Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.144
Filtrar
1.
Zhongguo Gu Shang ; 34(2): 191-4, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33666010

RESUMO

Femorotibial mechanical axis (FTMA) is one of important factors influencing clinical effect after total knee arthroplasty (TKA). It is generally believed that the range of lower limb alignment after TKA is controlled within neutral FTMA ± 3 °, which has more advantages in improving joint function, prolonging prosthesis survival rate and reducing revision rate, and obtain better clinical results. Therefore, neutral FTMA is also considered to be the gold standard for TKA. However, with the application of computer-assisted surgery and other technologies, the alignment of FTMA is more accurate than before, but the clinical effect after surgery has not significantly improved. Some scholars have begun to question the necessity of neutral alignment of FTMA, and proposed alignment methods such as kinematics and retained residual deformity, which could achieve better clinical effects. In recent years, it has been reported that FTMA might not be the most important factor influencing postoperative clinical effects, and it is suggested that the arrangement and measurement of lower limbs and the effects on adjacent joint functions could affect clinical effect after TKA. The paper reviews neutral FTMA alignment is still an important factor for success of TKA. After a thorough evaluation according to the patient's condition, it should be appropriately applied in the case of neutral FTMA alignment; the operator should explore other factors which affect clinical outcome after TKA, and improve it to achieve the best therapeutic effect.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Cirurgia Assistida por Computador , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/cirurgia , Extremidade Inferior , Osteoartrite do Joelho/cirurgia , Falha de Prótese
2.
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
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.
JAMA ; 325(6): 568-578, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33560326

RESUMO

Importance: Osteoarthritis (OA) is the most common joint disease, affecting an estimated more than 240 million people worldwide, including an estimated more than 32 million in the US. Osteoarthritis is the most frequent reason for activity limitation in adults. This Review focuses on hip and knee OA. Observations: Osteoarthritis can involve almost any joint but typically affects the hands, knees, hips, and feet. It is characterized by pathologic changes in cartilage, bone, synovium, ligament, muscle, and periarticular fat, leading to joint dysfunction, pain, stiffness, functional limitation, and loss of valued activities, such as walking for exercise and dancing. Risk factors include age (33% of individuals older than 75 years have symptomatic and radiographic knee OA), female sex, obesity, genetics, and major joint injury. Persons with OA have more comorbidities and are more sedentary than those without OA. The reduced physical activity leads to a 20% higher age-adjusted mortality. Several physical examination findings are useful diagnostically, including bony enlargement in knee OA and pain elicited with internal hip rotation in hip OA. Radiographic indicators include marginal osteophytes and joint space narrowing. The cornerstones of OA management include exercises, weight loss if appropriate, and education-complemented by topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs) in those without contraindications. Intra-articular steroid injections provide short-term pain relief and duloxetine has demonstrated efficacy. Opiates should be avoided. Clinical trials have shown promising results for compounds that arrest structural progression (eg, cathepsin K inhibitors, Wnt inhibitors, anabolic growth factors) or reduce OA pain (eg, nerve growth factor inhibitors). Persons with advanced symptoms and structural damage are candidates for total joint replacement. Racial and ethnic disparities persist in the use and outcomes of joint replacement. Conclusions and Relevance: Hip and knee OA are highly prevalent and disabling. Education, exercise and weight loss are cornerstones of management, complemented by NSAIDs (for patients who are candidates), corticosteroid injections, and several adjunctive medications. For persons with advanced symptoms and structural damage, total joint replacement effectively relieves pain.


