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1.
Orthop Clin North Am ; 52(2): 83-92, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33752841

RESUMO

The success of total knee arthroplasty (TKA) depends on restoration of the stability and biomechanical efficiency of the native knee. The emergence of robotic surgical technologies has greatly increased the precision and reproducibility. We discuss contemporary robotic TKA systems by reviewing the features of the individual platforms, their accuracy, and the clinical outcomes. While early results suggest significant gains in patient outcomes, long-term evidence is still awaited from multicenter prospective clinical trials. Moreover, advances in this technology are needed to address knee laxity while individualizing the functional performance of each patient's new joint.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho , Ajuste de Prótese/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Artroplastia do Joelho/métodos , Humanos , Ajuste de Prótese/métodos , Procedimentos Cirúrgicos Robóticos/métodos
2.
Medicine (Baltimore) ; 100(4): e23809, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530177

RESUMO

OBJECTIVE: To evaluate the clinical and radiographic outcomes of total knee arthroplasties (TKA) between using medial-pivot (MP) and posterior-stabilized (PS) prosthesis. Does MP prosthesis and PS prosthesis influence the clinical results of a TKA? METHODS: An electronic literature search of PubMed Medline and the Cochrane Library was performed from inception to October 1, 2019. A meta-analysis to compare postoperative outcomes of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS), range of motion (ROM), complications, and radiographic results between MP and PS prosthesis were conducted. RESULTS: Seven eligible studies involving 934 adult patients (MP group, n = 461; PS group, n = 473) were identified for analysis. This study showed no significant difference between the 2 groups in the WOMAC scores, KSS, ROM, and complications (P > .05). The differences of the femorotibial angle, position of implant, and patellar tilt were also not significant between the 2 groups (P > .05). CONCLUSION: The present meta-analysis has shown that patients with the MP prosthesis have similar clinical results as patients with PS prosthesis. Furthermore, the radiographic results, especially patella tilt angle, were also similar between the 2 groups. Therefore, surgeons should be aware that the types of prostheses are not a decisive factor to ensure successful operation.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Desenho de Prótese , Artroplastia do Joelho/métodos , Humanos , Joelho/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Radiografia , Amplitude de Movimento Articular , Resultado do Tratamento
3.
Bone Joint J ; 103-B(2): 338-346, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517724

RESUMO

AIMS: This study aimed to identify the tibial component and femoral component coronal angles (TCCAs and FCCAs), which concomitantly are associated with the best outcomes and survivorship in a cohort of fixed-bearing, cemented, medial unicompartmental knee arthroplasties (UKAs). We also investigated the potential two-way interactions between the TCCA and FCCA. METHODS: Prospectively collected registry data involving 264 UKAs from a single institution were analyzed. The TCCAs and FCCAs were measured on postoperative radiographs and absolute angles were analyzed. Clinical assessment at six months, two years, and ten years was undertaken using the Knee Society Knee score (KSKS) and Knee Society Function score (KSFS), the Oxford Knee Score (OKS), the 36-Item Short-Form Health Survey questionnaire (SF-36), and range of motion (ROM). Fulfilment of expectations and satisfaction was also recorded. Implant survivorship was reviewed at a mean follow-up of 14 years (12 to 16). Multivariate regression models included covariates, TCCA, FCCA, and two-way interactions between them. Partial residual graphs were generated to identify angles associated with the best outcomes. Kaplan-Meier analysis was used to compare implant survivorship between groups. RESULTS: Significant two-way interaction effects between TCCA and FCCA were identified. Adjusted for each other and their interaction, a TCCA of between 2° and 4° and a FCCA of between 0° and 2° were found to be associated with the greatest improvements in knee scores and the probability of fulfilling expectations and satisfaction at ten years. Patients in the optimal group whose TCCA and FCCA were between 2° and 4°, and 0° and 2°, respectively, had a significant survival benefit at 15 years compared with the non-optimal group (optimal: survival = 100% vs non-optimal: survival = 92%, 95% confidence interval (CI) 88% to 96%). CONCLUSION: Significant two-way interactions between the TCCA and FCCA demonstrate the importance of evaluating the alignment of the components concomitantly in future studies. By doing so, we found that patients who concomitantly had both a TCCA of between 2° and 4° and a FCCA of between 0° and 2° had the best patient-reported outcome measures at ten years and better survivorship at 15 years. Cite this article: Bone Joint J 2021;103-B(2):338-346.


