Background:Arthrofibrosis is a joint disorder characterized by excessive scar formation in the joint tissues.Vitamin E is an antioxidant with potential anti-fibroblastic effect.The aim of this study was to establish a...Background:Arthrofibrosis is a joint disorder characterized by excessive scar formation in the joint tissues.Vitamin E is an antioxidant with potential anti-fibroblastic effect.The aim of this study was to establish an arthrofibrosis rat model after joint replacement and assess the effects of vitamin E supplementation on joint fibrosis.Methods:We simulated knee replacement in 16 male Sprague–Dawley rats.We immobilized the surgical leg with a suture in full flexion.The control groups were killed at 2 and 12 weeks(n=5 per group),and the test group was supplemented daily with vitamin E(0.2 mg/mL)in their drinking water for 12 weeks(n=6).We performed histological staining to investigate the presence and severity of arthrofibrosis.Immunofluorescent staining andα2-macroglobulin(α2M)enzyme-linked immunosorbent assay(ELISA)were used to assess local and systemic inflammation.Static weight bearing(total internal reflection)and range of motion(ROM)were collected for functional assessment.Results:The ROM and weight-bearing symmetry decreased after the procedure and recovered slowly with still significant deficit at the end of the study for both groups.Histological analysis confirmed fibrosis in both lateral and posterior periarticular tissue.Vitamin E supplementation showed a moderate anti-inflammatory effect on the local and systemic levels.The vitamin E group exhibited significant improvement in ROM and weight-bearing symmetry at day 84 compared to the control group.Conclusions:This model is viable for simulating arthrofibrosis after joint replacement.Vitamin E may benefit postsurgical arthrofibrosis,and further studies are needed for dosing requirements.展开更多
Background: Knee range of motion is an essential outcome measure following total knee arthroplasty and it is important to measure this outcome with a simple and accurate tool. Measurement from digital photographs coul...Background: Knee range of motion is an essential outcome measure following total knee arthroplasty and it is important to measure this outcome with a simple and accurate tool. Measurement from digital photographs could provide a superior clinical alternative to the common goniometer as devices for capturing digital photographs are becoming more accessible, measurement accuracy is assisted with the associated software and images can be saved and stored for later reference. This ability to store images with measurements could be particularly useful in research involving knee range of motion. This study evaluated the validity and reliability of a simple photographic measurement technique to measure knee flexion and extension of patients following knee arthroplasty.Methods: Knee flexion and extension of 38 subjects who had undergone total knee arthroplasty were assessed at the one year post-operative review with the digital technique and a universal goniometer as the criterion reference. Digital measurements were repeated one month later by the first assessor (intra-tester reliability) and another independent assessor (inter-tester reliability).Results: Validity: the digital technique was found to have a high level of agreement with the universal goniometer measurements (all MAD sion with almost perfect Intra-Class Correlations (Intra-tester;flexion 0.99, extension 0.96;inter-tester;flexion 0.97, extension 0.93).Conclusion: Measurement of knee range of motion from digital photographs can be used in routine clinical total knee arthroplasty follow-up instead of, or interchangeably with the universal goniometer.展开更多
