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Objective To explore the application effect of new improved 3D printing individualized guidance(3D psi)in total knee arthroplasty(TKA)for knee osteoarthritis(KOA).Methods A total of 100 patients with KOA in 920th Hospital of Joint Logistics Support Force,PLA from January 2021 to January 2022 were selected,and were divided into 2 groups of 50 patients each using the randomized numerical table method.The control group was treated with conventional TKA,and the study group was treated with new improved 3D psi assisted TKA.The operation conditions,postoperative rehabilitation,complications,prosthesis component position deviation,knee range of motion(ROM),lower limb force line parameters[coronal distal femoral mechanical axis lateral angle(mldfa),lower limb mechanical axis angle(HKA)],gait parameters(percentage of support time,stride,pace),knee function(HSS score),quality of life(AIMS2 score)were observed.Results Com-pared with control group,the amount of intraoperative and postoperative blood loss and drainage volume 2 days after operation were less in the study group,and the operation time and hospital stay were shorter(P<0.05).The deviations of LTC Angle,FFC Angle,HKA Angle,LFC Angle and FTC Angle in the study group were smaller than those in the control group(P<0.05).At 3 months,6 months and 12 months after surgery,the percentage of knee ROM,supporting time,stride length and walking speed of the research group were higher than those of the control group,while the coronal-position mLDFA and HKA were lower than those of the control group(P<0.05).The proportion of WBC and PMN in joint fluid at 3 months,6 months and 12 months after surgery was lower than that in control group(P<0.05).The HSS score of the study group was higher than that of the control group at 3 months,6 months and 12 months after operation,and the AIMS2 score was lower than that of the control group(P<0.05).There was no statistically significant difference in the incidence of complications between the study group and the control group(P>0.05).Conclusion The new improved 3D PSI-assisted TKA treatment of KOA can optimize the surgical situation,improve operating accuracy,improve the patient's lower limb alignment,promote limb function recovery,help improve the quality of life,and has high safety.
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Objective:To construct a nursing quality evaluation index system for knee ligament injury to provide a basis for standardizing the nursing practice and improving the nursing quality of knee ligament injury.Methods:Based on the three-dimensional quality structure model of "structure-process-outcome" proposed by Donabedian, the quality evaluation index system for knee ligament injury specialties was constructed through literature review, brainstorming, and Delphi expert consultation from April to June 2023.Results:Sixteen experts were included in the inquiry. The effective recovery rate of the two rounds of expert correspondence questionnaires was 16/16, the expert authority coefficient was 0.95, and the Kendell harmony coefficients of the expert correspondence were 0.116 and 0.122, respectively (both P<0.05). The final constructed knee ligament injury specialty care quality evaluation index system contained 3 primary indicators (structural quality, process quality and outcome quality), 16 secondary indicators, and 69 tertiary indicators.Conclusions:The specialized nursing quality evaluation index system for knee ligament injury constructed in this study is scientific and reliable, which can provide a basis for the evaluation and assessment of the nursing quality of knee ligament injury specialties and promote the continuous improvement of their nursing quality.
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Objective To observe the safety and effectiveness of ultrasound-guided femoral nerve combined with femoral artery block to reduce tourniquet reaction in patients undergoing knee arthroplasty.Methods 100 patients(18～75 years old,body mass index 18～30 kg/m2)who were classified as grade Ⅰ-Ⅲ according to ASA standard and received unilateral total knee arthroplasty.The patients were randomly divided into two groups,the ultrasound-guided femoral nerve combined with femoral artery block with general anesthesia was utilized in group NA with 50 cases,and femoral nerve block alone with general anesthesia was used in group N with 50 cases.The target nerve block was guided by ultrasound before induction of anesthesia in both two groups,and anesthesia induction was performed after the block effect was etermined.Patients in two groups underwent surgery under general anesthesia of the laryngeal mask,and all patients under went self-controlled intravenous analgesia(PCIA).If a patient had a visual analogue score(VAS)score>5 after surgery,flurbiprofenate 50 mg will be given intravenously as a remedy for anal-gesia.The patients'SBP,DBP and HR were recorded before anesthesia(T1),1 min before tourniquet inflation(T2),15 min after tourniquet inflation(T3),30 min(T4),45 min(T5),and 60 min(T6),the number of cases of tourniquet hypertension occurring in patients intraoperatively and the amount of nicardipine and esmolol were recorded,and the movement and static VAS scores at 2,6,12,and 24 h after surgery were recorded.the postoperative rescue analgesic requirements and the time of getting out of bed were recorded.The incidence of adverse reactions such as nausea,vomiting,deliriumand infection were also recorded.Results Compared with group N,SBP,DBP and HR were significantly lower in group NA at 45 and 60 min after tourniquet inflation,and the incidence of tourniquet hypertension and the amount of nicardipine and esmolol were also significantly lower(P<0.05),and the time of getting out of bed was advanced(P<0.05);the movement and static VAS scores,the time of the first remedial analgesia,and number of times of remedial analgesia,as well as the occurrence of nausea,vomiting,delirium and infection were not statistically significant.Conclusion Ultrasound-guided femoral nerve combined with femoral artery block can be safely and effectively used to reduce the reaction of tourniquet in patients with knee arthroplasty,and can shorten the time of getting out of bed after surgery,contributing to promoting postoperative rehabilitation.
