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BACKGROUND: The cause of early septic failure after two-stage exchange revision total knee arthroplasty (TKA) for chronic periprosthetic joint infection (PJI) and the factors affecting it are not well known. The purpose of this study was to determine the surgical outcomes and the risk factors for early septic failure after two-stage revision TKA for chronic PJI. METHODS: We identified a total of 246 adult patients who met the Musculoskeletal Infection Society (MSIS) diagnostic criteria for chronic PJI at two academic tertiary hospitals from March 2012 to December 2018. Finally, 151 patients who consecutively received two-stage exchange revision TKA for chronic PJI and who had a minimum 3-year follow-up were enrolled and retrospectively reviewed. Successful surgical treatment was evaluated for two-stage revision TKA and risk factors for early septic failure were identified. RESULTS: Early septic failures occurred within 3 years after reimplantation in 48 patients (31.8%). After accounting for potentially confounding variables, we found that male patient [odds ratio (OR): 2.753, 95% confidence interval (CI) 1.099-6.893, p = 0.031], fungus or mycobacterial infection (OR: 5.224, 95% CI 1.481-18.433, p = 0.01), and positive culture at reimplantation (OR: 4.407, 95% CI 1.255-15.480, p = 0.021) were independently associated with early septic failure after two-stage exchange revision TKA. CONCLUSION: Male patients, fungus or mycobacterial infection, and positive culture at reimplantation were independently associated with an increased risk of early septic failure after two-stage exchange revision TKA despite normal C-reactive protein values prior to reimplantation. Further prospective and high-quality studies are needed to determine the risk factors of two-stage exchange revision TKA for chronic PJI. LEVEL OF EVIDENCE: level IV; retrospective comparison; treatment study.
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Artroplastia do Joelho , Prótese do Joelho , Infecções Relacionadas à Prótese , Adulto , Humanos , Masculino , Artroplastia do Joelho/efeitos adversos , Estudos Retrospectivos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Antibacterianos/uso terapêutico , Fatores de Risco , Reoperação , Articulação do Joelho/cirurgiaRESUMO
INTRODUCTION: This study aimed to compare the clinical outcomes of silicon ring tourniquets and conventional pneumatic tourniquets in total knee arthroplasty (TKA). The study compared the operation time, total bleeding amount, length from the tourniquet distal end to the patella superior pole (L_TP), and complications related to the two tourniquet application methods and attempted to determine whether the silicon ring tourniquet has advantages over conventional pneumatic tourniquets. MATERIALS AND METHODS: This prospective comparative study included 30 patients who underwent bilateral simultaneous TKA for degenerative osteoarthritis in August to December 2021. All patients underwent TKA on one side with a conventional pneumatic tourniquet, while TKA on the other side with a silicon ring tourniquet. The primary outcomes were the L_TP, operation time, tourniquet time, total bleeding amount, total drainage amount, and postoperative visual analog scale (VAS) score of the tourniquet applied site at 6, 24, and 48 h postoperatively. The secondary outcome was tourniquet-related complications in both groups. RESULTS: L_TP was significantly longer in the silicon ring tourniquet group compared with that in the pneumatic tourniquet group (20.22 ± 2.74 cm versus 15.12 ± 2.40, p < 0.001). No significant difference was found in other results. The tourniquet applied site pain was less in the silicon ring tourniquet group (p = 0.037). CONCLUSIONS: Silicon ring tourniquet application resulted in better clinical outcomes than conventional pneumatic tourniquets in TKA. Because we can obtain a wider surgical field using silicon ring tourniquets without complications, silicon ring tourniquets could be a substitute for conventional pneumatic tourniquets in total knee arthroplasty or distal femoral surgeries.
