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1.
Acta Chir Orthop Traumatol Cech ; 87(5): 356-359, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-33146605

RESUMO

The anterior cruciate ligament reconstruction is currently one of the most commonly performed arthroscopic procedures of knee joint. Overall, it is a reliable and sophisticated procedure associated with a relatively low complication rate. In the available literature, less severe complications are reported in 3-7% of cases. The most frequent complications are intractable pain not manageable using analgesic therapy (6.7%), hemarthrosis requiring puncture (4.4%), fever (3.2%) and other complications related in particular to immobilisation (1.2%). The percentage of severe complications is very low (less than 1%). These include deep vein thrombosis (0.6%), cellulitis (0.6%) and infectious complications requiring arthroscopic or surgical revision (0.3%). Vascular injuries around the knee joint are rare and are described in case studies only. The authors present a patient with reduced mobility of the knee and significant pain, haematoma and swelling in the calf, which developed within a short time span after the reconstruction of anterior cruciate ligament. It was caused by bleeding into the medial gastrocnemius muscle. This rare vascular complication was diagnosed angiographically and coiling was used to stop the arterial bleeding, once deep vein thrombosis, congenital haemostasis, gonitis and compartment syndrome were excluded. Key words: ACL reconstruction, angiography, anterior cruciate ligament, arthroscopy, inferior medial genicular artery, vascular complications.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Artroscopia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia
2.
Bone Joint J ; 102-B(11): 1511-1518, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135443

RESUMO

AIMS: The aim of this study was to compare robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) in order to determine the changes in the anatomy of the knee and alignment of the lower limb following surgery. METHODS: An analysis of 38 patients who underwent TKA and 32 who underwent bi-UKA was performed as a secondary study from a prospective, single-centre, randomized controlled trial. CT imaging was used to measure coronal, sagittal, and axial alignment of the knee preoperatively and at three months postoperatively to determine changes in anatomy that had occurred as a result of the surgery. The hip-knee-ankle angle (HKAA) was also measured to identify any differences between the two groups. RESULTS: The pre- to postoperative changes in joint anatomy were significantly less in patients undergoing bi-UKA in all three planes in both the femur and tibia, except for femoral sagittal component orientation in which there was no difference. Overall, for the six parameters of alignment (three femoral and three tibial), 47% of bi-UKAs and 24% TKAs had a change of < 2° (p = 0.045). The change in HKAA towards neutral in varus and valgus knees was significantly less in patients undergoing bi-UKA compared with those undergoing TKA (p < 0.001). Alignment was neutral in those undergoing TKA (mean 179.5° (SD 3.2°)) while those undergoing bi-UKA had mild residual varus or valgus alignment (mean 177.8° (SD 3.4°)) (p < 0.001). CONCLUSION: Robotic-assisted, cruciate-sparing bi-UKA maintains the natural anatomy of the knee in the coronal, sagittal, and axial planes better, and may therefore preserve normal joint kinematics, compared with a mechanically aligned TKA. This includes preservation of coronal joint line obliquity. HKAA alignment was corrected towards neutral significantly less in patients undergoing bi-UKA, which may represent restoration of the pre-disease constitutional alignment (p < 0.001). Cite this article: Bone Joint J 2020;102-B(11):1511-1518.


Assuntos
Artroplastia do Joelho , Articulação do Joelho/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Fenômenos Biomecânicos , Mau Alinhamento Ósseo/prevenção & controle , Feminino , Fêmur/cirurgia , Humanos , Articulação do Joelho/anatomia & histologia , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tíbia/cirurgia
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1369-1375, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191692