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Objective To investigate the influencing factors of peripheral infections of knee joint tumor prosthesis as well as the value of serum D-D and TLR2 in predicting the infection risks so as to provide a reference for early diagnosis of tumorous periprosthetic infection(PJI)of knee joint.Methods The patients who were treated and followed up in our department from January 2008 to June 2020 were selected.According to the inclusion and exclusion criteria,136 of the patients were selected.The data including age,gender,BMI,history of diabetes,smoking history,tumor location,stage of malignant tumor,operation time,osteotomy length,intraoperative bleed-ing,and the percentage of neutrophils,leukocytes,serum D-dimer,and serum TLR value 3 days after operation were collected.The risk factors of PJI and the diagnostic value of serum D-dimer and serum TLR were analyzed.Results The incidence of PJI was 11.76%.Postoperative chemotherapy and operation time≥180 min were the risk factors of PJI(P<0.05).The area under curve(AUC)of the combination of two indicators,serum D-dimer and serum TLR2 were 0.917,0.894 and 0.778,respectively.The AUC of TLR2 was lower than that of the combina-tion of two indicators(P<0.05);The sensitivity was 0.975,0.908 and 0.708,respectively,and the specificity was 0.75,0.75,and 0.812,respectively.Conclusion Postoperative chemotherapy and operation time≥180 min are the risk factors of PJI.The combination of D-dimer and TLR2 has good diagnostic value.
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BACKGROUND:Previous studies have shown that knee joint moment changes in patients with knee osteoarthritis,but there are few reports on the correlation of moment changes with knee extensor muscle strength and gait spatiotemporal parameters. OBJECTIVE:To explore the correlation of knee extensor muscle strength and gait spatiotemporal parameters with peak knee flexion moment and knee adduction moment in female patients with knee osteoarthritis. METHODS:Twenty knee osteoarthritis female patients with single knee disease hospitalized in Guizhou Hospital,Beijing Jishuitan Hospital from February to August 2022 were selected as the knee osteoarthritis group,and an additional 20 healthy females without musculoskeletal disease were selected as the control group.The knee extensor force at 60(°)/s was measured with the Biodex isokinetic instrument.The gait spatiotemporal parameters and peak knee flexion moment and knee adduction moment were collected with the Italian BTS infrared motion capture system and force measuring platform.Pearson correlation analysis was used to explore the correlation of muscle strength and gait spatiotemporal parameters with peak knee adduction moment and knee flexion moment,and the variables significantly related to knee joint moment were further included in the multiple stepwise regression analysis. RESULTS AND CONCLUSION:(1)Compared with the control group,the knee osteoarthritis group had significantly lower knee extensor force,step speed,step frequency,step length,step width,peak knee adduction moment and knee flexion moment at 60(°)/s(P<0.05).(2)Pearson correlation analysis showed that the 60(°)/s centripetal extensor force,step speed,step frequency and step length were positively correlated with the peak knee flexion moment,and negatively correlated with the peak knee adduction moment,with a statistically significant difference(P<0.05).(3)The results of multiple stepwise regression showed that step speed and 60(°)/s knee extensor force were the strongest predictors of peak knee flexion moment,and the total R2 value of the two factors was 0.426,indicating that 42.6%of the total variance of this parameter could be explained.Step length and 60(°)/s centripetal extensor force were the strongest predictors of peak knee adduction moment.The total R2 value of the two factors was 0.602,indicating that 60.2%of the total variance of this parameter could be explained.(4)It is concluded that knee extensor strength,step speed and step length are the main variables affecting peak knee adduction moment and knee flexion moment.Therefore,these variables can be used for clinical gait monitoring and guidance to change knee joint load during knee osteoarthritis rehabilitation.
