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1.
Zhonghua Yi Xue Za Zhi ; 100(3): 187-191, 2020 Jan 21.
Artigo em Chinês | MEDLINE | ID: mdl-32008284

RESUMO

Objective: To compare the clinical outcome of posterior cruciate ligament (PCL) retention type and PCL substituting type using Advance(®) Medial Pivot (AMP) inner-axis knee prosthesis. Methods: A retrospective analysis was conducted on the cases of total knee arthroplasty (TKA) with AMP prosthesis in the Affiliated Hospital of Qingdao University from January 2011 to September 2016. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), American Knee Society Knee Score (KSS) clinical scores, KSS functional scores and knee-joint range of motion (ROM) before and after TKA, and Forgotten Joint Scores (FJS) after TKA were collected. The matching group was obtained by 1∶1 propensity score matching (PSM). Results: Complete scoring data were obtained in 47 knees of CR group and 1 059 knees of CS group, there were statistical differences in age, sex, body mass index, preoperative WOMAC score, preoperative KSS function score and ROM between the two groups (all P<0.05), except preoperative KSS clinical score (25±4 and 24±7, respectively, t=0.82, P=0.41). With the PSM matching, 37 knees in CR group and 37 knees in CS group were obtained. No significant differences in preoperative indexes were found between the matching groups (all P>0.05). The WOMAC, KSS clinical scores, KSS functional scores and ROM after TKA in each matching group were all much better than those before TKA (all P<0.05); no statistical differences existed in WOMAC, KSS clinical scores, KSS functional scores, ROM and FJS after TKA between the matching groups (all P>0.05). One PCL injury was found in CR matching group after TKA. Incidence of complications in the CR matching group (8.1%) was higher than that in the CS matching group (2.7%), but there was no statistical difference (χ(2)=1.04, P=0.31). Conclusions: When using AMP prosthesis, both CR insert and CS insert can obtain good clinical results in TKA. The potential risk of PCL injury and other complications after CR TKA makes it necessary for surgeons to carefully select an appropriate type of prosthesis.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Desenho de Prótese , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
2.
Bone Joint J ; 102-B(1): 108-116, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888356

RESUMO

AIMS: Limited evidence is available on mid-term outcomes of robotic-arm assisted (RA) partial knee arthroplasty (PKA). Therefore, the purpose of this study was to evaluate mid-term survivorship, modes of failure, and patient-reported outcomes of RA PKA. METHODS: A retrospective review of patients who underwent RA PKA between June 2007 and August 2016 was performed. Patients received a fixed-bearing medial or lateral unicompartmental knee arthroplasty (UKA), patellofemoral arthroplasty (PFA), or bicompartmental knee arthroplasty (BiKA; PFA plus medial UKA). All patients completed a questionnaire regarding revision surgery, reoperations, and level of satisfaction. Knee Injury and Osteoarthritis Outcome Scores (KOOS) were assessed using the KOOS for Joint Replacement Junior survey. RESULTS: Mean follow-up was 4.7 years (2.0 to 10.8). Five-year survivorship of medial UKA (n = 802), lateral UKA (n = 171), and PFA/BiKA (n = 35/10) was 97.8%, 97.7%, and 93.3%, respectively. Component loosening and progression of osteoarthritis (OA) were the most common reasons for revision. Mean KOOS scores after medial UKA, lateral UKA, and PFA/BiKA were 84.3 (SD 15.9), 85.6 (SD 14.3), and 78.2 (SD 14.2), respectively. The vast majority of the patients reported high satisfaction levels after RA PKA. Subgroup analyses suggested tibial component design, body mass index (BMI), and age affects RA PKA outcomes. Five-year survivorship was 98.4% (95% confidence interval (CI) 97.2 to 99.5) for onlay medial UKA (n = 742) and 99.1% (95% CI 97.9 to 100) for onlay medial UKA in patients with a BMI < 30 kg/m2 (n = 479). CONCLUSION: This large single-surgeon study showed high mid-term survivorship, satisfaction levels, and functional outcomes in RA UKA using metal-backed tibial onlay components. In addition, favourable results were reported in RA PFA and BiKA. Cite this article: Bone Joint J 2020;102-B(1):108-116.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Prótese do Joelho/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/métodos , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Medidas de Resultados Relatados pelo Paciente , Falha de Prótese , Reoperação/estatística & dados numéricos , Estudos Retrospectivos
3.
Bone Joint J ; 102-B(1): 132-136, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888367