Assuntos
Artroplastia do Joelho/métodos , Hemiartroplastia/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/instrumentação , Fenômenos Biomecânicos , Feminino , Fêmur/patologia , Fêmur/fisiologia , Fêmur/cirurgia , Seguimentos , Hemiartroplastia/instrumentação , Humanos , Articulação do Joelho/patologia , Articulação do Joelho/fisiologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Tíbia/patologia , Tíbia/fisiologia , Tíbia/cirurgia , Resultado do Tratamento
4.
Bone Joint J ; 103-B(3): 507-514, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33467917

RESUMO

AIMS: Total knee arthroplasty (TKA) using functional alignment aims to implant the components with minimal compromise of the soft-tissue envelope by restoring the plane and obliquity of the non-arthritic joint. The objective of this study was to determine the effect of TKA with functional alignment on mediolateral soft-tissue balance as assessed using intraoperative sensor-guided technology. METHODS: This prospective study included 30 consecutive patients undergoing robotic-assisted TKA using the Stryker PS Triathlon implant with functional alignment. Intraoperative soft-tissue balance was assessed using sensor-guided technology after definitive component implantation; soft-tissue balance was defined as intercompartmental pressure difference (ICPD) of < 15 psi. Medial and lateral compartment pressures were recorded at 10°, 45°, and 90° of knee flexion. This study included 18 females (60%) and 12 males (40%) with a mean age of 65.2 years (SD 9.3). Mean preoperative hip-knee-ankle deformity was 6.3° varus (SD 2.7°). RESULTS: TKA with functional alignment achieved balanced medial and lateral compartment pressures at 10° (25.0 psi (SD 6.1) vs 23.1 psi (SD 6.7), respectively; p = 0.140), 45° (21.4 psi (SD 5.9) vs 20.6 psi (SD 5.9), respectively; p = 0.510), and 90° (21.2 psi (SD 7.1) vs 21.6 psi (SD 9.0), respectively; p = 0.800) of knee flexion. Mean ICPD was 6.1 psi (SD 4.5; 0 to 14) at 10°, 5.4 psi (SD 3.9; 0 to 12) at 45°, and 4.9 psi (SD 4.45; 0 to 15) at 90° of knee flexion. Mean postoperative limb alignment was 2.2° varus (SD 1.0°). CONCLUSION: TKA using the functional alignment achieves balanced mediolateral soft-tissue tension through the arc of knee flexion as assessed using intraoperative pressure-sensor technology. Further clinical trials are required to determine if TKA with functional alignment translates to improvements in patient satisfaction and outcomes compared to conventional alignment techniques. Cite this article: Bone Joint J 2021;103-B(3):507-514.


Assuntos
Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Fenômenos Biomecânicos , Mau Alinhamento Ósseo/prevenção & controle , Feminino , Humanos , Masculino , Pressão , Estudos Prospectivos
5.
Bone Joint J ; 102-B(11): 1527-1534, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135435

RESUMO

AIMS: Vitamin E-infused highly cross-linked polyethylene (E1) has recently been introduced in total knee arthroplasty (TKA). An in vitro wear simulator study showed that E1 reduced polyethylene wear. However there is no published information regarding in vivo wear. Previous reports suggest that newly introduced materials which reduce in vitro polyethylene wear do not necessarily reduce in vivo polyethylene wear. To assist in the evaluation of the newly introduced material before widespread use, we established an in vivo polyethylene wear particle analysis for TKA. The aim of this study was to compare in vivo polyethylene wear particle generation between E1 and conventional polyethylene (ArCom) in TKA. METHODS: A total of 34 knees undergoing TKA (17 each with ArCom or E1) were investigated. Except for the polyethylene insert material, the prostheses used for both groups were identical. Synovial fluid was obtained at a mean of 3.4 years (SD 1.3) postoperatively. The in vivo polyethylene wear particles were isolated from the synovial fluid using a previously validated method and examined by scanning electron microscopy. RESULTS: The total number of polyethylene wear particles obtained from the knees with E1 (mean 6.9, SD 4.0 × 107 counts/knee) was greater than that obtained from those with ArCom (mean 2.2, SD 2.6 × 107 counts/knee) (p = 0.001). The particle size (equivalent circle of diameter) from the knees with E1 was smaller (mean 0.5 µm, SD 0.1) than that of knees with ArCom (mean 1.5, SD 0.3 µm) (p = 0.001). The aspect ratio of particles from the knees with E1 (mean 1.3, SD 0.1) was smaller than that with ArCom (mean 1.4, SD 0.1) (p < 0.001 ). CONCLUSION: This is the first report of in vivo wear particle analysis of E1. E1 polyethylene did not reduce the number of in vivo polyethylene wear particles compared with ArCom in early clinical stage. Further careful follow-up of newly introduced E1 for TKA should be carried out. Cite this article: Bone Joint J 2020;102-B(11):1527-1534.