RESUMO

Objective: To explore the gait trajectory characteristics and effectiveness after unicompartmental knee arthroplasty (UKA). Methods: Thirty patients (30 knees) with anterior medial compartment osteoarthritis who were treated with UKA between January 2017 and December 2018 were selected as subjects (UKA group). According to age, gender, and side, 30 patients (30 knees) with knee osteoarthritis treated with total knee arthroplasty (TKA) were selected as control (TKA group). In addition to the range of motion (ROM) before operation showing significant difference between the two groups ( t=4.25, P=0.00), there was no significant difference in gender, age, disease duration, sides, body mass index, and preoperative hip-knee-ankle angle (HKA), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between the two groups ( P>0.05). The incision length, drainage volume within 24 hours after operation, and the changes of hemoglobin and albumin were recorded. The WOMAC score, ROM, and HKA before and after operation were compared between the two groups. At 1 year after operation, the gait trajectory characteristics of two groups were analyzed by Vicon three-dimensional gait capture system, and the absolute symmetry index (ASI) of the lower limbs of the two groups was calculated. Results: The incisions of the two groups healed by first intention, with no complications. The incision length, drainage volume within 24 hours, and the changes of hemoglobin and albumin after operation in the UKA group were significantly smaller than those in the control group ( P<0.05). All patients were followed up completely, the follow-up time ranged from 13 to 20 months of UKA group (mean, 18 months) and 16 to 24 months of control group (mean, 20 months). The imaging review showed that the lower limb alignment of the two groups were restored to a neutral position, and the position of prosthesis was good. At 1 year after operation, the WOMAC score, HKA, and ROM of two groups were significantly improved when compared with those before operation ( P<0.05); the postoperative WOMAC score and ROM of the UKA group were significantly better than those of the control group ( P<0.05), and there was no significant difference in HKA between the two groups ( t=1.54, P=0.13). Gait analysis at 1 year after operation showed that the walking speed, stride length, knee extension at mid-stance, and flexion at swing in the UKA group were significantly better than those in the TKA group ( P<0.05); there was no significant difference in cadence, knee flexion at initial contact, and knee flexion at loading response between the two groups ( P>0.05). The ASI of bilateral knee flexion in the UKA group was significantly greater than that in the TKA group during the initial contact and loading response period ( P<0.05). Conclusion: Compared with TKA, UKA has the advantages of small incision, less blood loss, and quicker functional recovery. The early gait after UKA is mainly manifested as the increase in walking speed, stride length, knee flexion at swing, and extension at mid-stance phase. From the analysis of gait symmetry, during the initial contact and loading response phase, the operation side after UKA undertakes more shock absorption and joint stabilization functions than the contralateral side.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Marcha , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular , Resultado do Tratamento
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1376-1381, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191693

RESUMO

Objective: To evaluate the performance, safety, and precision of the Yuanhua robotic-assisted total knee arthroplasty system (YUANHUA-TKA) through animal experiments, which will provide reference data for human clinical trials. Methods: Six 18-month-old goats, weighing 30-35 kg, were used in this study. The experimental study was divided into two parts: the preoperative planning and intraoperative bone resection. CT scans of the goats' lower extremities were firstly performed before the experiments. Then the CT scans were segmented to generate the femoral and tibial three-dimensional (3D) models in the YUANHUA-TKA system. The volumes and angles of each resection plane on the femur and tibia were planned. The bone resection was finally implemented under the assistance of the YUANHUA-TKA system. After completing all bone resections, the lower extremities of each goat were taken to have CT scans. By comparing the femoral and tibial 3D models before and after the experiments, the actual bone resection volumes and angles were calculated and compared with the preoperative values. Results: During the experiments, no abnormal bleeding was found; the YUANHUA-TKA system ran smoothly and stably and was able to stop moving and keep the osteotomy in the safe zone all the time. After the experiment, the resection planes were observed immediately and found to be quite flat. There was no significant difference between the planned and actual osteotomy thickness and osteotomy angle ( P>0.05); the error of the osteotomy thickness was less than 1 mm, and the error of the osteotomy angle was less than 2°. Conclusion: The YUANHUA-TKA system can assist the surgeons to perform osteotomy following the planned thickness and angle values. It is expected to assist surgeons to implement more accurate and efficient osteotomy in the future clinical applications.


Assuntos
Experimentação Animal , Artroplastia do Joelho , Osteoartrite do Joelho , Robótica , Cirurgia Assistida por Computador , Animais , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
5.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1233-1237, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063485

