Alignment Techniques in Total Knee Arthroplasty:Where do We Stand Today?

Achieving optimal alignment in total knee arthroplasty(TKA)is a critical factor in ensuring optimal outcomes and long-term implant survival.Traditionally,mechanical alignment has been favored to achieve neutral post-operative joint alignment.However,contemporary approaches,such as kinematic alignments and hybrid techniques including adjusted mechanical,restricted kinematic,inverse kinematic,and functional alignments,are gaining attention for their ability to restore native joint kinematics and anatomical alignment,potentially leading to enhanced functional outcomes and greater patient satisfaction.The ongoing debate on optimal alignment strategies considers the following factors:long-term implant durability,functional improvement,and resolution of individual anatomical variations.Furthermore,advancements of computer-navigated and robotic-assisted surgery has augmented the precision in implant positioning and objective measurements of soft tissue balance.Despite ongoing debates on balancing implant longevity and functional outcomes,there is an increasing advocacy for personalized alignment strategies that are tailored to individual anatomical variations.This review evaluates the spectrum of various alignment techniques in TKA,including mechanical alignment,patient-specific kinematic approaches,and emerging hybrid methods.Each technique is scrutinized based on its fundamental principles,procedural techniques,inherent advantages,and potential limitations,while identifying significant clinical gaps that underscore the need for further investigation.

Mortality rate after total knee arthroplasty or total hip arthroplasty in patients with a history of liver transplant

In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023;14:784-790.It is well known that patients who have undergone a liver transplant(LT)may need to have a total hip arthroplasty(THA)or total knee arthroplasty(TKA)implanted.Ahmed et al stated that the mortality rate in these patients was similar to the one of the general population.However,there are three articles previously published that found higher mortality in LT patients who experienced THA/TKA than in the general population(individuals without LT).Therefore,in this Editorial I would like to point out that there is controversy in the literature regarding whether LT patients undergoing THA/TKA have higher mortality than the general population.Therefore,future research should attempt to resolve this controversy.

Single-center experience with Knee+^(TM) augmented reality navigation system in primary total knee arthroplasty

BACKGROUND Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years,as they enhance precision compared to conventional hardware.The expansion of computer assistance is evolving with the employment of augmented reality.Yet,the accuracy of augmented reality navigation systems has not been determined.AIM To examine the accuracy of component alignment and restoration of the affected limb’s mechanical axis in primary total knee arthroplasty(TKA),utilizing an augmented reality navigation system and to assess whether such systems are conspicuously fruitful for an accomplished knee surgeon.METHODS From May 2021 to December 2021,30 patients,25 women and five men,under-went a primary unilateral TKA.Revision cases were excluded.A preoperative radiographic procedure was performed to evaluate the limb’s axial alignment.All patients were operated on by the same team,without a tourniquet,utilizing three distinct prostheses with the assistance of the Knee+™augmented reality navigation system in every operation.Postoperatively,the same radiographic exam protocol was executed to evaluate the implants’position,orientation and coronal plane alignment.We recorded measurements in 3 stages regarding femoral varus and flexion,tibial varus and posterior slope.Firstly,the expected values from the Augmented Reality system were documented.Then we calculated the same values after each cut and finally,the same measurements were recorded radiolo-gically after the operations.Concerning statistical analysis,Lin’s concordance correlation coefficient was estimated,while Wilcoxon Signed Rank Test was performed when needed.RESULTS A statistically significant difference was observed regarding mean expected values and radiographic mea-surements for femoral flexion measurements only(Z score=2.67,P value=0.01).Nonetheless,this difference was statistically significantly lower than 1 degree(Z score=-4.21,P value<0.01).In terms of discrepancies in the calculations of expected values and controlled measurements,a statistically significant difference between tibial varus values was detected(Z score=-2.33,P value=0.02),which was also statistically significantly lower than 1 degree(Z score=-4.99,P value<0.01).CONCLUSION The results indicate satisfactory postoperative coronal alignment without outliers across all three different implants utilized.Augmented reality navigation systems can bolster orthopaedic surgeons’accuracy in achieving precise axial alignment.However,further research is required to further evaluate their efficacy and potential.