Assuntos
Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Prótese do Joelho/efeitos adversos , Falha de Prótese , Líquido Sinovial/química , Idoso , Idoso de 80 Anos ou mais , Materiais Biocompatíveis/análise , Humanos , Polietileno/análise , Falha de Prótese/etiologia , Vitamina E
6.
Bone Joint J ; 102-B(10): 1324-1330, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993324

RESUMO

AIMS: Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon's experience level. METHODS: A conventional jig-based TKA procedure with medial parapatellar approach was performed on 12 cadaveric knees by three experienced surgeons and three residents. During the proximal tibial resection, the motion of the oscillating saw with respect to the tibia was recorded. The distance of the outer point of this cutting portion to the edge of the bone was defined as the excursion of the oscillating saw. The excursion of the sawblade was evaluated in six zones containing the following structures: medial collateral ligament (MCL), posteromedial corner (PMC), iliotibial band (ITB), lateral collateral ligament (LCL), popliteus tendon (PopT), and neurovascular bundle (NVB). RESULTS: The mean 75th percentile value of the excursion of all cases was mean 2.8 mm (SD 2.9) for the MCL zone, mean 4.8 mm (SD 5.9) for the PMC zone, mean 3.4 mm (SD 2.0) for the ITB zone, mean 6.3 mm (SD 4.8) for the LCL zone, mean 4.9 mm (SD 5.7) for the PopT zone, and mean 6.1 mm (SD 3.9) for the NVB zone. Experienced surgeons had a significantly lower excursion than residents. CONCLUSION: This study showed that the oscillating saw significantly passes the edge of the bone during the tibial resection in TKA, even in experienced hands. While reported neurovascular complications in TKA are rare, direct injury to the capsule and stabilizing structures around the knee is a consequence of the use of a hand-held oscillating saw when making the tibial cut. Cite this article: Bone Joint J 2020;102-B(10):1324-1330.


Assuntos
Artroplastia do Joelho/instrumentação , Doença Iatrogênica , Lesões dos Tecidos Moles/etiologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Desenho de Equipamento , Humanos , Fatores de Risco , Tomografia Computadorizada por Raios X
7.
Bone Joint J ; 102-B(7): 861-867, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600131

RESUMO

AIMS: Cementless unicompartmental knee arthroplasty (UKA) has advantages over cemented UKA, including improved fixation, but has a higher risk of tibial plateau fracture, particularly in Japanese patients. The aim of this multicentre study was to determine when cementless tibial components could safely be used in Japanese patients based on the size and shape of the tibia. METHODS: The study involved 212 cementless Oxford UKAs which were undertaken in 174 patients in six hospitals. The medial eminence line (MEL), which is a line parallel to the tibial axis passing through the tip of medial intercondylar eminence, was drawn on preoperative radiographs. Knees were classified as having a very overhanging medial tibial condyle if this line passed medial to the medial tibial cortex. They were also classified as very small if a size A/AA tibial component was used. RESULTS: The overall rate of fracture was 8% (17 out of 212 knees). The rate was higher in knees with very overhanging condyles (Odds ratio (OR) 13; p < 0.001) and with very small components (OR 7; p < 0.001). The OR was 21 (p < 0.001) in those with both very overhanging condyles and very small components. In all, 69% of knees (147) had neither very overhanging nor very small components, and the fracture rate in these patients was 1.4% (2 out of 147 knees). Males had a significantly reduced risk of fracture (OR 0.13; p = 0.002), probably because no males required very small components and females were more likely to have very overhanging condyles (OR 3; p = 0.013). 31% of knees (66) were in males and in these the rate of fracture was 1.5% (1 out of 66 knees). CONCLUSION: The rate of tibial plateau fracture in Japanese patients undergoing cementless UKA is high. We recommend that cemented tibial fixation should be used in Japanese patients who require very small components or have very overhanging condyles, as identified from preoperative radiographs. In the remaining 69% of knees cementless fixation can be used. This approach should result in a low rate of fracture. Cite this article: Bone Joint J 2020;102-B(7):861-867.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Complicações Pós-Operatórias/etiologia , Tíbia/anatomia & histologia , Fraturas da Tíbia/etiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/instrumentação , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco
8.
Bone Joint J ; 102-B(7): 852-860, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600135

RESUMO

AIMS: Our objective is to describe our early and mid-term results with the use of a new simple primary knee prosthesis as an articulating spacer in planned two-stage management for infected knee arthroplasty. As a second objective, we compared outcomes between the group with a retained first stage and those with a complete two-stage revision. METHODS: We included 47 patients (48 knees) with positive criteria for infection, with a minimum two-year follow-up, in which a two-stage approach with an articulating spacer with new implants was used. Patients with infection control, and a stable and functional knee were allowed to retain the initial first-stage components. Outcomes recorded included: infection control rate, reoperations, final range of motion (ROM), and quality of life assessment (QoL) including Western Ontario and McMaster Universities osteoarthritis index, Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score, 12-Item Short-Form Health Survey questionnaire, and University of California Los Angeles (UCLA) activity score and satisfaction score. These outcomes were evaluated and compared to additional cohorts of patients with retained first-stage interventions and those with a complete two-stage revision. Mean follow-up was 3.7 years (2.0 to 6.5). RESULTS: Eight knees failed directly related to lack of infection control (16%), and two patients (two knees) died within the first year for causes not directly related, giving an initial success rate of 79% (38/48). Secondary success rate after a subsequent procedure was 91% (44/48 knees). From the initially retained spacers, four knees (22%) required a second-stage revision for continuous symptoms and one (5%) for an acute infection. There were no significant differences regarding the failure rate due to infection, ROM, and QoL assessment between patients with a retained first-stage procedure and those who underwent a second-stage operation. CONCLUSION: Our protocol of two-stage exchange for infected knee arthroplasties with an articulating spacer and using new primary knee implants achieves adequate infection control. Retained first-stage operations achieve comparable results in selected cases, with no difference in infection control, ROM, and QoL assessment in comparison to patients with completed two-stage revision surgery. Cite this article: Bone Joint J 2020;102-B(7):852-860.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho , Desenho de Prótese , Infecções Relacionadas à Prótese/cirurgia , Idoso , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Satisfação do Paciente , Qualidade de Vida , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos
9.
Jt Dis Relat Surg ; 31(2): 399-402, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584745