Assuntos
Osteoartrite do Quadril , Osteoartrite do Joelho , Corticosteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Artroplastia de Substituição , Progressão da Doença , Exercício Físico , Prótese de Quadril , Humanos , Injeções Intra-Articulares , Prótese do Joelho , Imagem por Ressonância Magnética , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/terapia , Perda de Peso
5.
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
6.
Orthopade ; 50(2): 124-129, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33394068

RESUMO

BACKGROUND: Numerous long-term results for both medial and lateral unicondylar knee arthroplasty (UKA) demonstrate that UKA is a reliable and successful treatment for isolated anteromedial or lateral osteoarthritis of the knee when the correct indications are used. The relationship between operation volume and implant performance has clearly been established from recent studies and registry data. The use of novel technologies allows for an improvement in the accuracy of implant positioning with fewer outliers. However, evidence-based target zones for the positioning of available implants have not been sufficiently established. INDIVIDUAL ENDOPROSTHETICS: Current data does not support the routine use of patient-specific instruments or custom-made implants. ROBOTICS: Robot-assisted procedures must be interpreted as a very promising approach for the future. So far, there is insufficient evidence that robotically assisted surgical techniques improve implant performance or lead to better functional results from the patient's point of view.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Robótica , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Resultado do Tratamento
7.
Instr Course Lect ; 70: 235-246, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438913

RESUMO

Unicompartmental knee arthroplasty and patellofemoral arthroplasty were pioneered in the 1970s but abandoned by most in favor of total knee arthroplasty because of inconsistent early outcomes. Advancements in implant design, instrumentation, indications, and surgical techniques have enhanced results and led to a resurgence in both unicompartmental knee arthroplasty and patellofemoral arthroplasty for appropriate candidates. In appropriately selected patients, current implants and techniques provide surgeons the resources to carry out a surgical procedure that is simpler to perform and easier to recover from. Furthermore, unicompartmental knee arthroplasty is associated with fewer postoperative complications and lower mortality and is equal to or better than total knee arthroplasty.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Artroplastia do Joelho/efeitos adversos , Humanos , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
8.
Instr Course Lect ; 70: 247-258, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438914

RESUMO

The number of revision total knee arthroplasties (TKAs) is greatly increasing. It is important to know how to approach the painful and malfunctioning TKA to determine the etiology and establish surgical plan, and also how to perform a basic revision TKA. Following the conclusion of this chapter, the reader should feel familiar with the full spectrum of treatment for patients who may be indicated for revision TKA.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Artroplastia do Joelho/efeitos adversos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Reoperação , Fatores de Risco , Resultado do Tratamento
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(1): 51-57, 2021 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-33448199

RESUMO

Objective: To compare the effectiveness of partial versus intact posterior cruciate ligament (PCL)-retaining in total knee arthroplasty (TKA) with cruciate-retaining (CR) prosthesis. Methods: A total of 200 patients with osteoarthritis, who met the selection criteria and proposed unilateral TKA with CR prosthesis, were included in the study and randomly assigned into two groups ( n=100). The patients were treated with intact retention of the double bundles of PCL in intact group and with partial resection of the anterior lateral bundle of PCL and the anterior bone island at the time of intraoperative tibial osteotomy in partial group. Patients with lost follow-up and re-fracture were excluded, and 84 cases in partial group and 88 cases in intact group were included in the final study. There was no significant difference between the two groups ( P>0.05) in terms of gender, age, body mass index, course and grade of osteoarthritis, preoperative varus deformity of knee joint, flexion contracture, range of motion, clinical and functional scores of Knee Society Score (KSS). The operation time, wound drainage volume during 24 hours after operation, visual analogue scale (VAS) score at 24 hours after operation, range of motion of knee joint, clinical and functional scores of KSS, and the anteroposterior displacement of knee joint at 30° and 90° flexion positions were compared between the two groups. Results: There was no significant difference between the two groups in operation time, wound drainage volume during 24 hours after operation, and VAS score at 24 hours after operation ( P>0.05). Patients in both groups were followed up after operation. The follow-up time was 25-40 months (mean, 30.2 months) in intact group and 24-40 months (mean, 31.8 months) in partial group. There was no significant difference in the range of motion and clinical scores of KSS between the two groups at 6, 12, and 24 months after operation ( P>0.05). The functional scores of KSS were significantly higher in intact group than in partial group ( P<0.05). There was no significant difference between the two groups in the anteroposterior displacement of knee joints at 30° flexion position at 6, 12, and 24 months after operation ( P>0.05). When the knee was at 90° flexion position, there was no significant difference between the two groups at 6 and 12 months after operation ( P>0.05), but the intact group was significantly smaller than partial group at 24 months after operation ( P<0.05). Postoperative incision continued exudation in 4 patients (2 cases of partial group and 2 cases of intact group), and incision debridement in 2 patients (1 case of partial group and 1 case of intact group). No prosthesis loosening, excessive wear, or dislocation of gasket was found during follow-up. Conclusion: The double bundle of PCL plays an equally important role in maintaining the stability of the knee joint, and the integrity of PCL should be kept as much as possible when TKA is performed with CR prosthesis.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Ligamento Cruzado Posterior , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Amplitude de Movimento Articular , Resultado do Tratamento
11.
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
12.
Orthopade ; 50(2): 130-135, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33346868