RESUMO

Objective: To investigate the technique of optimizing the location of femoral attachment in medial patellofemoral ligament (MPFL) reconstruction assisted with arthroscopy and evaluate the effectiveness. Methods: Between January 2014 and September 2018, 35 patients with patellar dislocation were admitted. There were 14 males and 21 females with an average age of 22.6 years (range, 16-38 years). All patients had a history of knee sprain. The disease duration ranged from 1 to 7 days (mean, 2.8 days). Patellar dislocation occurred 2-4 times (mean, 2.5 times). The preoperative Lysholm score and Kujala score were 47.60±11.24 and 48.37±9.79, respectively. The patellar congruence angle was (31.40±6.81)°, the patellar tilt angle was (29.95±5.44)°, the lateral patellofemoral angle was (-11.46±5.18)°, and the tibial tubercle-trochlear groove distance was (16.66±1.28) mm. All patients were treated by MPFL reconstruction with the semitendinosus tendon under arthroscopy. During operation, the suture anchors were inserted into the midpoint and the 1/3 point of superomedial edge of the patella. Then, the femoral tunnels were created in medial femoral condyle through limited excision. For tendon fixation, the Kirschner wires were inserted into adductor tubercle, medial epicondyle of femur, and the midpoint between the two points, as well as the anteriorly and posteriorly. Afterwards, the changes of ligament length and tension, patellar tracking, and the relationship of patella and femoral trochlea were evaluated, thereby determining the optimized femoral attachment for MPFL reconstruction. Finally, the patellar congruence angle, patellar tilt angle, and lateral patellofemoral angle were measured by imaging to assess the relationship of patella and femoral trochlea. Moreover, Lysholm score and Kujala score were used to evaluate the knee joint function. Results: All incisions healed by first intention without infection. All patients were followed up 12-18 months (mean, 15.4 months). At 12 months, the Lysholm score was 94.40±3.99 and the Kujala score was 92.28±4.13, which were significant higher than those before operation ( P<0.05). No patellar dislocation occurred during follow-up. At 12 months, the patellar congruence angle was (6.57±4.59)°, the patellar tilt angle was (9.73±2.82)°, the lateral patellofemoral angle was (7.14±4.63)°, which were superior to those before operation ( P<0.05). Conclusion: During the MPFL reconstruction under arthroscopy, a higher positioning accuracy for the femoral attachment and satisfactory effectiveness can be obtained by evaluating MPFL length and tension, patellofemoral joint kinematics, and patellar tracking.


Assuntos
Luxação Patelar , Adolescente , Adulto , Artroscopia , Feminino , Humanos , Articulação do Joelho/cirurgia , Ligamentos Articulares/cirurgia , Masculino , Patela , Luxação Patelar/cirurgia , Adulto Jovem
6.
Arthroscopy ; 36(10): 2728-2730, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33039043

RESUMO

The posterior tibial slope (PTS), as part of the complex 3-dimensional bony knee morphology, has been a topic of interest for many years but has recently become a hot topic in the scope of reconstructive knee ligament surgery. Biomechanical and clinical evidence suggests that the PTS is an independent and well-accepted risk factor for primary and recurrent anterior cruciate ligament (ACL) injuries. As part of an individualized approach to anatomic ACL reconstruction, the PTS should be respected, and if necessary, addressed, which is especially true for the treatment of multiple failed ACL reconstructions.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Osteotomia , Sobrevivência , Tíbia/cirurgia
7.
BMJ ; 371: m3576, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33051212

RESUMO

OBJECTIVE: To evaluate whether a progressive course of outpatient physiotherapy offers superior outcomes to a single physiotherapy review and home exercise based intervention when targeted at patients with a predicted poor outcome after total knee arthroplasty. DESIGN: Parallel group randomised controlled trial. SETTING: 13 secondary and tertiary care centres in the UK providing postoperative physiotherapy. PARTICIPANTS: 334 participants with knee osteoarthritis who were defined as at risk of a poor outcome after total knee arthroplasty, based on the Oxford knee score, at six weeks postoperatively. 163 were allocated to therapist led outpatient rehabilitation and 171 to a home exercise based protocol. INTERVENTIONS: All participants were reviewed by a physiotherapist and commenced 18 sessions of rehabilitation over six weeks, either as therapist led outpatient rehabilitation (progressive goal oriented functional rehabilitation protocol, modified weekly in one-one contact sessions) or as physiotherapy review followed by a home exercise based regimen (without progressive input from a physiotherapist). MAIN OUTCOME MEASURES: Primary outcome was Oxford knee score at 52 weeks, with a 4 point difference between groups considered to be clinically meaningful. Secondary outcomes included additional patient reported outcome measures of pain and function at 14, 26, and 52 weeks post-surgery. RESULTS: 334 patients were randomised. Eight were lost to follow-up. Intervention compliance was more than 85%. The between group difference in Oxford knee score at 52 weeks was 1.91 (95% confidence interval -0.18 to 3.99) points, favouring the outpatient rehabilitation arm (P=0.07). When all time point data were analysed, the between group difference in Oxford knee score was a non-clinically meaningful 2.25 points (0.61 to 3.90, P=0.01). No between group differences were found for secondary outcomes of average pain (0.25 points, -0.78 to 0.28, P=0.36) or worst pain (0.22 points, -0.71 to 0.41, P=0.50) at 52 weeks or earlier time points, or of satisfaction with outcome (odds ratio 1.07, 95% confidence interval 0.71 to 1.62, P=0.75) or post-intervention function (4.64 seconds, 95% confidence interval -14.25 to 4.96, P=0.34). CONCLUSIONS: Outpatient therapist led rehabilitation was not superior to a single physiotherapist review and home exercise based regimen in patients at risk of poor outcomes after total knee arthroplasty. No clinically relevant differences were observed across primary or secondary outcome measures. TRIALS REGISTRATION: Current Controlled Trials ISRCTN23357609 and ClinicalTrials.gov NCT01849445.


