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1.
BMC Musculoskelet Disord ; 22(1): 505, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074280

RESUMO

BACKGROUND: Although Oxford unicompartmental knee arthroplasty (UKA) is used in patients of wide age ranges, there is no clear information regarding the age differences in terms of intraoperative femorotibial rotational kinematics and its influence on clinical outcomes. Therefore, this study was conducted to examine the age differences in terms of intraoperative rotational kinematics and postoperative clinical outcomes and to analyze their relationship with classification according to the age group. METHODS: We investigated 111 knees of patients who underwent Oxford UKA using a navigation system and divided them into two groups: elderly (aged ≥75 years; 48 knees) and nonelderly (aged < 75 years; 63 knees). Intraoperative tibial internal rotational angles relative to the femur during passive knee flexion were measured using a navigation system, and clinical outcomes were evaluated using knee range of motion, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Knee Society Functional Score at 2 years postoperatively. The relationships between intraoperative tibiofemoral rotational angles and clinical outcomes were also evaluated in the two groups. RESULTS: The intraoperative tibial internal rotational angle relative to the femur during knee flexion was significantly larger in the nonelderly group (13.5°) than in the elderly group (9.0°). The intraoperative tibial internal rotational angle showed a positive correlation with the pain subscale of KOOS only in the nonelderly group. CONCLUSION: Intraoperative rotational kinematics and its influence on clinical outcomes were different between elderly and nonelderly patients, and the tibial internal rotational angle could be a more important factor for successful UKA in nonelderly patients.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Idoso , Artroplastia do Joelho/efeitos adversos , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
2.
J Pak Med Assoc ; 71(5): 1499-1502, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34091645

RESUMO

Neurofibromatosis type 1 is an autosomal dominant, common genetic disorder that affects many systems, including the skeleton and neurocutaneous system. Skeletal involvement is seen in 38% of patients with NF1. Bowing deformity and pseudarthrosis are observed in 5.7% of the long bones, most of which are common in the tibia. A 13-year-old Somalian girl visited our orthopaedic clinic with complaints of deformity, inability to walk and pain in both legs. The deformity in both legs was present at birth and progressed further. A pathological fracture in the right tibia and a wide range of pseudarthrosis, hamartomatous bone tissues, medullary canal and diaphyseal narrowing towards the pseudoarthrosis range and cortical thickening were observed on her radiographs. Ilizarov technique was used for the case in this study.


Assuntos
Neurofibromatose 1 , Pseudoartrose , Adolescente , Feminino , Humanos , Recém-Nascido , Neurofibromatose 1/complicações , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/etiologia , Pseudoartrose/cirurgia , Radiografia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Caminhada
3.
Bone Joint J ; 103-B(6): 1168-1172, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058877

RESUMO

AIMS: The STRYDE nail is an evolution of the PRECICE Intramedullary Limb Lengthening System, with unique features regarding its composition. It is designed for load bearing throughout treatment in order to improve patient experience and outcomes and allow for simultaneous bilateral lower limb lengthening. The literature published to date is limited regarding outcomes and potential problems. We report on our early experience and raise awareness for the potential of adverse effects from this device. METHODS: This is a retrospective review of prospective data collected on all patients treated in our institution using this implant. We report the demographics, nail accuracy, reliability, consolidation index, and cases where concerning clinical and radiological findings were encountered. There were 14 STRYDE nails implanted in nine patients (three male and six female) between June 2019 and September 2020. Mean age at surgery was 33 years (14 to 65). Five patients underwent bilateral lengthening (two femoral and three tibial) and four patients unilateral femoral lengthening for multiple aetiologies. RESULTS: At the time of reporting, eight patients (13 implants) had completed lengthening. Osteolysis and periosteal reaction at the junction of the telescopic nail was evident in nine implants. Five patients experienced localized pain and swelling. Macroscopic appearances following retrieval were consistent with corrosion at the telescopic junction. Tissue histology was consistent with effects of focal metallic wear debris. CONCLUSION: From our early experience with this implant we have found the process of lengthening to be accurate and reliable with good regenerate formation and consolidation. Proposed advantages of early load bearing and the ability for bilateral lengthening are promising. We have, however, encountered concerning clinical and radiological findings in several patients. We have elected to discontinue its use to allow further investigation into the retrieved implants and patient outcomes from users internationally. Cite this article: Bone Joint J 2021;103-B(6):1168-1172.