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BACKGROUND:The medial patellofemoral ligament reconstruction is the most commonly used method for the treatment of lateral dislocation of patella at present.The ultimate goal is to adjust the patella to the normal anatomical position and restore the patella track.Currently,the main core problem of medial patellofemoral ligament reconstruction is the selection of its femoral end fixation point. OBJECTIVE:Finite element method was used to analyze the limiting effect of the reconstructed medial patellofemoral ligament on the patella at different flexion angles of the knee joint,and to simulate the limiting effect of medial patellofemoral ligament reconstruction at different fixation points of the femoral end on the patellofemoral end,so as to provide help for the selection of fixation points of the femoral end during the reconstruction of the medial patellofemoral ligament. METHODS:A finite element model of knee including bone and soft tissue was established according to the extracted CT and MRI data of knee joint.When the knee flexion angle of 30° and 60° was simulated,the medial patellofemoral ligament was constructed by selecting different fixation points of femur end.The contact stress and contact area between patellofemoral joints at different points were compared,as well as the transverse binding force on patella.The equilength of the medial patellofemoral ligament constructed from the same fixation point of the femoral end at different flexion angles was verified to study the effect of various reconstruction positions of the medial patellofemoral ligament. RESULTS AND CONCLUSION:(1)A three-dimensional finite element model of the knee joint at 30° and 60° flexion angles was established to construct the medial patellofemoral ligament at different fixation points of the femur end.The medial patellofemoral ligament constructed at the same position of the femur end had usable isometric length at different flexion angles.(2)After the lateral displacement of the patella,in the transverse direction,the medial patellofemoral ligament constructed at different fixed points of the femur end produced different transverse binding force on the patella,and the transverse binding force was maximum at the anterior 10 mm and minimum at the proximal 5 mm.In the longitudinal direction,the location and size of stress concentration points on the patella cartilage were roughly the same,and the contact pressure did not change much.However,the contact area between the patella cartilage and the femoral cartilage was significantly different,with the maximum contact area at 10 mm at the front end and the minimum contact area at 5 mm at the proximal end.(3)The medial patellofemoral ligament constructed at the center of the saddle region has a good lateral restriction on the patella,but does not cause excessive restriction on the patella in the longitudinal restriction,and can achieve a good restriction on the patella.
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BACKGROUND:Grafts are often used to reconstruct the anterior cruciate ligament in clinical practice,while different types of grafts affect postoperative knee function and the development of rehabilitation programs. OBJECTIVE:To retrospectively analyze the effects of different graft types on muscle strength,joint stability,functional activities,and return to sports in patients after anterior cruciate ligament reconstruction. METHODS:Related studies were searched through PubMed,Web of Science,Cochrane,CNKI,and WANFANG databases.The Chinese and English key words were"anterior cruciate ligament reconstruction,autografts,allografts,artificial ligaments,bone-patellatendon-bone,quadriceps tendon autograft,hamstring tendon autograft,peroneus longus tendon autograft,rehabilitation,exercise,protocol,return to sport". RESULTS AND CONCLUSION:Patients with bone-patellar tendon-bone grafts should strengthen centrifugal contraction exercises of quadriceps muscle,and pay attention to the recovery of quadriceps muscle endurance and explosive power in the later stage of rehabilitation.Compared with bone-patellar tendon-bone grafts and hamstring tendon grafts,significantly fewer patients with quadriceps tendon grafts met regression criteria within 5-8 months,and a longer training plan should be developed,with the training cycle lasting as long as possible to more than 3 years.The selection of hamstring tendon grafts should strengthen the hamstring muscle strength training under multiple angles,especially the cycle of bending the knee above 60° until at least 18 weeks after surgery.Patients who choose peroneus longus tendon graft should strengthen the muscle strength around the ankle,mainly the plantar muscle strength.In the selection of allograft,attention should be paid to the reduction of tension resistance of 20%after the graft is disinfected by low-dose radiation,so attention should be paid to knee stability training.Patients who choose artificial ligament grafts can gradually enhance quadriceps and hamstring muscle strength training within 3-6 weeks,pay attention to early proprioceptive exercises,and conduct targeted training on balance,jumping,and flexibility.
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BACKGROUND:With social progress,the incidence rate of knee osteoarthritis is getting higher and higher in the face of the rapidly developing aging problem in the social population,and the number of total knee replacement operations is gradually increasing. OBJECTIVE:To study the relationship between prosthesis size and stress shielding by improving the tibial prosthesis base. METHODS:A female patient with severe knee osteoarthritis was selected.Based on Mimics,through extracting the bone structure of the knee joint and simulating the total knee replacement surgery,osteotomy,positioning,and implantation operations were carried out to establish the geometric modeling of the total knee replacement prosthesis(including the femoral prosthesis,tibial bracket,and tibial pad),and improve the design of the tibial prosthesis base,analyze the effect of different tibial prosthesis bases on stress shielding of surrounding bone tissue. RESULTS AND CONCLUSION:(1)Compared with single-stem tibial intramedullary stem prosthesis,the design of four-post tibial intramedullary stem prosthesis created a certain degree of stress shielding around the short stem.However,compared with a thicker single long stem,this stress shielding effect was significantly reduced,and the load was evenly distributed among the four short stems,so there was no stress concentration at the bottom of the pile.(2)The design with a rectangular hole in the middle not only provided relatively good stability,but also helped to reduce stress shielding of cancellous bone to a certain extent,with a reduction rate of 77.5%.(3)Compared with a single-stem tibial intramedullary stem prosthesis,both the four-post tibial intramedullary stem prosthesis and the four-post tibial intramedullary stem prosthesis with a hole in the middle have good stability,which can reduce stress shielding to a certain extent without causing stress concentration,providing theoretical guidance for the design of the tibial intramedullary stem.