Assuntos
Artroplastia do Joelho/reabilitação , Terapia por Exercício/métodos , Osteoartrite do Joelho/reabilitação , Dor Pós-Operatória/reabilitação , Modalidades de Fisioterapia , Idoso , Artroplastia do Joelho/efeitos adversos , Protocolos Clínicos , Feminino , Humanos , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Medição da Dor , Dor Pós-Operatória/etiologia , Cooperação do Paciente , Medidas de Resultados Relatados pelo Paciente , Resultado do Tratamento
8.
Zhonghua Wai Ke Za Zhi ; 58(11): 876-881, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120452

RESUMO

Objective: To explore the feasibility of fast and accurate osteotomy using a new angle adjustable osteotomy guide (AAOG) in closing wedge distal femoral osteotomy(CWDFO). Methods: The clinical data of 14 patients (17 knees) with valgus knee treated with CWDFO at Department of Integrated Chinese and Western Medicine Orthopedics, Honghui Hospital, Xi'an Jiaotong University from January 2018 to July 2019 were analyzed retrospectively. There were 3 males and 11 females, aging (41.4±16.4) years (range: 18 to 56 years). The body mass index was (23.5±3.5) kg/m(2) (range: 18.1 to 28.9 kg/m(2)). The guide pins were placed with the assistance of the self-designed AAOG. Before the surgery, Solidworks software was used to calculate the correction angle and the osteotomy radius accurately. The osteotomy guide was adjusted according to these two parameters. During the surgery, the adjusted osteotomy guide was placed to the surface of bone closely and the guide pins were drilled into the bone through the guide holes. The position of the guide pins was confirmed under fluoroscopy. The osteotomy was finished under guide of pins and fixed with Tomofix plate (Synthes). The times and duration of placement of the guide pins, the times of X-ray examination, the planned and actual thickness of the osteotomy wedge, the top and bottom area of the osteotomy wedge, the posterior distal femoral angle(PDFA), the correction of the weight line, and the American Knee Society Score(AKSS) and Tegner scores were collected and compared by paired t test or Kruskal-Wallis non-parametric test. Healing time after osteotomy and complications were recorded. Results: The guide pins were successfully placed once in 10 knees, adjusted once in 5 knees and twice in 2 knees. The time spent in placing all the 6 pins was 82.4 seconds (range: 51 to 125 seconds), and the times of X-ray examination was 1.5 times (range: 1 to 5 times). The top and bottom areas of the osteotomy wedge were (5.52±0.52)cm(2) and (5.36±0.49)cm(2). PDFA was (85.2±2.6)° preoperatively and (85.5±1.4)° postoperatively (t=-0.401, P>0.05). The thickness of the osteotomy was (11.3±1.9)mm according to the preoperative plan, and the actual thickness was (8.1±1.7)mm. All the patients were followed up for 6 months after surgery and AKSS and Tegner scores improved significantly (all P<0.05). The correction of the weight lines was within the ideal range. Fractures of the hinge point occurred in 3 knees. All of the osseous healing without complications. Conclusion: The new osteotomy guide helps to place the guide pins rapidly and precisely according to the preoperative planning, which should be widely used in clinical applications with promising outcomes.


Assuntos
Fêmur/cirurgia , Osteoartrite do Joelho , Osteotomia , Adolescente , Adulto , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Osteotomia/instrumentação , Osteotomia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
9.
Medicine (Baltimore) ; 99(44): e22984, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126373

RESUMO

The objective of this study was to examine the relationship between cartilage degeneration early after partial medial meniscectomy and abnormal alignment in the lower extremity.The subjects were 34 patients (37 knees) with medial meniscal tear who underwent arthroscopic partial meniscectomy. MRI was performed before and 6 months after surgery. T2 mapping images in sagittal sections of medial femoral condyle were produced and 10 regions of interest were set at intervals of 10° in the articular cartilage in the femur. Subjects with an increase in T2 of ≥6% at a flexion angle of 30° were assigned to the degeneration group. Patient background, hip-knee-ankle (HKA) angle, and total resection of meniscal segments were compared between this group and the other patients to identify factors involved in degeneration of articular cartilage.T2 values 6 months after surgery in 3 ROIs at flexion angles of 30° to 50° were significantly longer than those before surgery. The preoperative HKA angle was significantly higher in the degeneration group. T2 values in articular cartilage of the femoral condyle increased earlier after meniscectomy with abnormal alignment in the lower extremity.Meniscectomy in cases with abnormal alignment may have a risk of early onset of osteoarthritis.Level of evidence: Level IV.