BACKGROUND There is a lack of studies on the effects of enhanced recovery after surgery(ERAS)with multidisciplinary collaboration on the nursing outcomes of total knee arthroplasty(TKA).AIM To explore the effect of ER...BACKGROUND There is a lack of studies on the effects of enhanced recovery after surgery(ERAS)with multidisciplinary collaboration on the nursing outcomes of total knee arthroplasty(TKA).AIM To explore the effect of ERAS with multidisciplinary collaboration on nursing outcomes after TKA.METHODS We retrospectively analyzed the clinical data of 80 patients who underwent TKA at a tertiary hospital between January 2021 and December 2022.The patients were divided into two groups according to the nursing mode:the ERAS group(n=40)received ERAS with multidisciplinary collaboration,and the conventional group(n=40)received routine nursing.The following indicators were compared between the two groups:length of hospital stay,hospitalization cost,intraoperative blood loss,hemoglobin level 24 h after surgery,visual analog scale(VAS)score for pain,range of motion(ROM)of the knee joint,Hospital for Special Surgery(HSS)knee score,and postoperative complications.RESULTS The ERAS group had a significantly shorter length of hospital stay,lower hospitalization cost,less intraoperative blood loss,higher hemoglobin level 24 h after surgery,lower VAS score for pain,higher knee joint ROM,and higher HSS knee score than the conventional group(all P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).CONCLUSION Multidisciplinary collaboration with ERAS can reduce blood loss,shorten hospital stay,and improve knee function in patients undergoing TKA.展开更多
BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare primary neoplasms of the gastrointestinal tract,accounting for 1%to 2%of all gastrointestinal neoplasms worldwide.GISTs are frequently discovered incidentally ...BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare primary neoplasms of the gastrointestinal tract,accounting for 1%to 2%of all gastrointestinal neoplasms worldwide.GISTs are frequently discovered incidentally during workup for other diagnosis or intestinal obstruction,as they can present with few or no symptoms.Simultaneously,GISTs confer a high degree of malignant transformation,with a progression in about 10%to 30%of cases.CASE SUMMARY A 63-year-old healthy female presented to our institution with complaints of right knee pain and limited passive and active motion in the setting of a previous right total knee arthroplasty(TKA).One year after TKA,the patient was incidentally diagnosed with a GIST,which was successfully removed.After removal,the patient continued to have limited range of motion of the right knee and subsequently underwent revision TKA.Intraoperatively significant fibrotic adhesions were found encapsulating the femoral and tibial components.The patient’s pain improved postoperatively,however,she continued to have decreased range of motion with difficulty ambulating.CONCLUSION We propose that this case may demonstrate a proinflammatory milieu arising from a GIST,which had a direct influence on the outcome of recent total knee arthroplasty.This proposed mechanism between neoplastic cytokinetic activity and adhesion formation could have implications on preoperative and postoperative orthopedic management of total knee arthroplasty.展开更多
Objective To introduce the improved quadricep splasty and rehabi li tation trainin g in the therapy of arthroclisis of kn ee,and to e-valuate its curative effect in the near future.Methods21patients with old arthrocli...Objective To introduce the improved quadricep splasty and rehabi li tation trainin g in the therapy of arthroclisis of kn ee,and to e-valuate its curative effect in the near future.Methods21patients with old arthroclisis of knee result fromsurrounding bone fr acture were treated with improved quadricep splasty and early rehabilitation training includin g ROM training,myodynamic ex ercise and physiotherapy for more than half a year.Knee joint functions before and after were compared to summarize th e feasibility and effects of the therapy .Results After above mentioned therapy;the patients’ knee joint functions were obviously improved.ROM and function scores we re significantly increased than tha t before operation(P <0.01).Conclusion Compared with the former styl e,the i mproved quadricepsplasty has some m erits such as better wound healing ,s uitable for early functional exercise and le ss complication.Combining it w ith e arly rehabilitation training is an e ffective treatment on arthroclisis of knee.展开更多
