactorily improved ROM, it was associated with a relatively high incidence of early loosening of the femoral components. This might be associated with passive-maximal flexion activity, such as squatting or kneeling. The clinical relevance of this study is that squatting or kneeling, common activity in Asian, may not be allowed after NexGen® LPS-flex TKA.
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Artroplastia do Joelho/métodos , Articulação do Joelho/fisiopatologia , Prótese do Joelho , Amplitude de Movimento Articular/fisiologia , Suporte de Carga/fisiologia , Idoso , Artroplastia do Joelho/reabilitação , Estudos de Coortes , Exercício Físico , Feminino , Seguimentos , Humanos , Instabilidade Articular/prevenção & controle , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Medição da Dor , Satisfação do Paciente/estatística & dados numéricos , Exame Físico/métodos , Cuidados Pós-Operatórios/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
PURPOSE: We tried to demonstrate whether the posterior condylar offset (PCO, the distance from the femoral diaphysis posterior cortex to the posterior condylar margin) and ratio (PCOR, dividing PCO by the maximum antero-posterior diameter of the distal femur) could be used as predictive factors for overhang of the implants or using gender implants in total knee arthroplasty (TKA). MATERIALS AND METHODS: One hundred and one women who underwent TKA using NexGen® (LPS) implants, were analyzed prospectively. After distal femoral resection, the mediolateral (ML) width was measured at four points (anterior, distal anterior, distal posterior and posterior) and compared with the ML width of the implant. The aspect ratio (AR, ML/AP ratio) and anterior/distal posterior ML width (Ant/DP) were calculated. Preoperative radiographic PCO and PCOR were measured. Differences of PCO, PCOR, AR and Ant/DP according to the size were analyzed and correlations between PCO, PCOR and AR were also analyzed. The patients were classified into two groups according to the presence of overhang, and differences of each parameter were compared between the two groups. RESULTS: The size of the implant was positively correlated PCO, not significantly correlated with PCOR, and negatively correlated with AR and Ant/DP. PCO and PCOR and AR showed no correlation with each other. PCO and PCOR were not significantly different between the two groups. However, AR and Ant/DP were statistically low in the group with overhang. CONCLUSIONS: Preoperative radiographic PCO or PCOR could not be used as a predictive factor for overhang of the implants or using gender implants in TKA.
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BACKGROUND: Osteonecrosis of the femoral head is classified into idiopathic and secondary forms. A number of etiological factors in the development of osteonecrosis have been suggested but the biological mechanisms are still unclear. Recently, some reports suggested that the apoptosis is closely related to osteonecrosis of the femoral head. Therefore, this study examined the expression of apoptosis in osteonecrosis of the femoral head. METHODS: Of the patients diagnosed preoperatively with osteonecrosis and underwent total hip replacement arthroplasty between August 2004 and July 2005, 58 patients (58 hips) were available for this study. Their diagnoses were confirmed by the postoperative pathology findings. Tissue samples of the femoral head sections were terminal deoxynucleotydyl transferase mediated dUTP nick-end labeling (TUNEL) stained using an in situ cell death detection POD kit. The number of total and TUNEL-positive osteocytes, and the average ratio of TUNEL-positive cells were calculated and analyzed according to the cause. RESULTS: Osteonecrosis was steroid-induced in 8 cases (13.8%), alcohol-induced in 29 cases (50%), post-traumatic in 6 cases (10.3%) and idiopathic in 15 cases (25.9%). The percentage of TUNEL-positive osteocytes was high in patients with steroid- and alcohol-induced osteonecrosis of the femoral head but low in patients with post-traumatic and idiopathic osteonecrosis. The difference in the percentage of TUNEL-positive osteocytes between these groups was significant (p < 0.05). CONCLUSIONS: Apoptosis might play an important role in the pathogenesis of osteonecrosis of the femoral head induced by steroid and alcohol. These findings highlight a need for further research into the role of apoptosis in the development of osteonecrosis of the femoral head.
Assuntos
Apoptose , Necrose da Cabeça do Fêmur/patologia , Cabeça do Fêmur/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Necrose da Cabeça do Fêmur/etiologia , Necrose da Cabeça do Fêmur/cirurgia , Humanos , Marcação In Situ das Extremidades Cortadas , Masculino , Pessoa de Meia-IdadeRESUMO
Three hundred and sixty-four low contact stress (LCS) total knee arthroplasties that could be followed up for more than 5 years were clinically and radiographically analyzed. The median postoperative Hospital for Special Surgery score improved from 56 (range 32-77) to 91 (range 64-100) points, but median range of motion did not change from 120° (range 50°-135°) to 120° (range 85°-135°). Complications occurred in 16 cases (4%), and included postoperative polyethylene dislocation and intraoperative tibial condylar fracture, while five knees (1%) required revision surgery due to mechanical reasons. The overall prosthesis survival rate was 91% at 12 years. Although the LCS mobile-bearing knee system has theoretical advantages in terms of wear and loosening, the problem of polyethylene dislocation, intraoperative tibial fracture, and radiolucent lines should be solved for long survival. The clinical relevance of this study is that the LCS system provided good clinical and survival results.