Coronal plane stability of cruciate-retaining total knee arthroplasty in valgus gonarthrosis patients:A mid-term evaluation using stress radiographs

BACKGROUND Total knee arthroplasty(TKA)using implants with a high level of constraint has generally been recommended for patients with osteoarthritis(OA)who have valgus alignment.However,studies have reported favorable outcomes even with cruciate-retaining(CR)implants.AIM To evaluate the coronal plane stability of CR-TKA in patients with valgus OA at the mid-term follow-up.METHODS Patients with primary valgus OA of the knee who underwent TKA from January 2014 to January 2021 were evaluated through stress radiography using a digital stress device with 100 N of force on both the medial and lateral side.Gap openings and degrees of angulation change were determined.Descriptive statistical analysis was performed for both continuous and categorical variables.Inter-rater reliability of the radiographic measurements was evaluated using Cronbach’s alpha.RESULTS This study included 25 patients(28 knees)with a mean preoperative mechanical valgus axis of 11.3(3.6-27.3)degrees.The mean follow-up duration was 3.4(1.04-7.4)years.Stress radiographs showed a median varus and valgus gap opening of 1.6(IQR 0.6-3.0)mm and 1.7(IQR 1.3-2.3)mm and varus and valgus angulation changes of 2.5(IQR 1.3-4.8)degrees and 2.3(IQR 2.0-3.6)degrees,respectively.No clinical signs of instability,implant loosening,or revision due to instability were observed throughout this case series.CONCLUSION The present study demonstrated that using CR-TKA for patients with valgus OA of the knee promoted excellent coronal plane stability.

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.

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.

The clinical comparison of simultaneous bilateral total knee arthroplasty in treatment of osteoarthritis

Objective： To evaluate the risk and efficacy of simultaneous bilateral total knee arthroplasty（TKA） in treatment of osteoarthritis when compared with sequential bilateral TKA and unilateral TKA. Methods：A retrospective analysis was performed on 162 patients who underwent TKA from 2003 to 2006. The analyses were adjusted for demographics, preexisting medical conditions, and osteoar- thrifts diagnosis. Results：Patients undergoing simultaneous bilateral TKA had significantly lower amounts of blood loss, shorter surgical time, shorter hospitalization time, less hospital charges and lower rates of perioperative complications compared with patients undergoing sequential bilateral TKA. No significant difference was found with regard to postoperative complications between the simultaneous bilateral and the unilateral TKA groups. Patient＇ s knee range of motion and the postoperative Hospital for Special Surgery scores（HSS） were similar for the three groups. Conclusion：When there are adequate indications for bilateral TKA, simultaneous bilateral TKA is beneficial to patients compared with sequential bilateral or unilateral TKA.

Re-revision surgery for re-recurrent valgus deformity after revision total knee arthroplasty in a patient with a severe valgus deformity: A case report

BACKGROUND A recurrent valgus deformity was a common complication after total knee arthroplasty(TKA)in patients with valgus deformity.However,re-revision surgery for re-recurrent valgus deformity after revision TKA in patients with valgus deformity before primary TKA was uncommon.CASE SUMMARY We reported a 72-year-old female patient with two recurrent valgus deformities after TKA for a valgus knee deformity who underwent two revision surgeries to rectify the deformity.In the re-revision surgery,bone defects were successfully reconstructed by the augments and cement in combination with screws and a sleeve.An appropriate neutral alignment of the lower limb was restored by the perfect femoral entry point and the long diaphyseal cementless stem.Adequate fixation of the metaphysis and diaphysis of the femur was obtained by the sleeve and long diaphyseal cementless stem.The patient was pain-free and deformityfree for 2.5 years.CONCLUSION The management of bone defects,the choice of the stem and the femoral entry point were of vital importance in the revision or re-revision TKA for a recurrent valgus deformity.

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.