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BACKGROUND:Prosthesis restricted selection,soft tissue release,patellar trajectory recovery,and bone defect reconstruction were need to be optimized in total knee arthroplasty for moderate and severe valgus knee.The medial parapatellar approach has disadvantages in the treatment of valgus knee,such as aggravating the medial soft tissue relaxation.In recent years,it has been found that the lateral parapatellar approach has advantages in the treatment of valgus knee,such as exposure and release. OBJECTIVE:To observe the efficacy of the lateral and medial parapatellar approach in total knee arthroplasty for moderate and severe valgus knee,and to explore a more suitable surgical approach for moderate and severe valgus knee. METHODS:Totally 56 patients with moderate and severe valgus knee underwent total knee arthroplasty and would take turns performing surgery through the medial and lateral parapatellar approach according to the order of admission.The lateral group(n=28)underwent total knee arthroplasty through lateral parapatellar approach,and the medial group(n=28)through medial parapatellar approach.Posterior stablized knee prosthesis was used in all patients.The restricted types of prosthesis,thickness of polyethylene,operation time,amount of blood loss,femoro-tibia angle,patellar tilt angle,range of motion,Hospital for Special Surgery score,Western Ontario and McMaster Universities Arthritis Index(WOMAC)score,and complications were collected as observation indexes for statistical analysis. RESULTS AND CONCLUSION:(1)The utilization rate of condyle-restricted prosthesis in the lateral group was significantly lower than that in the medial group.The average thickness of polyethylene liner was lower,and the operation time was shorter in the lateral group compared with the medial group.There were significant differences between the two groups(P<0.05),and there was no significant difference in the amount of surgical bleeding.(2)56 patients were followed up for an average of 2-5 years.There were no signs of prosthesis loosening or bone resorption in all patients.The average patellar tilt angle and femoral tibial angle of the lateral group were lower than those of the medial group,and the average Hospital for Special Surgery score and WOMAC score of the lateral group were higher than those of the medial group,with significant differences(P<0.05).There was no significant difference in the range of motion of the knees between the two groups.(3)Incision fat liquefaction and calf intermuscular venous thrombosis occurred in one case in each group.No infection,poor incision healing,incisional hematoma,prosthesis dislocation,iatrogenic nerve injury,ectopic ossification,or periprosthesis fracture occurred during follow-up.(4)In conclusion,the treatment of moderate and severe valgus knee by lateral parapatellar approach can better protect the tension of the medial soft tissue of the knee,use less condylar restrictive prostheses,and have a more friendly patellar trajectory and higher postoperative function score.
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BACKGROUND:The basic principle of the design of the robot system used for total knee arthroplasty is to combine three-dimensional surgical planning,early warning of danger areas during surgery,real-time data feedback,robot arm assisted osteotomy and other technologies to achieve precision and personalization of total knee arthroplasty,which is exactly its biggest advantage.Therefore,it has become a hot topic in the field of joint surgery in recent years and attracted much attention. OBJECTIVE:To summarize the development status of robotic-assisted total knee arthroplasty in the field of joint surgery and the comparison of advantages and disadvantages with conventional total knee arthroplasty and to prospect the future development of robotic-assisted total knee arthroplasty. METHODS:Relevant articles were searched from PubMed,CNKI,Wanfang and VIP databases by computer.English key words were"robot OR robotic OR robotics OR robotically OR computer,total knee arthroplasty OR total knee replacement,TKA OR TKR".Chinese key words were"robotic-assisted,computer navigation,total knee arthroplasty".Finally,64 articles were included for review and analysis. RESULTS AND CONCLUSION:(1)The robot system used to assist total knee arthroplasty is divided into active,semi-active and passive according to its degree of freedom.The semi-active system,currently widely used in robotic systems,effectively enhances the accuracy and personalization of total knee arthroplasty.However,its high implementation cost and relatively steep learning curve remain key factors to be balanced when promoting its adoption in joint surgery field.(2)Robotic-assisted total knee arthroplasty can achieve precise osteotomy and correct placement of prosthesis in local three-dimensional space of the knee joint.It has been widely proven that it can provide better accuracy of prosthesis implantation,reduce imaging abnormalities,obtain good soft tissue balance during the operation,and ultimately improve the motion and functional status of the knee joint after the operation.(3)However,the current robotic-assisted system still has objective shortcomings,including the problem of learning curve between different robot devices and operators,additional installation and maintenance costs,and potential complications related to robot surgery.Therefore,whether it can truly benefit the medical system and patients still needs to be proven by long-term research,and the robotic-assisted system also needs to be further improved substantially.(4)Robotic-assisted total knee arthroplasty technique is still in the preliminary research stage in clinical practice and has not been widely applied.To better define the usage of robotic-assisted total knee arthroplasty and enhance its clinical procedural standards and safety,refining these aspects will become a focal point of future research on robotic-assisted total knee arthroplasty.
