RESUMO
Objective:To analyze the effect of patellar tilt angle on postoperative outcomes after total knee arthroplasty (TKA) without patella resurfacing.Methods:A total of 143 patients with end-stage knee osteoarthritis who underwent TKA without patellar replacement in the First Affiliated Hospital of Nanjing Medical University from October 2020 to October 2021 were retrospectively analyzed. There were 32 males and 111 females, aged 68.44±6.79 years (range, 52-86 years). Patients were divided into three groups according to the postoperative patellar tilt angle: tilt angle<5° was the mild tilt group (97 cases), 5°≤tilt angle<10° was the moderate tilt group (31 cases), and tilt angle≥10° was the severe tilt group (15 cases). All patients were followed up in the outpatient clinic at 3, 6 and 12 months after surgery, and knee visual analogue score (VAS), Hospital for Special Surgery (HSS) score and patella Feller score were observed and recorded to compare the postoperative knee pain and function of patients in different patella tilt groups.Results:All patients were followed up for 1.16±0.23 years (range, 1.0-2.0 years). There was no significant difference in baseline data between the groups. There were significant differences in the intra-group comparison of the VAS score before and after surgery among the three groups ( F=51.12, P<0.001; F=36.90, P<0.001; F=15.76, P<0.001). The VAS scores at 3, 6 and 12 months after operation were significantly lower than those before operation ( P<0.05). The knee VAS of the severe group was higher than that of the mild and moderate groups at 3, 6 and 12 months after surgery, and the difference was statistically significant ( P<0.05). There were statistically significant differences in knee HSS scores before and after surgery among the three groups ( F=81.12, P<0.001; F=36.05, P<0.001; F=32.93, P<0.001). The knee HSS scores at 3, 6 and 12 months after surgery were higher than those before surgery, and the difference was statistically significant ( P<0.05). The knee HSS scores of the severe tilt group at 3, 6 and 12 months after surgery were lower than those of the mild and moderate groups, and the difference was statistically significant ( P<0.05). There were statistically significant differences in the intra-group comparison of the patella Feller score before and after surgery among the three groups ( F=88.81, P<0.001; F=49.59, P<0.001; F=37.40, P<0.001). The patellar Feller score at 3, 6 and 12 months after surgery was higher than that before surgery, and the difference was statistically significant ( P<0.05). The patellar Feller score of the severe group at 3, 6 and 12 months after surgery was lower than that of the mild and moderate groups, and the difference was statistically significant ( P<0.05). Conclusion:Patellar tilt angle after TKA without patellar resurfacing will increase knee pain and limit joint function.
RESUMO
Objective:To investigate the effects of periacetabular osteotomy (PAO) combined with hip arthroscopy in treating adult developmental dysplasia of the hip (DDH).Methods:A total of sixty-one patients with DDH who received PAO surgery were enrolled in the present retrospective study. Of all patients, forty of them were treated by PAO combined with open arthrotomy from December 2015 to June 2018 as arthrotomy group. There were three males and 37 females in this group. Twenty-one DDH patients, including 2 males and 19 females, were treated by PAO combined with hip arthroscopy from July 2018 to June 2019 as arthroscopy group. The average ages were 31.08±11.24 and 33.25±11.70 years, respectively. Radiological parameters before and after surgery were compared between two groups. Modified Harris hip score (mHHS), nonarthritic hip score (NAHS), hip outcome score activity of daily living scale (HOS-ADL) at 6 months and 12 months postoperatively were compared between two groups.Results:The preoperative LCE (lateral center edge) angle, ACE (anterior center edge) angle, T?nnis angle, extrusion index in each group were 8.53°±9.09° vs. 9.15°±10.86°, 13.69°±12.43° vs. 7.18°±15.74°, 20.12°±6.24° vs. 22.13°±8.86° and 38.97%±7.55% vs. 37.64%±10.01% respectively. There was no statistical difference between two groups. Cam deformity (α angle >50°) existed in 17 patients (81%, 17/21) in arthroscopy group and in 31 patients (78%, 31/40) in arthrotomy group without significant difference between two groups (χ 2=0.096, P=0.756). At 12 months follow-up, all radiological parameters were improved from those before surgery. The LCE angle, ACE angle, T?nnis angle, extrusion index were 34.29°±5.07° vs. 32.76°±9.48°, 32.87°±4.23° vs. 30.26°±5.39°, -1.82°±5.88° vs. 2.16°±7.89° and 16.81%±4.53% vs. 18.20%±9.16% between groups without significant difference. The preoperative mHHS, NAHS, HOS-ADL in two groups were 60.38±12.19, 50.90±8.54, 72.23±11.86 and 60.00±13.53, 52.55±7.92, 72.70±12.18 respectively. At 12 months, there was no statistical difference in mHHS between the two groups (87.90±4.34 vs. 86.50±5.11, t=1.135, P=0.261). The NAHS and HOS-ADL in arthroscopy group were higher than those in arthrotomy group at 12 months follow-up (88.71±4.49 vs. 82.17±5.23, t=6.066, P<0.001; 90.33±2.71 vs. 87.12±3.33, t=3.800, P<0.001). Conclusion:During PAO in treating DDH, better short-term clinical results could be achieved when it combined with hip arthroscopy.