Physical activity after total knee arthroplasty: A critical review

Total knee arthroplasty(TKA) is the most commonly performed elective surgery in the United States. TKA typically improves functional performance and reduces pain associated with knee osteoarthritis. Little is known about the influence of TKA on overall physical activity levels. Physical activity, defined as "any bodily movement produced by skeletal muscles that results in energy expenditure", confers many health benefits but typically decreases with endstage osteoarthritis. The purpose of this review is to describe the potential benefits(metabolic, functional, and orthopedic) of physical activity to patients undergoing TKA, present results from recent studies aimed to determine the effect of TKA on physical activity, and discuss potential sources of variability and conflicting results for physical activity outcomes. Several studies utilizing self-reported outcomes indicate that patients perceive themselves to be more physically active after TKA than they were before surgery. Accelerometry-based outcomes indicate that physical activity for patients after TKA remains at or below pre-surgical levels. Several different factors likely contributed to these variable results, including the use of different instruments, duration of follow-up, and characteristics of the subjects studied. Comparison to norms, however, suggests that daily physical activity for patients following TKA may fall short of healthy agematched controls. We propose that further study of the relationship between TKA and physical activity needs to be performed using accelerometry-based outcome measures at multiple post-surgical time points.

Muscle force and movement variability before and after total knee arthroplasty: A review

Variability in muscle force output and movement variability are important aspects of identifying individuals with mobility deficits, central nervous system impairments, and future risk of falling. This has been investigated in elderly healthy and impaired adults, as well as in adults with osteoarthritis(OA), but the question of whether the same correlations also apply to those who have undergone a surgical intervention such as total knee arthroplasty(TKA) is still being investigated. While there is a growing body of literature identifying potential rehabilitation targets for individuals who have undergone TKA, it is important to first understand the underlying post-operative impairments to more efficiently target functional deficits that may lead to improvedlong-term outcomes. The purpose of this article is to review the potential role of muscle force output and movement variability in TKA recipients. The narrative review relies on existing literature in elderly healthy and impaired individuals, as well as in those with OA before and following TKA. The variables that may predict longterm functional abilities and deficits are discussed in the context of existing literature in healthy older adults and older adults with OA and following TKA, as well as the role future research in this field may play in providing evidence-based data for improved rehabilitation targets.

Alignment of the hindfoot following total knee arthroplasty: A systematic review

BACKGROUND There appears to be a close relationship between deformities at the knee joint and at the hindfoot in patients with knee osteoarthritis(OA).Despite this intrinsic link,there is a dearth of studies investigating alterations in hindfoot alignment following total knee arthroplasty(TKA)in patients with knee OA.AIM To evaluate changes in alignment of the hindfoot following TKA,foot and ankle clinical outcomes in terms of subjective clinical scoring tools following surgical intervention,and to analyse the level of evidence(LOE)and quality of evidence(QOE)of the included studies.METHODS MEDLINE,EMBASE and Cochrane Library databases were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Studies reporting changes in the postoperative alignment of the hindfoot following TKA were included.The level and QOE were recorded and assessed.RESULTS Eleven studies with a total of 1142 patients(1358 knees)met the inclusion/exclusion criteria.Six studies were of LOE II and 5 studies were of LOE III.Patients with preoperative varus knee deformity and valgus hindfoot deformity demonstrated improvement in hindfoot alignment post TKA.Patients with preoperative varus knee deformity and varus hindfoot deformity demonstrated no improvement in hindfoot alignment following TKA.Twelve different radiographic parameters were used to measure the alignment of the hindfoot across the included studies,with the tibio-calcaneal angle most frequently utilised(27.3%).CONCLUSION This systematic review demonstrated that the hindfoot may display compensatory changes in alignment following TKA in patients with knee OA.However,the marked heterogeneity between the included studies and poor QOE limits any meaningful cross sectional comparisons between studies.Further,well designed studies are necessary to determine the changes and outcomes of hindfoot alignment following TKA.

