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1.
BMC Musculoskelet Disord ; 22(1): 859, 2021 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-34625077

RESUMEN

BACKGROUND: The use of Oxford uni-compartmental knee arthroplasty (UKA) has rapidly increased worldwide,however,the relevance of younger patients for postoperative function after Oxford UKA remains unclear. The main purpose of our study is to clarify the effectivemess of Oxford UKA in the younger Chinese patients with anteromedial osteoarthritis (AMOA). METHODS: We retrospectively enrolled 252 consecutive patients who underwent Oxford UKA for AMOA with a minimum follow-up of 5 years between March 2013 and December 2016. The patients were divided into the younger (≤60 years) and elderly (> 60 years) age groups. The demographic data and surgery variables were recorded and compared. Patient satisfaction grade, range of motion (ROM), Oxford knee score (OKS), Hospital for Special Surgery (HSS) score, Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Index score and postoperative complications were recorded. The 5-year survival of the implants were also compared with TKA revision as the endpoint. RESULTS: A total of 252 consecutive patients were recruited, including 96 aged 60 years or less and 156 aged over 60 years. The mean follow-up duration in the younger and elderly groups were 73.6 months (SD,standard deviation, 4.1) and 74.7 months (SD 6.2) respectively. Patient satisfaction rate was high in both groups (P = 0.805). Furthermore, no significant differences were observed in postoperative ROM(P = 0.299), OKS(P = 0.117), HSS(P = 0.357) and WOMAC scores(P = 0.151) between the younger and elderly groups (P>0.05). However, the incidence of joint stiffness (P = 0.033) and delayed wound dehiscence (P = 0.026) were significantly different between both groups. Five-year implant survival without revision were also similar in both groups (96.9% vs 97.4%, P = 0.871), and that for the entire cohort was 97.2% (95% CI 95.4-99.6). CONCLUSION: Oxford UKA for AMOA demonstrated favorable results in younger patients aged ≤60 years at a minimum 5-year follow-up in terms of patient satisfaction, functional outcomes, implant survival and postoperative complications. Therefore, younger patients might not be considered as an absolute contraindication to Oxford UKA.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Anciano , Artroplastia de Reemplazo de Rodilla/efectos adversos , Estudios de Seguimiento , Humanos , Osteoartritis de la Rodilla/cirugía , Estudios Retrospectivos , Resultado del Tratamiento
2.
BMC Musculoskelet Disord ; 22(1): 862, 2021 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-34627203

RESUMEN

OBJECTIVE: To explore the relationships between participant characteristics, perceptions of a short educational video about osteoarthritis and its management, and immediate changes in behavioural determinants for effective self-management behaviours. METHODS: Seventy-eight participants with knee OA (77% female, mean age 63.0 ± 8.7) watched the 9-min video that included evidence-based content and was designed to foster empowerment to self-manage effectively. Data were collected by online questionnaire at baseline and immediately after watching the video. Associations were tested between baseline health and information processing characteristics (health literacy, need for cognition), perceptions of the video (enjoyment, helpfulness, believability, novelty and relevance) and pre-post changes in behavioural determinants (self-efficacy for managing arthritis, attitude to self-management or 'activation', and importance/confidence for physical activity). RESULTS: All behavioural determinants improved immediately after watching the video. Positive perceptions were associated with greater improvements in self-efficacy for arthritis (Spearman's rho, ρ = 0.26-0.47). Greater perceived relevance was associated with increased self-rated importance of being physically active (ρ = 0.43). There were small positive associations between health literacy domains related to health information and positive viewer perceptions of the video. People with higher need for cognition may achieve greater improvement in confidence to be physically active (ρ = 0.27). CONCLUSION: The educational video may help achieve outcomes important for increasing self-management behaviours in people with knee osteoarthritis. Positive perceptions appear to be important in achieving these improvements. People with lower health literacy and lower need for cognition may respond less well to this information about knee osteoarthritis delivered in this way.


Asunto(s)
Osteoartritis de la Rodilla , Anciano , Estudios de Cohortes , Ejercicio Físico , Femenino , Humanos , Articulación de la Rodilla , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/terapia , Autoeficacia
3.
BMC Musculoskelet Disord ; 22(1): 844, 2021 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-34600505

RESUMEN

BACKGROUND: Prevalence for knee osteoarthritis is rising in both Sweden and globally due to increased age and obesity in the population. This has subsequently led to an increasing demand for knee arthroplasties. Correct diagnosis and classification of a knee osteoarthritis (OA) are therefore of a great interest in following-up and planning for either conservative or operative management. Most orthopedic surgeons rely on standard weight bearing radiographs of the knee. Improving the reliability and reproducibility of these interpretations could thus be hugely beneficial. Recently, deep learning which is a form of artificial intelligence (AI), has been showing promising results in interpreting radiographic images. In this study, we aim to evaluate how well an AI can classify the severity of knee OA, using entire image series and not excluding common visual disturbances such as an implant, cast and non-degenerative pathologies. METHODS: We selected 6103 radiographic exams of the knee taken at Danderyd University Hospital between the years 2002-2016 and manually categorized them according to the Kellgren & Lawrence grading scale (KL). We then trained a convolutional neural network (CNN) of ResNet architecture using PyTorch. We evaluated the results against a test set of 300 exams that had been reviewed independently by two senior orthopedic surgeons who settled eventual interobserver disagreements through consensus sessions. RESULTS: The CNN yielded an overall AUC of more than 0.87 for all KL grades except KL grade 2, which yielded an AUC of 0.8 and a mean AUC of 0.92. When merging adjacent KL grades, all but one group showed near perfect results with AUC > 0.95 indicating excellent performance. CONCLUSION: We have found that we could teach a CNN to correctly diagnose and classify the severity of knee OA using the KL grading system without cleaning the input data from major visual disturbances such as implants and other pathologies.