RESUMO

Streptococcus dysgalactiae (SD) is a common pathogen among elderly population. However, to our knowledge, there is no periprosthetic joint infection case reported that is infected with Streptococcus dysgalactiae subspecies equisimilis (SDSE) in the English literature. In this article, we report a 77-year-old male patient who had undergone total knee arthroplasty three years ago and had the diagnosis of cellulitis at his leg followed by swelling, pain and hyperemia localized at his knee. Three knee aspirations were performed and the SDSE was identified. There was no direct contact of patient to animals.


Assuntos
Artroplastia do Joelho , Cefalosporinas/administração & dosagem , Desbridamento/métodos , Infecções Relacionadas à Prótese , Infecções Estreptocócicas , Streptococcus/isolamento & purificação , Idoso , Antibacterianos/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Humanos , Masculino , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/fisiopatologia , Infecções Relacionadas à Prótese/cirurgia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/etiologia , Infecções Estreptocócicas/fisiopatologia , Infecções Estreptocócicas/terapia , Resultado do Tratamento
10.
Clin Orthop Surg ; 12(2): 178-186, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32489539

RESUMO

Backgroud: The indications for total knee arthroplasty (TKA) have been expanded to include younger, demanding patients. Some TKA patients expect a return to high-performance activities to restore optimum quality of life. The concept of the medial pivot (MP) TKA is that more natural knee kinematics can be achieved by altering the bearing design. In the present study, we compared the early outcomes of MP TKA with posterior-stabilized (PS) TKA in terms of patient-reported outcomes, function, and performance. Methods: This randomized study was performed in a high volume joint replacement facility of a tertiary care military hospital. We enrolled 40 patients each in the MP group and PS group and assessed knee flexion, patient-reported outcome (new Knee Society Score [new KSS]), patient performance (Delaware Osteoarthritis Profile Score [DOPS]), and function (Forgotten Joint Score [FJS]) at 2 years after surgery. Results: Compared to PS group patients, MP group patients had similar patient-reported outcomes assessed by new KSS (satisfaction, expectation, and activity scales) and FJS. MP knee patients had better performance in the timed up and go test (p < 0.026) and self-paced walk test (p < 0.002) of DOPS. The gain in knee flexion (9.3° ± 14°) compared to baseline was significantly greater in the PS group (p < 0.013). Conclusions: When assessed by DOPS, getting up from chair and walking speed were significantly better in MP knee patients than in PS knee patients. However, considering the predictable rollback ensured by cam and post, the PS knee produced better knee flexion. Despite these results, patients were equally satisfied with the two designs.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho , Desenho de Prótese , Idoso , Feminino , Hospitais Militares , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Teste de Caminhada
11.
Zhonghua Wai Ke Za Zhi ; 58(6): 416-419, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498478

RESUMO

Bearing dislocation is a special complication of mobile-bearing unicompartmental arthroplasty, caused by many factors, such as imbalance of the flexion and extension gap, malposition of components, impingement by the remaining osteophytes and cement, damage or delayed chronic laxity of medial collateral ligament, traumatic accident and habitual high knee flexion. It can be reduced by strictly controlling the operation indications before operation, osteotomy and implanting the prosthesis accurately while protecting the medial collateral ligament during operation, actively guiding the appropriate rehabilitation actions and activity intensity of patients after operation. Treatment should be individualized according to the causes and individual conditions of patients.