Meta-analysis of factors influencing anterior knee pain after total knee arthroplasty

BACKGROUND Total knee arthroplasty(TKA)is a mature procedure recommended for correcting knee osteoarthritis deformity,relieving pain,and restoring normal biomechanics.Although TKA is a successful and cost-effective procedure,patient dissatisfaction is as high as 50%.Knee pain after TKA is a significant cause of patient dissatisfaction;the most common location for residual pain is the anterior region.Between 4%and 40%of patients have anterior knee pain(AKP).AIM To investigate the effect of various TKA procedures on postoperative AKP.METHODS We searched PubMed,EMBASE,and Cochrane from January 2000 to September 2022.Randomized controlled trials with one intervention in the experimental group and no corresponding intervention(or other interventions)in the control group were collected.Two researchers independently read the title and abstract of the studies,preliminarily screened the articles,and read the full text in detail according to the selection criteria.Conflicts were resolved by consultation with a third researcher.And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software.RESULTS There were 25 randomized controlled trials;13 were comparative studies with or without patellar resurfacing.The meta-analysis showed no significant difference between the experimental and control groups(P=0.61).Six studies were comparative studies of circumpatellar denervation vs non-denervation,divided into three subgroups for meta-analysis.The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups(P=0.31,P=0.50).One subgroup meta-analysis showed a significant difference between the experimental and control groups(P=0.001).Two studies compared fixed-bearing TKA and mobile-bearing TKA;the results meta-analysis showed no significant difference between the experimental and control groups(P=0.630).Two studies compared lateral retinacular release vs non-release;the meta-analysis showed a significant difference between the experimental and control groups(P=0.002);two other studies compared other factors.CONCLUSION Patellar resurfacing,mobile-bearing TKA,and fixed-bearing TKA do not reduce the incidence of AKP.Lateral retinacular release can reduce AKP;however,whether circumpatellar denervation can reduce AKP is controversial.

Readmission rate and early complications in patients undergoing total knee arthroplasty:A retrospective study

BACKGROUND Total knee arthroplasty(TKA)can improve pain,quality of life,and functional outcomes.Although uncommon,postoperative complications are extremely consequential and thus must be carefully tracked and communicated to patients to assist their decision-making before surgery.Identification of the risk factors for complications and readmissions after TKA,taking into account common causes,temporal trends,and risk variables that can be changed or left unmodified,will benefit this process.AIM To assess readmission rates,early complications and their causes after TKA at 30 days and 90 days post-surgery.METHODS This was a prospective and retrospective study of 633 patients who underwent TKA at our hospital between January 1,2017,and February 28,2022.Of the 633 patients,28 were not contactable,leaving 609 who met the inclusion criteria.Both inpatient and outpatient hospital records were retrieved,and observations were noted in the data collection forms.RESULTS Following TKA,the 30-day and 90-day readmission rates were determined to be 1.1%(n=7)and 1.8%(n=11),respectively.The unplanned visit rate at 30 days following TKA was 2.6%(n=16)and at 90 days was 4.6%(n=28).At 90 days,the unplanned readmission rate was 1.4%(n=9).Reasons for readmissions included medical(27.2%,n=3)and surgical(72.7%,n=8).Unplanned readmissions and visits within 90 days of follow-up did not substantially differ by age group(P=0.922),body mass index(BMI)(P=0.633),unilateral vs bilateral TKA(P=0.696),or patient comorbidity status(30-day P=0.171 and 90-day P=0.813).Reoperation rates after TKA were 0.66%(n=4)at 30 days and 1.15%(n=8)at 90 days.The average length of stay was 6.53 days.CONCLUSION In this study,there was a low readmission rate following TKA.There was no significant correlation between readmission rate and patient factors such as age,BMI,and co-morbidity status.

Mid-term outcomes of a kinematically designed cruciate retaining total knee arthroplasty

BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.

Malnutrition Assessed Using the Geriatric Nutritional Risk Index Is Associated with Preoperative Incidence of Deep Vein Thrombosis in Japanese Patients Undergoing Total Knee Arthroplasty