BACKGROUND The posterior cruciate ligament(PCL) is important for cruciate-retaining(CR)total knee arthroplasty(TKA). Whether the entire PCL should be retained during CR-TKA is controversial.AIM To evaluate the clinica...BACKGROUND The posterior cruciate ligament(PCL) is important for cruciate-retaining(CR)total knee arthroplasty(TKA). Whether the entire PCL should be retained during CR-TKA is controversial.AIM To evaluate the clinical outcomes of PCL preservation in CR-TKA and the methods used to deal with the PCL during surgery.METHODS A retrospective review of patients with osteoarthritis undergoing primary CRTKA(176 patients, 205 knees) in our institution between March 2012 and March 2014 was performed. A PCL protector was used to preserve the intact PCL bone block. The status of the PCL was recorded during surgery. Intact PCL preserved,pie-crusting and repairing were used to balance the tension of the PCL. Range of motion(ROM) and the Knee Society Clinical Rating system(KSS) were evaluated preoperatively and at the endpoint of follow-up.RESULTS The mean ROM of the knee was 103.2 ± 17.2°, KSS clinical score was 47.6 ± 9.5 and KSS functional score was 46.3 ± 11.9 before surgery. The mean ROM of the knee was 117.5 ± 9.7°, KSS clinical score was 89.2 ± 3.6 and KSS functional score was 84.6 ± 9.8 at 5 years follow-up. ROM, KSS clinical scores and KSS functional scores were significantly improved after surgery(P < 0.01). Thirty-two(23.7%)TKAs involved PCL pie-crusting and 18(13.3%) involved PCL repair. Eighty-five(63.0%) TKAs applied standard operating procedures and preserved intact PCL.At 5 years follow-up, in the intact PCL group, the mean ROM of the knee was 118.0 ± 8.3°, KSS clinical score was 89.1 ± 3.7 and KSS functional score was 84.9 ±9.6. In the PCL pie-crusting group, mean ROM of the knee was 114.0 ± 13.5°, KSS clinical score was 88.8 ± 3.4 and KSS functional score was 83.8 ± 10.5. In the PCL repair group, mean ROM of the knee was 120.3 ± 7.0°, KSS clinical score was 89.0± 3.6 and KSS functional score was 89.4 ± 4.5. There were no significant differences in ROM, KSS clinical scores and KSS functional scores among the three groups(P > 0.05).CONCLUSION The clinical outcomes of preserving the PCL in CR-TKA are encouraging. Piecrusting and PCL repair do not affect the function. The PCL protector effectively protected the PCL bone block.展开更多
Total knee arthroplasty is highly successful,in part due to range of motion(RoM)recovery.This is typically estimated goniometrically/visually by physical therapists(PTs)in the clinic,which is imprecise.Accordingly,a v...Total knee arthroplasty is highly successful,in part due to range of motion(RoM)recovery.This is typically estimated goniometrically/visually by physical therapists(PTs)in the clinic,which is imprecise.Accordingly,a validated inertial measurement unit(IMU)method for capturing knee RoM was deployed assessing postoperative RoM both in and outside of the clinical setting.The study's objectives were to evaluate the feasibility of continuously capturing knee RoM pre-/post-op via IMUs,dividing data into PT/non-PT portions of each day,and comparing PT/non-PT metrics.We hypothesized IMU-based clinical knee RoM would differ from IMU-based knee RoM captured outside clinical settings.10 patients(3 M,69±13 years)completed informed consent documents following ethics board approval.A validated IMU method captured long duration(8–12 h/day,~50 days)knee RoM pre-/post-op.Post-op metrics were subdivided(PT versus non-PT).Clinical RoM and patient reported outcome measures were also captured.Compliance and clinical disruption were evaluated.ANOVA compared post-op PT and non-PT means and change scores.Maximum flexion during PT was less than outside PT.PT stance/swing RoM and activity level were greater than outside PT.No temporal variable differences were found PT versus non-PT.IMU RoM measurements capture richer information than clinical measures.Maximum PT flexion was likely less than non-PT due to the exercises completed(i.e.high passive RoM vs.low RoM gait).PT gait flexion likely exceed non-PT because of‘white coat effects’wherein patients are closely monitored clinically.This implies data captured clinically represents optimum performance whereas data captured non-clinically represents realistic performance.展开更多