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Artroplastia do Joelho , Torniquetes , Humanos , Torniquetes/efeitos adversos , Silicones , Artroplastia do Joelho/efeitos adversos , Silício , Estudos Prospectivos , ExsanguinaçãoRESUMO
BACKGROUND: Preoperative carbohydrate treatment attenuates insulin resistance and improves metabolism to an anabolic state. Despite these benefits, impaired glycemic control and aspiration risk related to gastroparesis represent concerns for patients with diabetes undergoing surgery. This randomized controlled trial investigated the effects of oral carbohydrate therapy on perioperative glucose variability, metabolic responses, and gastric volume in diabetic patients undergoing elective total hip or knee arthroplasty. METHODS: Fifty diabetic patients scheduled to undergo elective total knee or hip arthroplasty during August 2019-October 2020 were randomly assigned to a control or carbohydrate therapy (CHO) group. CHO group of patients received a 400-mL carbohydrate drink 2-3 h before anesthesia; control group of patients underwent overnight fasting from midnight, one night before surgery. Blood glucose levels were measured before intake of the carbohydrate drink, before spinal anesthesia, preoperatively, immediately postoperatively, and 1 h postoperatively. Insulin level and gastric volume were measured before spinal anesthesia. RESULTS: The glucose variability of patients in the CHO group was significantly higher than that of those in the control group (16.5 vs. 10.1%, P = 0.008). Similarly, insulin resistance was higher in the CHO group than in the control group (8.5 vs. 2.7, P < 0.001). The gastric volume did not differ significantly between the groups (61.3 vs. 15.2 ml, P = 0.082). CONCLUSIONS: Preoperative oral carbohydrate therapy increases glucose variability and insulin resistance in diabetic patients. Therefore, carbohydrate beverages should be cautiously administered to diabetic patients, considering metabolic and safety aspects. Trial registration number ClinicalTrials.gov (No. NCT04013594).
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Artroplastia de Quadril , Artroplastia do Joelho , Diabetes Mellitus Tipo 2 , Resistência à Insulina , Administração Oral , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/cirurgia , Carboidratos da Dieta , Jejum , Humanos , Resistência à Insulina/fisiologia , Cuidados Pré-Operatórios , Estudos ProspectivosRESUMO
BACKGROUND: Setting bone cutting levels for different joint line orientations of the medial and lateral tibia plateaus in individual patients is not clear. We aimed to evaluate the difference between joint line orientation of the medial and lateral tibia plateaus relative to the horizontal line of mechanical axis of tibia as tibial plateau difference (TPD) for an optimal tibial bone cut in medial unicompartmental knee arthroplasty (UKA) and determine which factors could influence TPD. We aimed to investigate the effect of preoperative TPD on polyethylene liner size in medial UKA. METHODS: TPD in the coronal plane were measured in 181 female patients (181 knees). To determine the morphology of proximal tibia according to the severity of osteoarthritis, the patients were classified into three groups based on diagnosis and treatment: 80 who underwent robot-assisted medial UKA, 45 who underwent total knee arthroplasty (TKA), and 56 with early-stage osteoarthritis (OA) who had conservative management. Also, we divided the medial UKA group into two groups according to TPD (greater than or less than 5 mm) and compared polyethylene liner sizes. RESULTS: No significant difference was observed in TPD (p = 0.662), difference between the medial and lateral femoral condyle levels (p = 0.54), medial proximal tibial angle (p = 0.169), or posterior tibial slope (p = 0.466) among the three groups. Increased TPD was significantly associated with increased mechanical femorotibial angle(mFTA) (p < 0.01). The medial UKA group was divided into two groups according to TPD greater or less than 5 mm. Thicker polyethylene liners were used for groups with TPD greater than 5 mm (8.5 ± 0.7 mm versus 8.2 ± 0.3 mm, p = 0.01). Additionally, the proportion of patients using the thinnest polyethylene (8 mm) in each TPD group (greater or less than 5 mm) was higher in patients with TPD less than 5 mm (82.4% versus 58.7%, p = 0.038). CONCLUSIONS: Preoperative measurement of TPD is important to help surgeons predict the most appropriate bone cutting level in the coronal plane in primary medial UKA. Tibial bone resection would be likely to be thicker than needed in patients with increased TPD in medial UKA.
