BACKGROUND Sagittal alignment of the spine,pelvis,and lower extremities is essential for maintaining a stable and efficient posture and ambulation.Imbalance in any element can result in compensatory changes in the oth...BACKGROUND Sagittal alignment of the spine,pelvis,and lower extremities is essential for maintaining a stable and efficient posture and ambulation.Imbalance in any element can result in compensatory changes in the other elements.Knee flexion is a compensatory mechanism for spinopelvic sagittal alignment and is markedly affected in severe knee osteoarthritis(OA).The correction of knee flexion deformity(KFD)by total knee arthroplasty(TKA)can lead to complementary changes in the sagittal spinopelvic parameters(SSPs).AIM To determine the SSP changes in patients with knee OA,with or without KFD undergoing TKA.METHODS The study was conducted in 32 patients who underwent TKA.A neutral standing whole-spine lateral radiograph was performed before surgery and 3 mo after surgery in these patients.Subjects were divided into two groups(Group 1 obtained>10°corrections in KFD;group B obtained<10°correction).The pelvic tilt(PT),pelvic incidence(PI),sacral slope(SS),lumbar lordosis(LL),and sagittal vertical axis(SVA)were measured.RESULTS The median of change in PT,PI,SS,LL,and SVA was 0.20 mm,1.00 mm,2.20 mm,−0.40 mm,and 6.8 mm,respectively.The difference in the change in SSPs between the two groups was statistically non-significant.CONCLUSION SSPs,such as PI,PT,SS,LL,and SVA,do not change significantly following TKA in end-stage knee OA despite a significant correction(>10°)in KFD.展开更多
BACKGROUND Ankylosing spondylitis(AS)is a chronic rheumatic disease that primarily affects the spine and the sacroiliac and peripheral joints.Juvenile-onset AS(JoAS)patients will likely present with peripheral joint s...BACKGROUND Ankylosing spondylitis(AS)is a chronic rheumatic disease that primarily affects the spine and the sacroiliac and peripheral joints.Juvenile-onset AS(JoAS)patients will likely present with peripheral joint symptoms.Knee flexion contracture(KFC)and hip flexion contracture(HFC)are common in these patients due to subchondral bone inflammation.The Ilizarov technique is the most commonly used technique for treating KFC.However,its use to treat JoAS-associated KFC has not been reported.CASE SUMMARY This report presents a case study of a 31-year-old male patient with a squatting gait due to severe bilateral KFC and HFC.The patient had a normal walking pattern until the age of eight,after which he experienced knee and hip pain,leading to the gradual development of KFC and HFC.The patient’s primary complaint was an inability to walk upright.The patient was diagnosed with JoAS and under-went hip dissection and release,limited soft tissue release of the hamstring,and gradual traction using the Ilizarov method.Ultimately,the patient was able to walk upright.CONCLUSION The incidence of squatting gait due to KFC in individuals diagnosed with JoAS was low.Utilizing the Ilizarov technique has proven to be a secure and effective method for managing KFC in JoAS patients.Although the Ilizarov technique cannot substitute for total knee arthroplasty(TKA),its application can delay the need for primary TKA in JoAS patients and alleviate the intricacy and potential complications associated with the procedure.展开更多
AIM: To quantify and reduce the errors in visual estimation of knee flexion contractures during total knee arthroplasty(TKA).METHODS: This study was divided into two parts: Quantification of error and reduction of err...AIM: To quantify and reduce the errors in visual estimation of knee flexion contractures during total knee arthroplasty(TKA).METHODS: This study was divided into two parts: Quantification of error and reduction of error. To quantify error, 3 orthopedic surgeons visually estimated preoperative knee flexion contractures from lateral digital images of 23 patients prior to and after surgical draping. A repeated-measure analysis of variance was used to compare the estimated angles prior to and following the placement of the surgical drapes with the true knee angle measured with a long-arm goniometer. In an effort to reduce the error of visual estimation, a dual set of inclinometers was developed to improve intraoperative measurement of knee flexion contracture during TKA. A single surgeon performed 6 knee extension measurements with the device during 146 consecutive TKA cases. Three measurements were taken with the desired tibial liner trial thickness, and 3 were taken with a trial that was 2 mm thicker. An intraclass correlation coefficient(ICC) was calculated to assess the testretest reliability for the 3 measurements taken with the desired liner thickness, and a paired t test was used to determine if the knee extension measurements differed when a thicker tibial trial liner was placed.RESULTS: The surgeons significantly overestimated flexion contractures in 23 TKAs prior to draping and significantly underestimated the contractures after draping(actual knee angle = 6.1°± 6.4°, pre-drape estimate = 6.9°± 6.8°, post-drape estimate = 4.3°± 6.1°, P = 0.003). Following the development and application of the measurement devices, the measurements were highly reliable(ICC = 0.98), and the device indicated that 2.7°± 2.2° of knee extension was lost with the insertion of a 2 mm thicker tibial liner. The device failed to detect a difference in knee extension angle with the insertion of the 2 mm thicker liner in 9/146 cases(6.2%).CONCLUSION: We determined the amount of error associated with visual estimation of knee flexion contractures, and developed a simple, reliable device and method to improve feedback related to sagittal alignment during TKA.展开更多