目的:观察四黄散联合间断垂直钢丝缝合加张力带对髌骨下极骨折患者膝关节活动度及骨折愈合时间的影响。方法:选取2021年9月至2022年9月丰城市中医院收治的髌骨下极骨折患者40例,按照随机数字表法分为对照组和试验组,每组20例。两组患者...目的:观察四黄散联合间断垂直钢丝缝合加张力带对髌骨下极骨折患者膝关节活动度及骨折愈合时间的影响。方法:选取2021年9月至2022年9月丰城市中医院收治的髌骨下极骨折患者40例,按照随机数字表法分为对照组和试验组,每组20例。两组患者均给予切开复位内固定,对照组给予间断垂直钢丝缝合联合张力带治疗,试验组给予四黄散联合间断垂直钢丝缝合加张力带治疗。观察两组患者术后6周、3个月、6个月、1年及末次随访时膝关节疼痛评分、屈伸活动范围(range of motion, ROM)、Bostman评分、骨折愈合时间、各项临床指标及并发症发生情况。结果:试验组术后6周、3个月、6个月、1年膝关节疼痛评分均低于对照组,差异有统计学意义(P<0.05)。试验组术后6周、3个月、6个月、1年ROM、Bostman评分高于对照组,差异有统计学意义(P<0.05)。试验组术后1年骨折愈合时间、各项临床指标均优于对照组,并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:四黄散联合间断垂直钢丝缝合加张力带能改善髌骨下极骨折患者膝关节功能,降低术后并发症发生率,促进骨折早日愈合。展开更多
基金supported in part by the Ruth Jackson Orthopedic Society and the Harris Orthopedic Laboratoryapproved by the Institutional Care and Use Committee of Massachusetts General Hospital(2020N000081)。
文摘Background:Arthrofibrosis is a joint disorder characterized by excessive scar formation in the joint tissues.Vitamin E is an antioxidant with potential anti-fibroblastic effect.The aim of this study was to establish an arthrofibrosis rat model after joint replacement and assess the effects of vitamin E supplementation on joint fibrosis.Methods:We simulated knee replacement in 16 male Sprague–Dawley rats.We immobilized the surgical leg with a suture in full flexion.The control groups were killed at 2 and 12 weeks(n=5 per group),and the test group was supplemented daily with vitamin E(0.2 mg/mL)in their drinking water for 12 weeks(n=6).We performed histological staining to investigate the presence and severity of arthrofibrosis.Immunofluorescent staining andα2-macroglobulin(α2M)enzyme-linked immunosorbent assay(ELISA)were used to assess local and systemic inflammation.Static weight bearing(total internal reflection)and range of motion(ROM)were collected for functional assessment.Results:The ROM and weight-bearing symmetry decreased after the procedure and recovered slowly with still significant deficit at the end of the study for both groups.Histological analysis confirmed fibrosis in both lateral and posterior periarticular tissue.Vitamin E supplementation showed a moderate anti-inflammatory effect on the local and systemic levels.The vitamin E group exhibited significant improvement in ROM and weight-bearing symmetry at day 84 compared to the control group.Conclusions:This model is viable for simulating arthrofibrosis after joint replacement.Vitamin E may benefit postsurgical arthrofibrosis,and further studies are needed for dosing requirements.
文摘Background: Knee range of motion is an essential outcome measure following total knee arthroplasty and it is important to measure this outcome with a simple and accurate tool. Measurement from digital photographs could provide a superior clinical alternative to the common goniometer as devices for capturing digital photographs are becoming more accessible, measurement accuracy is assisted with the associated software and images can be saved and stored for later reference. This ability to store images with measurements could be particularly useful in research involving knee range of motion. This study evaluated the validity and reliability of a simple photographic measurement technique to measure knee flexion and extension of patients following knee arthroplasty.Methods: Knee flexion and extension of 38 subjects who had undergone total knee arthroplasty were assessed at the one year post-operative review with the digital technique and a universal goniometer as the criterion reference. Digital measurements were repeated one month later by the first assessor (intra-tester reliability) and another independent assessor (inter-tester reliability).Results: Validity: the digital technique was found to have a high level of agreement with the universal goniometer measurements (all MAD sion with almost perfect Intra-Class Correlations (Intra-tester;flexion 0.99, extension 0.96;inter-tester;flexion 0.97, extension 0.93).Conclusion: Measurement of knee range of motion from digital photographs can be used in routine clinical total knee arthroplasty follow-up instead of, or interchangeably with the universal goniometer.