Assuntos
Artroplastia do Joelho/efeitos adversos , Artropatias/cirurgia , Prótese do Joelho/efeitos adversos , Falha de Prótese , Artroplastia do Joelho/instrumentação , Humanos , Artropatias/etiologia , Artropatias/prevenção & controle , Articulação do Joelho/cirurgia , Desenho de Prótese , Falha de Prótese/etiologia
12.
Zhonghua Wai Ke Za Zhi ; 58(6): 457-463, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498486

RESUMO

Objective: To examine the clinical effects of the treatment of knee osteoarthritis patients with kinematic alignment technique of total knee replacement (KA-TKA) assisted by patient-specific instrumentation (PSI). Methods: The clinical data of 14 patients with knee osteoarthritis treated with unilateral KA-TKA assisted by PSI at Department of Orthopaedic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from May 2018 to August 2019 were analyzed retrospectively. There were 6 males and 8 females, aged 66.6 years (range: 56 to 79 years), 9 left knees and 5 right knees. The operation time, soft tissue release and extra varus or valgus osteotomy were recorded. The data of osteotomy blocks were measured and compared with the corresponding position of the prostheses. The hip knee ankle angle (HKA), the mechanical distal femoral lateral angle (mLDFA) and the proximal tibial medial angle (MPTA) were measured before and 3 months after the operation. The knee joint functional score (KS-F) , knee joint clinical score (KS-C) and the Western Ontario McMaster (WOMAC) Osteoarthritis Index were recorded and compared by paired t test or Wilcoxon non-parametric test. Results: The operation time was (81.8±16.9) minutes (range: 60 to 115 minutes), 2 cases were manually increased varus osteotomy by 2 mm and 1 patient received lateral retinaculum release. There was no extra medial or lateral soft tissue release. Intraoperative measurement of the resection showed that the femoral side mismatch was within 2 mm. The medial and lateral condyle, the medial and lateral posterior condyles were relatively overcut by 0.50 mm, 0.21 mm, 0.93 mm, and 0.71 mm, respectively. The tibial side mismatch was within 1.5 mm, the medial and lateral plateau were relatively undercut by 0.43 mm and 0.32 mm. HKA was corrected from (8.8±5.6) ° to (1.6±4.3) ° (t=20.723, P=0.000) .KS-C improved from 28.21±13.47 preoperative to 78.07±8.01 postoperative (t=-16.570, P=0.000); KS-F improved from 41.00±15.25 preoperative to 84.93±10.85 postoperative (t=-14.675, P=0.000).WOMAC Osteoarthritis Index decreased from 53.5 (25.75) (M(Q(R))) preoperative to 5.5 (5.25) postoperative (Z=-3.297, P=0.001) .No statistically significant difference was found in mLDFA and MPTA before and after surgery. No significant patellofemoral complication was recorded during follow-up time. Conclusions: PSI assisted TKA resection has high accuracy. KA-TKA aims to restore the native anatomy of the knee joint, only corrects the malalignment of lower extremities caused by articular cartilage wear, with less interference to soft tissues, easy to obtain satisfactory knee joint laxity and has a promising early clinical effect.


Assuntos
Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Idoso , Fenômenos Biomecânicos , Mau Alinhamento Ósseo/etiologia , Mau Alinhamento Ósseo/prevenção & controle , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Modelagem Computacional Específica para o Paciente , Estudos Retrospectivos , Cirurgia Assistida por Computador
13.
Medicine (Baltimore) ; 99(21): e19945, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481258

RESUMO

BACKGROUND: Barbed suture has been widely used in some surgical fields, and it has achieved good results, but the application in total knee arthroplasty is still controversial. OBJECTIVE: Literature is collected for statistical analysis so as to provide evidence for the use of barbed suture in Total knee arthroplasty. METHODS: We searched PubMed, the Cochrane library and EMBASE database for randomized controlled trials (RCTs) using barbed suture and conventional suture to close incisions after primary total knee arthroplasty, and the retrieval time was from July 2019 to the establishment of the database. Literature was screened according to inclusion and exclusion criteria, quality evaluation and data extraction were conducted for the final included literature, and statistical analysis was conducted using RevMan 5.3 software. RESULTS: A total of six RCTs (826 knees) were included in our meta-analysis. The results showed that the re-negative conversion could shorten the wound closure time (MD -4.41, 95% CI -5.11 to -3.72, P < .00001) and reduce the wound closure total cost (MD -282.61, 95% CI -445.36 to -119.85, P = .0007) and acupuncture injury (RR 0.14, 95% CI 0.03-0.78, P = .02), and did not significantly increasing the incidence of complications (RR 0.80, 95% CI 0.05-0.96, P = .38) or suture breakages (RR 4.58, 95% CI 0.16-128.29, P = .37). There were no significant differences in ROM at postoperative 6 weeks and 3 months (MD -0.74, 95% CI -4.19 to 2.71, P = .67; MD -0.30, 95% CI -2.62 to 2.02, P = .80) and no significant differences in KSS at postoperative 6 weeks (MD -0.22, 95% CI -3.10 to 2.66, P = .88). CONCLUSIONS: Our study shows that barbed suture is a fast, low-cost, safe and effective suture method in total knee arthroplasty compared with traditional suture, we also need more literature and longer follow-up to confirm this conclusion.