RESUMO

BACKGROUND: Unicondylar knee arthroplasty offers the advantage that partial degenerative changes can be addressed with partial prosthetic solutions, thus preserving as much of the native joint as possible, including the cruciate ligaments. On the other hand, the number of revisions is still higher than for total knee endoprosthetics. In the literature, the causes mentioned are insufficient fit of the components as well as surgical errors. The use of new technologies to achieve a better fit and higher surgical precision and reproducibility, therefore, represents a promising approach. INDIVIDUAL ENDOPROSTHETICS: Individual endoprosthetics offers the advantage that the prosthesis is adapted to the individual anatomy of each patient and not the patient's anatomy to the prosthesis, as is the case with standard prostheses. This allows for an optimal fit of the prosthesis while avoiding excessive bone resections and soft tissue releases. ROBOTICS: The use of robotics in endoprosthetics makes it easier to correctly perform bone resections and align components. This ensures high and reproducible precision even for surgeons with lower case numbers. Studies on individual unicondylar endoprosthetics and robotics are reporting promising results. However, long-term results of high-quality randomized studies must be awaited in order to make a scientifically sound statement.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Robótica , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Reprodutibilidade dos Testes , Resultado do Tratamento
13.
Orthopade ; 50(2): 104-111, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33346867

RESUMO

BACKGROUND: A higher patient satisfaction stands in contrast to higher revision rates of unicondylar knee joint endoprosthetics (UKE) compared to total knee joint endoprosthetics (TKE). Furthermore, old "dogmas" regarding indications and contraindications persist, which is still reflected in the significantly different case numbers. AIM: The aim of this article is to provide an overview of the current literature regarding 1. indication and contraindication (BMI, age, sport, arthrosis of other compartments, ligament status) and 2. the "eternal rival" fixed or mobile bearing for UKE. RESULTS: The choice of the right patient remains essential, even if all the old "dogmas" of contraindications have been relativized or even outdated. Arthroses of the contralateral (in medial UKE correspondingly lateral) compartment and advanced arthroses of the lateral patella facet remain the only persistent contraindications. In contrast, a high BMI, age, chondrocalcinosis, medial patella facet and a defective (but particularly functionally stable) ACL are not contraindications; however, severe obesity is responsible for a significantly higher complication rate and probably a higher rate of loosening. Rather, the experience and thus the number of UKEs of the individual surgeon is decisive for the outcome, to which the discussion about mobile or fixed inlays must also be completely subordinated. CONCLUSION: The indications for UKE can, therefore, be extended with a clear conscience on the basis of literature, and the current 1:10 UKE:TKE ratio in Germany can be shifted significantly.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Alemanha , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Resultado do Tratamento
14.
Orthopade ; 50(2): 136-142, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33355685

RESUMO

Isolated arthrosis of the patellofemoral joint is a rare and complex disease. After conservative therapy has been exhausted, the orthopedist has various soft-tissue and bone reconstructive procedures as well as cartilage regenerative procedures at his hands. In cases of failed or unsatisfactory therapy, patellofemoral arthroplasty continues to be controversially discussed as an alternative therapy. A closer look at these studies reveals promising results with the correct indication and patient selection. The different prosthesis designs provide good postoperative results while considering general and specific risks. The current generation of patellofemoral inlay prostheses shows high patient satisfaction with significant improvements in knee function and pain relief in mid-term outcomes. However, a relatively high revision rate must be considered.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Articulação Patelofemoral , Humanos , Osteoartrite do Joelho/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Resultado do Tratamento
15.
Bone Joint J ; 103-B(1): 98-104, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380179