Assuntos
Cartilagem Articular/patologia , Articulação do Joelho/cirurgia , Meniscectomia/efeitos adversos , Lesões do Menisco Tibial/cirurgia , Cartilagem Articular/lesões , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
10.
Zhonghua Yi Xue Za Zhi ; 100(39): 3104-3108, 2020 Oct 27.
Artigo em Chinês | MEDLINE | ID: mdl-33105963

RESUMO

Objective: To explore the effect of a delayed pedicle gastrocnemius muscle flap transposition for the treatment of a knee joint deep infection secondary to wound necrosis after total knee arthroplasty (TKA). Methods: The clinical data of 7 patients treated in Shanxi Provincial People's Hospital with a delayed pedicle gastrocnemius muscle flap transposition from December 2015 to September 2019 for wound necrosis, exposed prosthesis and deep infection of knee joint after TKA were analyzed retrospectively. Before the muscle flap transplantation, 5 of the patients had received at least one debridement but failed for relapse, and resulted in an exposed prostheses and infected knee joint. Four patients were positive in their wounds or joint exudates bacterial culture, while the other 3 patients were negative but only with an obvious purulent secretion. The radiographs in all of the patients had no signs of lucent peripheral to or sink of the prosthesis. Results: The patients were followed-up for a mean time of 16.5 months (7-39 months). The flap and skin graft survived uneventfully with no pain, sinus, fistula, edema, and hematoma occurred. The appearances of the legs were normal. Only 1 patient had a mild limp, and the others gained almost a normal gait. One of the patients recurred 5 months after the gastrocnemius muscle flap transposition, and a two-stage revision procedure was applied, that involving a prosthesis remove and vancomycin impregnated cement (4 grams of vancomycin powder mixed with forty grams of polymethylmethacrylate) spacer implanted, and a new prosthesis was re-implanted 6 months later. The assessment of Knee Society Score (KSS) graded as: 4 patients classified as excellence, 2 as fine, 1 as general. Conclusions: Delayed pedicle gastrocnemius muscle flap transposition is an effective method for the complication of wound necrosis, deep infection, prosthesis exposure after TKA. This protocol was appropriate for those who have experienced a comparative long time of infection while had no signs of prosthesis loosening, and with which the implant may be salvaged, the defect be closed, and the infection be eradicated.


Assuntos
Artroplastia do Joelho , Infecções , Artroplastia do Joelho/efeitos adversos , Humanos , Articulação do Joelho/cirurgia , Músculo Esquelético , Estudos Retrospectivos
11.
Zhongguo Gu Shang ; 33(10): 922-7, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33107254

RESUMO

OBJECTIVE: To compare influence of retention or resection subpatellar fat pad on patella height during rheumatoid knee replacement. METHODS: Totally 48 patients with rheumatoid arthritis who underwent total knee replacement from October 2013 to October 2017 were retrospectively analyzed and divided into resection and retention subpatellar fat pad group. There were 23 patients in resection subpatellar fat pad group, including 9 males and 14 females aged from 48 to 69 years old with an average of(55.83±5.65) years old; subpatellar fat pad were resected during opertaion. There were 25 patients in retention subpatellar fat pad group, including 6 males and 19 femlaes aged from 49 to 70 years old with an average age of (55.52± 6.28) years old;subpatellar fat pad were retentedduring opertaion. Postopertaive complications were observed between two groups, visual analogue scale (VAS) and Hospital for Special Surgery (HSS) at 1 year after operation were used to evaluate relieve pain degree and clnical effect of knee joint, Insall-Salvati ratio(I-S ratio) was used to compare changes of postoperative patella height at 1 year after operation. RESULTS: All patients were followed up from 12 to 39 months with an average of (23.85± 8.82) months. The postoperative wound healed well without infection complications and no prosthetic loosening or revision. Postoperative VAS score at 1 year between two groups was lower than that of before opertaion(P<0.05), but no statistical difference between two groups at 1 year after operation(P>0.05). Postopertaive HSS score between two groups was higer than that of before operation(P<0.05), while no difference in HSS score at 1 year after operation between two groups (P>0.05). I-S ratio of subpatellar fat pad resection group (1.03±0.04) was lower than that of subpatellar fat pad retention group (1.06±0.06), and difference was statistically significant (P<0.05). CONCLUSION: Resection or retention subpatellar fat pad in rheumatoid knee replacement have advantages of relieving postoperative pain and improving functional recovery, however, retention of infrapatellar fat pad is beneficial to restoration of patellar height.