Purpose: Few studies have evaluated the association between malnutrition and the risk of preoperative deep vein thrombosis (DVT) in patients undergoing primary total joint arthroplasty. This study aimed to investigate the prevalence of preoperative DVT in Japanese patients undergoing total knee arthroplasty (TKA) and the importance of malnutrition in the risk of preoperative DVT. Methods: We retrospectively analyzed 394 patients admitted for primary TKA at our institution between January 2019 and December 2023. All patients scheduled for TKA at our institution had serum D-dimer levels measured preoperatively. Lower-limb ultrasonography was examined to confirm the presence of DVT in patients with D-dimer levels ≥ 1.0 µg/mL or who were considered to be at high risk of DVT by the treating physician. Based on the results of lower-limb ultrasonography, all patients were divided into the non-DVT and DVT groups. The incidence of and risk factors for preoperative DVT were investigated, as well as the correlation of DVT with the patient’s nutritional parameters. We used two representative tools for nutritional assessment: the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status Score. Results: The mean age was 77.8 ± 6.9 years. Preoperative DVT was diagnosed in 57 of the 394 (14.5%) patients. Multivariate logistic regression analysis showed that advanced age and malnutrition status, assessed using the GNRI, were independent risk factors for preoperative DVT. Conclusion: A high incidence of preoperative DVT was observed in patients who underwent TKA. Malnutrition status, as assessed using the GNRI, increased the risk of preoperative DVT. Our findings suggest that clinicians should consider these factors when tailoring preventive strategies to mitigate DVT risk in patients undergoing TKA.

Analysis of the causes of primary revision after unicompartmental knee arthroplasty: A case series

BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and analyse the causes of revision after UKA.METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized.We analysed the clinical symptoms,medical histories,laboratory test results,imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA.RESULTS A total of 13 patients,including 3 males and 10 females,underwent revision surgery after UKA.The average age of the included patients was 67.62 years.The prosthesis was used for 3 d to 72 months.The main reasons for revision after UKA were improper suturing of the surgical opening(1 patient),osteophytes(2 patients),intra-articular loose bodies(2 patients),tibial prosthesis loosening(2 patients),rheumatoid arthritis(1 patient),gasket dislocation(3 patients),anterior cruciate ligament injury(1 patient),and medial collateral ligament injury with residual bone cement(1 patient).CONCLUSION The causes of primary revision after UKA were gasket dislocation,osteophytes,intra-articular loose bodies and tibial prosthesis loosening.Avoidance of these factors may greatly reduce the rate of revision after UKA,improve patient satisfaction and reduce medical burden.

Analysis of causes for revision in unicompartmental knee arthroplasty

The study by Zhao et al identifies the factors leading to the failure of unicompartmental knee arthroplasty(UKA)in their patients.These factors include substandard suturing of the wound,the presence of osteophytes and intra-articular loose bodies causing impingement,premature loosening of the tibial component,choosing unsuitable patients for the procedure,dislocation of the movable insert,and damage to the anterior cruciate ligament and medial collateral ligament.The findings suggest that employing the correct surgical techniques and indications is essential for successful outcomes in the UKA.

Insights into complications after unicompartmental knee arthroplasty

Zhao's study,offers a comprehensive analysis of unicompartmental knee arthroplasty(UKA)revision indications.The study provides a detailed,case-by-case analysis of the factors leading to knee revision surgery in 13 patients.Not only elucidates the complexities of UKA revisions but also underscores the importance of continuous improvement in surgical techniques and the adoption of innovative technologies.

Effect of weight-adjusted antimicrobial antibiotic prophylaxis on postoperative dosage and surgical site infection incidence in total joint arthroplasty

Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI.However,the correct dosage and frequency of administration remains debatable.In this editorial,we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty.The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI.In addition,weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration,drug resistance,drug toxicity,and costs.

Addressing metallosis in knee arthroplasty:From diagnostic challenges to innovative treatments

In this editorial,we comment on the article by Toro et al published in the recent issue of World Journal of Orthopedics.This editorial review provides a comprehensive exploration of the landscape surrounding knee arthroplasty metallosis,focusing on key aspects ranging from the mechanisms influencing susceptibility to clinical implications and advanced treatment strategies.We elucidate the complex interplay of implant design,patient-specific variables,and wear-related processes contributing to metallosis.Furthermore,we seek to shed light on diagnostic challenges,the necessity of a multidisciplinary approach,and the imperative for vigilant implant surveillance.Uni-on-uni revision,as a targeted treatment modality,is discussed,highlighting its potential to address metallosis in unicompartmental knee arthroplasty(UKA).There is a need for heightened awareness among clinicians regarding the subtle presentations of metallosis,coupled with the limitations of traditional imaging techniques.Addressing metallosis requires a collaborative,multidisciplinary approach to effectively navigate the complexities associated with this complication.Furthermore,the review emphasizes the evolving paradigm of personalized care,with uni-on-uni revision emerging as a promising surgical solution.In conclusion,the editorial outlines the dynamic nature of knee arthroplasty metallosis and its multifaceted impact on clinical practice.It calls for ongoing collaboration,education,and integration of innovative solutions to enhance diagnostic accuracy,proactive management,and overall patient outcomes in the realm of UKA.