Asunto(s)
Aprendizaje Profundo , Osteoartritis de la Rodilla , Adulto , Inteligencia Artificial , Humanos , Articulación de la Rodilla , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/epidemiología , Osteoartritis de la Rodilla/cirugía , Reproducibilidad de los Resultados
4.
Medicine (Baltimore) ; 100(40): e27405, 2021 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-34622845

RESUMEN

BACKGROUND: Hyaluronan (HA), glucosamine, and chondroitin sulfate are widely consumed as dietary supplements for the treatment of knee osteoarthritis (OA). This study aimed to explore the efficacy and safety of a dietary liquid supplement mixture containing HA, glucosamine, and chondroitin in patients with knee OA who had moderate knee pain (visual analogue scale of 4-6 points). METHODS: This was a short-term, randomized, double-blind, placebo-controlled study. Subjects were allocated to administer either a bottle of 20 mL supplement mixture (50 mg HA plus 750 mg glucosamine plus 250 mg chondroitin, namely A + HA) or placebo once daily for 8 weeks. Outcome measures included the Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, 36-item Short Form Survey (SF-36), Chinese version of Pittsburgh Sleep Quality Index, and incidence of adverse event were evaluated at the end of week 8. Efficacy analyses were conducted in the modified intent-to-treat population. RESULTS: Of the 80 subjects in the modified intent-to-treat population, 39 received A + HA while 41 received placebo. After 8 weeks of treatment, the A + HA group failed to demonstrate a significant symptomatic efficacy and quality of life improvement in terms of Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, SF-36, and Chinese version of Pittsburgh Sleep Quality Index as compared to the placebo group. However, the mean changes in most of the SF-36 scale scores were numerically higher in the A + HA group than in the placebo group. No treatment-related adverse event was reported in both groups. CONCLUSIONS: This present study found that the combination of liquid low molecular weight HA, glucosamine, and chondroitin oral supplement did not effectively improve knee OA pain and symptoms after short-term use in knee OA patients with moderate knee pain. However, these results should be interpreted with caution due to the intrinsic limitation of the study design.


Asunto(s)
Condroitín/administración & dosificación , Glucosamina/administración & dosificación , Ácido Hialurónico/administración & dosificación , Osteoartritis de la Rodilla/tratamiento farmacológico , Manejo del Dolor/métodos , Administración Oral , Anciano , Suplementos Dietéticos , Método Doble Ciego , Combinación de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad
5.
J Pak Med Assoc ; 71(Suppl 5)(8): S21-S25, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34634010

RESUMEN

OBJECTIVE: To compare pre-operative characteristics and peri-operative findings in patients undergoing unilateral total knee arthroplasty (UTKA) and simultaneous bilateral total knee arthroplasty (BTKA). To work out safety criterion for selection of patients for simultaneous BTKA. Methods: Patients undergoing UTKA (39) and BTKA (36) in Department of Orthopaedic Surgery, Combined Military Hospital, Rawalpindi from March 2014 to August 2014 were compared in terms of patient characteristics, underlying pathology, peri-operative blood loss, transfusion requirements and in hospital complications. RESULTS: The mean age of patients undergoing UTKA was 61±11 years and those undergoing BTKA was 64±8 years, with similar male to female ratio (1:1.8) in both groups. Males undergoing BTKA were significantly older than other patients (71±6 years). Primary osteoarthritis was the most common initial diagnosis (59% in UTKA and 89% in BTKA, p<0.05) followed by rheumatoid arthritis. Average blood loss per knee was higher in BTKA procedures but difference did not reach statistical significance. Blood transfusion requirements in BTKA patients not receiving antifibrinolytic agent were significantly higher than in similar UTKA patients (75% vs 17%, p<0.05) but were significantly reduced with peri-operative administration of antifibrolytic therapy (30% BTKA, p<0.05). Complication rates, low in both, were more frequent in BTKA patients with co-morbidities. CONCLUSIONS: In patients requiring bilateral knee replacements, staged total knee replacement [i.e. the two knees are replaced with a gap of at least 3 months] is a safe approach. Unilateral knee replacement is associated with lesser complications and blood transfusion requirements as compared to simultaneous bilateral total knee replacements.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Anciano , Femenino , Humanos , Articulación de la Rodilla , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Complicaciones Posoperatorias/epidemiología , Resultado del Tratamiento
6.
J Pak Med Assoc ; 71(Suppl 5)(8): S94-S98, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34634026

RESUMEN

OBJECTIVE: To clinically assess the efficacy of Platelet rich Plasma (PRP) in improving the functional movement in knee osteoarthritis. Methods: This prospective case series, on 89 patients, was studied in Sindh Rangers Hospital, Karachi, Pakistan from 1st October 2018 to 31st March 2019. The analysis involved all patients aged 30-65 years diagnosed with grade 1, 2 and 3 arthritis. PRP was administered in three doses one month apart, and patients were evaluated for outcome measures after the third month of the third dose of PRP. To measure functional improvement in knee osteoarthritis, the range of motion (ROM), McMaster University Osteoarthritis index (WOMAC), Western Ontario, and Visual analogue scale (VAS) were used. RESULTS: PRP was infused into 89 patients, with a mean age of 61.24±8.92 years. The average pre-treatment WOMAC score was 37.0 ±2.9, and it was lowered to 18.8± 5.2 after PRP (p<0.02). The pre-treatment VAS was 8.42 ±0.84, and it was reduced to 4.91±2.12, indicating mild to moderate pain. Our PRP therapy was appreciated by 63 (70.07%) patients, while 17 (19.1%) were only partly satisfied. However, 9 (10.1%) patients were dissatisfied. CONCLUSIONS: The results of this case series showed that the use of PRP injections for treating osteoarthritis (grade 1 to 3) proved to be successful in terms of improving functional outcomes and reducing pain intensity.