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BACKGROUND:The incidence of medial collateral ligament injuries in the knee joint is easy to lead to secondary meniscus and cartilage damage,and long-term chronic damage can lead to the occurrence of osteoarthritis.At present,there are few studies on the mechanics of meniscus and articular cartilage injury caused by medial collateral ligament rupture. OBJECTIVE:To investigate the effect of different degrees of medial collateral ligament injury on the biomechanics of meniscus and cartilage of knee joint. METHODS:The CT and MRI examinations of the knee joint of a healthy volunteer were performed to obtain the image data.The scanning data were imported into Mimics,Geomagic,and Solidworks software in turn.After registration and fusion,a 3D model of normal knee joint was established.On this basis,models of medial collateral ligament injury in different degrees of knee joint were simulated,which were divided into four groups,including:(1)medial collateral ligament was intact;(2)deep medial collateral ligament fracture;(3)superficial medial collateral ligament fracture;(4)complete rupture of medial collateral ligament.Finally,Ansys software was introduced to apply three modes of loads to the knee joint:(1)10 N·m valvaration torque was applied to the top of the femur.(2)A 4 N·m internal torque was applied to the top of the femur.(3)A 4 N·m external torque was applied to the top of the femur.The effects of four groups of models on knee biomechanics under different loads were analyzed. RESULTS AND CONCLUSION:(1)In the extension position of the knee joint,when a 10 N·m valgus torque was applied to the knee joint,the overall stress of the posterolateral meniscus increased with different degrees of medial collateral ligament injuries,while the stress of the articular cartilage did not change significantly.The peak stress of the posterolateral meniscus increased significantly with superficial medial collateral ligament rupture.(2)In the knee extension position,when a 4 N·m internal rotation torque was applied to the knee joint,the overall stress of the medial and lateral meniscus increased after different degrees of medial collateral ligament injury.When superficial medial collateral ligament rupture occurred,the peak stress of the meniscus shifted from the anterior horn of the medial meniscus to the anterior horn of the lateral meniscus.(3)In the knee extension position,applying a 4 N·m external rotation torque to the knee joint,the peak stress of the posterolateral meniscus increased more significantly than that of the medial meniscus,and the stress of the articular cartilage changed less.(4)These results show that the risk of meniscus injury secondary to superficial medial collateral ligament rupture is much higher than that of deep medial collateral ligament rupture when the knee is in extension,and the lateral meniscus is more vulnerable to injury than the medial meniscus.Both superficial medial collateral ligament and deep medial collateral ligament play an important role in the rotational stability of the knee joint.
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BACKGROUND:Compared with total knee arthroplasty,unicondylar knee arthroplasty has such advantages as quick recovery,low cost and good proprioception,but its high revision rate after operation is also a problem that cannot be ignored.At present,the reasons for the high revision rate after unicondylar knee arthroplasty are not completely clear.Therefore,preoperative strict control of surgical indication may be crucial to improve postoperative outcome and reduce revision rate after unicondylar knee arthroplasty.As an index commonly used in the measurement of imaging,the evaluation of joint space width may have important clinical reference value in the selection of indications for unicondylar knee arthroplasty. OBJECTIVE:To review the measurement of joint space width and its effect on the curative effect and outcome of medial unicondylar knee arthroplasty. METHODS:WanFang and PubMed were used to search the relevant literature published from January 1,1950 to June 1,2023 on the evaluation factors of curative effect of unicondylar knee arthroplasty and the influence of joint space width on the curative effect of unicondylar knee arthroplasty.By summarizing and analyzing the literature,the measurement methods of joint space width,the influence of preoperative medial compartment joint space width on the curative effect of medial compartment joint space width,and the influence of postoperative lateral compartment joint space width on the outcome were reviewed. RESULTS AND CONCLUSION:(1)Although many methods have been used to study and measure knee joint space width,X-ray measurement of joint space width under weight-bearing position is still a common method in daily orthopedic practice to assess the progression of osteoarthritis,and it can moderately reflect the thickness of cartilage.(2)Preoperative medial compartment joint space width of knee joint can affect the efficacy of medial movable platform after unicondylar knee arthroplasty.Patients with knee osteoarthritis whose medial joint space width/lateral joint space width ratio is<40%or medial joint space width≤2 mm may be more suitable for medial movable platform unicondylar knee arthroplasty.(3)Changes in lateral compartment joint space width after medial unicondylar knee arthroplasty also have a certain impact on outcome.Improving the joint matching degree of lateral compartment after surgery can delay the progression of lateral compartment joint degeneration and reduce the prosthesis revision rate.However,relevant clinical studies are still lacking.In conclusion,the imaging measurement of joint space width has important clinical reference value for evaluating the postoperative efficacy and prognosis of medial unicondylar knee arthroplasty.
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With enhanced recovery after surgery (ERAS), research and application of knee revision protheses and customized components or prostheses in the past decade, revision of total knee arthroplasty (TKA) is developing rapidly. However, periprosthetic joint infection (PJI) has always been a major clinical challenge. A comprehensive preoperative examination to find any potential infection sites should be conducted. The overall condition of the patients should be improved. Surgeons should evaluate the classification and degree of soft tissue and bone defects comprehensively and carefully select appropriate surgical approaches, bone reconstruction strategies, and revision prostheses to ultimately restore the alignment, stability, and the range of motion of the knee joint. In the future, efforts should be made to build a team of experts for the support of revisions of TKAs, including preoperative planning, 3D printing, surgical techniques, and ERAS. Nevertheless, primary TKAs protocols should always be firmly sticked to, which are a key to a low rate of revision surgeries. Prevention of PJIs and periprosthetic fractures, as well as establishing a high-quality follow-up system are of the same importance.