Surgical treatment outcome of painful traumatic neuroma of the infrapatellar branch of the saphenous nerve during total knee arthroplasty

BACKGROUND Development of infrapatellar saphenous neuroma(ISN)is a well-recognized reason for knee pain following total knee arthroplasty(TKA).So far,very few studies have addressed the development of painful ISN after TKA and its impact on functional outcome and patient satisfaction.AIM To present the results of surgical treatment for ISN after primary TKA,the level of pain relief,and the improvement of knee motion and function.METHODS Fifteen patients(13 women,2 men)with persistent medial pain for more than six months after primary TKA,due to osteoarthritis,underwent surgical excision of ISN.ISN diagnosis was confirmed with the presence of Tinel’s sign along the course of the infrapatellar branch of the saphenous nerve and with pain relief after selective nerve block using local anesthetic.Component loosening,malalignment,instability and infection were excluded systematically in all patients as a source of pain.Pain relief in terms of visual analog scale(VAS),active knee range of motion(ROM),and the Knee Society Score(KSS)for pain and function were evaluated preoperatively and at least six months postoperatively.RESULTS The mean patients’age was 71.3±5.4 years old.The mean interval between TKA and neuroma excision was 10 mo(range,6 to 14 mo),while the mean follow-up was 8 mo(range:6 to 11 mo).All 15 patients experienced almost complete immediate pain relief and resolution of allodynia and hyperesthesia after surgery.Pain on the VAS scale improved from 8.6±1.3 preoperatively to 0.8±0.9 at the final follow-up(P=0.001).KSS pain and function scores were improved from 49.3±5.9 and 62.7±12.8 before surgery to 91.8±4.2 and 75.3±11.3 after surgery,respectively(P=0.001 and P=0.015).Active knee ROM was also increased postoperatively from 96±4 to 105±6 degrees(P=0.001).There were no complications and no further operations required.CONCLUSION ISN should be considered a potential cause of persistent pain following TKA.Neuroma excision not only provides immediate pain relief and resolution of symptoms but may also improve the knee range of motion.

Bicruciate-retaining total knee arthroplasty: What’s new?

Primary total knee arthroplasty(TKA)is a widespread procedure to address end stage osteoarthritis with good results,clinical outcomes,and long-term survivorship.Although it is frequently performed in elderly,an increased demand in young and active people is expected in the next years.However,a considerable dissatisfaction rate has been reported by highly demanding patients due to the intrinsic limitations provided by the TKA.Bicruciate-retaining(BCR)TKA was developed to mimic knee biomechanics,through anterior cruciate ligament preservation.First-generation BCR TKA has not gained popularity due to its being a challenging technique and having poor survival outcomes.Thanks to implant design improvement and surgeon-friendly instrumentation,secondgeneration BCR TKA has seen renewed interest.This review will focus on surgical indications,kinematical basis,clinical results and latest developments of secondgeneration BCR TKA.

Influence of Psychiatric Problems on Clinical Outcomes during the First 12 Months after Primary Total Knee Arthroplasty

Background: Total knee arthroplasty (TKA) is a useful treatment option for advanced knee osteoarthritis. Excellent clinical outcomes after TKA have been widely recognized, but the influence of psychiatric problems on them has not been focused on until quite recently. This study aimed to assess the influence of psychiatric problems on clinical outcomes after TKA in Japanese patients using two assessment scales developed in Japan because the Japanese cultural lifestyle is specifically characterized by bending to the floor and standing up. Methods: Clinical outcomes and psychiatric problems were evaluated using the Japanese Knee Osteoarthritis Measure (JKOM) and Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP), respectively. A total of 115 TKA patients were evaluated preoperatively and at 3, 6, and 12 months after TKA. The patients were classified into four groups (groups A-D) based on the BS-POP score. The JKOM scores were then compared between the two groups (groups A and D) with the worst and least psychiatric problems. The JKOM improvement rate between pre- and postoperative status in both groups A and D was also calculated. Results: The total JKOM score was significantly poorer in group A than in group D preoperatively and at 3, 6, and 12 months after TKA. The improvement rate showed no significant difference between groups A and D. Conclusion: Psychiatric problems influence both the poorer post- and preoperative clinical outcomes. However, a similar improvement rate in both groups A and D has indicated that TKA can be an effective treatment even for patients with psychiatric problems.