RESUMO

AIMS: We report the natural course of Baker's cysts following total knee arthroplasty (TKA) at short- and mid-term follow-up. METHODS: In this prospective case series, 105 TKA patients were included. All patients who received surgery had a diagnosis of primary osteoarthritis and had preoperatively presented with a Baker's cyst. Sonography and MRI were performed to evaluate the existence and the gross size of the cyst before TKA, and sonography was repeated at a mean follow-up time of 1.0 years (0.8 to 1.3; short-term) and 4.9 years (4.0 to 5.6; mid-term) after TKA. Symptoms potentially attributable to the Baker's cyst were recorded at each assessment. RESULTS: At the one-year follow-up analysis, 102 patients were available. Of those, 91 patients were available for the 4.9-year assessment (with an 86.7% follow-up rate (91/105)). At the short- and mid-term follow-up, a Baker's cyst was still present in 87 (85.3%) and 30 (33.0%) patients, respectively. Of those patients who retained a Baker's cyst at the short-term follow-up, 31 patients (35.6%) had popliteal symptoms. Of those patients who continued to have a Baker's cyst at the mid-term follow-up, 17 patients (56.7%) were still symptomatic. The mean preoperative cyst size was 14.5 cm2 (13.1 to 15.8). At the short- and mid-term follow-up, the mean cyst size was 9.7 cm2 (8.3 to 11.0) and 10.4 cm2 (9.8 to 11.4), respectively. A significant association was found between the size of the cyst at peroperatively and the probability of resolution, with lesions smaller than the median having an 83.7% (36/43) probability of resolution, and larger lesions having a 52.1% (25/48) probability of resolution (p < 0.001). At the mid-term follow-up, no association between cyst size and popliteal symptoms was found. CONCLUSION: At a mean follow-up of 4.9 years (4.0 to 5.6) after TKA, the majority (67.0%, 61/91) of the Baker's cysts that were present preoperatively had disappeared. The probability of cyst resolution was dependent on the size of the Baker's cyst at baseline, with an 83.7% (36/43) probability of resolution for smaller cysts and 52.1% (25/48) probability for larger cysts. Cite this article: Bone Joint J. 2020;102-B(1):132-136.


Assuntos
Artroplastia do Joelho/métodos , Cisto Popliteal/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/patologia , Osteoartrite do Joelho/cirurgia , Cisto Popliteal/cirurgia , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia
4.
Medicine (Baltimore) ; 99(4): e18910, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977905

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a common disease in the elderly, which seriously reduces the quality of life of patients and increases the social burden. proximal fibula osteotomy (PFO) and high tibial osteotomy (HTO) are effective methods to treat KOA. However, it is not entirely clear which method has the advantage. Therefore, we evaluated the efficacy and safety of HTO and PFO in the treatment of KOA. METHODS: Randomized controlled trials from online databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Data and Chinese Biomedical Literature Database that compared the efficacy of HTO and PFO in the treatment of KOA were retrieved. The main outcomes included hospital for special surgery (HSS) knee scores, knee society knee scoring system (KSS) score, visual analog scale (VAS) knee pain scores, western ontario and McMaster universities osteoarthritis index score, operation time, intraoperative bleeding volume, hospitalization time, complications. The Cochrane risk of bias tool was used to assess methodological quality. RESULTS: The literature will provide a high-quality analysis of the current evidence supporting HTO for KOA based on various comprehensive assessments including HSS scores, KSS score, VAS scores, western Ontario and McMaster universities osteoarthritis index score, operation time, intraoperative bleeding volume, hospitalization time, and complications. CONCLUSION: This proposed systematic review will provide up-to-date evidence to assess the effect of HTO in the treatment for patients with KOA.


Assuntos
Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Fíbula/cirurgia , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisão Sistemática como Assunto , Tíbia/cirurgia
5.
Bone Joint J ; 102-B(1): 117-124, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888372