Assuntos
Alongamento Ósseo/instrumentação , Pinos Ortopédicos , Desigualdade de Membros Inferiores/cirurgia , Adolescente , Adulto , Idoso , Remoção de Dispositivo , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Desigualdade de Membros Inferiores/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
4.
Bone Joint J ; 103-B(6): 1103-1110, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058882

RESUMO

AIMS: This study aimed to determine outcomes of isolated tibial insert exchange (ITIE) during revision total knee arthroplasty (TKA). METHODS: From 1985 to 2016, 270 ITIEs were performed at one institution for instability (55%, n = 148), polyethylene wear (39%, n = 105), insert fracture/dissociation (5%, n = 14), or stiffness (1%, n = 3). Patients with component loosening, implant malposition, infection, and extensor mechanism problems were excluded. RESULTS: Survivorship free of any re-revision was 68% at ten years. For the indication of insert wear, survivorship free of any re-revision at ten years was 74%. Re-revisions were more frequent for index diagnoses other than wear (hazard ratio (HR) 1.9; p = 0.013), with ten-year survivorships of 69% for instability and 37% for insert fracture/dissociation. Following ITIE for wear, the most common reason for re-revision was aseptic loosening (33%, n = 7). For other indications, the most common reason for re-revision was recurrence of the original diagnosis. Mean Knee Society Scores improved from 54 (0 to 94) preoperatively to 77 (38 to 94) at ten years. CONCLUSION: After ITIE, the risk and reasons for re-revision correlated with preoperative indications. The best results were for polyethylene wear. For other diagnoses, the re-revision rate was higher and the failure mode was most commonly recurrence of the original indication for the revision TKA. Cite this article: Bone Joint J 2021;103-B(6):1103-1110.


Assuntos
Artroplastia do Joelho/métodos , Tíbia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Falha de Prótese , Reoperação , Fatores de Risco
5.
Acta Chir Orthop Traumatol Cech ; 88(2): 87-94, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-33960920

RESUMO

PURPOSE OF THE STUDY Hemiepiphyseodesis is commonly used to correct a coronal plane knee deformity during childhood. Since 2007 Blount staple method has been replaced by the eight-Plate Guided Growth System. We retrospectively analysed the indications, results and complications of the older Blount staple method so as to compare them with the newer eight-Plate Guided Growth system. MATERIAL AND METHODS In the period from 2009 to 2019, a total of 98 lower extremities of 54 patients were treated by hemiepiphyseodesis. Lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and mechanical axis deviation (MAD) were measured before and after the correction. We focused on the location of hemiepiphyseodesis (distal femur/proximal tibia/both), the operative time and compared the results of implanting 2 or 3 Blount staples. RESULTS The primary correction of valgus knee deformity was achieved in 97%, of which only partial correction was observed in 9.2% and slight overcorrection in 6.1%. A total of 4 patients (4.1%) underwent subsequent corrective osteotomy. The mean LDFA increased from 80° to 86°, while the mean MPTA decreased from 94° to 92°. The mean MAD decreased from 23 mm to 3 mm. The reported complication rate was 5.1%, including four cases of loosening of staples and one case of superficial infection. DISCUSSION It has been verified that the LDFA reduction correlates with staple implantation into the distal femur, conversely the increase in the MPTA correlated with the implantation of staples into the proximal tibia or into both locations. The number of implanted staples (2 or 3) did not affect the size of the resulting correction, but the operative time was statistically significantly shorter when 2 instead of 3 staples were implanted. CONCLUSIONS Blount staple hemiepiphyseodesis is an older method, but it still gives very good results with a low rate of complications. The operating time can be shortened by using 2 staples only, with the same correction effect. The LDFA and MPTA parameters are helpful in identifying the location of hemiepiphyseodesis. The key to success of treatment still remains in correct timing of the implantation of staples with sufficient growth potential. Key words: hemiepiphyseodesis, guided growth, valgus knee deformity, Blount staple.