Asunto(s)
Osteoartritis de la Rodilla , Plasma Rico en Plaquetas , Anciano , Humanos , Inyecciones Intraarticulares , Persona de Mediana Edad , Osteoartritis de la Rodilla/terapia , Centros de Atención Terciaria , Resultado del Tratamiento
7.
J Orthop Traumatol ; 22(1): 41, 2021 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-34655357

RESUMEN

BACKGROUND: Valgus deformity of the knee remains a complaint after total hip arthroplasty (THA) among some patients with Crowe type IV hip dysplasia. We aimed to identify the knee alignment in these patients before and after surgery, and to explore the factors contributing to postoperative knee valgus alignment. MATERIALS AND METHODS: We retrospectively reviewed a series of Crowe type IV patients who received THA between February 2010 and May 2019 in our hospital. The patients' medical data were collected from the hospital information system. On both preoperative and postoperative full limb length standing radiographs, the following parameters were measured: hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle, anatomical tibiofemoral angle, anatomical lateral distal femoral angle, femoral neck-shaft angle, pelvic obliquity, limb length, height and lateral distance of hip center, and femoral offset. Univariate and multivariate binary logistic regression were used to identify the factors influencing postoperative knee valgus alignment. RESULTS: A total of 64 Crowe type IV patients (87 hips) were included in the study. Overall, HKA improved from 176.54 ± 3.52° preoperatively to 179.45 ± 4.31° at the last follow-up. Those hips were subdivided into non-valgus group (≥ 177.0°, n = 65) and valgus group (< 177.0°, n = 22) according to postoperative HKA. Only postoperative mLDFA was a significant factor in the multivariate regression model. CONCLUSIONS: The postoperative mLDFA is a major factor related to knee valgus alignment after THA, which combines the preoperative anatomy and surgical reconstruction. Other factors previously published were found to have no significance. LEVEL OF EVIDENCE: III.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Luxación Congénita de la Cadera , Luxación de la Cadera , Osteoartritis de la Rodilla , Fémur/cirugía , Luxación Congénita de la Cadera/cirugía , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Estudios Retrospectivos
8.
Zhongguo Zhen Jiu ; 41(10): 1063-8, 2021 Oct 12.
Artículo en Chino | MEDLINE | ID: mdl-34628735

RESUMEN

OBJECTIVE: To observe the moxibustion sensation and the clinical therapeutic effect of heat-sensitive moxibustion of two different suspension moxibustion methods and imitation moxibustion apparatus on mild to moderate knee osteoarthritis (KOA), and compare the therapeutic effect of different moxibustion methods. METHODS: A total of 90 patients with mild to moderate KOA were randomized into a hand-held group (30 cases, 1 case dropped off), an imitation moxibustion apparatus group (30 cases) and a moxibustion shelf group (30 cases, 1 case dropped off). Ashi point, Dubi (ST 35), Neixiyan (EX-LE 4), Yanglingquan (GB 34), Yinlingquan (SP 9), Liangqiu (ST 34) and Xuehai (SP 10) were selected as the frequent acupoint areas to explore and determine the heat-sensitive acupoints, after that, hand-held suspension moxibustion, suspension moxibustion with imitation moxibustion apparatus and suspension moxibustion with moxibustion shelf were adopted in the 3 groups respectively. The treatment was given once every 2 days, and totally 10-time treatment was required in the 3 groups. The moxibustion sensation (composition of moxibustion sensation, number of moxibustion sensation types in individuals and moxibustion sensation intensity) after each treatment, the visual analogue scale (VAS) score, the Lysholms knee function score and the depth of effusion and thickness of synovial hyperplasia of affected knee joint before and after treatment were observed, and the clinical therapeutic efficacy was compared in the 3 groups. RESULTS: The compositions of moxibustion sensation and numbers of moxibustion sensation types in individuals in the hand-held group and the moxibustion shelf group were richer, the moxibustion sensation intensity was higher than that in the imitation moxibustion apparatus group (P<0.01, P<0.05). After treatment, the VAS scores were decreased, the Lysholms knee function scores were increased compared before treatment in the 3 groups (P<0.01); the VAS score in the hand-held group was lower than the imitation moxibustion apparatus group (P<0.05), the Lysholms knee function scores in the hand-held group and the moxibustion shelf group were higher than the imitation moxibustion apparatus group (P<0.05). After treatment, the depth of effusion and thickness of synovial hyperplasia of affected knee joint were decreased compared before treatment in the 3 groups (P<0.01), and those in the hand-held group and the moxibustion shelf group were lower than the imitation moxibustion apparatus group (P<0.05). The cured and markedly effective rate in the hand-held group was 79.3% (23/29), which was better than 36.7% (11/30) in the imitation moxibuation apparatus group and 58.6% (17/29) in the moxibustion shelf group (P<0.01, P<0.05). CONCLUSION: Heat-sensitive moxibustion can effectively treat knee osteoarthritis, while the different suspension moxibustion methods have an influence on clinical therapeutic effect, hand-held suspension moxibustion has the best efficacy.