RESUMO

AIMS: It is unknown whether kinematic alignment (KA) objectively improves knee balance in total knee arthroplasty (TKA), despite this being the biomechanical rationale for its use. This study aimed to determine whether restoring the constitutional alignment using a restrictive KA protocol resulted in better quantitative knee balance than mechanical alignment (MA). METHODS: We conducted a randomized superiority trial comparing patients undergoing TKA assigned to KA within a restrictive safe zone or MA. Optimal knee balance was defined as an intercompartmental pressure difference (ICPD) of 15 psi or less using a pressure sensor. The primary endpoint was the mean intraoperative ICPD at 10° of flexion prior to knee balancing. Secondary outcomes included balance at 45° and 90°, requirements for balancing procedures, and presence of tibiofemoral lift-off. RESULTS: A total of 63 patients (70 knees) were randomized to KA and 62 patients (68 knees) to MA. Mean ICPD at 10° flexion in the KA group was 11.7 psi (SD 13.1) compared with 32.0 psi in the MA group (SD 28.9), with a mean difference in ICPD between KA and MA of 20.3 psi (p < 0.001). Mean ICPD in the KA group was significantly lower than in the MA group at 45° and 90°, respectively (25.2 psi MA vs 14.8 psi KA, p = 0.004; 19.1 psi MA vs 11.7 psi KA, p < 0.002, respectively). Overall, participants in the KA group were more likely to achieve optimal knee balance (80% vs 35%; p < 0.001). Bone recuts to achieve knee balance were more likely to be required in the MA group (49% vs 9%; p < 0.001). More participants in the MA group had tibiofemoral lift-off (43% vs 13%; p < 0.001). CONCLUSION: This study provides persuasive evidence that restoring the constitutional alignment with KA in TKA results in a statistically significant improvement in quantitative knee balance, and further supports this technique as a viable alternative to MA. Cite this article: Bone Joint J. 2020;102-B(1):117-124.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Feminino , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Osteoartrite do Joelho/fisiopatologia , Planejamento de Assistência ao Paciente , Cuidados Pré-Operatórios , Implantação de Prótese/métodos , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(4): e18636, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977853

RESUMO

RATIONALE: Knee osteoarthritis (KOA) is a common disease. It has long been believed that the main causes of KOA are knee degenerative diseases, trauma, overwork, and labor habits. However, long-term deformity leads to uneven stress on the surface of the knee joint, and the cause of lower limb force line damage has not been taken seriously. Comprehensive application of high tibial osteotomy (HTO), chronic distraction tissue regeneration, and computer-assisted external fixation for the treatment of severe KOA has many advantages over total knee arthroplasty, such as lasting and thorough orthopedic effects, a lower cost, and a faster recovery. PATIENT CONCERNS: The patient was a 48-year-old male with KOA caused by long-term genu varus, resulting in pain in both knees, especially in the right knee. The right knee pain had been aggravated for 2 years, and he was admitted to the hospital for left knee pain for 1 month. DIAGNOSES: X-ray: The patient has right KOA and varus deformity INTERVENTIONS: Comprehensive application of HTO, chronic distraction tissue regeneration technology, and computer-assisted external fixation technology has a good therapeutic effect for patients with KOA and varus. OUTCOMES: The patient's severe genu varus was corrected, the bone and soft tissue regeneration was good, the lower limb force line was improved, lower limb function was restored well, and the treatment was satisfactory. CONCLUSION: For the treatment of KOA patients with genu varus, the combination of HTO, chronic distraction tissue regeneration, and computer-assisted adjustment of external fixation technology have a good effect on the correction of genu varus deformity and the recovery of the lower limb force line. This treatment method is also conducive to preventing postoperative infection and avoiding secondary trauma caused by the removal of internal fixation plates.


Assuntos
Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Fixadores Externos , Regeneração Tecidual Guiada/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tíbia/cirurgia
9.
J Surg Oncol ; 121(1): 57-66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31197837

RESUMO

INTRODUCTION: Patients with pre-existing lymphedema who undergo total knee arthroplasty (TKA) for osteoarthritis (OA) are at high risk for periprosthetic joint infection. This complication usually requires removal of the implant. This study aimed to investigate whether surgical treatment of lymphedema reduces the rate of prosthesis removal in such patients. MATERIALS AND METHODS: We retrospectively reviewed our prospective database of patient information collected between January 2009 and December 2018. A total of 348 cases of lower extremity lymphedema were reviewed, and those who underwent total knee TKA for OA of the knee were included. Patient demographics, clinical data, lymphedema surgical history, and TKA surgical history including any episodes of removal were collected and analyzed. RESULTS: There were nine of 15 lymphedema patients with knee OA who subsequently underwent TKA. The mean patient age was 70.4 ± 7.1 years. A total of 18 TKAs were performed in nine patients. The knee prosthesis removal rate was 66.7% (12/18). The prosthesis removal rate was 40% (2/5) in patients who underwent lymphedema microsurgery vs 76.9% (10/13) for those who did not (P = .03). CONCLUSIONS: Pre-existing lymphedema is associated with a high rate of knee prosthesis removal. Lymphedema microsurgery reduced the removal rate of knee prostheses. We recommend that lymphedema microsurgery be considered for patients who require TKA as a treatment for of the knee.