Modified treatment of knee osteoarthritis complicated with femoral varus deformity:A case report

BACKGROUND Surgical treatment of knee osteoarthritis(KOA)complicated by extra-articular deformity has always been controversial regardless of whether it is simultaneous or staged.Simultaneous total knee arthroplasty(TKA)combined with supracondylar osteotomy without plate for treatment of KOA complicated by femoral varus deformity has not been reported in the literature.CASE SUMMARY A 53-year-old Chinese woman complained of left knee pain for 6 years that worsened for 4 mo during her visit on April 3,2020,accompanied by instability in walking,which seriously affected quality of life.According to her medical history and preoperative imaging,the patient was diagnosed with left KOA with varus deformity.We used the angular center of rotation principle for osteotomy of the femur deformity and placed a poststabilized femur prosthesis into the knee joint.At the same time,a 13 mm×130 mm femur extension rod was used instead of a steel plate to fix the end of the femur osteotomy,reducing the possible complications caused by steel plate implantation and reducing the economic burden on patients.The operation successfully solved two major problems of KOA and varus deformity,and the clinical and imaging evaluation of postoperative followup were satisfactory.CONCLUSION TKA and supracondylar femoral osteotomy can be used for simultaneous KOA treatment and deformity correction.

Impact of medial open-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee

BACKGROUND Most populations worldwide,who are used to squatting and sitting cross-legged for their activities of daily living,largely comprise the lower socioeconomic strata,thus making them candidates for exclusion for total knee arthroplasty.Proximal/high tibial osteotomy(HTO)is a preferred strategy for clinically symptomatic osteoarthritis(OA)with genu varum due to painful medial compartment OA which is not amenable to conservative measures.AIM To evaluate the outcomes of medial open-wedge HTO along with autologous bone grafting and buttress plate for the treatment of genu varum due to OA of the knee in a rural population of central India.METHODS A total of 65 knees in 56 patients with a mean age of 58.22±5.63 years with genu varum due to intractable painful knee OA were treated with medial open-wedge HTO along with autologous bone grafting and buttress plate osteosynthesis from June 2015 to May 2018.The mean preoperative radiological angle of genu varum was 13.4°.Clinical outcomes were assessed by the range of movement,knee scores,pain scores,and functional scores.Radiographic studies were performed preoperatively and at regular intervals during the follow-up period.RESULTS All patients reported pain relief immediately after the osteotomy and during the long-term analysis covering between one to three years.The genu varum angle was overcorrected to approximately four degrees in all patients.There was a loss of reduction by approximately three degrees in all patients at around six weeks postoperatively.Preoperative knee movements were restored in all patients.No major perioperative complications were noted during surgery and postoperative follow-up and the clinical scores were significantly improved during the final analysis which revealed good pain relief.CONCLUSION Medial open-wedge HTO is a reliable,safe,practical,physiological,and feasible treatment for populations who are used to increased activity in their occupation and lifestyle and is associated with excellent short-term and long-term results for OA in genu varum knees.

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.