RESUMO

AIMS: For many designs of total knee arthroplasty (TKA) it remains unclear whether cemented or uncemented fixation provides optimal long-term survival. The main limitation in most studies is a retrospective or non-comparative study design. The same is true for comparative trials looking only at the survival rate as extensive sample sizes are needed to detect true differences in fixation and durability. Studies using radiostereometric analysis (RSA) techniques have shown to be highly predictive in detecting late occurring aseptic loosening at an early stage. To investigate the difference in predicted long-term survival between cemented, uncemented, and hybrid fixation of TKA, we performed a randomized controlled trial using RSA. METHODS: A total of 105 patients were randomized into three groups (cemented, uncemented, and hybrid fixation of the ACS Mobile Bearing (ACS MB) knee system, implantcast). RSA examinations were performed on the first day after surgery and at scheduled follow-up visits at three months, six months, one year, and two years postoperatively. Patient-reported outcome measures (PROMs) were obtained preoperatively and after two years follow-up. Patients and follow-up investigators were blinded for the result of randomization. RESULTS: RSA secondary stabilization did not show a significant difference between the three types of fixation. A maximum total point motion of less than 0.2 mm in the second postoperative year was shown in each group, which suggests stabilization of the implant. At 24 months after surgery, PROMs significantly improved compared to baseline in all treatment groups. No significant difference was observed between the three groups. CONCLUSION: Secondary stabilization measurements in this study demonstrated no significant difference between the groups. In all groups migration stabilized after initial settling of the implant. For this implant the long-term outcome is not expected to be influenced by the type of fixation to the bone. Cite this article: Bone Joint J 2021;103-B(1):98-104.


Assuntos
Artroplastia do Joelho/métodos , Cimentação , Prótese do Joelho , Análise Radioestereométrica , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Desenho de Prótese , Falha de Prótese
16.
Bone Joint J ; 103-B(1): 105-112, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380183

RESUMO

AIMS: Modern total knee arthroplasty (TKA) prostheses are designed to restore near normal kinematics including high flexion. Kneeling is a high flexion, kinematically demanding activity after TKA. The debate about design choice has not yet been informed by six-degrees-of-freedom in vivo kinematics. This prospective randomized clinical trial compared kneeling kinematics in three TKA designs. METHODS: In total, 68 patients were randomized to either a posterior stabilized (PS-FB), cruciate-retaining (CR-FB), or rotating platform (CR-RP) design. Of these patients, 64 completed a minimum one year follow-up. Patients completed full-flexion kneeling while being imaged using single-plane fluoroscopy. Kinematics were calculated by registering the 3D implant models onto 2D-dynamic fluoroscopic images and exported for analysis. RESULTS: CR-FB designs had significantly lower maximal flexion (mean 116° (SD 2.1°)) compared to CR-RP (123° (SD 1.6°)) and PS-FB (125° (SD 2.1°)). The PS-FB design displayed a more posteriorly positioned femur throughout flexion. Furthermore, the CR-RP femur was more externally rotated throughout kneeling. Finally, individual patient kinematics showed high degrees of variability within all designs. CONCLUSION: The increased maximal flexion found in the PS-FB and CR-RP designs were likely achieved in different ways. The PS-FB design uses a cam-post to hold the femur more posteriorly preventing posterior impingement. The external rotation within the CR-RP design was surprising and hasn't previously been reported. It is likely due to the polyethylene bearing being decoupled from flexion. The findings of this study provide insights into the function of different knee arthroplasty designs in the context during deep kneeling and provide clinicians with a more kinematically informed choice for implant selection and may allow improved management of patients' functional expectations. Cite this article: Bone Joint J 2021;103-B(1):105-112.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Desenho de Prótese , Amplitude de Movimento Articular/fisiologia , Idoso , Fenômenos Biomecânicos , Feminino , Fluoroscopia , Humanos , Estudos Longitudinais , Masculino , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Estudos Prospectivos
17.
J Surg Oncol ; 123(4): 1126-1133, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33373471