Asunto(s)
Moxibustión , Osteoartritis de la Rodilla , Calor , Humanos , Conducta Imitativa , Osteoartritis de la Rodilla/terapia , Sensación , Resultado del Tratamiento
9.
Ann Palliat Med ; 10(9): 9859-9869, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34628912

RESUMEN

BACKGROUND: Knee osteoarthritis (KOA) causes joint pain and dysfunction that severely affects the patient's ability to walk. Arthroscopy combined with intraarticular injection of sodium hyaluronate can slow the development of knee osteoarthritis, but there is a lack of rigorous evidence-based medicine evaluation, and it has not been recognized by some scholars at home and abroad. This paper analyzed the clinical efficacy of arthroscopy combined with intraarticular injection of sodium hyaluronate in slowing knee osteoarthritis based on Lysholm score. METHODS: Randomized control trials of arthroscopy combined with intra-articular injection of sodium hyaluronate in the treatment of KOA on Chinese and English databases were retrieved using the following search terms: "knee osteoarthritis", "arthroscopic debridement of the joint", "articular cavity", and "sodium hyaluronate". The quality of the literature was evaluated using the Rev Man 5.3 software. RESULTS: Twelve literatures were included in the meta-analysis. Regarding Newcastle-Ottawa Scale (NOS) score, of the 12 literatures, 7 literatures (58.33%) scored 6-9 points, 3 literatures (25%) scored 3-5 points, and 2 literatures (16.67%) scored 0-2 points. With a random effects model used for analysis, the Lysholm score after 1 month of combined treatment was significantly higher than that before treatment [mean difference (MD) =30.65, 95% confidence interval (CI): 19.44, 41.86, P<0.01]. Further, after 3 months of combination treatment, the Lysholm score was significantly higher than that before treatment (MD =24.04, 95% CI: 13.75, 34.32, P<0.01), and the same trend was also observed after 6 months (MD =20.41, 95% CI: 14.43, 26.40, P<0.01) and after 12 months (MD =20.86, 95% CI: 8.99, 32.72, P<0.01) of combination treatment. Overall, the combined treatment achieved significantly better clinical therapeutic effects than the single treatments in the control group [odds ratio (OR) =7.51, 95% CI: 4.84, 11.65, P<0.01]. DISCUSSION: This meta-analysis has confirmed that arthroscopy combined with intra-articular injection of sodium hyaluronate demonstrates significant clinical therapeutic effects in the treatment of KOA. This combination treatment can significantly improve knee joint function, relieve clinical symptoms, and improve patients' quality of life.


Asunto(s)
Ácido Hialurónico , Osteoartritis de la Rodilla , Artroscopía , Humanos , Ácido Hialurónico/uso terapéutico , Inyecciones Intraarticulares , Osteoartritis de la Rodilla/tratamiento farmacológico , Calidad de Vida
10.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(5): 877-882, 2021 Oct 18.
Artículo en Chino | MEDLINE | ID: mdl-34650288

RESUMEN

OBJECTIVE: To evaluate the relationship between postoperative knee function and the sagittal position of tibial component in unicompartmental knee arthroplasty (UKA). METHODS: We retrospectively enrolled the patients who underwent UKA from January 2016 to May 2020. They were assigned into 2 groups according to postoperative posterior tibial slope (PTS): the normal PTS group (PTS≥3° and PTS < 8°) and the abnormal PTS group (PTS < 3° or ≥8°). The patients were followed up for at least 12 months. The postoperative Knee Society Clinical Score (KSS-C), Knee Society Functional Score (KSS-F) and knee range of motion (ROM) were compared between the two groups. RESULTS: A total of 72 patients (82 knees) were included with 51 patients (58 knees) in PTS normal group and 21 patients (24 knees) in PTS abnormal group. All the patients were followed up with median of 23.6 months. There was no significant difference in the general data [gender, age, body mass index (BMI)], pre-operative knee range of motion, preoperative KSS-C score and KSS-F score (P > 0.01). The KSS-C score, KSS-F score, and knee range of motion significantly improved after surgery (P < 0.01) for all the patients. The postoperative KSS-C score in normal PTS group (88.76±2.79) was significantly higher than the KSS-C score in abnormal PTS group (84.42±3.35, P < 0.01), but no significant difference between the 2 groups was observed in postoperative KSS-F score and knee range of motion (P > 0.01). In addition, there was no correlation between the change of PTS and postoperative KSS-C score (r=-0.034, 95%CI: -0.247 to 0.186, P = 0.759), KSS-F score (r = -0.014, 95%CI: -0.238 to 0.198, P = 0.901) and knee range of motion (r= 0.045, 95%CI: -0.214 to 0.302, P = 0.686). CONCLUSION: The posterior tibial slope between 3° and < 8° can be recommended to improve knee joint function in mobile UKA, and excessive or insufficient PTS should be avoided.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Osteoartritis de la Rodilla , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento
11.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1221-1226, 2021 Oct 15.
Artículo en Chino | MEDLINE | ID: mdl-34651472