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Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Polietileno , Tíbia/diagnóstico por imagem , Tíbia/cirurgiaRESUMO
PURPOSE: The aim of this study was to investigate the association between pelvic sagittal parameters and acetabular labral tears. METHODS: Three-hundred and sixty-five patients (449 hips) who underwent magnetic resonance imaging (MRI) or magnetic resonance arthrogram (MRA) for hip pain were enrolled in this study. Pelvic sagittal parameters, including the pelvic incidence, pelvic tilt, and sacral slope, were measured with a standing lumbosacral lateral radiograph. All subjects were divided into two groups according to the presence or absence of radiologic acetabular labral tears and compared. Furthermore, the two groups were divided into subgroups according to whether femoroacetabular impingement (FAI) morphology was present or not and compared. RESULTS: Pelvic incidence was greater in the labral tear group than in the non-labral tear group (52.3° ± 8.2° versus 47.1° ± 6.8°, p < 0.001). After accounting for potentially confounding variables, we found that higher age (odds ratio 1.04, 95% confidence interval [CI] 1.02 to 1.06, p = 0.001), FAI (odds ratio 15.11, 95% CI 7.43 to 30.75, p < 0.001), and high pelvic incidence (odds ratio 1.13, 95% CI 1.09 to 1.17, p < 0.001) were independently associated with acetabular labral tear. When only the patients without FAI (308 hips) were divided into groups with and without acetabular labral tear, we found that higher age (odds ratio 1.03, 95% CI 1.01 to 1.06, p = 0.008) and high pelvic incidence (odds ratio 1.15, 95% CI 1.11 to 1.19, p < 0.001) were independently associated with acetabular labral tear. CONCLUSION: Acetabular labral tear is associated with high pelvic incidence with or without FAI morphology. LEVEL OF EVIDENCE: III.
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Impacto Femoroacetabular , Lesões do Quadril , Acetábulo/diagnóstico por imagem , Acetábulo/patologia , Artralgia/complicações , Artrografia , Artroscopia , Impacto Femoroacetabular/complicações , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/epidemiologia , Articulação do Quadril/diagnóstico por imagem , Humanos , Pelve , Estudos RetrospectivosRESUMO
PURPOSE: This study aimed to investigate stress shielding of anatomical tibial components (ATCs) in comparison to conventional symmetric tibial components (STCs) in Korean patients which may be related to medial tibial bone loss. METHOD: 78 knees in 59 patients with ATCs (Persona™) and 74 knees in 58 patients with STCs (NexGen LPS-Flex™) were retrospectively reviewed. Radiographic parameters and clinical outcomes in both groups were compared. Logistic regression analysis was performed to identify risk factors for medial tibial bone loss. RESULTS: Medial tibial bone loss was significantly greater in the ATC group (1.6 ± 1.3 mm) than in the STC group (0.4 ± 0.8 mm) (p < 0.001). The ATC group showed a shorter distance between the distal metal tip and anteromedial cortex and higher invading into the sclerotic bone lesion (ISBL) than the STC group (p = 0.034 and p = 0.044, respectively). Multiple logistic regression analysis suggested ATC, a shorter distance to the anteromedial cortex, and the presence of ISBL as risk factors for medial tibial bone loss. The odds ratios of medial tibial bone loss according to type of prosthesis, distance to anteromedial cortex, and presence of ISBL were 6.25 (range 2.86-13.63, p < 0.001), 0.69 (range 0.51-0.93, p = 0.015), and 3.79 (range 1.56-9.21, p = 0.003), respectively. Notwithstanding, there was no difference in clinical outcomes between the two groups. CONCLUSION: In Korean patients, ATCs potentially causes greater medial tibial bone loss due to stress shielding than STCs. The design, however, does not yet appear to affect clinical outcomes at mid-term follow-up. LEVEL OF EVIDENCE: Retrospective cohort study, level III.