The Effects of Pre-Surgical Education on Patient Expectations in Total Knee Arthroplasties

As patients prepare for total-knee arthroplasty surgery, they have many expectations related to their long-term recovery and function. This research examined whether the use of a pre-surgical patient education class with an additional long-term expectation module addressing recovery during the first 12 months after surgery was more effective in modifying participant’s pre-surgical expectations than participants receiving the standard pre-surgical education class alone. Prior to the class each participant completed one disease-specific instrument, a general-health survey, and a total-knee replacement expectation survey. After the class, each participant once again completed the total-knee replacement survey. Included in the study were 42 participants who were enrolled in a pre-surgical education course that was randomized. The participants in the control group received the standard pre-surgical education addressing pre-surgical topics. The participants in the intervention group received the standard pre-surgical education plus an additional module that specifically addressed long-term recovery and function up to 12 months post surgery. The primary outcome of the data revealed that participants’ who received the standard pre-surgical education with the additional module and who had an educational level higher than highschool, had expectations that were able to be modified to coincide with the surgeons’ expectations.

Analysis on hidden blood loss of total knee arthroplasty in treating knee osteoarthritis

Background Total knee arthroplasty （TKA） is an important therapy for the treatment of various late-stage knee diseases. However, it has been observed that patients have lower hemoglobin （HB） counts postoperatively, which are significantly inconsistent with the measured blood loss. Although the concept of hidden blood loss has been presented in 2000, very little clinical attention has been paid since then. In this study, we investigated the characteristics and influential factor of hidden blood loss after TKA in treating knee osteoarthritis.

Total knee arthroplasty for severe valgus knee deformity

Background Primary total knee arthroplasty(TKA) in severe valgus knees may prove challenging, and choice of implant depends on the severity of the valgus deformity and the extent of soft-tissue release. The purpose of this study was to review 8 to 11 years(mean, 10 years) follow-up results of primary TKA for varient-III valgus knee deformity with use of different type implants. Methods Between January 2002 and January 2005, 20 women and 12 men, aged 47 to 63(mean, 57.19±6.08) years old, with varient-III valgus knees underwent primary TKA. Of the 32 patients, 37 knees had varient-III deformities. Pie crusting was carefully performed with small, multiple inside-out incisions, bone resection balanced the knee in lieu of soft tissue releases that were not used in the series. Cruciate-retaining knees(Gemini MKII, Link Company, Germany) were used in 13 knees, Genesis II(Simth & Nephew Company, USA) in 14 knees, and hinged knee(Endo-Model Company, Germany) in 10 knees. In five patients with bilateral variant-III TKAs, three patients underwent 1-stage bilateral procedures, and two underwent 2-stage procedures. All implants were cemented and the patella was not resurfaced. The Hospital for Special Surgery(HSS) knee score was assessed. Patients were followed up from 8 to 11 years.Results The mean HSS knee score were improved from 50.33±11.60 to 90.06±3.07(P <0.001). The mean tibiofemoral alignment were improved from valgus 32.72o±9.68 o pre-operation to 4.89o±0.90 o post-operation(P <0.001). The mean range of motion were improved from 93.72o±23.69 o pre-operation to 116.61±16.29 o post-operation(P <0.001). No patients underwent revision. One patient underwent open reduction and internal fixation using femoral condylar plates for supracondylar femoral fractures secondary to a fall at three years. Three patients developed transient peroneal nerve palsies, which resolved within nine months. Two patients developed symptomatic deep vein thrombosis that was managed with rivaroxaban and thrombo-embolic deterrent stockings. There was no incidence of pulmonary embolism. Postoperative patient satisfaction was 80.7±10.4 points in the groups. Prosthetic survival rate was 100% at mean 10 years postoperative.Conclusions Not only hinged implants can be successfully used in variant-III valgus knees. As our results show, if proper ligament balancing techniques are used and proper ligament balance is attained, the knee may not require the use of a more constrained components. Our results also present alternative implant choices for severe knee deformities.