Objective To verify the influence of flexion position of the knee on limb alignment,the change of the standing femorotibial angle(FTA)with knee flexion was radiologically investigated. Methods Radiographs were taken o...Objective To verify the influence of flexion position of the knee on limb alignment,the change of the standing femorotibial angle(FTA)with knee flexion was radiologically investigated. Methods Radiographs were taken on each left knee of 47 volunteers with seldom complaints in a one-leg standing position,The standing femorotibial angles(FTA)in full knee extension were compared with the corresponding ones in different angles of knee flexion,and the relationship between the FTA and the flexion angle was investigated. Results Standing FTAs in knee flexion were always smaller than the corresponding ones in full knee extension.With the increment of the flexion angle,the FTA decreased.Positive correlation was found between the difference(△FTA)of the standing FTA in full extension and in flexion and the flexion angle of the knee. Conclusion In the preoperative planning of knee surgeries such as high tibial osteotomy and arthroplasty,the influence of flexion contracture on limb alignment should be taken into consideration to avoid overcorrection or undercorrection.展开更多
目的观察固定平台单髁置换加髁间窝成形术治疗中度固定屈曲畸形膝内侧间室骨关节炎的临床效果。方法选取2021年11月至2023年6月青岛市市立医院收治的合并有中度固定屈曲畸形的膝内侧间室骨关节炎患者50例,其中男24例,女26例,年龄64~75岁...目的观察固定平台单髁置换加髁间窝成形术治疗中度固定屈曲畸形膝内侧间室骨关节炎的临床效果。方法选取2021年11月至2023年6月青岛市市立医院收治的合并有中度固定屈曲畸形的膝内侧间室骨关节炎患者50例,其中男24例,女26例,年龄64~75岁,平均(69.69±3.53)岁。按手术方式分为研究组(采用固定平台单髁置换加髁间窝成形术)和对照组(采用全膝关节表面置换术)各25例。对比两组手术前后Lysholm评分、美国特种外科医院(the hospital for special surgery,HSS)膝关节评分及疼痛视觉模拟评分(visual analogue scale,VAS),测量术前及术后12个月膝关节屈曲角度,对比两组伸膝角度改善情况。结果患者均获得12个月完整随访。术后2周、6周、3个月研究组Lysholm评分、HSS评分及VAS均优于对照组,差异有统计学意义(P<0.05);两组术后6个月、12个月Lysholm评分、HSS评分及VAS差异均无统计学意义(P>0.05);研究组术后12个月残留畸形角度大于对照组,差异有统计学意义(P<0.05)。结论对老年骨关节炎合并中度固定屈曲畸形患者采取固定平台单髁置换加髁间窝成形手术可以有效地减轻疼痛,改善膝关节功能,但对屈曲畸形的矫正能力小于全膝关节置换。展开更多
BACKGROUND Tibial tubercle osteotomy(TTO) is a well-established surgical technique to deal with a stiff knee in revision total knee arthroplasty(RTKA). However, several reports have described potential osteotomy-relat...BACKGROUND Tibial tubercle osteotomy(TTO) is a well-established surgical technique to deal with a stiff knee in revision total knee arthroplasty(RTKA). However, several reports have described potential osteotomy-related complications such as nonunion, tibial tubercle migration and fragmentation, and metalware related pain.AIM To evaluate the literature and estimate the efficiency of TTO in RTKA in terms of osteotomy union, knee mobility and complications.METHODS MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were investigated for completed studies until February 2020. The principle outcome of the study was the incidence of union of the osteotomy. Secondary outcomes were the knee range of motion as well as the TTO-related and overall procedure complication rate.RESULTS Fifteen clinical studies with a total of 593 TTOs were included. The TTO union rate was 98.1%. Proximal migration and anterior knee pain were the most common TTO-related complications accounting for 6.9% and 6.4% of all cases,respectively. However, only 2.2% of cases suffering from anterior knee pain needed hardware removal. Knee flexion was improved from 82.9° preoperatively to 100.1° postoperatively and total knee range of motion was increased from 73.4° before surgery to 97° after surgery. Stiffness requiring manipulation under anesthesia was recorded in 4.6% of cases. No major complications were reported.CONCLUSION The current systematic review supports the use of TTO in RTKA, as it is associated with high union rate, significant improvement in knee motion and low osteotomy-related complication risk that rarely leads to secondary tibial tubercle procedures.展开更多
We report a case of acquired genu recurvatum treated with a proximal tibial flexion osteotomy. A partial growth arrest at the anterior portion of the proximal tibial physis following a conservatively treated Meyers-Mc...We report a case of acquired genu recurvatum treated with a proximal tibial flexion osteotomy. A partial growth arrest at the anterior portion of the proximal tibial physis following a conservatively treated Meyers-McKeever type II injury of the tibial eminence. This is a reliable method in the correction of genu recurvatum. By using tricortical autogenous iliac crest graft, the osteotomy may be made very stable intra-operatively circumventing the need for fixation.展开更多