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Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Tíbia/cirurgia , Idoso , Artroplastia do Joelho/efeitos adversos , Reabsorção Óssea/epidemiologia , Reabsorção Óssea/etiologia , Feminino , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Modelos Logísticos , Masculino , Radiografia/métodos , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Estresse Fisiológico , Tíbia/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: Although several factors exacerbate osteonecrosis of the femoral head (ONFH), little is known about whether pelvic sagittal parameters are associated with a greater risk of ONFH progression. QUESTIONS/PURPOSES: The purpose of this study was to investigate the association between pelvic sagittal parameters and disease progression (collapse of the femoral head) in patients with nontraumatic ONFH. METHODS: From March 2010 through December 2016, we saw 401 patients with unilateral ONFH diagnosed at an outpatient clinic using plain radiography and MRI that were retrospectively reviewed. Of those, 276 patients met our inclusion criteria: Association Research Circulation Osseous (ARCO) Stage I or II nontraumatic unilateral ONFH without femoral head collapse, older than 18 years, and no prior surgical treatment. In all, 74% (203 of 276) of hips had complete follow-up (clinical and radiographic) at a minimum of 2 years. The pelvic sagittal parameters (pelvic incidence, pelvic tilt, and sacral slope) of all patients were measured with standing radiographs by two observers. Progression of disease and potential collapse of the femoral head of all patients (ARCO Stage ≥ III) was examined using radiography every 2 to 3 months after the first outpatient clinic visit. If patients with intractable pain associated with collapse of the femoral head did not respond to nonoperative treatment, THA was performed during the follow-up period. The patients were divided into two groups for comparison: those whose femoral head collapsed within 12 months (rapid progression group) and those whose femoral head did not collapse (nonrapid progression group). The rapid progression group consisted of 49 men and 55 women with a mean age of 55 years; the nonrapid progression group consisted of 60 men and 39 women with a mean age of 56 years. Factors such as age, sex, BMI, size of necrotic lesions, location of necrosis, necrosis risk factor associated with the rapid progression of disease were analyzed using an exploratory univariate analysis followed by a multivariate analysis. RESULTS: Pelvic incidence (53° ± 9° versus 49° ± 7°; p < 0.01) and sacral slope (38° ± 9° versus 33° ± 7°; p < 0.01) were greater in the rapid progression group than in the non-rapid progression group. After accounting for potentially confounding variables like age, sex, BMI, size of necrotic lesions, location of necrosis, and necrosis risk factors, the only variable we found that was independently associated with more rapid disease progression was high (> 55°) pelvic incidence (odds ratio, 0.95 [95% CI 0.91 to 0.99]; p = 0.03). CONCLUSIONS: After controlling for potential confounders such as age, sex, BMI, size of necrotic lesions, location of necrosis, and necrosis risk factors, we found that a high pelvic incidence was associated with a greater likelihood of femoral head collapse in patients with nontraumatic ONFH. Assessing pelvic sagittal parameters in patients with early nontraumatic ONFH may help anticipate which patients are at risk for femoral head collapse, but future prospective studies are needed to confirm these findings. LEVEL OF EVIDENCE: Level III, therapeutic study.
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Necrose da Cabeça do Fêmur/patologia , Cabeça do Fêmur/patologia , Pelve/patologia , Adulto , Idoso , Progressão da Doença , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Radiografia , Estudos Retrospectivos , Fatores de RiscoRESUMO
Background and objective With the steady advancement of computer-assisted surgical techniques, the importance of assessing and researching technology related to total knee arthroplasty (TKA) procedures has increased. Augmented reality (AR), a recently proposed next-generation technology, is expected to enhance the precision of orthopedic surgery by providing a more efficient and cost-effective approach. However, the accuracy of image-based AR in TKA surgery has not been established. Therefore, this study aimed to determine whether accurate bone resection can be achieved in TKA surgery using image-based AR. Methods In this study, we replaced traditional CT imaging and reconstructions for creating a bone 3D model by direct 3D scanning of the femur and tibia. The preoperative planning involved identifying anatomical landmarks and determining the surgical details. During surgery, markers were employed to create a local coordinate system for an AR-assisted surgical system using a Polaris camera. This approach helped minimize discrepancies between the 3D model and actual positioning, ensuring accurate alignment. Results The AR-assisted surgery using the image method resulted in fewer errors [average error: 0.32 mm; standard deviation (SD): 0.143] between the bone resection depth of the preoperative surgical plan and the bone model test results. Conclusions Our findings demonstrated the accuracy of bone resectioning by using image-based AR-assisted navigation for TKA surgery. Image-based AR-assisted navigation in TKA surgery is a valuable tool not only for enhancing accuracy by using smart glasses and sensors but also for improving the efficiency of the procedure. Therefore, we anticipate that image-based AR-assisted navigation in TKA surgery will gain wide acceptance in practice.
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The aim of this study was to investigate the biomechanical effects of stem extension with a medial tibial bone defect in primary total knee arthroplasty (TKA) on load distribution and stress in the proximal tibia using finite element (FE) analysis.FE simulations were performed on the tibia bone to evaluate the stress and strain on the tibia bone and bone cement. This was done to investigate the stress shielding effect, stability of the tibia plate, and the biomechanical effects in TKA models with various medial defects and different stem length models.The results demonstrated that in the bone defect model, the longer the stem, the lower the average von Mises stress on the cortical and trabecular bones. In particular, as the bone defect increased, the average von Mises stress on cortical and trabecular bones increased. The average increase in stress according to the size of the bone defect was smaller in the long stem than in the short stem. The maximal principal strain on the trabecular bone occurred mainly at the contact point on the distal end of the stem of the tibial implant. When a short stem was applied, the maximal principal strain on the trabecular bone was approximately 8% and 20% smaller than when a long stem was applied or when no stem was applied, respectively.The findings suggest that a short stem extension of the tibial component could help achieve excellent biomechanical results when performing TKA with a medial tibial bone defect.