单髁关节置换后患者膝关节等速肌力的特征分析

背景:膝骨关节炎作为导致老年人残疾的重要原因,目前终末期患者可进行单髁关节置换等手术治疗,但单髁置换后患者的肌肉力量恢复情况尚不明确。目的:分析单侧膝骨关节炎患者单髁关节置换后中短期膝关节等速肌力特征,并比较其与健侧的差异,分析患肢肌力的恢复情况。方法:招募2023年6-12月在青岛市市立医院进行单髁关节置换的患者,进行规范化的功能康复锻炼。于术前、术后1,3个月使用A8-2M型多关节等速训练与测试系统检测患者健侧及患侧膝关节伸屈肌峰力矩、最大单次做功,角速度为60(°)/s、关节活动范围为0°-90°。结果与结论:①在角速度60(°)/s时,术前患侧伸肌的峰力矩和最大单次做功均较健侧降低(P<0.05);②术后1个月患侧屈伸肌峰力矩和最大单次做功均较健侧显著降低(P<0.05);同时患侧术后1个月与术前相比,屈伸肌峰力矩及最大单次做功同样显著降低(P<0.05);③术后3个月,患侧屈伸肌峰力矩及屈伸肌最大单次做功与健侧已无显著性差异;同时术后3个月与术前相比,屈伸肌峰力矩已高于术前(P<0.05);④提示单髁关节置换后,经过规范的功能康复,患侧在1个月后肌力恢复较差;但3个月后,患侧肌力已同健侧无明显差异。

巨刺电针联合超前镇痛治疗初次单膝人工关节置换后疼痛

背景:随着人工生物材料和手术技术的不断更新进步,人工膝关节置换已成为改善膝骨关节炎患者生活质量的首选方式。但是人工膝关节置换后疼痛剧烈,目前尚无较好的治疗措施。电针治疗是缓解疼痛的低成本选择,结合超前镇痛具有广泛应用前景。目的:观察巨刺电针联合超前镇痛对膝骨关节炎患者初次行单侧人工膝关节置换后镇痛效果的影响。方法:采用随机对照设计,选择上海市光华中西医结合医院初次行单膝人工关节置换患者120例为研究对象,采用统计软件SPSS 25随机分为3组:超前电针组、术后电针组和假电针组,每组40例。超前电针组在术前1 d、麻醉诱导前30 min、术后1-3 d进行巨刺法电针治疗;术后电针组在术后1-3 d进行相同取穴和参数的治疗,术前1 d、麻醉诱导前30 min行假电针治疗;假电针组取相同穴位参数的5次假电针治疗。比较3组术后患者数字疼痛评分较术前改善情况、术中瑞芬太尼和丙泊酚使用量、患者术后首次使用静脉自控镇痛的时间、术后恶心呕吐例数、术后术侧大腿周径增加率和电针实施盲法成功率。结果与结论:(1)与超前电针组比较,术后第4天术后电针组和假电针组静息数字疼痛评分差值明显降低,术后第7天假电针组静息数字疼痛评分差值明显降低(P<0.05);(2)与超前电针组比较,术后第4天术后电针组和假电针组运动数字疼痛评分差值明显降低(P<0.05),术后第7天3组运动数字疼痛评分差值无显著性意义(P>0.05);(3)与超前电针组比较,术后电针组和假电针组术中瑞芬太尼用量明显增加(P<0.05);(4)与超前电针组比较,术后电针组和假电针组术后首次使用静脉镇痛泵自控镇痛的时间明显缩短(P<0.05);(5)与超前电针组比较,术后电针组和假电针组术后恶心例数明显增加(P<0.05);(6)与超前电针组比较,术后第3,7天术后电针组和假电针组大腿周径增加率明显增加(P<0.05);与术后电针组比较,术后第3,7天假电针组大腿周径增加率明显增加(P<0.05);(7)3组患者电针实施盲法成功率比较差异无显著性意义(P>0.05);(8)人工膝关节假体具有良好的生物相容性。结果表明:巨刺电针结合超前镇痛可缓解术后急性疼痛,减少术中麻醉药量,延长术后补救镇痛时间,减轻术后不良反应,降低术后大腿周径增加率。