Assuntos
Articulação do Joelho , Tíbia , Placas Ósseas , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Estudos Retrospectivos , Tíbia/cirurgia
6.
BMC Musculoskelet Disord ; 22(1): 437, 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985470

RESUMO

BACKGROUND: Anterior cruciate ligament (ACL) injury may be associated with genu varum. There are a few indications in which the varus deformity can be corrected at the time of ACL reconstruction. However, as the genu varum originates mostly from the tibia and the simultaneous presence of ACL deficiency and femur originated genu varum is uncommon, only a few papers have described their management for ACL deficient patients with femur originated genu varum. CASE PRESENTATION: A young patient visited our clinic with a complaint of right knee pain and giving way. Further work up revealed a full mid substance ACL tear, mild medial knee osteoarthritis and femur originated genu varum of his right knee. He was managed with simultaneous ACL reconstruction and distal femoral valgus osteotomy. CONCLUSIONS: Any corrective osteotomy for genu varum should be performed at center of rotation angle. Isolated ACL reconstruction in patients with simultaneous ACL deficiency and genu varum may hasten the knee degeneration. LEVEL OF EVIDENCE: IV.


Assuntos
Lesões do Ligamento Cruzado Anterior , Genu Varum , Osteoartrite do Joelho , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
7.
BMC Musculoskelet Disord ; 22(1): 434, 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985478

RESUMO

BACKGROUND: A functionally deficient anterior cruciate ligament (ACL) is considered one of the contraindications in unicompartmental knee arthroplasty (UKA). But there is still a lack of standardized and reproducible methods to assess ACL functional integrity in patients with advanced anteromedial osteoarthritis of the knee (AMOA). This study explores the value of passive anterior tibial subluxation (PATS) on axial MRI in evaluating ACL status in this population. METHODS: Patients who met UKA indications between November 2017 and September 2020 were included and grouped into "intact" (ACLI) or "deficient" (ACLD) group according to their ACL status during surgery. All participants underwent MRI with a standardized protocol. The measurements of medial and lateral PATS were conducted on axial MRI, and the mean of them was calculated as global PATS. Then the reliability and diagnostic ability of PATS were determined. RESULTS: A total of 85 patients (45 for ACLI group, 40 for ACLD group) were included after selection. The measurements of PATS showed excellent intra- and inter-observer reliabilities (with an intraclass correlation coefficient of at least 0.986). The global PATS of the ACLI group was significantly lower than that of the ACLD group (- 2.30 ± 1.96 vs. 1.03 ± 1.96 mm, P<0.0001). The diagnostic ability of global PATS was good (area under the curve = 0.897), and a threshold of 1.2 mm had a specificity of 100%, a sensitivity of 55%, and an accuracy of 78.82%. CONCLUSION: An axial global PATS of 1.2 mm on MRI is greatly specific for identifying a functionally deficient ACL in patients with advanced AMOA.


Assuntos
Lesões do Ligamento Cruzado Anterior , Osteoartrite do Joelho , Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos de Casos e Controles , Humanos , Articulação do Joelho , Imageamento por Ressonância Magnética , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Reprodutibilidade dos Testes , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
9.
Zhongguo Gu Shang ; 34(5): 417-24, 2021 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-34032042