Assuntos
Artroplastia do Joelho/efeitos adversos , Remoção de Dispositivo , Prótese do Joelho , Linfedema/cirurgia , Osteoartrite do Joelho/cirurgia , Infecções Relacionadas à Prótese/prevenção & controle , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Linfedema/fisiopatologia , Microcirurgia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Bone Joint J ; 101-B(11): 1331-1347, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674244

RESUMO

AIMS: Antibiotic-loaded bone cements (ALBCs) may offer early protection against the formation of bacterial biofilm after joint arthroplasty. Use in hip arthroplasty is widely accepted, but there is a lack of evidence in total knee arthroplasty (TKA). The objective of this study was to evaluate the use of ALBC in a large population of TKA patients. MATERIALS AND METHODS: Data from the National Joint Registry (NJR) of England and Wales were obtained for all primary cemented TKAs between March 2003 and July 2016. Patient, implant, and surgical variables were analyzed. Cox proportional hazards models were used to assess the influence of ALBC on risk of revision. Body mass index (BMI) data were available in a subset of patients. RESULTS: Of 731 214 TKAs, 15 295 (2.1%) were implanted with plain cement and 715 919 (97.9%) with ALBC. There were 13 391 revisions; 2391 were performed for infection. After adjusting for other variables, ALBC had a significantly lower risk of revision for any cause (hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77 to 0.93; p < 0.001). ALBC was associated with a lower risk of revision for all aseptic causes (HR 0.85, 95% CI 0.77 to 0.95; p < 0.001) and revisions for infection (HR 0.84, 95% CI 0.67 to 1.01; p = 0.06). The results were similar when BMI was added into the model, and in a subanalysis where surgeons using only ALBC over the entire study period were excluded. Prosthesis survival at ten years for TKAs implanted with ALBC was 96.3% (95% CI 96.3 to 96.4) compared with 95.5% (95% CI 95.0 to 95.9) in those implanted with plain cement. On a population level, where 100 000 TKAs are performed annually, this difference represents 870 fewer revisions at ten years in the ALBC group. CONCLUSION: After adjusting for a range of variables, ALBC was associated with a significantly lower risk of revision in this registry-based study of an entire nation of primary cemented knee arthroplasties. Using ALBC does not appear to increase midterm implant failure rates. Cite this article: Bone Joint J 2019;101-B:1331-1347.


Assuntos
Antibacterianos/administração & dosagem , Artroplastia do Joelho/métodos , Cimentos para Ossos , Prótese do Joelho/efeitos adversos , Adulto , Idoso , Anticoagulantes/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Tromboembolia/prevenção & controle , Resultado do Tratamento
11.
Eklem Hastalik Cerrahisi ; 30(3): 233-40, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650919

RESUMO

OBJECTIVES: This study aims to investigate the long-term clinical outcomes, complications and survival rates of cemented Oxford medial unicompartmental knee arthroplasty (UKA) and to compare the findings with the reported outcomes of UKA and total knee arthroplasty (TKA) in the literature. PATIENTS AND METHODS: In the study, 133 knees of 115 patients (16 males, 99 females; mean age 65.5±8.3 years; range, 50 to 88 years) who underwent Oxford medial UKA between May 2007 and August 2013 were followed-up for an average of 126 months. Prosthetic complications and revisions were evaluated. While Kaplan-Meier method was used to evaluate implant survival, Knee Society, Functional Knee Society and visual analog scale scores were used for determining final functional outcomes. RESULTS: Totally 29 prosthetic complications (21.6% of total patients) were observed and the most common one was insert dislocation observed in 17 knees (12.6%). Revision surgeries were performed for all of these patients. Among the 17 patients who underwent insert replacement surgeries, the inserts were stable in eight during the follow-up while insert dislocation reoccurred in nine. Revision surgeries were performed in a total of 21 patients (15.6%). There were statistically significant improvements in final follow-up functional knee scores of patients without complications compared to preoperative scores. CONCLUSION: According to our findings, while reoperation and early aseptic revision rates of Oxford medial UKA are high compared to the TKA results reported in the literature, functional results are satisfactory for patients with no revision.


