It is suggested that unicompartmental knee replacement (UKR) offers the potential to restore normal knee kinematics better than total knee replacement (TKR) because of retaining the cruciate ligaments, and better pres...It is suggested that unicompartmental knee replacement (UKR) offers the potential to restore normal knee kinematics better than total knee replacement (TKR) because of retaining the cruciate ligaments, and better preservation of the overall geometry. It was hypothesized that patient-specific UKR would restore normal knee kinematics even better because of a customised articular shape. A comparative kinematics study was conducted on three cadaver limbs using two different test setups, a loaded ankle rig and an unloaded ankle rig. Kinematics was compared between a patient-specific UKR and a conventional fixed-bearing UKR. Both the UKRs showed similar kinematic patterns to the normal knee using both the test apparatus. The patient-specific UKR showed good results and with the other benefits it shows potential to dramatically improve clinical outcomes of knee replacement surgery.展开更多
Background： Controversies about the rational positioning of the tibial component in unicompartmental knee arthroplasty （UKA） still exist. Previous finite element （FE） studies were rare, and the results varied. Th...Background： Controversies about the rational positioning of the tibial component in unicompartmental knee arthroplasty （UKA） still exist. Previous finite element （FE） studies were rare, and the results varied. This FE study aimed to analyze the influence of the tibial component coronal alignment on knee biomechanics in mobile-bearing UKA and find a ration range of inclination angles. Methods： A three-dimensional FE model of the intact knee was constructed from image data of one normal subject. A 1000 N compressive load was applied to the intact knee model for validating. Then a set of eleven UKA FE models was developed with the coronal inclination angles of the tibial tray ranging from 10° valgus to 10° varus. Tibial bone stresses and strains, contact pressures and load distribution in all UKA models were calculated and analyzed under the unified loading and boundary conditions. Results： Load distribution, contact pressures, and contact areas in intact knee model were validated. In UKA models, von Mises stress and compressive strain at proximal medial cortical bone increased significantly as the tibial tray was in valgus inclination 〉4°, which may increase the risk of residual pain. Compressive strains at tibial keel slot were above the high threshold with varus inclination 〉4°, which may result in greater risk of component migration. Tibial bone resection comer acted as a strain-raiser regardless of the inclination angles. Compressive strains at the resected surface slightly changed with the varying inclinations and were not supposed to induce bone resorption and component loosening. Contact pressures and load percentage in lateral compartment increased with the more varus inclination, which may lead to osteoarthritis progression. Conclusions： Static knee biomechanics after UKA can be greatly affected by tibial component coronal alignment. A rauge from 4° valgus to 4° varus inclination oftibial component can be recommended in mobile-bearing UKA.展开更多