RESUMO

OBJECTIVE: This study aimed to research whether anterior tibial crest is a reliable anatomical reference for rotational alignment of tibial component in TKA. METHODS: The study included 122 patients who underwent computed tomography angiography (CTA) examination for unilateral lower extremity trauma with normal contralateral lower extremities, including 89 males and 33 females, with an average age of(51.4±16.4) years old(ranged 18 to 81 years old). Picture archiving and communication system (PACS) was used to mark 11 lines including the surgical epicondylar axis (SEA) connecting the most prominent points of the lateral epicondyle and the deepest point of the sulcus on the medial epicondyle of the femur, axis of medial border of patellar tendon (MEPT)connecting the middle of the posterior cruciate ligament (PCL) and medial border of the patellar tendon at the level of a standard tibial cut from 8 mm distal of the lateral tibial joint surface, transverse axis of tibia (TAT) at the level of a standard tibial cut from 8 mm distal of the lateral tibial joint surface, Akagi line connecting the projected middle of the PCL and medial border of the patellar tendon at the tibial attachment, the axis of the medial 1/3 of patellar tendon(M1/3) connecting the projected middle of PCL and the medial 1/3 of the patellar tendon at the patellar tendon attachment level, Insall line connecting the projected middle of the PCL and the medial 1/3 of tibial tubercle, the axis of medial border of tibial tubercle (MBTT) connecting the projected middle of the PCL and medial border of tibial tubercle, as well as the axis of the proximal anterior tibial crest (PATC), axis 1 of the middle anterior tibial crest (MATC1), axis 2 of the middle anterior tibial crest (MATC2) and the axis of the distal anterior tibial crest (DATC) which were marked by connecting the 4 equidistant points on the sharp anterior tibial crest and the projected middle of the PCL. The angles between TAT and SEA as well as the angles between other axes and the perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined using One-Way ANOVA and paired t-test. RESULTS: The angles between the axes of MEPT, Akagi line, M1/3, Insall line, MBTT, PATC, MATC1, MATC2, DATC and the perpendicular to SEA were (-1.6 ±4.5)° , (1.4 ±5.0)° , (10.2±5.1)°, (11.9±5.4)°, (3.6±4.8)°, (12.0±6.9)°, (7.2±8.6)°, (7.1±10.4)°, (6.6±13.5)°, respectively. The angle between TAT and SEA was (4.1±5.3)°. MEPT was external rotation compared to SEA. M1/3, Insall line and PATC were significantly greater than Akagi line, MBTT, TAT (P<0.001). MATC1, MATC2 and DATC were also significantly greater than Akagi line, MBTT axis and TAT (P<0.001). However, MATC1, MATC2 and DATC were also significantly less than M1/3 axis, Insall line and PATC(P<0.01). There were no significant statistical differences between MATC1, MATC2 and DATC(P>0.05). CONCLUSION: The middle tibial anterior crest can be used as a reference for rotational alignment of tibial component in TKA, and its reliability is better than Insall line, but worse than Akagi line, TAT and MBTT.


Assuntos
Artroplastia do Joelho , Ligamento Cruzado Posterior , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Ligamento Cruzado Posterior/cirurgia , Reprodutibilidade dos Testes , Rotação , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Adulto Jovem
10.
Orthop Clin North Am ; 52(3): 215-229, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34053567

RESUMO

Rotational malreduction is a common yet underreported postoperative complication following intramedullary nailing of long bone fractures. In most situations, this can be prevented at the time of initial surgery with meticulous preoperative planning, careful use of intraoperative fluoroscopy, and awareness of risk factors for malrotation. However, rotational alignment remains difficult to assess by clinical examination so a high index of suspicion is always necessary. Here, the authors review the literature on this complication and report on 3 such cases of femoral and the tibial malrotation, methods for calculating femoral version and tibial torsion, and techniques for correcting these deformities.


Assuntos
Mau Alinhamento Ósseo , Fixação Intramedular de Fraturas/efeitos adversos , Complicações Pós-Operatórias , Adolescente , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/fisiopatologia , Fraturas do Fêmur/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/fisiopatologia , Fêmur/cirurgia , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Rotação , Tíbia/diagnóstico por imagem , Tíbia/fisiopatologia , Tíbia/cirurgia
11.
BMC Musculoskelet Disord ; 22(1): 486, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34044787

RESUMO

BACKGROUND: Femoral posterior condylar offset (PCO) and posterior tibial slope (PTS) are important for postoperative range of motion after total knee arthroplasty (TKA). However, normative data of PCO and PTS and the correlation between them among healthy populations remain to be elucidated. The purpose of this study was to determine PCO and PTS in normal knees, and to identify the correlation between them. METHODS: Eighty healthy volunteers were recruited. CT scans were performed followed by three-dimensional reconstruction. PCO and PTS were measured and analyzed, as well as the correlation between them. RESULTS: PTS averaged 6.78° and 6.11°, on the medial and lateral side respectively (P = 0.002). Medial PCO was greater than lateral (29.2 vs. 23.8 mm, P <  0.001). Both medial and lateral PCO of male were larger than female. On the contrary, male medial PTS was smaller than female, while there was no significant difference of lateral PTS between genders. There was an inverse correlation between medial PCO and PTS, but not lateral. CONCLUSIONS: Significant differences exhibited between medial and lateral compartments, genders, and among individuals. An inverse correlation exists between PCO and PTS in the medial compartment. These results improve our understanding of the morphology and biomechanics of normal knees, and subsequently for optimising prosthetic design and surgical techniques.