Assuntos
Artroplastia do Joelho/instrumentação , Ensaios Clínicos Controlados Aleatórios como Assunto , Suturas , Artroplastia do Joelho/métodos , Desenho de Equipamento , Humanos
14.
Acta Orthop ; 91(4): 420-425, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32420778

RESUMO

Background and purpose - Registries report high revision rates after unicompartmental knee replacement (UKR) due, in part, to aseptic loosing. In an attempt to improve Oxford UKR femoral component fixation a new design was introduced with a Twin rather than a Single peg. We used the National Joint Registry (NJR) to compare the 5-year outcomes of the Single and Twin Peg cemented Oxford UKRs.Patients and methods - We performed a retrospective observational study using NJR data on propensity score matched Single and Twin Peg UKRs (matched for patient, implant and surgical factors). Data on 2,834 Single Peg and 2,834 Twin Peg were analyzed. Cumulative implant survival was calculated using the Kaplan-Meier method and comparisons between groups performed using Cox regression models.Results - In the matched cohort, the mean follow up for both Single and Twin Peg UKRs was 3.3 (SD 2) and 3.4 years (SD 2) respectively. The 5-year cumulative implant survival rates for Single Peg and Twin Peg were 94.8% (95% CI 93.6-95.8) and 96.2% (CI 95.1-97.1) respectively. Implant revision rates were statistically significantly lower in the Twin Peg (hazard ratio [HR)] = 0.74; p = 0.04). The revision rate for femoral component aseptic loosening decreased significantly (p = 0.03) from 0.4% (n = 11) with the Single Peg to 0.1% (n = 3) with the Twin Peg. The revision rate for pain decreased significantly (p = 0.01) from 0.8% (n = 23) with the Single Peg to 0.3% (n = 9) with the Twin Peg. No other reasons for revision had significant differences in revision rates.Interpretation - The revision rate for the cemented Twin Peg Oxford UKR was 26% less than the Single Peg Oxford UKR. This was mainly because the revision rates for femoral loosening and pain more than halved. This suggests that the Twin Peg component should be used in preference to the Single Peg design.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Prótese do Joelho/efeitos adversos , Reoperação/estatística & dados numéricos , Idoso , Artroplastia do Joelho/instrumentação , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Irlanda do Norte/epidemiologia , Falha de Prótese/efeitos adversos , Sistema de Registros , Estudos Retrospectivos , Reino Unido/epidemiologia , País de Gales/epidemiologia
15.
Medicine (Baltimore) ; 99(20): e20017, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443303

RESUMO

BACKGROUND: Recently, controversy still exists regarding the clinical effects of measured resection or gap-balancing technique in total knee arthroplasty (TKA). The objective of this retrospective study was to compare the clinical outcomes of conventional measured resection technique and computer-assisted gap-balancing technique in TKA. METHODS: Strengthening the Reporting of Observational studies in Epidemiology checklist. Patients underwent primary TKA by a single surgeon between 2014 and 2016 were reviewed. This study was approved by the institutional review board in our hospital and was registered in the Research Registry. Outcome measures included surgical time, intraoperative complications, patient satisfaction, Oxford Knee Score, range of motion, postoperative complications, and revision. RESULTS: This study had limited inclusion and exclusion criteria and a well-controlled intervention. CONCLUSION: We were able to directly compare the outcomes of measured resection versus gap-balancing techniques and might reveal a better technique in TKA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5441).


Assuntos
Artroplastia do Joelho/métodos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/estatística & dados numéricos , Humanos , Prótese do Joelho/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Assistida por Computador
16.
Bone Joint J ; 102-B(4): 434-441, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228078

RESUMO

AIMS: There are comparatively few randomized studies evaluating knee arthroplasty prostheses, and fewer still that report longer-term functional outcomes. The aim of this study was to evaluate mid-term outcomes of an existing implant trial cohort to document changing patient function over time following total knee arthroplasty using longitudinal analytical techniques and to determine whether implant design chosen at time of surgery influenced these outcomes. METHODS: A mid-term follow-up of the remaining 125 patients from a randomized cohort of total knee arthroplasty patients (initially comprising 212 recruited patients), comparing modern (Triathlon) and traditional (Kinemax) prostheses was undertaken. Functional outcomes were assessed with the Oxford Knee Score (OKS), knee range of movement, pain numerical rating scales, lower limb power output, timed functional assessment battery, and satisfaction survey. Data were linked to earlier assessment timepoints, and analyzed by repeated measures analysis of variance (ANOVA) mixed models, incorporating longitudinal change over all assessment timepoints. RESULTS: The mean follow-up of the 125 patients was 8.12 years (7.3 to 9.4). There was a reduction in all assessment parameters relative to earlier assessments. Longitudinal models highlight changes over time in all parameters and demonstrate large effect sizes. Significant between-group differences were seen in measures of knee flexion (medium-effect size), lower limb power output (large-effect size), and report of worst daily pain experienced (large-effect size) favouring the Triathlon group. No longitudinal between-group differences were observed in mean OKS, average daily pain report, or timed performance test. Satisfaction with outcome in surviving patients at eight years was 90.5% (57/63) in the Triathlon group and 82.8% (48/58) in the Kinemax group, with no statistical difference between groups (p = 0.321). CONCLUSION: At a mean 8.12 years, this mid-term follow-up of a randomized controlled trial cohort highlights a general reduction in measures of patient function with patient age and follow-up duration, and a comparative preservation of function based on implant received at time of surgery. Cite this article: Bone Joint J 2020;102-B(4):434-441.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/instrumentação , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Período Pós-Operatório , Desenho de Prótese , Falha de Prótese/etiologia , Amplitude de Movimento Articular , Reoperação/estatística & dados numéricos , Índice de Gravidade de Doença
17.
Bone Joint J ; 102-B(4): 458-462, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228079