Assuntos
Artroplastia do Joelho/instrumentação , Cimentos para Ossos , Prótese do Joelho , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Escala Visual Analógica
12.
Bone Joint J ; 101-B(10): 1230-1237, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564152

RESUMO

AIMS: The aim of this study was to assess the effect of posterior cruciate ligament (PCL) resection on flexion-extension gaps, mediolateral soft-tissue laxity, fixed flexion deformity (FFD), and limb alignment during posterior-stabilized (PS) total knee arthroplasty (TKA). PATIENTS AND METHODS: This prospective study included 110 patients with symptomatic osteoarthritis of the knee undergoing primary robot-assisted PS TKA. All operations were performed by a single surgeon using a standard medial parapatellar approach. Optical motion capture technology with fixed femoral and tibial registration pins was used to assess gaps before and after PCL resection in extension and 90° knee flexion. Measurements were made after excision of the anterior cruciate ligament and prior to bone resection. There were 54 men (49.1%) and 56 women (50.9%) with a mean age of 68 years (sd 6.2) at the time of surgery. The mean preoperative hip-knee-ankle deformity was 4.1° varus (sd 3.4). RESULTS: PCL resection increased the mean flexion gap significantly more than the extension gap in the medial (2.4 mm (sd 1.5) vs 1.3 mm (sd 1.0); p < 0.001) and lateral (3.3 mm (sd 1.6) vs 1.2 mm (sd 0.9); p < 0.01) compartments. The mean gap differences after PCL resection created significant mediolateral laxity in flexion (gap difference: 1.1 mm (sd 2.5); p < 0.001) but not in extension (gap difference: 0.1 mm (sd 2.1); p = 0.51). PCL resection significantly improved the mean FFD (6.3° (sd 4.4) preoperatively vs 3.1° (sd 1.5) postoperatively; p < 0.001). There was a strong positive correlation between the preoperative FFD and change in FFD following PCL resection (Pearson's correlation coefficient = 0.81; p < 0.001). PCL resection did not significantly affect limb alignment (mean change in alignment: 0.2° valgus (sd 1.2); p = 0.60). CONCLUSION: PCL resection creates flexion-extension mismatch by increasing the flexion gap more than the extension gap. The increase in the lateral flexion gap is greater than the increase in the medial flexion gap, which creates mediolateral laxity in flexion. Improvements in FFD following PCL resection are dependent on the degree of deformity before PCL resection. Cite this article: Bone Joint J 2019;101-B:1230-1237.


Assuntos
Artroplastia do Joelho/métodos , Instabilidade Articular/prevenção & controle , Osteoartrite do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Amplitude de Movimento Articular/fisiologia , Procedimentos Cirúrgicos Robóticos/métodos , Fatores Etários , Idoso , Análise de Variância , Artroplastia do Joelho/efeitos adversos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Melhoria de Qualidade , Medição de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Fatores Sexuais , Resultado do Tratamento
13.
BMC Health Serv Res ; 19(1): 688, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604433

RESUMO

BACKGROUND: The main purpose of health service systems is to improve patients' quality of life (QoL) and to ensure equitable access to health services. However, in reality, nearly half of knee osteoarthritis (OA) patients present to the health system do not have access to health services, and their QoL remains poor. These circumstances raise important questions about what (if any) factors can improve health care accessibility and QoL for knee OA patients. METHODS: A multicenter, cross-sectional survey was performed with 618 knee OA patients who received care at 16 hospitals in Thailand. Structural equation modeling (SEM) was conducted to investigate the association of health service factors and patient factors with access to health services and QoL. RESULTS: The QoL of knee OA patients was very poor (mean score = 33.8). Only 2.1% of the knee OA patients found it easy to obtain medical care when needed. Approximately 39.4% of them were able to access appropriate interventions before being referred for knee replacement. More than 85% of orthopedic health services had implemented chronic disease management (CDM) policy into practice. However, the implementation was basic, with an average score of 5.9. SEM showed that QoL was determined by both health system factors (ß = .10, p = .01) and patient factors (ß = .29, p = .00 for self-management and ß = -.49, p = .00 for disease factors). Access to health services was determined by self-management (ß = .10, p = .01), but it was not significantly associated with QoL (ß = .00, p = 1.0). CONCLUSIONS: This study provides compelling information about self-management, access to health services and QoL from the individual and health service system perspectives. Furthermore, it identifies a need to develop health services that are better attuned to the patient's background, such as socioeconomic status, disease severity, and self-management skills.