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BACKGROUND: This study aimed to quantitatively evaluate lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) according to sex and the anterior pelvic plane (APP) tilt angle and analyze the correlation between these measurements and acetabular coverage. METHODS: Computed tomography scans of 71 adults (38 men and 33 women) with normal hip joints were obtained. LCEA, anterior ACEA, and acetabular coverage were measured with APP tilt every 5° from - 30° to + 30° and were compared between the sexes. The correlation between acetabular coverage and LCEA/ACEA was also analyzed. RESULTS: (1) LCEA, ACEA, and acetabular coverage were statistically larger in men than in women at all APP tilt angles (with the exception of acetabular coverage ≥ 25°). (2) LCEA, ACEA, and acetabular coverage differed according to APP tilt angle. LCEA and acetabular coverage showed maximum values at 10°. ACEA showed a tendency to increase by an average of 3.6° for every 5° increase in the APP tilt angle. LCEA demonstrated strong and very strong associations across all APP tilting angles, whereas ACEA showed a moderate association at angles ≥ 15° in men and ≥ 30° in women. CONCLUSIONS: The LCEA and ACEA are adequate measurement methods that reflect actual acetabular coverage unless the pelvis is tilted excessively anteriorly. While pelvic tilting does not need to be considered for LCEA within the physiologic range, it should always be taken into account for ACEA, as it increases by an average of 3.6° for every 5° increase in APP tilt angle. LEVEL OF EVIDENCE: Level III: retrospective cohort study.
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Articulação do Quadril , Pelve , Adulto , Masculino , Humanos , Feminino , Estudos Retrospectivos , Acetábulo , PosturaRESUMO
PURPOSE: The aim of this study was to compare the anatomical structures of the acetabular rim around the anterior inferior iliac spine (AIIS) ridge that indicate anterior focal coverage of acetabulum between the sexes using a three-dimensional (3D) model. METHODS: 3D models of 71 adults (38 men and 33 women) with normal hip joints were used. Based on the location of the inflection point (IP) of the acetabular rim around the AIIS ridge, the patients were classified into anterior and posterior types, and the ratios thereof for each sex were compared. Coordinates for the IP, the most anterior point (MAP), and the most lateral point (MLP) were obtained and compared between the sexes and between anterior and posterior types. RESULTS: Coordinates for IPs in men were located anterior and inferior to those in women. MAP coordinates for men were located inferior to those for women, and MLP coordinates for men were located lateral and inferior to those for women. Comparing AIIS ridge types, we noted that coordinates for IPs of the anterior type were located medial, anterior, and inferior to those of the posterior type. Meanwhile, MAP coordinates of the anterior type were located inferior to those of the posterior type, and MLP coordinates of the anterior type were located lateral and inferior to those of the posterior type. CONCLUSION: Anterior focal coverage of the acetabulum appears to differ between the sexes, and this difference may affect the development of pincer-type femoroacetabular impingement (FAI). Additionally, we found that anterior focal coverage differs according to anterior or posterior positioning of the bony prominence around the AIIS ridge, which may affect development of FAI.