Assuntos
Artroplastia do Joelho , Patela , Tecido Adiposo , Idoso , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Patela/cirurgia , Estudos Retrospectivos
12.
Zhongguo Gu Shang ; 33(10): 938-42, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33107257

RESUMO

OBJECTIVE: To explore clinical and radiographic effects of percutaneous pie-crusting deep medial collateral ligament release in patients with posterior horn tear of medial meniscus combined with tight medial compartment. METHODS: From January 2012 to December 2016, 35 patients with medial meniscus posterior horn injury were treated with percutaneous pie crusting deep medial collateral ligament release technique, including 21 males and 14 females, aged from 21 to 55 years old with an average of (39.1±6.5) years old. Degree of meniscus extrusion were recorded before and 24 months after operation. The knee valgus stress test was performed to evaluate stability of medial collateral ligament, and compared difference between healthy and affected side. Lysholm and IKDC functional scores were compared before and 24 months after operation. RESULTS: All patients were followed up from 27 to 60 months with an average of (36.7±6.8) months. All patients were underwent operation, the wound healed well without complications. Operative time ranged from 0.5 to 1.2 h with an average of (0.8±0.4) h. Nineteen patients were performed partial meniscectomy, 16 patients were performed repair suture. Convex of meniscus before operation was (1.5±0.7) mm, and (1.7±0.4) mm after operation;had no statistical difference(P>0.05). Lysholm score was improved from 53.4±8.8 before operation to 91.5±4.6 at 24 months after operation;IKDC score was increased from 50.7±9.2 before operation to 90.6±3.9 at 24 months after operation;there was statistically significant (P<0.05). Valgus stress test was performed on 0 ° and 30 ° position of knee flexion in affected side and compared with ipsilateral side, all patients showed negative. CONCLUSION: For patients with medial meniscus tear of posterior horn combined with tight medial compartment, percutaneous pie-crusting deep medial collateralligament release could improve medial compartment space, and Knee valgus instability and meniscus extrusion are not affected.


Assuntos
Ligamentos Colaterais , Instabilidade Articular , Adulto , Artroscopia , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Adulto Jovem
13.
Zhonghua Wai Ke Za Zhi ; 58(9): 687-690, 2020 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-32878415

RESUMO

There is a low prevalence of osteoarthritis in the lateral compartment of the knee, but the overall number of domestic patients is large, and lateral unicompartmental arthroplasty (UKA) has good prospects.The unique anatomical structure and kinematic characteristics of the lateral compartment make the surgical operation more challenging.Traditional UKA patients have a high incidence of lower limb mal-alignment and poor prosthetic position, which leads to limit of their promotion and application.In recent years, with the development of treatment concepts, surgical techniques and materials, the survival time of UKA prosthesis has been continuously extended, and the clinical effect has been continuously optimized.Strictly grasp the surgical indications in radiology, anatomy and clinical manifestations, familiarize with the lateral compartment anatomy and biomechanical features, and master the technical details are the prerequisites and guarantees for the success of the lateral UKA.With the advancement of technology, minimal invasion, precision and individuation should be the goal pursued for lateral UKA surgery.


Assuntos
Artroplastia do Joelho , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Fenômenos Biomecânicos , Humanos , Prótese do Joelho , Resultado do Tratamento
14.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(9): 1096-1100, 2020 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-32929900