RESUMEN

Lower limb alignment and soft tissue balance are important factors affecting patient satisfaction, clinical functional outcome, and prosthetic long-term survival rate after total knee arthroplasty (TKA). Robot-assisted TKA (rTKA) has the advantages of achieving precise osteotomy and soft tissue balance. However, rTKA under the guidance of classic mechanical alignment principles does not significantly improve the functional outcome after operation. The new TKA alignment principles, such as kinematic alignment (KA) and functional alignment (FA), can better consider the patient's own knee joint morphology and kinematic characteristics, which may help improve the clinical results of TKA. With the help of more objective and accurate soft tissue balance assessment tool such as pressure sensors, KA and FA have been proven to better achieve soft tissue balance. rTKA can achieve non-neutral alignment goals such as KA or FA more accurately and reproducibly. The use of these lower limb alignment and soft tissue balancing strategies will be expected to further increase the patients' satisfaction rate after rTKA.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Osteoartritis de la Rodilla , Robótica , Fenómenos Biomecánicos , Humanos , Articulación de la Rodilla/cirugía , Extremidad Inferior , Osteoartritis de la Rodilla/cirugía
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1251-1258, 2021 Oct 15.
Artículo en Chino | MEDLINE | ID: mdl-34651477

RESUMEN

Objective: To explore the short-term effectiveness of domestic robot-assisted total knee arthroplasty (RATKA) conducted by a prospective randomized controlled trial. Methods: Patients who were scheduled for primary unilateral TKA between October 2020 and December 2020 were eligible in this randomized controlled trial. According to the random number table method, they were allocated to the traditional TKA group and the RATKA group [application of the Yuanhua robotic-assisted TKA (YUANHUA-TKA) system during operation]. A total of 63 patients met the selection criteria were enrolled in the study, of which 3 cases voluntarily withdrew from the trial. And finally 60 cases were enrolled for analysis; of which 28 cases were in the RATKA group and 32 cases were in the traditional TKA group. There was no significant difference in gender, age, body mass index, American Society of Anesthesiologists (ASA) classification, duration of osteoarthritis, surgical side, and preoperative knee visual analogue scale (VAS) resting and motion scores, joint range of motion (ROM), Knee Society Score (KSS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain, stiffness, and function scores, hip-knee-ankle angle (HKA) deviation ( P>0.05). The operation time and intraoperative blood loss of the two groups were recorded. Knee joint VAS resting and motion scores, ROM, KSS scores, and WOMAC pain, stiffness, and function scores were used to evaluate the knee joint function and pain. Gait analysis (flexion and extension angle) was conducted at 3 months after operation. The full length X-ray films of lower limbs and anteroposterior and lateral X-ray films of knee joint were taken. The HKA deviation, lateral tibia component (LTC), frontal femoral component (FFC), frontal tibia component (FTC), and lateral femoral component (LFC) measured on the X-ray films were used to evaluat the lower limb alignment and prosthesis position. Results: The operations of the two groups completed successfully; the incisions healed by first intention after operation, and no complications related to the operation occurred. The operation time of the RATKA group was significantly longer than that of the traditional TKA group ( t=12.253, P=0.001), and there was no significant difference in intraoperative blood loss between the two groups ( t=3.382, P=0.071). All patients were followed up 3 months. At 3 months after operation, the knee joint VAS resting and motion scores, ROM, KSS scores, and WOMAC pain, stiffness, and function scores improved significantly when compared with preoperatively in the two groups ( P<0.05); there was no significant difference of pre- and post-operative indicators between the two groups ( P>0.05). The gait analysis showed that the flexion and extension angle in the RATKA group was significantly bigger than that in the traditional TKA group ( t=9.469, P=0.003). X-ray films reexamination at 3 months after operation showed that the prostheses in the two groups were in good positions, and there was no adverse events such as prosthesis loosening or sinking. There were significant differences in the HKA deviation between pre- and post-operation in the two groups ( P<0.05), but the difference of pre- and post-operative HKA deviation between the two groups was not significant ( t=1.254, P=0.267). There was no significant difference in FFC, FTC, and LFC between the two groups ( P>0.05); the LTC was significantly smaller in the RATKA group than in the traditional TKA group ( t=17.819, P=0.000), which was closer to the ideal value. Conclusion: YUANHUA-TKA system can improve the accuracy of osteotomy and the prosthesis placement as well as the lower limb alignment. Its short-term effectiveness can be promised, but long-term effectiveness needs to be further studied.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Osteoartritis de la Rodilla , Robótica , Humanos , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Estudios Prospectivos , Rango del Movimiento Articular , Resultado del Tratamiento
13.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1259-1264, 2021 Oct 15.
Artículo en Chino | MEDLINE | ID: mdl-34651478