Assuntos
Artroplastia do Joelho , Imageamento Tridimensional , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Joelho , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Amplitude de Movimento Articular , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
12.
BMC Musculoskelet Disord ; 22(1): 490, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049518

RESUMO

BACKGROUND: Difficulty in obtaining union, recurrent fractures, and residual deformities remain the problems challenging the management of congenital pseudarthrosis of the tibia (CPT). We applied the "Eiffel Tower" double titanium elastic nails (TENs) in the existing combined approach, which takes advantages of TEN's mechanical stability with the protection against refracture, Ilizarov's high fusion rate with alignment control and the biologic environment provided by bone grafting for bony union. The results of this procedure are presented and discussed. METHODS: Seventeen patients with CPT treated by combined surgery including pseudarthrosis resection, the "Eiffel Tower" double TENs technique, autogenous iliac bone grafting, and Ilizarov fixation between 2013 and 2019 were retrospectively investigated. Signs of bone union, limb length discrepancy (LLD), rate of refracture, and degree of residual deformities were reviewed. The AOFAS Ankle Hindfoot scale and measurement of ankle motion were used to evaluate ankle function. The mean follow-up time was 40.5 (11 to 91) months. RESULTS: The mean age at index surgery was 6.2 (2.5 to 15) years. Union of the pseudarthrosis was achieved in 100% of cases. Among them, 15 (88.2%) patients obtained union of the pseudarthrosis on the first attempt (primary union). The average time to primary union was 3.8 (2 to 6) months. The rest 2 cases achieved union after additional surgeries (secondary union). In terms of complications, refracture occurred in 2 patients (11.8%) and 4 patients (23.5%) developed pin infection. The mean limb length discrepancy at the final follow up was 33.4 (6-141) mm. The average AOFAS score improved from 38.2 (27 to 51) pre-operatively to 77 (63 to 87) post-operatively (p < 0.01). CONCLUSIONS: The "Eiffel Tower" double TENs technique is an ideal intramedullary fixation method in the surgical treatment of CPT. The combination of TENs technique with bone grafting and Ilizarov fixation has the advantages of early bone union, less injury on metaphysis, and early functional recovery. LEVEL OF EVIDENCE: Level IV.


Assuntos
Fixação Intramedular de Fraturas , Técnica de Ilizarov , Pseudoartrose , Fixação Intramedular de Fraturas/efeitos adversos , Humanos , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/cirurgia , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Titânio
15.
J Int Med Res ; 49(5): 3000605211017618, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34044634

RESUMO

OBJECTIVE: To evaluate the clinical efficacy of free flap transplantation combined with Ilizarov bone transport in the treatment of severe composite tibial and soft tissue defects. METHODS: We retrospectively analyzed the clinical data of 40 patients with severe composite tibial and soft tissue defects who underwent free flap transplantation combined with Ilizarov bone transport. The clinical efficacy was evaluated according to the following criteria: success rate of wound repair by free flap transplantation, incidence or recurrence rate of deep infection, healing rate of bone defects and external fixation index, incidence of complications, and functional score of affected extremities. RESULTS: All infections were generally well controlled by radical debridement and negative-pressure therapy, and all 40 patients' wounds healed after repair and reconstruction of the tibia and soft tissues. Postoperative complications were alleviated by active treatment. The mean external fixation time was 12.83 ± 2.85 months, and the external fixation index was 1.55 m/cm. According to the Association for the Study and Application of Methods of Ilizarov (ASAMI) score, an excellent or good functional outcome was attained in 85% of patients. CONCLUSION: Free flap transplantation combined with Ilizarov bone transport is an effective treatment for severe composite tibial and soft tissue defects.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Fraturas da Tíbia , Humanos , Estudos Retrospectivos , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
16.
Bone Joint J ; 103-B(6 Supple A): 137-144, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34053294