Cost-effectiveness of patient specific vs conventional instrumentation for total knee arthroplasty:A systematic review and meta-analysis

BACKGROUND Over the past years,patient specific instrumentation(PSI)for total knee arthroplasty(TKA)has been implemented and routinely used.No clear answer has been given on its associated cost and cost-effectiveness when compared to conventional instrumentation(CI)for TKA.AIM To compare the cost and cost-effectiveness of PSI TKA compared to CI TKA.METHODS A literature search was performed in healthcare,economical healthcare,and medical databases(MEDLINE,EMBASE,CINAHL,Web of Science,Cochrane Library,EconLit).It was conducted in April 2021 and again in January 2022.Relevant literature included randomised controlled trials,retrospective studies,prospective studies,observational studies,and case control studies.All studies were assessed on methodological quality.Relevant outcomes included incremental cost-effectiveness ratio,quality-adjusted life years,total costs,imaging costs,production costs,sterilization associated costs,surgery duration costs and readmission rate costs.All eligible studies were assessed for risk of bias.Meta-analysis was performed for outcomes with sufficient data.RESULTS Thirty-two studies were included into the systematic review.Two were included in the metaanalysis.3994 PSI TKAs and 13267 CI TKAs were included in the sample size.The methodological quality of the included studies,based on Consensus on Health Economic Criteria-scores and risk of bias,ranged from average to good.PSI TKA costs less than CI TKA when considering mean operating room time and its associated costs and tray sterilization per patient case.PSI TKA costs more compared to CI TKA when considering imaging and production costs.Considering total costs per patient case,PSI TKA is more expensive in comparison to CI TKA.Meta-analysis comparing total costs for PSI TKA,and CI TKA showed a significant higher cost for PSI TKA.CONCLUSION Cost for PSI and CI TKA can differ when considering distinct aspects of their implementation.Total costs per patient case are increased for PSI TKA when compared to CI TKA.

Self-management of osteoarthritis while waiting for total knee arthroplasty during the COVID-19 pandemic among older Malaysians

BACKGROUND The study sought to understand the self-management strategies used by patients during the postponement of their total knee arthroplasty(TKA)procedure,as well as the associations between the length of waiting time,pain,and physical frailty and function.The study focused on individuals aged 50 years and above,as they are known to be more vulnerable to the negative impacts of delayed elective surgery and rehabilitation.This study hypothesizes that delayed TKR due to coronavirus disease 2019(COVID-19)will bear negative effect in self-management,pain,and physical frailty and function in older adults.AIM To investigate the effects of COVID-19 pandemic on self-management,pain,and physical function in older adults awaiting TKA in Malaysia.METHODS This cross-sectional study has the data of participants,who matched the criteria and scheduled for TKA for the first time,extracted from the TKA registry in the Department of Orthopaedics and Traumatology,Hospital Canselor Tuanku Mukhriz.Data on pain status,and self-management,physical frailty,and instrumental activities daily living were also collected.Multiple linear regression analysis with a significant level of 0.05 was used to identify the association between waiting time and pain on physical frailty and functional performance.RESULTS Out of 180 had deferred TKA,50%of them aged 50 years old and above,80%were women with ethnic distribution Malay(66%),Chinese(22%),Indian(10%),and others(2%)respectively.Ninety-two percent of the participants took medication to manage their pain during the waiting time,while 10%used herbs and traditional supplements,and 68%did exercises as part of their osteoarthritis(OA)self-management.Thirty-six participants were found to have physical frailty(strength,assistance with walking,rising from a chair,climbing stairs,and falls questionnaire score>4)which accounted for 72%.Increased pain was associated with physical frailty with odds ratio,odds ratio(95%confidence interval):1.46(1.04-2.05).This association remained significant even after the adjustment according to age and self-management.CONCLUSION While deferring TKA during a pandemic is unavoidable,patient monitoring for OA treatment during the waiting period is important in reducing physical frailty,ensuring the older patients’independence.