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Objective:To analyze the clinical efficacy of internal fixation and prosthesis revision in the treatment of periprosthesis fracture after total knee arthroplasty.Methods:A total of 35 patients (35 knees) with periprosthetic fractures after total knee arthroplasty were retrospectively analyzed from January 2008 to January 2022 in the Department of Orthopaedics, West China Hospital, Sichuan University, including 13 males and 22 females, aged 71.4±4.1 years (range, 62-81 years). Left knee 19 cases, right knee 16 cases. There were 20 cases of Rorabeck type II and 15 cases of Rorabeck type III. The initial replacement was performed using a fixed platform post-stabilized knee prosthesis, which was fixed with bone cement. Patients with Rorabeck type II were treated with internal fixation alone (internal fixation group) and patients with Rorabeck type III underwent revision with replacement prosthesis (revision group). The Hospital for Special Surgery (HSS) score, range of motion (ROM) of knee joint, alignment of lower extremity and incidence of postoperative complications were compared between the two groups.Results:All patients successfully completed the operation and were followed up for 5.2±3.6 years (range, 1-12 years). Intraoperative blood loss was 680±102 ml (range, 420-1100 ml). The operative time in the internal fixation group was 105±17 min, which was less than 140±21 min in the revision group, and the difference was statistically significant ( t=-5.450, P<0.001). There was no complication of nerve or blood vessel injury during the operation. Five cases in the internal fixation group had unsatisfactory lower extremity force lines (>3° deviation from normal) after surgery, and all lower extremity force lines in the revision group were satisfied, and the difference in the satisfaction rate of lower extremity force lines between the two groups was not statistically significant ( P=0.057). The fracture healing time, knee ROM and HSS scores at the last follow-up were 5.1±1.3 months, 86°±5° and 84±5 in the internal fixation group and 4.8±1.5 months, 83°±6° and 82±4 in the revision group. One case in the revision group was diagnosed postoperatively with periprosthetic infection with pathogen culture suggestive of Candida albicans, recurrent anterior knee sinus tracts and patellar ectasia, which progressed to osteomyelitis, and mid-thigh amputation was performed 1 year after revision. Conclusion:The stability of prosthesis is an important reference for the treatment of periprosthetic fractures after total knee arthroplasty. Strong internal fixation in patients with unloosened prosthesis and revision with replacement of prosthesis in patients with loose prosthesis can achieve good knee joint function.
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Objective:To assess causes for revision total knee arthroplasty (TKA) in China using the data of revision TKA in the past 15 years in our single center andcompare the differences in survival time, operation time and blood loss among different revision reasons.Methods:Data of 337 patients (345 knees) with revision TKAs at our institution from January 2007 to December 2021 (15 years) were retrospectively analyzed. The included population consists of 57 males and 288 females. The causes for first revision TKA were identified and compared according to the time of revision surgery as early (up to 2 years) and late revision (more than 2 years). The reason for revision before 2012 and after 2012 was also compared. Furthermore, the differences of survival time, operation time and blood loss among different revision reasons were compared.Results:The most common reasons for revision of knee joints in 345 cases were periprosthetic infection (133 knees, 38.6%), followed by aseptic loosening (97 knees, 28.1%) and joint instability (35 knees, 10.1%). Early revisions were performed in 171 knees (49.6%), while late revisions were performed in 174 knees (50.4%). Periprosthetic infection (96 knees, 56.1%) and aseptic loosening (86 knees, 49.4%) were the most common reasons for early and late revisions, respectively. There were 59 revisions performed before 2012 and 286 revisions performed after 2012, with periprosthetic infection being the main reason for revision in both groups. The percentage of revisions due to infection decreased from 64.4% before 2012 to 33.2% after 2012, and this difference was statistically significant (χ 2=18.790, P<0.001). The proportion of revisions due to aseptic loosening was 15.3% before 2012, which was significantly lower than the proportion of 30.8% after 2012 (χ 2=5.083, P=0.024). The median survival time of the prostheses in the included patients was 30 months, with shorter survival time observed in patients with stiffness, patellar complications, and periprosthetic infection, and longer survival time observed in patients with polyethylene wear and aseptic loosening. There were significant differences in operation time and blood loss among different reasons for revision ( P<0.001). Conclusion:In our specialized arthroplasty center periprosthesis infection was the most common reason for revision. Periprosthesis infection and aseptic loosening needed to be considered for early or late-stage revision. With the development of technique of total knee arthroplasty, the proportion of periprosthesis infection is decreasing, while the incidence of aseptic loosening is increasing.