RESUMO

AIMS: To establish our early clinical results of a new total knee arthroplasty (TKA) tibial component introduced in 2013 and compare it to other designs in use at our hospital during the same period. METHODS: This is a retrospective study of 166 (154 patients) consecutive cemented, fixed bearing, posterior-stabilized (PS) TKAs (ATTUNE) at one hospital performed by five surgeons. These were compared with a reference cohort of 511 knees (470 patients) of other designs (seven manufacturers) performed at the same hospital by the same surgeons. There were no significant differences in age, sex, BMI, or follow-up times between the two cohorts. The primary outcome was revision performed or pending. RESULTS: In total, 19 (11.5%) ATTUNE study TKAs have been revised at a mean 30.3 months (SD 15), and loosening of the tibial component was seen in 17 of these (90%). Revision is pending in 12 (7%) knees. There was no difference between the 31 knees revised or with revision pending and the remaining 135 study knees in terms of patient characteristics, type of bone cement (p = 0.988), or individual surgeon (p = 0.550). In the reference cohort, there were significantly fewer knees revised (n = 13, 2.6%) and with revision pending (n = 8, 1.5%) (both p < 0.001), and only two had loosening of the tibial component as the reason for revision. CONCLUSION: This new TKA design had an unexpectedly high early rate of revision compared with our reference cohort of TKAs. Debonding of the tibial component was the most common reason for failure. Additional longer-term follow-up studies of this specific component and techniques for implantation are warranted. The version of the ATTUNE tibial component implanted in this study has undergone modifications by the manufacturer. Cite this article: Bone Joint J 2021;103-B(6 Supple A):137-144.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Desenho de Prótese , Reoperação/estatística & dados numéricos , Tíbia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Estudos Retrospectivos
17.
Bone Joint J ; 103-B(6 Supple A): 165-170, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34053295

RESUMO

AIMS: Stemmed tibial components are frequently used in revision total knee arthroplasty (TKA). The purpose of this study was to evaluate patient satisfaction, overall pain, and diaphyseal tibial pain in patients who underwent revision TKA with cemented or uncemented stemmed tibial components. METHODS: This is a retrospective cohort study involving 110 patients with revision TKA with cemented versus uncemented stemmed tibial components. Patients who underwent revision TKA with stemmed tibial components over a 15-year period at a single institution with at least two-year follow-up were assessed. Pain was evaluated through postal surveys. There were 63 patients with cemented tibial stems and 47 with uncemented stems. Radiographs and Knee Society Scores were used to evaluate for objective findings associated with pain or patient dissatisfaction. Postal surveys were analyzed using Fisher's exact test and the independent-samples t-test. Logistic regression was used to adjust for age, sex, and preoperative bone loss. RESULTS: No statistically significant differences in stem length, operative side, or indications for revision were found between the two cohorts. Tibial pain at the end of the stem was present in 25.3% (16/63) of cemented stems and 25.5% (12/47) of uncemented stems (p = 1.000); 74.6% (47/63) of cemented patients and 78.7% (37/47) of uncemented patients were satisfied following revision TKA (p = 0.657). CONCLUSION: There were no differences in patient satisfaction, overall pain, and diaphyseal tibial pain in cemented and uncemented stemmed tibial components in revision TKA. Patient factors, rather than implant selection and surgical technique, likely play a large role in the presence of postoperative pain. Stemmed tibial components have been shown to be a possible source of pain in revision TKA. There is no difference in patient satisfaction or postoperative pain with cemented or uncemented stemmed tibial components in revision TKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):165-170.


Assuntos
Artroplastia do Joelho/métodos , Cimentação/efeitos adversos , Prótese do Joelho , Dor Pós-Operatória/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Reoperação , Estudos Retrospectivos , Tíbia/cirurgia
18.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(4): 409-413, 2021 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-33855822

RESUMO

Objective: To simulate and validate the performance, accuracy, and safety of the Yuanhua robotic-assisted total knee arthroplasty system (YUANHUA-TKA) through cadaver-based experiment, thus optimizing the robotic system for the future human clinical application. Methods: Six unilateral adult cadaver specimens of the lower limbs were scanned by three-dimensional CT before the experiment, and then the three-dimensional models of femur and tibia were obtained by using the preoperative software of YUANHUA-TKA system, so as to plan the type of prosthesis implant, the osteotomy volume and osteotomy angles [hip-knee-ankle angle (HKA), coronal frontal femoral component (FFC) and frontal tibial component (FTC)], the ideal value of HKA was set to 180°, and of FFC and FTC were set to 90°, respectively. The operator could further confirm the osteotomy plan according to the intraoperative situation before osteotomy, and then install the prosthesis after completing the osteotomy in each plane with the assistance of YUANHUA-TKA system. At last, the X-ray films of hip joint, knee joint, and ankle joint were taken and stitched into the full length X-ray film of the lower limb, and HKA, coronal FFC and FTC were measured. Results: During the experiment, YUANHUA-TKA system ran stably. All sections of femur and tibia were smooth and no ligament injury was found. After operation, the HKA was 177.1°-179.7°, FFC was 87.9°-91.4°, and FTC was 87.3°-91.4°, which were within ±3° from the ideal values of preoperative planning. Conclusion: The YUANHUA-TKA system can assist the surgeon to carry out precise osteotomy according to the preoperative planned value, which has a good auxiliary effect for total knee arthroplasty. It is expected to assist joint surgeons to improve the surgical accuracy in clinical application.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Robótica , Adulto , Cadáver , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Tíbia/cirurgia
19.
J Appl Oral Sci ; 29: e20200647, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33886940