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Impacto Femoroacetabular , Caracteres Sexuais , Adulto , Humanos , Feminino , Masculino , Acetábulo/diagnóstico por imagem , Impacto Femoroacetabular/diagnóstico por imagem , População do Leste Asiático , Articulação do Quadril/diagnóstico por imagemRESUMO
We sought to determine whether multiple drilling (MD) combined with the injection of recombinant human bone morphogenetic protein-2 (rhBMP-2) and ß-tricalcium phosphate (ß-TCP) could improve survival of the femoral head in pre-collapse lesions of non-traumatic osteonecrosis of the femoral head (ONFH) as compared with MD alone. We conducted a single-site, off-label, comparative and prospective cohort study between November 2017 and May 2019. We enrolled 25 hips (25 patients) with non-traumatic ONFH (Ficat-Arlet stage 2A or less). We performed a survival analysis, and the primary outcome was the occurrence of femoral head collapse on follow-up radiograph. Our cohort consisted of 11 men and 9 women of age 52.5 ± 8.8 years and a body mass index of 24.3 ± 3.0 kg/m2. The femoral heads were preserved in 9 hips (45.0%) and collapsed in 11 hips (55.0%) at the final follow-up; mean survival to collapse was 6.9 (range 2.8-13.5) months. There were no significant differences in the survival of the femoral head between the MD alone group and the MD with rhBMP-2 and ß-TCP group (five hips survived, 50% vs. four hips survived, 40%, respectively; p = 0.83). MD combined with the injection of rhBMP-2 and ß-TCP did not improve femoral head survival compared to MD alone in the pre-collapse non-traumatic ONFH lesion.
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PURPOSE: We sought to compare the radiographic parameters concerning the sagittal alignment of the standing whole-body skeletons between the knee extension group and control group using the low-dose biplanar X-ray system in a young adult population without knee pain, and to investigate the associated variables for the sagittal knee angle (sagKA) among the radiographic parameters of global sagittal alignment. MATERIALS AND METHODS: We reviewed whole-body standing sagittal radiographs of 124 young adults taken from December 2018 to May 2020 in a single institution. We compared the radiographic parameters concerning the lower extremity sagittal alignment and global sagittal alignment between the knee extension group and control group. The factors correlated with sagKA were evaluated using multiple linear regression analysis. RESULTS: The sagittal vertical axis (SVA), the horizontal offset between the gravity line (GL) and the posterior edge of S1 endplate (GL-S), and the horizontal offset between the GL and the hip center (GL-H) were -11.6±21.3 mm, 5.1±23.8 mm, and -25.1±27.1 mm in the knee extension group, respectively, which were significantly smaller than those in the control group. The C7 plumb line (C7PL) and GL were deviated posterior to the sacrum and the hip center in the knee extension group, with the mean sagKA of -5.6° in young adults. CONCLUSION: The GL-H using GL, not the SVA using C7PL, was a significant radiographic factor associated with the sagKA.
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Extremidade Inferior , Pelve , Humanos , Pelve/diagnóstico por imagem , Radiografia , Sacro , Raios X , Adulto JovemRESUMO
BACKGROUND: This study aimed to investigate how bone transparency affects loosening of the cementless femoral component by serially analyzing radiologic images in hybrid total knee arthroplasty (TKA). METHODS: A total of 214 cases of TKA performed using the hybrid technique that were followed up for at least 6 years were retrospectively investigated. Bone transparency around the femoral component during the follow up period was evaluated. All TKA cases were divided into two groups and compared: those with radiologic bone transparency (bone transparency group, n = 51) and those without radiologic bone transparency (no bone transparency group, n = 163). RESULTS: The incidence of revision TKA in all patients was 6.1%, and obesity, preoperative and postoperative mechanical alignment did not affect surgical outcomes. All bone transparency cases were asymptomatic, and only 8/51 cases (15.7%) of bone transparency spontaneously resolved. Between the bone transparency and no bone transparency groups, there was no difference found in the preoperative and postoperative radiologic parameters and clinical outcomes. During the follow up period, there were four (1.9%) cases with a definite radiolucent line in the femoral component, all of which belonged to the bone transparency group. CONCLUSIONS: The bone transparency around the femoral component that appears on radiography after hybrid TKA could be an early sign of aseptic loosening; therefore, follow up serial radiography is essential.