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With the increasing prevalence of total knee arthroplasty (TKA), there is a corresponding rise in the number of patients requiring revision of total knee arthroplasty (R-TKA) for various reasons. R-TKA presents several complex challenges, with severe bone defect reconstruction being a critical obstacle to securing favorable long-term outcomes. Recently, the approach to managing bone defects has seen significant advancements, with a range of techniques proposed contingent on the defect's size and location. Severe bone defects require reconstruction with autologous or allogeneic bone grafts or metal fillers. However, bone grafts have their usage constrained by limited availability, risks of resorption and collapse, and the potential for disease transmission. Consequently, metal fillers have received widespread attention in practical applications due to their advantages, such as comprehensive source, customizability, and safety. The advantages of metal augment are that they provide immediate support without reinforcement and are not subject to necrosis and resorptive collapse. However, the difference in elastic modulus between metal and bone may lead to stress shielding and increase the risk of potential bone loss. Both Cone and Sleeve can achieve biological fixation of metaphyseal bone; however, in cases of periprosthetic infections, it is generally difficult to remove them easily due to the prosthetic bone in-growth and osseointegration. This study aims to provide a comprehensive review of the use of metal fillers to reconstruct bone defects during R-TKA. It is intended to aid orthopedic surgeons in understanding the spectrum of reconstructive possibilities and provide high-performance revision strategies for their patients.
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Objective:To analyze the effect of mucosal ligament preservation on the outcome of arthroscopic repair of meniscus injury.Methods:A total of 77 patients with knee meniscus tears caused by sports injuries who underwent arthroscopic meniscus repair or suture in Zhengzhou Orthopaedic Hospital from June 2022 to June 2023, were retrospectively analyzed. Including 45 males and 32 females, aged 38.57±13.54 years (range, 52-87 years), body mass index 24.72±4.01 kg/m 2 (range, 34.14-13.61 kg/m 2). All patients complained of knee pain, limited activity and walking weakness. The symptoms were not relieved after 1 month of conservative treatment, which seriously affected daily work and life. According to the intraoperative treatment of mucosal ligament, the patients were divided into mucosal ligament preservation group and mucosal ligament removal group. The visual analogue score (VAS), Lysholm score, and total blood loss were compared between the two groups. Results:All patients successfully completed the operation and were followed up for an average of 5.23±2.16 months (range, 3-9 months). The operation time was 47.59±16.81 min in mucosal ligament preservation group and 45.25±15.93 min in mucosal ligament removal group, and there was no significant difference between the two groups ( t=0.628, P=0.532). The total blood loss in the mucosal ligament preservation group was 246±193 ml, which was less than 343±211 ml in the mucosal ligament removal group, and the difference was statistically significant ( t=2.095, P=0.040). None of the patients received allogeneic blood transfusion. The hematocrit of the mucosal ligament preservation group was 42.48%±4.57% before operation and 39.42%±4.65% on the third day after operation, while that of the mucosal ligament removal group was 41.24%±4.16% and 38.95%±3.80%. The difference between the two groups was statistically significant ( t=0.016, P=0.004; t=0.004, P=0.016). There was no significant difference between the two groups before operation and on the third day after operation ( t=0.217, P=0.545; t=0.629, P=0.159). The preoperative VAS score of mucosal ligament preservation group was 7.25±1.10, which was higher than that of 3 months after operation (0.83±1.06), and the difference was statistically significant ( t=0.062, P<0.001). The preoperative VAS score of mucosal ligament removal group was 7.16±1.21, which was higher than that of 3 months after operation (1.05±1.13), and the difference was statistically significant ( t=0.017, P<0.001). There was no significant difference in VAS scores between the two groups before operation and at 3 months after operation ( t=0.144, P=0.740; t= 0.273, P=0.603). The preoperative Lysholm score of mucosal ligament preservation group was 31.76±7.54, which was significantly lower than that of 3 months after operation 87.30±4.12 ( t=-39.329, P<0.001); The Lysholm score of the mucosal ligament removal group was 34.13±7.32 before operation, which was lower than 89.05±4.45 at 3 months after operation, and the difference was statistically significant ( t=-40.172, P<0.001); There was no significant difference in Lysholm score between the two groups before operation and 3 months after operation ( t=1.395, P=0.167; t=1.766, P=0.081). Conclusion:The preservation of mucosal ligament in arthroscopic surgery for meniscus injury does not prolong the operation time. It can reduce the total intraoperative blood loss, and the postoperative knee function recovery is similar to that of mucosal ligament removal.