RESUMO

OBJECTIVE: To evaluate the effect of different protocols of low-level intensity laser therapy (LLLT) irradiation on the osseointegration of implants placed in grafted areas. METHODOLOGY: 84 rats were randomly allocated into six groups: DBB: defect filled with deproteinized bovine bone; HA/TCP: defect filled with biphasic ceramic of hydroxyapatite/ß-tricalcium phosphate ; DBB-LI: defect filled with DBB and treated with LLLT after implant placement; HA/TCP-LI: defect filled with HA/TCP and treated with LLLT after implant placement; DBB-LIB: defect filled with DBB and treated with LLLT after graft procedure and implant placement; and HA/TCP-LIB: defect filled HA/TCP and treated with LLLT after graft procedure and implant placement. The bone defects were made in the tibia and they were grafted. After 60 days, the implants were placed. The rats were subsequently subjected to euthanasia 15 and 45 days after implant placement. The pattern of osseointegration and bone repair in the grafted area was evaluated by biomechanical, microtomographic, and histometric analyses. Furthermore, the expression of bone biomarker proteins was assessed. RESULTS: The LLLT groups presented higher removal torque, mineralized tissue volume, and a greater degree of osseointegration, especially when LLLT was performed only after implant placement, and these findings were associated with higher expression of BMP2 and alkaline phosphatase. CONCLUSION: LLLT performed on implants placed in grafted areas enhances the osseointegration process.


Assuntos
Implantes Dentários , Terapia com Luz de Baixa Intensidade , Animais , Bovinos , Cerâmica , Osseointegração , Ratos , Tíbia/cirurgia
20.
BMC Musculoskelet Disord ; 22(1): 346, 2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33845795

RESUMO

BACKGROUND: Tibial rotational alignment in total knee arthroplasty (TKA) is generally determined based on intra-articular structure, and can be difficult to ascertain in some cases. The aim of this study was to investigate whether the medial tangent angle of the tibia (MTAT) could be useful in determining the anteroposterior axis of the tibia. METHODS: This study was performed on 103 lower limbs in 53 patients who underwent primary total hip arthroplasty. The selection criteria for our study were based on the assumption that knees in patients undergoing THA exhibit fewer degenerative changes than knees in patients undergoing TKA. Using computed tomography images, the MTAT, comprising the medial tangent of the proximal tibia and the anteroposterior (AP) axis of the tibia, was measured on three horizontal planes: at the distal edge of the tibial tubercle (A), at 5 cm distally (B), and at 10 cm further distally (C). The tibial medial surface was grouped into three classes according to shape: valley type, flat type, and hill type. The percentage at which these shapes were observed in each group was also calculated. Measurement reliability was calculated using the intraclass correlation coefficient. RESULTS: The angles were 45.2° (interquartile range: IR 43.0-47.7) at A, 42.7° (IR 38.7-45.9) at B, and 42.4° (IR 38.2-45.9) at C. Intra-rater reliability and inter-rater reliability was 0.982 and 0.974 at A, 0.810 and 0.411 at B, and 0.940 and 0.811 at C, respectively. Regarding the tibial medial surface, the valley type was observed in all cases at A, and the hill type was observed in the highest percentage of cases at B and C. CONCLUSIONS: The MTAT was approximately 45° at level A, and reproducibility was the highest among the three groups. The two points forming the valley on the tibial medial surface were bony ridges. Therefore, the medial tangent of the tibia at level A could be easily determined. Because the distal edge of the tibial tubercle exists at the surgical area and the extra-articular area, it can be a suitable intraoperative, extra-articular landmark in determining the tibial AP axis, even for revision TKA.


Assuntos
Osteoartrite do Joelho , Tíbia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Reprodutibilidade dos Testes , Rotação , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
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