RESUMO

INTRODUCTION: All-polyethylene (AP) tibial components have demonstrated equivalent or improved long-term survivorship and reduced cost compared with metal-backed (MB) components in primary total knee arthroplasty; however, there is a lack of data comparing these outcomes in the setting of an oncologic endoprosthetic reconstruction. METHODS: A total of 115 (88 AP:27 MB) patients undergoing cemented distal femur endoprosthetic reconstruction following oncologic resection were reviewed. Mean age was 40 years and 51% were females. Cumulative incidences of all-cause revision, tibial component revision, reoperation, and infection were calculated utilizing a competing risk analysis with death as the competitor. Mean follow-up was 14 years. RESULTS: The 10-year cumulative incidence of all-cause revision was 19.9% in the AP group and 16.3% in the MB group (hazard ratio [HR] = 0.93, p = 0.88). The cumulative incidence of tibial component revision was significantly lower in AP compared with MB at 10 years (1.1% vs. 12.5%, HR = 0.18, p = 0.03). There was no difference in infection-free survival when comparing the two groups (p = 0.72). CONCLUSIONS: Reconstruction utilizing an MB or AP tibia component resulted in equivalent overall outcome; however, the tibial component in the AP group was less likely to be revised. AP tibial component should be considered for all primary oncologic reconstructions in the distal femur. LEVEL OF EVIDENCE: Level III Therapeutic.


Assuntos
Neoplasias Femorais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Tíbia/cirurgia , Adulto , Feminino , Neoplasias Femorais/patologia , Seguimentos , Humanos , Prótese do Joelho , Masculino , Metais/química , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Polietileno/química , Prognóstico , Estudos Prospectivos , Estados Unidos/epidemiologia
18.
Rev. Hosp. Ital. B. Aires (2004) ; 40(4): 171-183, dic. 2020. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1145445

RESUMO

Objetivo: comparar los resultados funcionales y de calidad de vida, y algunos indicadores de calidad y satisfacción, entre dos estrategias de cuidados posoperatorios de prótesis total de rodilla: 1) Cuidados protocolizados brindados por la Unidad de Rehabilitación del Hospital Italiano (URED) para pacientes que residen en CABA; 2) Cuidados habituales brindados por el sistema tercerizado de rehabilitación kinésica. Materiales y métodos: cohorte prospectiva de pacientes que fueron sometidos a una cirugía de reemplazo articular de la rodilla en el Hospital Italiano. Fueron evaluados mediante cuestionarios de funcionalidad y calidad de vida percibida, y goniometría, a los 45 días, por kinesiólogos entrenados. Resultados: se incluyeron 81 pacientes en el grupo de cuidados protocolizados y 28 en el de cuidados habituales. Se observaron diferencias estadísticamente significativas en todas las variables evaluadas y destacamos la relevancia clínica de que solamente el 2,43% de los pacientes atendidos en la URED continuaban usando andador a los 45 días frente al 35,71% de los que habían sido atendidos con los cuidados habituales (p = 0,004), así como la menor proporción de pacientes con déficit de flexión (2,47% vs. 46%, respectivamente; p < 0,001) y de extensión (18,52 vs. 75%; p < 0,001) en el mismo lapso, requisitos que son importantes para lograr una marcha funcional. Conclusión: un programa de rehabilitación domiciliaria protocolizada y supervisada por kinesiólogos entrenados mostró ser eficaz para una progresión más rápida hacia una marcha independiente con un menor riesgo de déficit de flexión o de extensión a los 45 días. (AU)