RESUMEN

Objective: To investigate the effect of Navio robot-assisted unicompartmental knee arthroplasty (UKA) on the biomechanics of knee joint during sitting-up movement, and to determine whether UKA can maintain the biomechanical characteristics of knee joint. Methods: The clinical data of 8 patients with medial compartment osteoarthritis treated with medial fixed platform of Navio robot-assisted UKA between January 2018 and January 2019 and had the complete follow-up data were retrospectively analyzed. There were 4 males and 4 females; the age ranged from 58 to 67 years, with an average of 62.3 years. The disease duration was 6-18 months, with an average of 13 months. The varus deformity ranged from 4° to 6°, with an average of 5°; the knee flexion range of motion was 0°-130°, with an average of 110°. All patients had no extension limitation. The imaging data of bilateral knees during sitting-up movement were collected by biplane C-arm X-ray machine at 3 weeks before operation and 7 months after operation. The three-dimensional models of femur and tibia were established by dual-energy CT scanning, and the three-dimensional models of femur and tibia were matched and synchronized with the femur and tibia in X-ray film by automatic matching tracer software. The biomechanical parameters of femur and tibia were measured, including internal rotation/external rotation, varus/valgus, forward/backward displacement of medial and lateral tibia contact center, and lateral compartment joint space. Results: Eight patients were followed up 5-7 months, with an average of 6.4 months. In the comparison of the affected side before and after operation, except for the difference of varus/valgus which was significant ( t=4.959, P=0.002), the differences in other indicators was not significant ( P>0.05). There were significant differences in varus/valgus and internal rotation/external rotation between healthy and affected sides at 3 weeks before operation ( P<0.05), and the differences in other indicators was not significant ( P>0.05). At 7 months after operation, the difference in the forward and backward displacement of medial tibia contact center was significant ( t=3.798, P=0.007), and the differences in other indicators was not significant ( P>0.05). Conclusion: UKA can effectively correct the varus and valgus of the knee joint, and restore the rotational biomechanical characteristics of the affected knee joint. It does not affect the establishment of the lateral compartment joint space, but the medial and lateral tibia contact center still changes.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Osteoartritis de la Rodilla , Robótica , Anciano , Fenómenos Biomecánicos , Femenino , Fémur/cirugía , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Rango del Movimiento Articular , Estudios Retrospectivos , Tibia/cirugía
14.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1273-1280, 2021 Oct 15.
Artículo en Chino | MEDLINE | ID: mdl-34651480

RESUMEN

Objective: To estimate the early effectivenss of computer navigation-assisted total knee arthroplasty (TKA) by comparing with traditional TKA. Methods: The clinical data of 89 patients (100 knees) underwent primary TKA between October 2017 and July 2018 were analyzed retrospectively, including 44 patients (50 knees) who completed the TKA under the computer-assisted navigation system as the navigation group and 45 patients (50 knees) treated with traditional TKA as the control group. There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, diagnosis, side, disease duration, Kellgren-Lawrence classification of osteoarthritis, and preoperative American Hospital for Special Surgery (HSS) score, range of motion (ROM), hip-knee-ankle angle (HKA) deviation. The operation time, incision length, difference in hemoglobin before and after operation, postoperative hospital stay, and the complications were recorded and compared between the two groups. The HSS score, ROM, and joint forgetting score (FJS-12) were used to evaluate knee joint function in all patients. Unilateral patients also underwent postoperative time of up and go test and short physical performance battery (SPPB) test. At 1 day after operation, the HKA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), sagittal femoral component angle (sFCA), and sagittal tibial component angle (sTCA) were measured and calculated the difference between the above index and the target value (deviation); and the joint line convergence angle (JLCA) was also measured. Results: The operations of the two groups were successfully completed, and the incisions healed by first intention. The operation time and incision length of the navigation group were longer than those of the control group ( P<0.05); the difference in difference of hemoglobin before and after the operation and the postoperative hospital stay between groups was not significant ( P>0.05). Patients in the two groups were followed up 27-40 months, with an average of 33.6 months. Posterior tibial vein thrombosis occurred in 1 case in each of the two groups, and 1 case in the control group experienced repeated knee joint swelling. The HSS scores of the two groups gradually increased after operation ( P<0.05); HSS scores in the navigation group at 1 and 2 years after operation, and knee ROM and FJS-12 scores at 2 years were significantly higher than those in the control group ( P<0.05). There was no significant difference in the postoperative time of up and go test and SPPB results between the two groups at 7 days after operation ( P>0.05); the postoperative time of up and go test of the navigation group was shorter than that of the control group at 2 years ( t=-2.226, P=0.029), but there was no significant difference in SPPB ( t=0.429, P=0.669). X-ray film measurement at 1 day after operation showed that the deviation of HKA after TKA in the navigation group was smaller than that of the control group ( t=-7.392, P=0.000); among them, the HKA deviations of 50 knees (100%) in the navigation group and 36 knees (72%) in the control group were less than 3°, showing significant difference between the two groups ( χ 2=16.279, P=0.000). The JLCA and the deviations of mLDFA, mMPTA, sFCA, and sTCA in the navigation group were smaller than those in the control group ( P<0.05). Conclusion: Compared with traditional TKA, computer navigation-assisted TKA can obtain more accurate prosthesis implantation position and lower limb force line and better early effectiveness. But there is a certain learning curve, and the operation time and incision length would be extended in the early stage of technology application.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Osteoartritis de la Rodilla , Computadores , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Estudios Retrospectivos
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1281-1285, 2021 Oct 15.
Artículo en Chino | MEDLINE | ID: mdl-34651481