文摘BACKGROUND Sagittal alignment of the spine,pelvis,and lower extremities is essential for maintaining a stable and efficient posture and ambulation.Imbalance in any element can result in compensatory changes in the other elements.Knee flexion is a compensatory mechanism for spinopelvic sagittal alignment and is markedly affected in severe knee osteoarthritis(OA).The correction of knee flexion deformity(KFD)by total knee arthroplasty(TKA)can lead to complementary changes in the sagittal spinopelvic parameters(SSPs).AIM To determine the SSP changes in patients with knee OA,with or without KFD undergoing TKA.METHODS The study was conducted in 32 patients who underwent TKA.A neutral standing whole-spine lateral radiograph was performed before surgery and 3 mo after surgery in these patients.Subjects were divided into two groups(Group 1 obtained>10°corrections in KFD;group B obtained<10°correction).The pelvic tilt(PT),pelvic incidence(PI),sacral slope(SS),lumbar lordosis(LL),and sagittal vertical axis(SVA)were measured.RESULTS The median of change in PT,PI,SS,LL,and SVA was 0.20 mm,1.00 mm,2.20 mm,−0.40 mm,and 6.8 mm,respectively.The difference in the change in SSPs between the two groups was statistically non-significant.CONCLUSION SSPs,such as PI,PT,SS,LL,and SVA,do not change significantly following TKA in end-stage knee OA despite a significant correction(>10°)in KFD.
文摘BACKGROUND Ankylosing spondylitis(AS)is a chronic rheumatic disease that primarily affects the spine and the sacroiliac and peripheral joints.Juvenile-onset AS(JoAS)patients will likely present with peripheral joint symptoms.Knee flexion contracture(KFC)and hip flexion contracture(HFC)are common in these patients due to subchondral bone inflammation.The Ilizarov technique is the most commonly used technique for treating KFC.However,its use to treat JoAS-associated KFC has not been reported.CASE SUMMARY This report presents a case study of a 31-year-old male patient with a squatting gait due to severe bilateral KFC and HFC.The patient had a normal walking pattern until the age of eight,after which he experienced knee and hip pain,leading to the gradual development of KFC and HFC.The patient’s primary complaint was an inability to walk upright.The patient was diagnosed with JoAS and under-went hip dissection and release,limited soft tissue release of the hamstring,and gradual traction using the Ilizarov method.Ultimately,the patient was able to walk upright.CONCLUSION The incidence of squatting gait due to KFC in individuals diagnosed with JoAS was low.Utilizing the Ilizarov technique has proven to be a secure and effective method for managing KFC in JoAS patients.Although the Ilizarov technique cannot substitute for total knee arthroplasty(TKA),its application can delay the need for primary TKA in JoAS patients and alleviate the intricacy and potential complications associated with the procedure.
文摘AIM: To quantify and reduce the errors in visual estimation of knee flexion contractures during total knee arthroplasty(TKA).METHODS: This study was divided into two parts: Quantification of error and reduction of error. To quantify error, 3 orthopedic surgeons visually estimated preoperative knee flexion contractures from lateral digital images of 23 patients prior to and after surgical draping. A repeated-measure analysis of variance was used to compare the estimated angles prior to and following the placement of the surgical drapes with the true knee angle measured with a long-arm goniometer. In an effort to reduce the error of visual estimation, a dual set of inclinometers was developed to improve intraoperative measurement of knee flexion contracture during TKA. A single surgeon performed 6 knee extension measurements with the device during 146 consecutive TKA cases. Three measurements were taken with the desired tibial liner trial thickness, and 3 were taken with a trial that was 2 mm thicker. An intraclass correlation coefficient(ICC) was calculated to assess the testretest reliability for the 3 measurements taken with the desired liner thickness, and a paired t test was used to determine if the knee extension measurements differed when a thicker tibial trial liner was placed.RESULTS: The surgeons significantly overestimated flexion contractures in 23 TKAs prior to draping and significantly underestimated the contractures after draping(actual knee angle = 6.1°± 6.4°, pre-drape estimate = 6.9°± 6.8°, post-drape estimate = 4.3°± 6.1°, P = 0.003). Following the development and application of the measurement devices, the measurements were highly reliable(ICC = 0.98), and the device indicated that 2.7°± 2.2° of knee extension was lost with the insertion of a 2 mm thicker tibial liner. The device failed to detect a difference in knee extension angle with the insertion of the 2 mm thicker liner in 9/146 cases(6.2%).CONCLUSION: We determined the amount of error associated with visual estimation of knee flexion contractures, and developed a simple, reliable device and method to improve feedback related to sagittal alignment during TKA.