Objective: to compare functionality and quality of life, and some indicators of patient satisfaction, between two postoperative rehabilitation care following total knee replacement: 1) Protocolized care provided by the Italian Hospital Rehabilitation Unit for patients who live in CABA; 2) Usual care provided by the outsourced rehabilitation system. Materials and methods: prospective cohort of patients who underwent total knee replacement at the Italian Hospital were evaluated using questionnaires of functionality and quality of life at 45 days. Results: 81 patients were included in the protocolized care group and 28 in the usual care group. Statistically significant differences were observed in all the variables evaluated, highlighting clinical relevance that only 2.43% of the patients treated by the URED continued using the walker at 45 days vs 35.71% of those who had been treated with the usual care (p = 0.004); as well as the lower proportion of patients with flexion deficit (2.47 vs. 46%, respectively; p < 0.001) and extension (18.52 vs. 75%; p < 0.001) at the same time. Conclusion: a home protocolarized rehabilitation program supervised by a physical therapist proved to be effective for a quicker progression to an independent walk with lower risks of flexion or extension deficits at 45 days. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cuidados Pós-Operatórios/reabilitação , Artroplastia do Joelho/reabilitação , Cuidados Pós-Operatórios/estatística & dados numéricos , Qualidade de Vida , Reabilitação/métodos , Reabilitação/estatística & dados numéricos , Andadores/estatística & dados numéricos , Medição da Dor/estatística & dados numéricos , Estudos de Coortes , Modalidades de Fisioterapia/tendências , Resultado do Tratamento , Artroplastia do Joelho/estatística & dados numéricos , Marcha , Assistência Domiciliar/estatística & dados numéricos , Prótese do Joelho
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(12): 1568-1573, 2020 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-33319537

RESUMO

Objective: To explore whether unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) or bilateral TKAs should be performed in patients with bilateral knee osteoarthritis. Methods: Between April 2015 and February 2017, 24 patients with bilateral knee osteoarthritis who met the selection criteria were included in the study and randomly divided into 2 groups ( n=12). The patients in observation group were treated with TKA of the multicompartmental osteoarthritis knee in the first-stage operation and UKA of the unicompartmental osteoarthritis knee in the second-stage operation; and the patients in control group were treated with bilateral TKAs in staging operation. The operation time, the amount of postoperative drainage, and the time of active flexion of the knee joint at 90° were recorded. The difference of hemoglobin (Hb) before and after the second-stage operation was recorded, and the decrease of Hb was observed. The hospital stay after the second-stage operation was observed. The Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, and range of motion (ROM) were recorded at 7 days after the first-stage operation, and at 15 days, 45 days, and 6 months after the second-stage operation. At 1 year after the second-stage operation, the mean values of the above indexes of both knees were taken as the individual comprehensive evaluation. The X-ray films were taken regularly to examine the prosthesis and lower extremity force line. Results: The incisions in both groups were healed by first intention after two stage operations. The differences in the operation time, the amount of postoperative drainage, and the time of active flexion of the knee joint at 90° between the two groups were not significant in the first-stage operation ( P>0.05) and were significant in the second-stage operation ( P<0.05). The decrease of Hb and hospital stay after the second-stage operation were significantly lower in observation group than in control group ( P<0.05). Both groups were followed up, the follow-up time was 12-18 months (mean, 14 months) in observation group and 12-21 months (mean, 16 months) in control group. During the follow-up period, X-ray films showed that the prosthesis positions of both sides were normal as well as the alignment line, and no infection, loosening or dislocation of prosthesis occurred. There was no significant difference in HSS score, VAS score, and ROM of multicompartmental osteoarthritis knee at 7 days after the first-stage operation between the two groups ( P>0.05), indicating that the two groups were still comparable. The HSS score, VAS score, and ROM of unicompartmental osteoarthritis knee in observation group were superior to control group ( P<0.05) after the second-stage operation. At 1 year, the HSS score, VAS score, and ROM in observation group were also superior to control group ( P<0.05). Conclusion: On the premise of strict indications, the patients with bilateral knee osteoarthritis should be treated according to their own pathological changes in order to obtain better short-term effectiveness.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
20.
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
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...