文摘BACKGROUND There is a lack of studies on the effects of enhanced recovery after surgery(ERAS)with multidisciplinary collaboration on the nursing outcomes of total knee arthroplasty(TKA).AIM To explore the effect of ERAS with multidisciplinary collaboration on nursing outcomes after TKA.METHODS We retrospectively analyzed the clinical data of 80 patients who underwent TKA at a tertiary hospital between January 2021 and December 2022.The patients were divided into two groups according to the nursing mode:the ERAS group(n=40)received ERAS with multidisciplinary collaboration,and the conventional group(n=40)received routine nursing.The following indicators were compared between the two groups:length of hospital stay,hospitalization cost,intraoperative blood loss,hemoglobin level 24 h after surgery,visual analog scale(VAS)score for pain,range of motion(ROM)of the knee joint,Hospital for Special Surgery(HSS)knee score,and postoperative complications.RESULTS The ERAS group had a significantly shorter length of hospital stay,lower hospitalization cost,less intraoperative blood loss,higher hemoglobin level 24 h after surgery,lower VAS score for pain,higher knee joint ROM,and higher HSS knee score than the conventional group(all P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).CONCLUSION Multidisciplinary collaboration with ERAS can reduce blood loss,shorten hospital stay,and improve knee function in patients undergoing TKA.
文摘BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare primary neoplasms of the gastrointestinal tract,accounting for 1%to 2%of all gastrointestinal neoplasms worldwide.GISTs are frequently discovered incidentally during workup for other diagnosis or intestinal obstruction,as they can present with few or no symptoms.Simultaneously,GISTs confer a high degree of malignant transformation,with a progression in about 10%to 30%of cases.CASE SUMMARY A 63-year-old healthy female presented to our institution with complaints of right knee pain and limited passive and active motion in the setting of a previous right total knee arthroplasty(TKA).One year after TKA,the patient was incidentally diagnosed with a GIST,which was successfully removed.After removal,the patient continued to have limited range of motion of the right knee and subsequently underwent revision TKA.Intraoperatively significant fibrotic adhesions were found encapsulating the femoral and tibial components.The patient’s pain improved postoperatively,however,she continued to have decreased range of motion with difficulty ambulating.CONCLUSION We propose that this case may demonstrate a proinflammatory milieu arising from a GIST,which had a direct influence on the outcome of recent total knee arthroplasty.This proposed mechanism between neoplastic cytokinetic activity and adhesion formation could have implications on preoperative and postoperative orthopedic management of total knee arthroplasty.
文摘Objective To introduce the improved quadricep splasty and rehabi li tation trainin g in the therapy of arthroclisis of kn ee,and to e-valuate its curative effect in the near future.Methods21patients with old arthroclisis of knee result fromsurrounding bone fr acture were treated with improved quadricep splasty and early rehabilitation training includin g ROM training,myodynamic ex ercise and physiotherapy for more than half a year.Knee joint functions before and after were compared to summarize th e feasibility and effects of the therapy .Results After above mentioned therapy;the patients’ knee joint functions were obviously improved.ROM and function scores we re significantly increased than tha t before operation(P <0.01).Conclusion Compared with the former styl e,the i mproved quadricepsplasty has some m erits such as better wound healing ,s uitable for early functional exercise and le ss complication.Combining it w ith e arly rehabilitation training is an e ffective treatment on arthroclisis of knee.