Assuntos
Acesso aos Serviços de Saúde/normas , Osteoartrite do Joelho/cirurgia , Qualidade de Vida , Artroplastia do Joelho/psicologia , Artroplastia do Joelho/normas , Doença Crônica , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Osteoartrite do Joelho/psicologia , Autogestão/estatística & dados numéricos , Tailândia
14.
Wiad Lek ; 72(9 cz 1): 1621-1632, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31586974

RESUMO

OBJECTIVE: Introduction: Osteoarthritis (OA) is the most common and burdensome illness in the elderly patients. It is the main cause of locomotor impairment and disability resulting in significant decrease of the quality of life (QL) in highly developed countries. Sf-36v2 questionnaire was standardized in the United States by J.E. Ware et al. in the years 1985-1992 and at present SF-36v2 is the most commonly used questionnaire for investigations in patients with various conditions. The aim: To compare two cohorts of post-menopausal female patients with the predominantly clinically active one-site advanced osteoarthritis of the hip and knee joint prior to the replacement surgery. PATIENTS AND METHODS: Material and methods: Two cohorts of fifty female postmenopausal patients aged from sixty to eighty were investigated. The inclusion criteria relied on sex, age and clinically single joint predominant OA disease prior to hip and knee joint replacement. The Polish version of SF-36v2 for the quality of life was accomplished by the patient under direct supervision of a trained nurse. The sets of obtained data were analyzed with the use of Statistica 10.0 (Shapiro-Wilk test, U - Mann-Whitney test, Spearmann, Kruskall-Wallis, Friedmann's ANOVA and Chi 2 Pearson). p <0.05 was regarded as significant. RESULTS: Results: It was found that patients with advanced knee OA demonstrated significantly lower QL than these with hip OA in Vitality (p=0,004), Functioning in Social Roles (p=0,0001), General Health (p <0,000001) and Pain (p <0,000001). No significant differences within the cohorts were observed as the other scales were concerned (p >0,05). In the general assessment as for the QL in the Physical domain significant difference was found with lower scoring in the knee group (p=0.00001). In the assessment of the general QL two domains were considered -Physical and Mental Health. Highly significant difference was recorded for the Physical better in regard for hip OA (p <0,00001). In the Mental Health domain no significant difference was found (p=0,09). CONCLUSION: Conclusions: 1. Quality of life of postmenopausal women with hip OA is predominantly lowered by the local disease whereas lower quality of life of these females with knee OA is related to the general poor health, low index of vitality and decrease of function in social functioning resulting from co-existence of chronic illnesses due to overweight and obesity. 2. Reduction of overweight or obesity in the group of patients with knee arthritis could improve their quality of life and general health.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgia , Idoso , Feminino , Humanos , Qualidade de Vida , Inquéritos e Questionários
15.
Orthopade ; 48(11): 963-968, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31506824

RESUMO

Total knee arthroplasty (TKA) is a frequent operation in Germany and in 2017 a total of 191,272 interventions were carried out. These interventions are associated with high costs and involve complex clinical workflow organization and time-consuming instrument logistics. With this in mind, the aim of this study was to identify the economic potential of the instrument configuration in order to optimize the entire process in TKA. Changing the composition of the set of instruments used in the operating theater for TKA resulted in time and cost saving for the complete TKA procedure, including all personnel and off-shoot procedures. In addition, the operating time saved by the introduction of a patient-specific instrumentation set meant that the operating theater could be used for more or other surgical procedures, also generating additional revenue.


Assuntos
Artroplastia do Joelho/instrumentação , Salas Cirúrgicas/organização & administração , Osteoartrite do Joelho/cirurgia , Instrumentos Cirúrgicos/economia , Artroplastia do Joelho/economia , Artroplastia do Joelho/métodos , Redução de Custos , Custos e Análise de Custo , Eficiência , Alemanha , Custos Hospitalares , Humanos , Salas Cirúrgicas/economia
16.
Chirurgia (Bucur) ; 114(4): 437-442, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511129

RESUMO

Total knee arthroplasty (TKA) is a key surgical procedure for the treatment of severe knee osteoarthritis. Although TKA has very good clinical results, revision knee arthroplasty can sometimes be necessary due to prosthetic components malalignment which leads to early polyethylene wear, instability and aseptic loosening. Currently, the revision risk of TKA at ten years is 5%. The finite element method (FEM) is a numerical technique which allows the modelling of complex geometry and system of loads. This method is a necessity in the field of orthopedics to simulate or predict the conditions that could lead to complications or failure and react to increase the longevity of TKA. The aim of this literature review is to highlight the relevance of using FEM along with TKA. Specialty literature research shows that the use of finite element analysis is widely spread in total knee arthroplasty. It is used to compare insert materials in order to obtain the most effective method and thus decrease the wear rate. Using simulated angles, forces and stress, FEM tests different malalignment conditions in order to apply these results in the pre-operative planning and avoid a possible TKA failure. The finite element analysis has a great potential of further refining TKA alignment outcome and is very important for the analysis of knee biomechanics under different loads. FEM is used to reduce the incidence of TKA revision and to improve patients satisfaction after TKA.