Artificial intelligence technology and ultrasound-guided nerve block for analgesia in total knee arthroplasty

BACKGROUND Knee diseases are more common in middle-aged and elderly people,so artificial knee replacement is also more used in middle-aged and elderly people.Although the patient’s pain can be reduced through surgery,often accompanied by moderate pain after surgery and neutralization,which not only increases the psychological burden of the patient,but also greatly reduces the postoperative recovery effect,and may also lead to the occurrence of postoperative adverse events in severe cases.AIM To investigate the analgesic effect of artificial intelligence(AI)and ultrasoundguided nerve block in total knee arthroplasty(TKA).METHODS A total of 92 patients with TKA admitted to our hospital from January 2021 to January 2022 were opted and divided into two groups according to the treatment regimen.The control group received combined spinal-epidural anesthesia.The research group received AI technique combined with ultrasound-guided nerve block anesthesia.The sensory block time,motor block time,visual analogue scale(VAS)at different time points and complications were contrasted between the two groups.RESULTS The time of sensory block onset and sensory block perfection in the research group was shorter than those in the control group,but the results had no significant difference(P>0.05).Duration of sensory block in the research group was significantly longer than those in the control group(P<0.05).The time of motor block onset and motor block perfection in the research group was shorter than those in the control group,but the results had no significant difference(P>0.05).Duration of motor block in the research group was significantly longer than those in the control group.The VAS scales of the research group were significantly lower than that of the control group at different time points(P<0.05).The postoperative hip flexion and abduction range of motion in the research group were significantly better than those in the control group at different time points(P<0.05).The incidence of complications was significantly lower in the research group than in the control group(P=0.049).CONCLUSION In TKA,the combination of AI technology and ultrasound-guided nerve block has a significantly effect,with fewer postoperative complications and significantly analgesic effect,which is worthy of application.

Kinematically Aligned Total Knee Arthroplasty for Valgus Osteoarthritis of More than 10°―Is It Still a “Challenging Surgery”?

Mechanically aligned total knee arthroplasty (TKA) for valgus knee is considered a “challenging surgery.” Recently, the kinematic alignment (KA) method has gained attention. This study aimed to present objective clinical data, such as intraoperative balance assessment and radiographic evaluation of postoperative lower extremity alignment after TKA using the KA method for valgus deformity. Twenty-one TKA knees (mean age, 74 years;2 males, 19 females) with KA for severe valgus deformity (hip-knee-ankle-angle ≥ 10°) performed at our department in the past 3 years were included in this study. Intraoperative gap and balance measurements and postoperative radiographic evaluation were performed. A total arc of range of motion was achieved up to 98% of preoperative values at 3 weeks postoperatively. Intraoperative gap and balance were stable throughout the entire range of motion. In addition, there were no statistically significant differences in either balance or gap values at each flexion angle. KA TKA is a “simple surgery” rather than a “challenging surgery” because additional soft tissue procedures are not required, operative time is short, intraoperative and postoperative balance is very stable, and a good alignment is achieved. This procedure may relieve surgeons of the stress of TKA for valgus deformities.

Clinical Outcomes and Prehabilitation Strategies of Patients Treated with Cement-Screw Technique for Tibial Defects in Total Knee Arthroplasty

Objective: To investigate the clinical efficacy of the cement-screw technique in repairing tibial plateau bone defects in total knee arthroplasty (TKA) recipients and summarize the preoperative prehabilitation strategies for such surgeries. Methods: A total of 33 TKA recipients (45 knees) in our department underwent repair of unilateral or bilateral tibial defects using the cement-screw technique. The subjects were divided into two groups based on the differences in preoperative interventions. The control group received routine preoperative health education according to the consensus, while the observation group received instructive and standardized prehabilitation exercises for four weeks in addition to the routine education. Scale scores, intraoperative parameters, and postoperative recovery indicators were recorded at different time pointsand subjected to statistical analysis for intra-group and inter-group differences. All subjects underwent long-term follow-up for at least 24 months. Results: Within each group at different time points, there were statistically significant differences in VAS, ROM, and HSS scores (p Conclusions: Cement-screw technique for repairing tibial plateau bone defects in TKA recipients can significantly relieve pain, and improve joint function. Prehabilitation can improve preoperative rehabilitation reserves in these patients, accelerate postoperative recovery, and contribute to better short-term clinical outcomes.