文摘BACKGROUND The posterior cruciate ligament(PCL) is important for cruciate-retaining(CR)total knee arthroplasty(TKA). Whether the entire PCL should be retained during CR-TKA is controversial.AIM To evaluate the clinical outcomes of PCL preservation in CR-TKA and the methods used to deal with the PCL during surgery.METHODS A retrospective review of patients with osteoarthritis undergoing primary CRTKA(176 patients, 205 knees) in our institution between March 2012 and March 2014 was performed. A PCL protector was used to preserve the intact PCL bone block. The status of the PCL was recorded during surgery. Intact PCL preserved,pie-crusting and repairing were used to balance the tension of the PCL. Range of motion(ROM) and the Knee Society Clinical Rating system(KSS) were evaluated preoperatively and at the endpoint of follow-up.RESULTS The mean ROM of the knee was 103.2 ± 17.2°, KSS clinical score was 47.6 ± 9.5 and KSS functional score was 46.3 ± 11.9 before surgery. The mean ROM of the knee was 117.5 ± 9.7°, KSS clinical score was 89.2 ± 3.6 and KSS functional score was 84.6 ± 9.8 at 5 years follow-up. ROM, KSS clinical scores and KSS functional scores were significantly improved after surgery(P < 0.01). Thirty-two(23.7%)TKAs involved PCL pie-crusting and 18(13.3%) involved PCL repair. Eighty-five(63.0%) TKAs applied standard operating procedures and preserved intact PCL.At 5 years follow-up, in the intact PCL group, the mean ROM of the knee was 118.0 ± 8.3°, KSS clinical score was 89.1 ± 3.7 and KSS functional score was 84.9 ±9.6. In the PCL pie-crusting group, mean ROM of the knee was 114.0 ± 13.5°, KSS clinical score was 88.8 ± 3.4 and KSS functional score was 83.8 ± 10.5. In the PCL repair group, mean ROM of the knee was 120.3 ± 7.0°, KSS clinical score was 89.0± 3.6 and KSS functional score was 89.4 ± 4.5. There were no significant differences in ROM, KSS clinical scores and KSS functional scores among the three groups(P > 0.05).CONCLUSION The clinical outcomes of preserving the PCL in CR-TKA are encouraging. Piecrusting and PCL repair do not affect the function. The PCL protector effectively protected the PCL bone block.
基金This was work supported by the National Center for Advancing Translational Sciences of the National Institutes of Health[UL1TR001086].
文摘Total knee arthroplasty is highly successful,in part due to range of motion(RoM)recovery.This is typically estimated goniometrically/visually by physical therapists(PTs)in the clinic,which is imprecise.Accordingly,a validated inertial measurement unit(IMU)method for capturing knee RoM was deployed assessing postoperative RoM both in and outside of the clinical setting.The study's objectives were to evaluate the feasibility of continuously capturing knee RoM pre-/post-op via IMUs,dividing data into PT/non-PT portions of each day,and comparing PT/non-PT metrics.We hypothesized IMU-based clinical knee RoM would differ from IMU-based knee RoM captured outside clinical settings.10 patients(3 M,69±13 years)completed informed consent documents following ethics board approval.A validated IMU method captured long duration(8–12 h/day,~50 days)knee RoM pre-/post-op.Post-op metrics were subdivided(PT versus non-PT).Clinical RoM and patient reported outcome measures were also captured.Compliance and clinical disruption were evaluated.ANOVA compared post-op PT and non-PT means and change scores.Maximum flexion during PT was less than outside PT.PT stance/swing RoM and activity level were greater than outside PT.No temporal variable differences were found PT versus non-PT.IMU RoM measurements capture richer information than clinical measures.Maximum PT flexion was likely less than non-PT due to the exercises completed(i.e.high passive RoM vs.low RoM gait).PT gait flexion likely exceed non-PT because of‘white coat effects’wherein patients are closely monitored clinically.This implies data captured clinically represents optimum performance whereas data captured non-clinically represents realistic performance.
文摘目的:观察四黄散联合间断垂直钢丝缝合加张力带对髌骨下极骨折患者膝关节活动度及骨折愈合时间的影响。方法:选取2021年9月至2022年9月丰城市中医院收治的髌骨下极骨折患者40例,按照随机数字表法分为对照组和试验组,每组20例。两组患者均给予切开复位内固定,对照组给予间断垂直钢丝缝合联合张力带治疗,试验组给予四黄散联合间断垂直钢丝缝合加张力带治疗。观察两组患者术后6周、3个月、6个月、1年及末次随访时膝关节疼痛评分、屈伸活动范围(range of motion, ROM)、Bostman评分、骨折愈合时间、各项临床指标及并发症发生情况。结果:试验组术后6周、3个月、6个月、1年膝关节疼痛评分均低于对照组,差异有统计学意义(P<0.05)。试验组术后6周、3个月、6个月、1年ROM、Bostman评分高于对照组,差异有统计学意义(P<0.05)。试验组术后1年骨折愈合时间、各项临床指标均优于对照组,并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:四黄散联合间断垂直钢丝缝合加张力带能改善髌骨下极骨折患者膝关节功能,降低术后并发症发生率,促进骨折早日愈合。