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Artroplastia do Joelho , Prótese do Joelho , Humanos , Artroplastia do Joelho/métodos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Estudos Retrospectivos , Radiografia , Falha de Prótese , ReoperaçãoRESUMO
INTRODUCTION: Preoperative carbohydrate drinks are recommended to reduce fasting time before surgery. Older adults are at risk of pulmonary aspiration and hyperglycemia after consuming carbohydrate drinks because of increased insulin resistance and delayed gastric emptying. We investigated the effects of oral carbohydrate drinks on perioperative insulin resistance, metabolic responses, and gastric volume in older adults. METHODS: Fifty-six patients (aged more than 65 years) were randomly assigned to the control or carbohydrate (CHO) group. The CHO group received 400 mL of a carbohydrate drink 2 to 3 hours before anesthesia. The control group was allowed clear fluid intake 2 hours before anesthesia. Blood glucose and insulin levels were measured before intake of the carbohydrate drink and 1 hour postoperatively. Gastric volume was measured before spinal anesthesia. Insulin resistance was calculated using the homeostasis model assessment for insulin resistance. RESULTS: Homeostasis model assessment for insulin resistance was not different between the control and CHO groups preoperatively (2.5 versus 3.3, P = 0.156) or postoperatively (2.6 versus 2.4, P = 0.817). Preoperative gastric volume was comparable between the control and CHO groups (35.5 versus 30.8 mL, P = 0.696). DISCUSSION: Preoperative oral consumption of carbohydrates did not affect insulin resistance or gastric volume in older adults undergoing total knee or hip arthroplasty. Preoperative carbohydrate loading is safe in older adults undergoing total knee or hip arthroplasty. DATA AVAILABILITY: The data that support the findings of this study are available from the corresponding author on reasonable request. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (No. NCT04206189).
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Artroplastia de Quadril , Artroplastia do Joelho , Resistência à Insulina , Administração Oral , Idoso , Glicemia , Humanos , Insulina , Cuidados Pré-Operatórios , Estudos ProspectivosRESUMO
BACKGROUND: It is well known that the measured resection (MR) technique in mechanically aligned (MA) total knee arthroplasty (TKA) generates significant gap imbalances, but little is known about whether this applies to the knees of Asian patients. The aim of this study was to evaluate the medio-lateral and flexion-extension gap imbalances and to find the most optimal posterior femoral condyle resection method for operating on the knees of Asian patients. METHODS: In total, 738 magnetic resonance imaging (MRI) scans of consecutive patients who underwent TKA were obtained. Four posterior femoral condylar resection methods were used: alignment by the surgical transepicondylar axis (TEA), Whiteside's line (WSL), 3° external rotation to the posterior condylar axis (PCA), and flexion-extension axis (FEA). RESULTS: For the medial compartments, there were significant differences between the flexion and extension gaps in the varus knee group in all four methods, but there were no differences between the flexion and extension gaps in the valgus knee group. For the lateral compartment, all the methods showed significant differences except for WSL of the valgus knee group and FEA of the varus knee group. CONCLUSIONS: In Asian patients, the use of the MA MR technique inevitably leads to medio-lateral or flexion-extension imbalances. Therefore, surgeons should consider which methods can minimize imbalances and choose the best method within the technically possible range.
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This study aimed to analyze the reproducibility and reliability of the alignment parameters measured using the EOS image system in both limbs while standing with an even weight-bearing posture. Overall, 104 lower extremities in 52 patients were analyzed retrospectively. The patients stood with an even load over both lower extremities then rotated 15° in both directions. Two EOS images were acquired and 104 pairs of lower extremities were compared according to the position of the indexed lower extremities. Then, the inter-observer reliability of the EOS system and the inter-modality reliability between EOS and computed tomography (CT) were evaluated. Femoro-tibial rotation (FTR) and tibial torsion demonstrated a significant difference between the anterior and posterior positions of the indexed lower extremity. In the inter-observer reliability analysis, all values except for FTR and tibial torsion demonstrated good or very good reliability. In the anterior position, FTR demonstrated moderate, and tibial torsion demonstrated poor reliability. In the posterior position, both FTR and tibial torsion demonstrated poor reliability. In the reliability analysis between the three-dimensional (3D) EOS model and 3D CT images, all measurements of the femur demonstrated very good reliability, but measurements of the tibia did not. For the coronal and sagittal alignment parameters measured by the EOS 3D system with rotated standing posture, except for the measurement including tibial torsion., there were no significant difference for either position of the indexed extremities with high agreement between the observers as well as with the CT 3D model.