Assuntos
Artroplastia do Joelho , Análise de Elementos Finitos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Humanos , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Falha de Prótese , Reoperação
17.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1121-1126, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512453

RESUMO

Objective: To compare the effectiveness of the intermittent suture and the cosmetic suture in total knee arthroplasty (TKA). Methods: A clinical data of 48 patients with knee osteoarthritis, who underwent initial TKA between January 2017 and April 2018, was retrospectively analyzed. Among them, 23 patients underwent intermittent suture (group A) and 25 patients underwent cosmetic suture (group B). There was no significant difference in gender, age, body mass index, disease duration, degrees of varus and valgus deformities, knee society score (KSS), visual analogue scale (VAS) score, and levels of interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in serum before operation between the two groups ( P>0.05). KSS scores at 1 and 6 months after operation were used to assess the knee function. VAS scores at 1, 3, and 5 days after operation were used to assess the pain degree of knee. Levels of IL-6, PCT, CRP, and ESR in serum at 1 day and 1 month after operation were recorded to evaluate the risk of periprosthetic infection. Likert score at 6 months after operation was used to evaluate the satisfaction of incision. The hospitalization time after operation was also recorded. Results: All patients were followed up 7- 17 months (mean, 11.3 months). There was no significant difference in hospitalization time after operation between two groups ( t=-1.907, P=0.063). The Likert score in group A was significantly lower than that in group B ( t=-2.196, P=0.033). The VAS score, KSS clinical score and KSS functional score at different time points after operation were significantly better than those before operation in two groups ( P<0.05). The VAS score at 5 days after operation was better than that at 1 day after operation in two groups, and the KSS clinical score and KSS functional score at 6 months after operation were better than those at 1 month after operation in two groups, all showing significant differences ( P<0.05). The VAS scores at 3 and 5 days after operation were significantly lower in group B than in group A ( P<0.05), and there was no significant difference in VAS score and KSS scores between two groups at other time points after operation ( P>0.05). There was no significant difference in the levels of IL-6, PCT, CRP, and ESR between the two groups at different time points after operation ( P>0.05). Conclusion: Cosmetic suture is superior to intermittent suture in incision appearance and pain management, but there is no significant difference in short-term joint function and risk of periprosthetic infection after TKA.


Assuntos
Artroplastia do Joelho , Articulação do Joelho , Osteoartrite do Joelho , Suturas , Artroplastia do Joelho/métodos , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Suturas/normas , Resultado do Tratamento
18.
Zhongguo Gu Shang ; 32(8): 707-711, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31533380

RESUMO

OBJECTIVE: To explore long-term following-up clinical effects of lateral closed high tibial osteotomy for the treatment of knee osteoarthritis. METHODS: Twenty patients with medial unicompartmental knee osteoarthritis were treated with lateral closed high tibial osteotomy and screw fixation from June 2005 to December 2015. Among them, including 17 females and 3 males, aged from 43 to 76 years old with an average of (57.80±8.05) years old. VAS score and KSS score were applied to evaluate recovery degree of pain and function before operation and after operation at 1, 5 and 10 years, and postoperative complications were observed. RESULTS: Sixteen patients were followed-up, the time ranged from 9 to 11(10.0±0.8) years, 4 patients were loss to follow-up. Preoperative VAS score was 7.88±1.15 and decreased to 3.19±0.91, 3.44±0.96, 3.69±1.20 at 1, 5 and 10 years after operation, and there were statistical differences in VAS score between before and after operation at different time points (P<0.05). Clinical score of KSS increased from 61.94±5.74 before opertaion to 75.50±4.62, 80.13±3.97, 77.38±6.40 at 1, 5 and 10 years after operation, and there were statistical differences in clinical score of KSS between before and after operation at different time points(P<0.05); functional score of KSS increased from 62.81±13.03 before operation to 77.50±8.56, 81.88±6.55, 76.88±10.78, and there were statistical differences in functional score of KSS between before and after operation at different time points(P<0.05). All incisions healed well without complications such as fibula nerve injury and fracture nonunion. CONCLUSIONS: Lateral closed high tibial osteotomy and screw fixation for knee osteoarthritis could receive good clinical results, stop and delay progress of knee osteoarthritis, and long-term following-up could achieve the same effect as total knee arthroplasty.