RESUMEN

Objective: To investigate the short-term effectiveness of novel computer navigation system (Knee 3 software; Brainlab, Germany) assisted total knee arthroplasty (TKA). Methods: Between July 2020 and December 2020, 19 patients underwent unilateral TKA assisted with Knee 3 software. There were 4 males and 15 females. The mean age was 66.3 years (range, 52-79 years). Eighteen patients were diagnosed with osteoarthritis and 1 patient with rheumatoid arthritis. Sixteen patients had varus knees and 3 patients had valgus knees. Preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain, stiffness, function, and total scores were 12.4±3.4, 2 (1, 4), 22 (18, 29), and 37 (29, 43), respectively. Intraoperatively, the medial and lateral gaps in knee extension and in 90° of knee flexion were recorded. The operation time, intraoperative blood loss, blood transfusion, and complications were recorded. The hip-knee-ankle angle (HKA), lateral distal femoral angle, and medial proximal tibial angle were measured to evaluate lower limb alignment and prostheses's alignment using X-ray films at 6 weeks after operation. Patient's satisfaction rate and WOMAC pain, stiffness, function, and total scores were investigated. Results: Eighteen patients (94.7%) had medial- lateral gap balancing in knee extension, 18 patients (94.7%) had medial-lateral gap balancing in 90° of knee flexion, 19 patients (100%) had medial gap balancing between knee extension and 90° of knee flexion, and 18 patients (94.7%) had lateral gap balancing between knee extension and 90° of knee flexion. The mean operation time was 126 minutes (range, 100-200 minutes). The mean intraoperative blood loss was 205 mL (range, 100-400 mL). Patients were followed up 4-8 months, with an average of 6.2 months. Postoperative complications included 1 deep vein thrombosis of lower extremities and 1 cerebral infarction. X-ray films showed that the mean HKA, lateral distal femoral angle, and medial proximal tibial angle were 179.8° (range, 178°-182°), 83.5° (range, 80°-87°), and 89.5° (range, 87°-93°), respectively. At last follow-up, WOMAC pain, stiffness, function, and total scores were 3.6±1.9, 0 (0, 2), 4 (2, 6), and 9 (5, 10), respectively, which improved when compared with preoperative scores ( P<0.05). Twelve patients were very satisfied with the operation results and 7 patients were satisfied with the operation results. The overall satisfaction rate was 100%. Conclusion: Knee 3 software can help to obtain good gap balancing and optimal lower limb alignment, with high patient's satisfaction and good short-term effecectiveness.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Anciano , Computadores , Femenino , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Masculino , Osteoartritis de la Rodilla/cirugía , Rango del Movimiento Articular , Tibia/cirugía
16.
J Orthop Sports Phys Ther ; 51(10): 492-502, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34592828

RESUMEN

OBJECTIVE: To report whether changes in knee joint movement parameters recorded during functional activities relate to change in activity limitation or pain after an exercise intervention in people with knee osteoarthritis (OA). DESIGN: Etiology systematic review. LITERATURE SEARCH: Four databases (MEDLINE, Embase, CINAHL, and AMED) were searched up to January 22, 2021. STUDY SELECTION CRITERIA: Randomized controlled trials or cohort studies of exercise interventions for people with knee OA that assessed change in knee joint movement parameters (moments, kinematics, or muscle activity) and clinical outcomes (activity limitation or pain). DATA SYNTHESIS: A descriptive synthesis of functional activities, movement parameters, and clinical outcomes. RESULTS: From 3182 articles, 22 studies met the inclusion criteria, and almost all were of low quality. Gait was the only investigated functional activity. After exercise, gait parameters changed 26% of the time, and clinical outcomes improved 90% of the time. A relationship between group-level changes in gait parameters and clinical outcomes occurred 24.5% of the time. Two studies directly investigated an individual-level relationship, reporting only 1 significant association out of 8 correlations tested. CONCLUSION: Most studies reported no change in gait-related movement parameters despite improvement in clinical outcomes, challenging the belief that changing movement parameters is always clinically important in people with knee OA. J Orthop Sports Phys Ther 2021;51(10):492-502. doi:10.2519/jospt.2021.10418.


Asunto(s)
Artralgia/fisiopatología , Artralgia/rehabilitación , Terapia por Ejercicio/métodos , Marcha/fisiología , Movimiento/fisiología , Osteoartritis de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/rehabilitación , Fenómenos Biomecánicos , Humanos , Dimensión del Dolor
17.
Acta Ortop Mex ; 35(1): 23-27, 2021.
Artículo en Español | MEDLINE | ID: mdl-34480435

RESUMEN

INTRODUCTION: Total navigated knee replacement uses a computer-guided system, which provides immediate information on pre-cut trans-operative conditions of the knee, in relation to pelvic limb alignment. MATERIAL AND METHODS: Observational, descriptive study conducted from March 2003 to February 2019. Total bilateral knee replacement was performed at the same time surgically by a surgeon, evaluating function and pain on the WOMAC, EVA, and range of motion scores of both knees. Two groups of patients were studied: the first represents presurgical and the second post-surgical. Student's t-test and 2 were applied for statistical analysis. RESULTS: 31 patients (62 prostheses), 83.9% of the female sex and 16.1% male, average age 67.32 years, average follow-up 6.55 years (± 3.8) were studied. It was identified that 100% of the patients in both knees have a deviation between 0o and 2o measured in the mechanical axis. The WOMAC scale showed an average of 22.71 ± 3.34 presurgical and 4.16 ± 1.84) post-surgical, with statistically significant differences. The average analog visual scale was 9.06 ± 0.814 presurgical and 2.35 ± 1.427 post-surgical. CONCLUSIONS: This technique is reliable, safe and satisfactory. Excellent clinical and radiographic results were evident regarding the positioning of prosthetic components.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Cirugía Asistida por Computador , Anciano , Computadores , Femenino , Humanos , Articulación de la Rodilla/cirugía , Masculino , Tempo Operativo , Osteoartritis de la Rodilla/cirugía , Resultado del Tratamiento
18.
BMC Musculoskelet Disord ; 22(1): 754, 2021 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-34479525