RESUMO

AIMS: Varus-valgus constrained (VVC) implants are often used during revision total knee arthroplasty (TKA) to gain coronal plane stability. However, the increased mechanical torque applied to the bone-cement interface theoretically increases the risk of aseptic loosening. We assessed mid-term survivorship, complications, and clinical outcomes of a fixed-bearing VVC device in revision TKAs. METHODS: A total of 416 consecutive revision TKAs (398 patients) were performed at our institution using a single fixed-bearing VVC TKA from 2007 to 2015. Mean age was 64 years (33 to 88) with 50% male (199). Index revision TKA diagnoses were: instability (n = 122, 29%), aseptic loosening (n = 105, 25%), and prosthetic joint infection (PJI) (n = 97, 23%). All devices were cemented on the epiphyseal surfaces. Femoral stems were used in 97% (n = 402) of cases, tibial stems in 95% (n = 394) of cases; all were cemented. In total, 93% (n = 389) of cases required a stemmed femoral and tibial component. Femoral cones were used in 29%, and tibial cones in 40%. Survivorship was assessed via competing risk analysis; clinical outcomes were determined using Knee Society Scores (KSSs) and range of movement (ROM). Mean follow-up was four years (2 to 10). RESULTS: The five-year cumulative incidence of subsequent revision for aseptic loosening and instability were 2% (95% confidence interval (CI) 0.2 to 3, number at risk = 154) and 4% (95% CI 2 to 6, number at risk = 153), respectively. The five-year cumulative incidence of any subsequent revision was 14% (95% CI 10 to 18, number at risk = 150). Reasons for subsequent revision included PJI (n = 23, of whom 12 had previous PJI), instability (n = 13), and aseptic loosening (n = 11). The use of this implant without stems was found to be a significant risk factor for subsequent revision (hazard ratio (HR) 7.58 (95% CI 3.98 to 16.03); p = 0.007). KSS improved from 46 preoperatively to 81 at latest follow-up (p < 0.001). ROM improved from 96° prerevision to 108° at latest follow-up (p = 0.016). CONCLUSION: The cumulative incidence of subsequent revision for aseptic loosening and instability was very low at five years with this fixed-bearing VVC implant in revision TKAs. Routine use of cemented and stemmed components with targeted use of metaphyseal cones likely contributed to this low rate of aseptic loosening. Cite this article: Bone Joint J 2020;102-B(4):458-462.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Cimentação/métodos , Feminino , Seguimentos , Humanos , Instabilidade Articular/etiologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Falha de Prótese/etiologia , Infecções Relacionadas à Prótese/etiologia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Reoperação/métodos , Fatores de Risco , Resultado do Tratamento
18.
Arch Orthop Trauma Surg ; 140(6): 793-800, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32124032

RESUMO

BACKGROUND: Coronal alignment of the tibial component determines functional outcome and survival in total knee arthroplasty (TKA). Innovative techniques for tibial instrumentation have been developed to improve accuracy and reduce the rate of outliers. METHODS: In a prospective study, 300 patients were allocated to four different groups using a randomization process (two innovative and two conventional) techniques of tibial instrumentation (conventional: extramedullary, intramedullary; innovative: navigation and patient-specific instrumentation (PSI); n = 75 for each group). The aims were to reconstruct the medial proximal tibial angle (MPTA) to 90° and the mechanical tibio-femoral axis (mTFA) to 0°. Both angles were evaluated and compared between all groups three months after the surgery. Patients who presented with a postoperative mTFA > 3° were classified as outliers. RESULTS: The navigation and intramedullary technique both demonstrated that they were significantly more precise in reconstructing a neutral mTFA and MPTA compared to the other two techniques. The odd's ratio (OR) for producing outliers was highest for the PSI method (PSI OR = 5.5, p < 0.05; extramedullary positioning OR = 3.7, p > 0.05; intramedullary positioning OR = 1.7, p > 0.05; navigation OR = 0.04, p < 0.05). We could only observe significant differences between pre- and postoperative MPTA in the navigation and intramedullary group. The MPTA showed a significant negative correlation with the mTFA in all groups preoperatively and in the extramedullary, intramedullary and PSI postoperatively. CONCLUSION: The navigation and intramedullary instrumentation provided the precise positioning of the tibial component. Outliers were most common within the PSI and extramedullary technique. Optimal alignment is dependent on the technique of tibial instrumentation and tibial component positioning determines the accuracy in TKA since mTFA correlated with MPTA pre- and postoperatively.