Assuntos
Osteoartrite do Joelho , Adulto , Idoso , Feminino , Seguimentos , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Osteotomia , Tíbia , Resultado do Tratamento
19.
Zhongguo Gu Shang ; 32(8): 755-758, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31533390

RESUMO

OBJECTIVE: To evaluate short-term clinical results of fixed-bearing unicompartmental knee arthroplasty (UKA) for patients with medial compartmental knee osteoarthritis. METHODS: From January 2015 to December 2017, 62 patients with medial compartmental knee osteoarthritis were treated by fixed-bearing UKA. Among them, including 19 males and 43 females, aged from 47 to 83 years old with an average of (65.3±8.2) years old. The courses of disease ranged from 5 to 72 months with an average of(19.4±14.3) months. Postoperative complications were observed, VAS score was used to observe degree of pain relief, Hospital for Special Surgery(HSS) score was used to evaluate clinical effects. RESULTS: All patients were followed up from 4 to 40 months with an average of(19.9 ±10.2) months. The incision healed well without blood transfusion, hospital stays ranged from 2 to 10 days with an average of (3.5±1.6) days. No deep infection, dislocation, loosing or per prosthetic fracture occurred after operation, while 1 patient suffered from posterior tibial vein thrombosis. HSS score improved from 69.9±7.2 before operation to 90.1±7.4 at final following-up, and 51 patients obtained excellent results, 9 patients good and 2 moderate. VAS score decreased from 3.8±0.9 before operation to 1.1±0.9 at final following-up. CONCLUSIONS: Fixed-bearing UKA for medial compartmental knee osteoarthritis could obtain short-term clinical results for shorter hospital stay, less complications. with fewer complication and fast recovery.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Resultado do Tratamento
20.
Clin Orthop Surg ; 11(3): 282-290, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475048

RESUMO

Background: Although microfracture is widely accepted as an effective treatment option for knee chondral lesions, little is known about the deterioration of clinical outcomes and radiological progression in middle-aged patients. Therefore, this study was conducted to evaluate the clinical and radiological changes after microfracture of knee chondral lesions in middle-aged Asian patients. Methods: A total of 71 patients were included in the study. They were between the ages of 40 and 60 years and underwent arthroscopic microfracture for localized full-thickness cartilage defects of the knee from January 2000 to September 2015. The recovery status of chondral lesions was assessed by using the magnetic resonance observation of cartilage repair tissue (MOCART) score in postoperative magnetic resonance imaging (MRI). Clinical and radiological results were reviewed, and survival rate with conversion to arthroplasty or osteotomy as an end point was evaluated. Results: The mean age of the patients at surgery was 51.3 ± 4.7 years (range, 40 to 60 years), and the mean follow-up period was 7.2 ± 2.6 years (range, 1.0 to 17.4 years). The MOCART scores of 32 patients at mean postoperative 2.1 years showed three cases (9%) of full recovery, two cases (7%) of hyperplastic recovery, 23 cases (70%) with more than 50% filling, and four cases (14%) with less than 50% filling. Clinical scores improved significantly at 1 year after surgery (p < 0.05); however, the scores deteriorated over time after postoperative 1 year, and the mean values reached preoperative levels at postoperative 10 years. Significant radiological progression of arthritis (Kellgren-Lawrence grade) was observed at 5 years after surgery. Four patients underwent total knee arthroplasty during follow-up. Conclusions: Most patients showed more than 50% of defect filling at 2 years after surgery on MRI. Clinical results of microfracture of knee chondral lesion showed the best improvement at postoperative 1 year but gradually worsened thereafter until postoperative 10 years. Radiological progression of arthritis was observed from 5 years after surgery.


Assuntos
Artroplastia Subcondral , Doenças das Cartilagens/cirurgia , Cartilagem Articular/cirurgia , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Adulto , Grupo com Ancestrais do Continente Asiático , Doenças das Cartilagens/diagnóstico , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/etnologia , Cartilagem Articular/diagnóstico por imagem , Progressão da Doença , Humanos , Articulação do Joelho/diagnóstico por imagem , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem
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