Incidence and Clinical Characteristics of Deep Vein Thrombosis (DVT) after Total Knee Arthroplasty (TKA) with DVT Chemoprophylaxis

Objective: Deep vein thrombosis (DVT) after total knee arthroplasty (TKA) is very common and leading cause of death due to this procedure. The objective of this study was to investigate the incidence and clinical characteristics of DVT after TKA with DVT chemoprophylaxis. Methods: This is a prospective cohort study in single institution. The patients received postoperative DVT chemoprophylaxis (low molecular weight heparin (LMWH) or Fondaparinux), followed by duplex ultrasonography to check for DVT 1 - 2 weeks after TKA. The clinical characteristics were summarized and analysed by chi-square test and regression analysis. Results: Five hundred and thirty four patients were enrolled from January 2007 to December 2010. DVT chemoprophylaxis was administered in 524 (98.1%) of the 534 patients. DVT occurred in 9 subjects (1.69%);8 subjects had DVT in the leg, and 1 subject had a pulmonary embolism. Among them, asymptomatic DVT was observed in 5 patients (0.94%). Univariate analysis showed that surgical methods (revision, P = 0.0007), body mass index (BMI) (>25, P = 0.0028), low platelet count (less than 150 × 103, P = 0.0219), time in the intensive care unit (ICU) (P < 0.0001), no administration of prophylactic LMWH (P = 0.0392), and a history of DVT (P < 0.0001) were significant risk factors of DVT. Conclusions: The incidence of DVT was 1.69% after TKA with prophylactic antithrombotic therapy. Revision surgery, BMI, low platelet count, time in ICU, absence of prophylactic LMWH and history of DVT were significant risk factors of DVT.

全膝关节置换中BrainlabKnee3导航辅助间隙平衡技术的应用优势

背景:近年来,计算机导航技术辅助关节置换逐渐受到医疗领域的关注。文献报道计算机导航在全膝关节置换中的应用临床效果不一。为了探索新一代Brainlab Knee 3导航系统的临床效果,进行了此项研究。目的:分析计算机导航系统(Brainlab Knee 3)结合间隙平衡技术在全膝关节置换中的应用效果。方法:2020年11月至2021年5月大连市第二人民医院关节外科收治71例行全膝关节置换患者,导航组35例,术中采用计算机导航结合间隙平衡技术行全膝关节置换;传统组36例,术中采用传统手术器械定位截骨。比较两组患者术中内、外侧关节间隙差;膝关节活动度、KSS评分;髋膝踝角;冠状面股骨组件角、冠状面胫骨组件角和矢状面胫骨组件角偏差值。结果与结论:①导航组伸直位内外侧间隙差0,1,2 mm的患者分别为19,14,2例;屈膝90°位内外侧间隙差0,1,2 mm的患者分别为18,15,2例。传统组伸直位内外侧间隙差0,1,2 mm的患者分别为10,20,6例;屈膝90°位内外侧间隙差0,1,2 mm的患者分别为10,15,8例。②导航组手术时间长于传统组(P<0.05),导航组有2例患者术后形成下肢肌间静脉血栓,传统组患者均无并发症。③置换后6,12个月两组患者膝关节活动度均明显增加,导航组膝关节活动度高于传统组(P<0.05)。④置换后12个月两组患者KSS评分均明显增加,导航组KSS评分高于传统组(P<0.05)。⑤置换后6个月髋膝踝角、冠状面股骨组件角、冠状面胫骨组件角、矢状面胫骨组件角偏差值均显著小于传统组(P<0.05)。⑥结果表明,采用计算机导航结合间隙平衡技术辅助全膝关节置换对关节活动度、下肢力线、胫骨假体组件位置的准确性方面具有优势,置换后关节功能恢复良好。

Comparison of clinical outcomes between total hip replacement and total knee replacement

BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for which remains unknown.This study compares clinical outcomes between THR and TKR.AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures(PROMs).METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre-and post-operatively.RESULTS A total of 131 patients were included in the study which comprised the THR group(68 patients)and the TKR group(63 patients).Both groups demonstrated significant post-operative improvements in all PROM scores(P<0.001).There were no significant differences in post-operative PROM scores between the two groups:Hip and Knee Osteoarthritis Outcome scores(P=0.140),Western Ontario and McMaster Universities Osteoarthritis Index pain(P=0.297)stiffness(P=0.309)and function(P=0.945),Oxford Hip and Knee Score(P=0.076),EuroQol-5D index(P=0.386)and Short-Form 12-item survey physical component score(P=0.106).Subgroup analyses showed no significant difference(P>0.05)between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference(P>0.05)between cemented and uncemented fixation in the THR group.Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR.CONCLUSION Contrary to some literature,THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs.The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome.Obesity had a greater influence on the outcome following TKR than that of THR.