文摘Objective To verify the influence of flexion position of the knee on limb alignment,the change of the standing femorotibial angle(FTA)with knee flexion was radiologically investigated. Methods Radiographs were taken on each left knee of 47 volunteers with seldom complaints in a one-leg standing position,The standing femorotibial angles(FTA)in full knee extension were compared with the corresponding ones in different angles of knee flexion,and the relationship between the FTA and the flexion angle was investigated. Results Standing FTAs in knee flexion were always smaller than the corresponding ones in full knee extension.With the increment of the flexion angle,the FTA decreased.Positive correlation was found between the difference(△FTA)of the standing FTA in full extension and in flexion and the flexion angle of the knee. Conclusion In the preoperative planning of knee surgeries such as high tibial osteotomy and arthroplasty,the influence of flexion contracture on limb alignment should be taken into consideration to avoid overcorrection or undercorrection.
文摘目的观察固定平台单髁置换加髁间窝成形术治疗中度固定屈曲畸形膝内侧间室骨关节炎的临床效果。方法选取2021年11月至2023年6月青岛市市立医院收治的合并有中度固定屈曲畸形的膝内侧间室骨关节炎患者50例,其中男24例,女26例,年龄64~75岁,平均(69.69±3.53)岁。按手术方式分为研究组(采用固定平台单髁置换加髁间窝成形术)和对照组(采用全膝关节表面置换术)各25例。对比两组手术前后Lysholm评分、美国特种外科医院(the hospital for special surgery,HSS)膝关节评分及疼痛视觉模拟评分(visual analogue scale,VAS),测量术前及术后12个月膝关节屈曲角度,对比两组伸膝角度改善情况。结果患者均获得12个月完整随访。术后2周、6周、3个月研究组Lysholm评分、HSS评分及VAS均优于对照组,差异有统计学意义(P<0.05);两组术后6个月、12个月Lysholm评分、HSS评分及VAS差异均无统计学意义(P>0.05);研究组术后12个月残留畸形角度大于对照组,差异有统计学意义(P<0.05)。结论对老年骨关节炎合并中度固定屈曲畸形患者采取固定平台单髁置换加髁间窝成形手术可以有效地减轻疼痛,改善膝关节功能,但对屈曲畸形的矫正能力小于全膝关节置换。
文摘BACKGROUND Tibial tubercle osteotomy(TTO) is a well-established surgical technique to deal with a stiff knee in revision total knee arthroplasty(RTKA). However, several reports have described potential osteotomy-related complications such as nonunion, tibial tubercle migration and fragmentation, and metalware related pain.AIM To evaluate the literature and estimate the efficiency of TTO in RTKA in terms of osteotomy union, knee mobility and complications.METHODS MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were investigated for completed studies until February 2020. The principle outcome of the study was the incidence of union of the osteotomy. Secondary outcomes were the knee range of motion as well as the TTO-related and overall procedure complication rate.RESULTS Fifteen clinical studies with a total of 593 TTOs were included. The TTO union rate was 98.1%. Proximal migration and anterior knee pain were the most common TTO-related complications accounting for 6.9% and 6.4% of all cases,respectively. However, only 2.2% of cases suffering from anterior knee pain needed hardware removal. Knee flexion was improved from 82.9° preoperatively to 100.1° postoperatively and total knee range of motion was increased from 73.4° before surgery to 97° after surgery. Stiffness requiring manipulation under anesthesia was recorded in 4.6% of cases. No major complications were reported.CONCLUSION The current systematic review supports the use of TTO in RTKA, as it is associated with high union rate, significant improvement in knee motion and low osteotomy-related complication risk that rarely leads to secondary tibial tubercle procedures.
文摘We report a case of acquired genu recurvatum treated with a proximal tibial flexion osteotomy. A partial growth arrest at the anterior portion of the proximal tibial physis following a conservatively treated Meyers-McKeever type II injury of the tibial eminence. This is a reliable method in the correction of genu recurvatum. By using tricortical autogenous iliac crest graft, the osteotomy may be made very stable intra-operatively circumventing the need for fixation.