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Postura , Humanos , Processamento de Imagem Assistida por Computador , Extremidade Inferior/diagnóstico por imagem , Radiografia , Estudos Retrospectivos , Software , Posição Ortostática , Suporte de CargaRESUMO
To compare the angle between the external rotation references of the femoral components in the axial plane by gender and lower limb alignment in Korean patients with osteoarthritis (OA). Magnetic resonance (MR) images of 1273 patients were imported into a modeling software and segmented to develop three-dimensional femoral bony and cartilaginous models. The surgical transepicondylar axis (sTEA), posterior condylar axis (PCA), the kinematically aligned axis (KAA), and anteroposterior axis were used as rotational references in the axial plane for mechanically aligned (MA) TKA. The relationship among axes were investigated. Among 1273 patients, 942 were female and 331 were male. According to lower limb alignment, the varus and valgus knee groups comprised 848 and 425 patients, respectively. All measurements, except PCA-sTEA, differed significantly between men and women; all measurements, except PCA-sTEA, did not differ significantly between the varus and valgus knee groups. In elderly Korean patients with OA, rotational alignment of the distal femur showed gender differences, but no differences were seen according to lower limb alignment. The concern for malrotation of femoral components during kinematically aligned TKA is less in Koreans than in Caucasians and relatively less in women than in men. In MA TKA, malrotation of the femoral components can be avoided by setting different rotational alignments for the genders.
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In mechanically aligned (MA) total knee arthroplasty (TKA), the grand piano sign helps surgeons to further ensure the proper external rotation of the femoral component. The goal of this study was to determine the sex-related differences in the shape of the anterior resection surface using 3D magnetic resonance imaging (MRI) models. MRI scans were performed on 267 consecutive patients (202 women and 65 men) with osteoarthritis who underwent TKA in order to reconstruct a 3D model. Virtual anterior condylar resection was performed based on the surgical transepicondylar axis (sTEA), Whiteside's line (WSL), and flexion-extension axis (FEA). On the anterior resection surface, both lateral length (LatL) and medial length (MedL) were measured, and the ratio between the two (MedL/LatL) was calculated. The mediolateral width of the distal femur (ML) and anterior resection surface (M'L') were measured, and the ratio between the M'L' and ML (M'L'/ML) was calculated. Both the lateral deviation (LD) and the ratio between LD and ML (LD/ML) were also determined. Morphological classification of the anterior resection surface was conducted based on the presence of a definite medial peak. When based on the sTEA or WSL, the MedL/LatL of female subjects was significantly greater than that of male subjects (p < 0.001 and p < 0.05, respectively). The MedL/LatL of the FEA was consistently larger than that obtained using the sTEA or WSL. Among female subjects, the MedL/LatL of the sTEA was significantly greater than that of the WSL, although this was not the case in either the total study population or the male subjects alone. When based on the sTEA, the M'L'/ML was statistically greater in the female subjects (p < 0.01). The LD was greater in the male subjects (p < 0.01), but there was no difference between the male and female subjects when comparing the LD/ML (p = 0.93). The proportion of double- and single-peak types was not significantly different between the sexes (p = 0.196). Surgeons should be aware that the shape of the anterior resection surface may differ depending on the sex of the patient. The results of this study provide more consistent surgical outcomes as well as fundamental anatomical data for designing suitable prostheses applicable to the Korean population.
RESUMO
Few studies have reported the relationship between knee pain and hypercholesterolemia in the elderly population with osteoarthritis (OA), independent of other variables. The aim of this study was to reveal the association between knee pain and metabolic diseases including hypercholesterolemia using a large-scale cohort. A cross-sectional study was conducted using data from the Korea National Health and the Nutrition Examination Survey (KNHANES-V, VI-1; 2010-2013). Among the subjects aged ≥60 years, 7438 subjects (weighted number estimate = 35,524,307) who replied knee pain item and performed the simple radiographs of knee were enrolled. Using multivariable ordinal logistic regression analysis, variables affecting knee pain were identified, and the odds ratio (OR) was calculated. Of the 35,524,307 subjects, 10,630,836 (29.9%) subjects experienced knee pain. Overall, 20,290,421 subjects (56.3%) had radiographic OA, and 8,119,372 (40.0%) of them complained of knee pain. Multivariable ordinal logistic regression analysis showed that among the metabolic diseases, only hypercholesterolemia was positively correlated with knee pain in the OA group (OR 1.24; 95% Confidence Interval 1.02-1.52, p = 0.033). There were no metabolic diseases correlated with knee pain in the non-OA group. This large-scale study revealed that in the elderly, hypercholesterolemia was positively associated with knee pain independent of body mass index and other metabolic diseases in the OA group, but not in the non-OA group. These results will help in understanding the nature of arthritic pain, and may support the need for exploring the longitudinal associations.