RESUMO

Objective: To explore the safety and effectiveness of quadriceps snip in complex total knee arthroplasty (TKA). Methods: A clinical data of 19 cases (29 knees) with complex TKA assisted with quadriceps snip between January 2016 and May 2017 were retrospectively analyzed. There were 9 males (13 knees) and 10 females (16 knees). The age of patients ranged from 34 to 66 years (mean, 50.2 years). Four patients (8 knees) were ankylosing spondylitis, 5 patients (7 knees) were rheumatoid arthritis, and 10 patients (14 knees) were knee osteoarthritis. The average disease duration was 10.9 years (range, 8-15 years). There were 12 knees of Kellgren-Lawrence grade Ⅲ and 17 knees of Kellgren-Lawrence grade Ⅳ. The range of motion (ROM) of knee was (19.86±7.23)°. The clinical and function scores of knee society score (KSS) were 47.86±11.26 and 15.52±11.21, respectively. Postoperative complications, ROM, KSS scores, extensor lag, and prosthesis loosening were observed to evaluate the effectiveness. Results: All incisions healed by first intention, and no infection or cardiovascular and cerebrovascular accidents occurred. All patients were followed up 25-39 months (mean, 30.3 months). At last follow-up, the ROM of knee was (91.03±7.30) °, the KSS clinical score was 83.62±9.99 and functional score was 66.38±7.89, showing significant differences when compared with preoperative ones ( P<0.05). Postoperative extensor lag (10°, 10°, 15°) occurred in 3 cases. There was no evidence of prosthesis loosening or osteolysis on X-ray films during follow-up. Conclusion: The application of quadriceps snip in complex TKA can effectively improve the operative field exposure and reduce incidence of complications such as patella tendon tearing, patella fracture, and quadriceps tendon injury. The surgical technique of Krackow tendon suture can effectively guarantee early rehabilitation without occurrence of other complications.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(9): 1200-1204, 2020 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-32929917

RESUMO

Objective: To summarize the methods of tibial prosthesis rotation alignment in total knee arthroplasty, and provide reference for clinicians to select and further study the methods of tibial prosthesis rotation alignment. Methods: The advantages and disadvantages of various tibial prosthesis rotation alignment methods were analyzed and summarized by referring to the relevant literature at home and abroad in recent years. Results: There are many methods for tibial prosthesis rotation alignment, including reference to relevant anatomical landmarks, range of motion (ROM) technique, computer-assisted navigation, and personalized osteotomy. The inner one-third of the tibial tuberosity is a more accurate reference anatomical landmark, but the obesity, severe knee deformity and dysplasia have impacts on the precise placement of the tibial prosthesis. ROM technique do not need to refer to the anatomical landmark of the tibia, and aren't affected by landmark variation. It can be used for severe knee valgus deformity and the landmarks that are difficult to identify. However, it may cause internal rotation of tibial prosthesis. Computer- assisted navigation and personalized osteotomy can achieve more accurate alignment in sagittal, coronal, and rotational alignment of femoral prosthesis. However, due to the lack of reliable anatomical landmarkers related to tibia fixation, it is still controversial whether it can help the alignment of tibial prosthesis rotation. Conclusion: The surgeon should master the methods of rotation and alignment of tibial prosthesis, make preoperative plans, select appropriate alignment methods for different patients, and achieve individualization. Meanwhile, several anatomical landmarkers should be referred to properly during the operation, which can be used to detect the correct placement of tibial prosthesis and avoid large rotation error.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Humanos , Articulação do Joelho/cirurgia , Rotação , Tíbia/cirurgia , Tomografia Computadorizada por Raios X
17.
Acta Chir Orthop Traumatol Cech ; 87(4): 251-258, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32940220

RESUMO

PURPOSE OF THE STUDY This study is a component part of the project focused on cartilage imaging after the treatment of a defect. It aims to compare the evaluation of postoperative status performed by two radiologists with the use of 2D MOCART scoring system and to determine whether this method is a reliable tool for the evaluation of postoperative changes. MATERIAL AND METHODS The study evaluated 78 MRI examinations from 25 patients (one patient had two defects treated), each of whom underwent 3 MRI examinations at 6, 12 and 18 months after surgery. The MRI examinations were performed on Philips Ingenia 3T scanner with 8-channel knee coil, in line with the routine protocol (coronal, sagittal and transversal PD SPAIR, coronal T1, sagittal PD HR, sagittal bFFE). The MRI examinations were evaluated independently by two radiologists using the 2D MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score. RESULTS The raters agreed in a total of 592 of 702 evaluations, therefore the inter-rater reliability is high, namely 84.3%. The highest inter-rater agreement was in assessing subchondral lamina and subchondral bone. Whereas the lowest inter-rater agreement was achieved in assessing effusion. The total score showed a very strong and statistically significant correlation (r = 0.893). In eight out of nine questions there was no statistically significant difference between the raters. A significant difference was seen only in the assessment of repair tissue structure. Excellent reliability of the total score was also confirmed by the intraclass correlation coefficient. DISCUSSION The high degree of agreement in assessing the signal intensity of repair tissue was considered very positive as it is generally viewed as the major pitfall in evaluations. On the contrary, subjective perception was confirmed in the evaluation of tissue homogeneity, especially when comparing homogeneity with the adjacent tissue in close vicinity that could have changed already. Surprisingly, the lowest inter-rater concordance was reported in the evaluation of effusion, where in some cases, its volume was underestimated, when traced back retrospectively. CONCLUSIONS The results of this study confirm that despite certain doubts regarding subjective perception of some of the evaluation criteria the 2D MOCART scoring system is a very good and objective tool to evaluate the effects of surgery. Key words: magnetic resonance imaging , hyaline cartilage, classification.