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Objective:To investigate the effects of marathon exercise on knee cartilage volume and T2 relaxation time (T2 value) based on MRI.Methods:From December 2018 to December 2021, 25 healthy volunteers without long-distance running habits and 32 non-professional marathon runners with long-term long-distance running were recruited to undergo knee MRI 3D water-selective excitation (three dimensional water-selective excitation, 3D-WATS) and T2 mapping imaging were performed, and the cartilage volumes in 5 knee areas and T2 values in 42 subareas were extracted for analysis. To compare the cartilage volume and its ratio to body surface area of knee joint of healthy volunteers and non-professional marathon runners, the T2 value of cartilage in each subregion, and the correlation between marathon exercise intensity and the volume and T2 value of cartilage in different regions.Results:Compared with healthy volunteers, there was no significant difference in cartilage volume or the ratio of body surface area to body volume of non-professional marathon runners ( P>0.05). There were significant differences between healthy volunteers and non-professional marathon runners in cartilage T2 values of the median layer of medial condyle of femur (47.61±5.65 ms and 44.29±6.10 ms) and the deep layer of medial condyle of femur (36.82±9.05 ms and 31.67±7.59 ms), deep precondylar area of medial femur (38.37±4.68 ms and 34.09±4.19 ms), shallow area of medial condylar area of femur (52.17±11.11 ms and 45.51±7.76 ms), middle layer of medial condylar area of femur (49.09±5.08 ms and 45.63±5.04 ms), medial layer of anterior condylar region of lateral femur (45.69±4.68 ms and 42.57±5.77 ms), superficial layer of posterior condylar region of lateral femur (55.42±18.41 ms and 47.99±8.39 ms), deep layer of anterior tibial medial plateau (33.40±7.76 ms and 29.03±5.69 ms), deep layer of posterior tibial medial plateau (31.28±5.02 ms and 27.92±5.99 ms), deep layer of patellofemoral surface (35.65±6.99 ms and 32.30±5.28 ms), respectively ( P<0.05). In non-professional marathon runners, the medial tibial plateau cartilage volume was negatively correlated with step frequency ( r=-0.371, P=0.035), the lateral femoral condylar cartilage volume was negatively correlated with step frequency ( r=-0.365, P=0.043), and the lateral tibial plateau cartilage volume was negatively correlated with step frequency ( r=-0.550, P=0.001). The T2 value of the medial layer cartilage in the anterior tibial medial plateau region was negatively correlated with body weight ( r=-0.277, P=0.039) and body mass index ( r=-0.290, P=0.030). The T2 value of the superficial layer of patellofemoral surface was negatively correlated with the amount of running in 3 months ( r=-0.457, P=0.010). The superficial T2 value in the posterior lateral plateau of the tibia was negatively correlated with stride length ( r=-0.437, P=0.014), and the medial layer cartilage T2 value in the anterior condylar area of the lateral femur was negatively correlated with stride frequency ( r=-0.380, P=0.035). Conclusion:Marathon exercise had little effect on the knee cartilage volume, but had a certain effect on the cartilage T2 value, resulting in changes in cartilage structure. The higher the step frequency, the smaller the cartilage volume. The greater the body weight or body mass index, the greater the amount of running in 3 months, and the greater the stride length, the lower the cartilage T2 value.
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Objective To establish a three-dimensional finite element model of knee joint in patients with mild knee osteoarthritis in the absence of CT and MRI with thin layer thickness,and to analyze the stress distributions of the tibial plateau.Methods A female patient with mild knee osteoarthritis was selected as the study object,and received serial CT scan from pelvis to distal tibia of fibula.The obtained files in DICOM format were imported into Mimics software for extracting the bony structures of knee joint through threshold segmentation,and then optimizing the extracted structures with Edit Masks,Cavity Fill and Region Grow.The generated model of bony structures was imported into 3-matic for smoothing and wrapping,and Geomagic Wrap was used for bony structure processing with mesh doctor inspection,surface defect repair and surface fitting.The cartilages,meniscus and ligaments were established by contour extension,and assembled with bony structures in SolidWorks in the way of origin coincidence.After defining material properties and contact relationships,meshing,and setting constraints and loads in ANSYS software,the stress distributions of the tibial plateau when standing with both legs were analyzed.Results A complete knee joint model including bony structure,cartilage and ligament was successfully established.When standing with two legs,the peak value of contact stress was about 1.21 MPa,and the maximum stress was 0.72 MPa at the medial middle of tibial plateau and lateral tibial plateau.The 62.7%and 37.3%of the total load were borne by the inner and outer compartments.Conclusion The model of the total knee joint is established with CT extraction and software rendering,and the finite element analysis results meet clinical expectations,indicating that the model established by the proposed method is reliable and can be used for follow-up research.
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Objective To compare the value of standard coronal MRI and multi-planar reconstruction(MPR)images for evaluation of anterolateral ligament(ALL).Methods Data of 130 patients who underwent knee joint MR examination were retrospectively analyzed,including standard coronal MRI and MPR images.ALL were identified on standard coronal MRI and MPR images and classified as fully visible,partially visible or invisible.The visibility of bilateral ALL on both standard coronal MRI and MPR images were compared,while Kappa test was used to evaluate the consistency on both kinds of images.Results Among 130 cases,on standard coronal MRI and MPR images,the left ALL was fully visible in 83 and 93 cases,partially visible in 21 and 12 cases but invisible cases in 26 and 25 cases,respectively,while the right side ALL was fully visible in 66 and 80 cases,partially visible cases in 29 and 15 cases but invisible cases each in 35 cases,respectively.Significant difference of visibility of bilateral ALL were found between standard coronal MRI and MPR images(both P＜0.05),both with excellent consistency(both Kappa＞0.80).Conclusion MPR could display bilateral ALL better than standard coronal MRI.If the scanning conditions for MPR could not be met,standard coronal MRI might be used to evaluate ALL rather accurately.