RESUMEN

BACKGROUND: Patients' perceptions and beliefs of disease could be influenced by their lifestyle and culture. Although it is important to understand their perceptions and beliefs toward disease to prevent and manage osteoarthritis (OA) through conservative care, this topic has not been investigated in Japanese people with knee OA. Therefore, this qualitative study aims to clarify how Japanese patients with knee OA experience and perceive their symptoms and disabilities, and how they face them during conservative care. METHODS: Participants were recruited by purposive sampling. Face-to-face, semi-structured interviews were conducted with nine patients (2 men and 7 women; mean age, 74.3 ± 5.5 years) with knee OA until data saturation was reached. Interview data comprised participants' accounts of particular personal experiences of living with knee OA, including their perceptions and attitudes toward knee OA-related symptoms and disabilities. Two physiotherapists (one with extensive experience conducting qualitative studies) and four physiotherapy students conducted the interviews. Recorded interview data were transcribed verbatim in Japanese. Data analysis, including developing a coding scheme, was conducted based on a grounded theory approach. RESULTS: Two core categories were extracted from the data: 'Negative experiences' and 'Coping with difficulties'. 'Negative experiences' included three main categories: 'Self-analysis on the cause of knee OA', 'Difficulties in daily life due to knee symptoms', and 'Psychological barrier'. 'Coping with difficulties' included three main categories: 'How to deal with knee pain and difficulty in moving', 'Information considered useful to cope with knee OA' and 'Importance of connecting with others'. Japanese patients with knee OA desired evidence-based information and to connect with other people in the same situation to solve problems related to their condition. CONCLUSIONS: To address patients' concerns, medical professionals should conduct careful interviews and obtain information regarding patients' past experiences, and understand their experiences related to knee OA. Symptoms and difficulties experienced by patients with knee OA should be managed by evidence-based information integrating their perceptions and beliefs toward knee OA.


Asunto(s)
Osteoartritis de la Rodilla , Anciano , Femenino , Humanos , Japón/epidemiología , Masculino , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/terapia , Percepción , Modalidades de Fisioterapia , Investigación Cualitativa
19.
Zhongguo Zhen Jiu ; 41(9): 1010-4, 2021 Sep 12.
Artículo en Chino | MEDLINE | ID: mdl-34491651

RESUMEN

OBJECTIVE: To compare the effect between acupoint application of Zhanjin Huoxue formula combined with local cold compress and simple local cold compress on swelling and pain after knee arthroscopy in patients with knee osteoarthritis (KOA). METHODS: A total of 62 KOA patients with knee swelling after knee arthroscopy were randomly divided into an observation group and a control group, 31 cases in each group. In the control group, cold compress was adopted after surgery, 3 times a day. On the basis of the treatment as the control group, acupoint application of Zhanjin Huoxue formula (angelicae sinensis radix, chuanxiong rhizome, cinnamon twig, poria, etc.) was applied at Liangqiu (ST 34), Xuehai (SP 10), Zusanli (ST 36), Fenglong (ST 40), Sanyinjiao (SP 6), Yinlingquan (SP 9), Yanglingquan (GB 34), Xuanzhong (GB 39) on the affected side in the observation group, 4 h each time, 2 times a day. The treatment was given 7 days in both groups. Before treatment and 1,3,5 and 7 days into treatment, the pain visual analogue scale (VAS) score and swelling value of knee joint (2 cm above the patella upper pole, patella midline, 5 cm below the patella lower pole) were compared in the two groups. RESULTS: The VAS scores 3, 5 and 7 days into treatment were lower than those before treatment in the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). The swelling values of 2 cm above the patella upper pole 3, 5 and 7 days into treatment were lower those before treatment in the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). The swelling values of patella midline 1, 3, 5 and 7 days into treatment were lower than those before treatment in the two groups (P<0.05), and except for 1 day into treatment, those in the observation group were lower than the control group (P<0.05). The swelling values of 5 cm below the patella lower pole 1 day into treatment in the observation group and 3, 5 and 7 days into treatment in the two groups were lower those before treatment (P<0.05), and except for 1 day into treatment, those in the observation group were lower than the control group (P<0.05). The total effective rate in the observation group was 93.5% (29/31), which was higher than 74.2% (23/31) in the control group (P<0.05). CONCLUSION: Acupoint application of Zhanjin Huoxue formula combined with cold compress could effectively improve the knee joint swelling and pain after arthroscopy in KOA patients, and the curative effect is better than simple cold compress.


Asunto(s)
Osteoartritis de la Rodilla , Puntos de Acupuntura , Artroscopía , Humanos , Articulación de la Rodilla , Osteoartritis de la Rodilla/terapia , Dolor , Resultado del Tratamiento
20.
Zhongguo Zhen Jiu ; 41(9): 1045-8, 2021 Sep 12.
Artículo en Chino | MEDLINE | ID: mdl-34491656

RESUMEN

Strengthening the compliance is conductive to the quality improvement of clinical trial of acupuncture and moxibustion. In terms to planning behavior and influencing factors of loyalty, the questionnaire was conducted among 200 participants on the compliance of clinical trial on knee osteoarthritis treated with acupuncture. The results showed that the subjective norms and perceptual behavior control of subjects affected their compliance in the trial. Medical service compensation became the primary factor of the subjects' loyalty, which further affected their compliance in the trial. It is suggested that the compliance should be managed according to the characteristics of different clinical researches, and the feasible medical service compensation scheme should be designed in advance by actively focusing on the subjects' features.


Asunto(s)
Terapia por Acupuntura , Moxibustión , Osteoartritis de la Rodilla , Humanos , Osteoartritis de la Rodilla/terapia , Encuestas y Cuestionarios
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