Assuntos
Cartilagem Articular , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Reprodutibilidade dos Testes , Estudos Retrospectivos
18.
Rev Med Suisse ; 16(701): 1428-1431, 2020 Aug 05.
Artigo em Francês | MEDLINE | ID: mdl-32833358

RESUMO

Meniscectomy in a young active patient can lead to poor outcomes with pain, decreased function and long-term osteoarthritis. Meniscal allograft transplantation (MAT) has therefore been developed to address this issue. We now have 30 years of experience with this technique which is no longer considered experimental and new indications have been added. MAT allows restoration of joint biomechanics, pain relief, improvement in knee function and stability, and reduce cartilage degeneration. This is a comprehensive review of the role of menisci, the indications and principles of MAT, as well as these results.


Assuntos
Menisco/transplante , Transplante Homólogo , Humanos , Articulação do Joelho/cirurgia , Meniscectomia , Menisco/cirurgia , Resultado do Tratamento
19.
Zhonghua Yi Xue Za Zhi ; 100(31): 2429-2434, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32819058

RESUMO

Objective: To investigate the application and efficacy of the one-stage total knee arthroplasty (TKA) of intra-articular compensation osteotomy in knee osteoarthritis(KOA) patients with extra-articular deformity (EAD). Methods: A retrospective study of 9 patients with end-stage KOA and EAD undergoing one-stage TKA from January 2014 to December 2017 in the First Affiliated Hospital of Zhejiang Chinese Medical University was performed. There were 3 males and 6 females with an average age of 56 years(range, 19-77 years);5 cases of simple coronal deformity (varus 10°-27°, mean 18.2°), 3 cases of sagittal deformity (recurvatum15°-35°, mean 22.6°), 1 case combined with coronal and sagittal deformity (varus 16°, recurvatum 31°); hemophilia dysplasia in 1 case, fracture malformation in 8 cases. Main outcome measures included the mechanical axis, range of motion (ROM) and Hospital for Special Surgery Knee Score (HSS). Results: The mean follow-up period was 33.2 months (range, 25-47 months). The mechanical axis angle was restored from 12.4°±4.1°to 1.4°±0.9°(t=7.954, P<0.01). The HSS was improved from 28±14 preoperatively to 87±7 postoperatively (t=-11.174, P=0.013). The ROM increased from 56°±22°to 99°±8° (t=-5.480, P=0.010). There was no complications such as joint instability, infection, fracture, common peroneal nerve injury and early prosthesis loosening. Conclusions: For KOA patients with femoral EAD, one-stage TKA with intra-articular compensatory osteotomy can effectively restore the mechanical axis and obtain satisfying joint function. Through a series of measures such as preoperative measurement, soft tissue evaluation and 3D printing, the accuracy of surgery can be improved and the difficulty of surgery can be reduced.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho/diagnóstico por imagem , Adulto , Idoso , Feminino , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
J Biol Regul Homeost Agents ; 34(3 Suppl. 2): 111-113, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32856449

RESUMO

Medial open-wedge (MOW) high tibial osteotomy (HTO) is proven treatment option, indicated in medial unicompartimental knee osteoarthritis (OA) and in varus OA. New devices and techniques were developed in last years, such as Activemotion plates with polyaxial locking system (Dualtec System®, NewClip-Technics) and PSI technique. We describe outcomes and rate of complications in patients treated with Activemotion plates and PSI technique. From January 2019 to August 2019 a sample of 77 cases (72 NCT plates, 5 PSI technique) was observed, evaluating the rate of complications and the return to activity. The rate of complications is 2.6% and the mean time to return to activity is 10 weeks. MOW HTO with Activemotion plate has showed good results with a low rate of complications. About PSI technique, the preliminary results are excellent, but we need to increase the sample.


Assuntos
Osteotomia , Tíbia , Placas Ósseas , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Radiografia , Tíbia/cirurgia , Resultado do Tratamento
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