Assuntos
Artroplastia do Joelho , Tíbia/cirurgia , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Artroplastia do Joelho/estatística & dados numéricos , Fenômenos Biomecânicos/fisiologia , Fêmur/cirurgia , Humanos , Estudos Prospectivos , Resultado do Tratamento
19.
Knee ; 27(3): 993-1002, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32115338

RESUMO

BACKGROUND: Unicompartmental knee replacement (UKR) offers advantages over total knee replacement but has higher revision rates. New instrumentation known as Microplasty was introduced to address this. The aim was to compare the revision rates of UKRs implanted with Microplasty and traditional instrumentation (Non-Microplasty). METHODS: National Joint Registry (NJR) data was used to propensity score match 15,906 UKRs (7953 Microplasty and 7953 Non-Microplasty) for important patient, implant and surgical factors. Implant survival rates were determined using the Kaplan-Meier method and compared using Cox regression models in a multilevel model. RESULTS: The five-year implant survival for Microplasty and Non-Microplasty UKRs were 96.7% (95% CI: 96.0%-97.2%) and 94.5% (CI: 93.8-95.1%), respectively. The revision rate for Microplasty UKR was significantly lower than that of Non-Microplasty UKRs (hazard ratio [HR] = 0.77, p = 0.008). Compared with Non-Microplasty UKRs, the revision rate of Microplasty UKRs implanted during the year after the introduction of Microplasty was lower, but the difference was not significant (HR: 0.86, CI: 0.67-1.10, p = 0.23), whereas for those implanted more than a year after introduction, the difference was significant (HR: 0.69, CI: 0.54-0.89, p = 0.004). CONCLUSION: The use of Microplasty instrumentation has resulted in an improved five-year UKR survival. Microplasty UKR implanted during the first year after introduction had a small, non-significant decrease in revision rate. As the revision rate did not increase, this suggests that there is no adverse learning curve effect. Microplasty UKRs implanted after this transition period had a revision rate 31% lower than the Non-Microplasty group. LEVEL OF EVIDENCE: II.


Assuntos
Artroplastia do Joelho/instrumentação , Osteoartrite do Joelho/cirurgia , Idoso , Artroplastia do Joelho/estatística & dados numéricos , Feminino , Humanos , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Falha de Prótese , Sistema de Registros/estatística & dados numéricos , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Reino Unido/epidemiologia
20.
Arch Orthop Trauma Surg ; 140(6): 801-806, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32146591

RESUMO

INTRODUCTION: The most commonly used tool for implant positioning are conventional instruments (CI) followed by computer-assisted surgery (CAS). A number of studies have investigated the cutting error of the tibial component when CAS is used, but most of them were focused on the cutting angles. The accuracy of CAS to determine the depth of the cut has not received much attention, even though implications are similar or worse, than with an angle mismatch. MATERIALS AND METHODS: This was an ethics board approved, prospective study of 23 consecutive varus TKAs by a single surgeon. Implant positioning was performed using CAS; however, the depth of the tibial cut was determined with both CAS and CI. Targeted alignment was the mechanical axis and 3° of posterior slope. The planned and the achieved cut, as determined by CAS needed to match. The achieved cut was then measured using a caliper and compared to the depth of the cut as per CAS. Medial and lateral cuts were analyzed separately. Analysis of variance and Bland-Altman plots were used for the comparison. RESULTS: Mean medial navigated cut was 6.3 (± 2.2) mm, mean measured medial cut was 6.6 (± 2.3) mm. Mean lateral navigated cut was 8.9 (± 1.8) mm, mean measured lateral cut was 8.8 (± 1.5) mm. There was a statistical significance for both the medial (p < 0.001) and the lateral (p = 0.004) navigated and measured cuts. CONCLUSIONS: The results of this study suggest that the tibial cut depth, measured by the navigation, does not match the actual bony cuts performed, even if a perfect cut was achieved in both sagittal and coronal plane. Surgeons should be aware of the measurement error in the navigation system and potentially add an additional step for verifying the achieved depth of the cut.


Assuntos
Artroplastia do Joelho , Cirurgia Assistida por Computador , Tíbia/cirurgia , Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/normas , Artroplastia do Joelho/estatística & dados numéricos , Humanos , Estudos Prospectivos , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/normas , Cirurgia Assistida por Computador/estatística & dados numéricos
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