Background:Patellofemoral joint(PFJ)degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty(UKA).More recently,some researchers have proposed that PFJ degeneration can ...Background:Patellofemoral joint(PFJ)degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty(UKA).More recently,some researchers have proposed that PFJ degeneration can be ignored in medial UKA,and others have proposed that this change should be reviewed in PFJ degenerative facets and severity.This study aimed to systematically evaluate the effect of PFJ degeneration on patient-reported outcome measures(PROMs)and revision rates after medial UKA.Methods:Electronic databases(PubMed,Embase,Web of Science,etc.)were searched for studies assessing the influence of PFJ degeneration on medial UKA.A random-effects meta-analysis was conducted for the Oxford knee score(OKS),Knee society score(KSS),and revision rates and stratified by PFJ degenerative facets(medial/lateral/trochlear/unspecified),severe PFJ degeneration(bone exposed),and bearing type(mobile/fixed).Heterogeneity was assessed by the Cochran Q test statistic and chi-squared tests with the I-squared statistic.Results:A total of 34 articles with 7007 knees(2267 with PFJ degeneration)were included(5762 mobile-bearing and 1145 fixed-bearing and 100 unspecified).Slight to moderate degenerative changes in the medial and trochlear facets did not decrease the OKS and KSS,and only lateral facets significantly decreased the OKS(mean difference[MD]=-2.18,P<0.01)and KSS(MD=-2.61,P<0.01).The severity degree of PFJ degeneration had no additional adverse effect on the OKS,KSS,or revision rates.For mobile-bearing UKA,only lateral PFJ degeneration significantly decreased the OKS(MD=-2.21,P<0.01)and KSS(MD=-2.44,P<0.01).For fixed-bearing UKA,no correlation was found between PROMs/revision rates and PFJ degeneration.Conclusion:For medial mobile-bearing UKA,slight to moderate degenerative changes in the PFJ,except lateral facet,did not compromise PROMs or revision rates.For medial fixed-bearing UKA,although it might not be conclusive enough,PROMs or revision rates were not adversely affected by PFJ degeneration(regardless of the facet).展开更多
目的建立初学者学习曲线,探讨LINK-Sled固定平台单髁置换手术的安全性及早期效果,总结技术要点、术中容易出现的操作失误并提出改进方法,为缩短学习曲线提供临床经验。方法回顾性分析2022年3月至11月由同一位高年资关节外科医生完成的...目的建立初学者学习曲线,探讨LINK-Sled固定平台单髁置换手术的安全性及早期效果,总结技术要点、术中容易出现的操作失误并提出改进方法,为缩短学习曲线提供临床经验。方法回顾性分析2022年3月至11月由同一位高年资关节外科医生完成的学习曲线初期的32例LINK-Sled固定平台单髁置换手术病例,记录患者术前及术后4周、6周和3个月时膝关节疼痛视觉模拟评分(visual analogue scale,VAS)和美国特种外科医院(Hospital for Special Surgery,HSS)评分,并观察术后并发症发生情况。采用改良Price膝关节单髁置换术后影像学评分系统评价假体情况。结果32例患者术前VAS平均(3.0±0.7)分、术后4周(1.8±0.5)分,6周(0.9±0.8)分,3个月(0.8±0.7)分;术前HSS评分平均(65.0±7.2)分,术后4周(93.0±2.1)分,6周(94.0±2.4)分,3个月(95.0±2.7)分。术后各随访时间点VAS和HSS评分均较术前有显著性差异(P<0.05);术后4周、6周、3个月的VAS和HSS评分两两比较均无显著性差异(P>0.05)。术后并发症有切口感染2例,术侧小腿肿胀3例,膝关节周围张力性水泡2例,膝关节积血、积液5例,膝关节周围麻木8例。改良Price膝关节单髁置换术后影像学评分平均(28.4±1.3)分。结论LINK-Sled固定平台单髁置换手术对学习曲线早期的病例具有较好的临床疗效,容错率高,并发症少,无垫片脱位风险。初学者应注意术中胫骨截骨后倾角的把控,避免后倾角过大;同时还应注意对间隙松紧度的把控,坚持宁松勿紧的原则,避免因对侧间室压力增高而导致退行性变。展开更多
目的比较OxfordⅢ代单髁置换(unicompartmental knee arthroplasty,UKA)和全膝关节置换术(total knee artgroplasty,TKA)治疗膝关节内侧胫股关节炎的早期疗效。方法 2013年4月至2014年8月我院收治内侧胫股关节炎患者31例32膝,UKA组15例1...目的比较OxfordⅢ代单髁置换(unicompartmental knee arthroplasty,UKA)和全膝关节置换术(total knee artgroplasty,TKA)治疗膝关节内侧胫股关节炎的早期疗效。方法 2013年4月至2014年8月我院收治内侧胫股关节炎患者31例32膝,UKA组15例16膝,TKA组16例16膝。术前对UKA组和TKA组患者膝关节的功能评价采用膝关节评分(keen society score,KSS),分别为55.94分和56.47分;美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)分别为57.25分和59.37分;分别进行单髁置换和全膝关节置换。结果两组患者术后2周的功能改善情况UKA组较TKA组好,膝关节活动度更大;两组的手术时间UKA组较TKA组短。结论人工单髁置换治疗膝内侧胫股关节炎是一种行之有效的方法,与全膝置换早期效果类似,但手术时间短,恢复快。展开更多
文摘It is suggested that unicompartmental knee replacement (UKR) offers the potential to restore normal knee kinematics better than total knee replacement (TKR) because of retaining the cruciate ligaments, and better preservation of the overall geometry. It was hypothesized that patient-specific UKR would restore normal knee kinematics even better because of a customised articular shape. A comparative kinematics study was conducted on three cadaver limbs using two different test setups, a loaded ankle rig and an unloaded ankle rig. Kinematics was compared between a patient-specific UKR and a conventional fixed-bearing UKR. Both the UKRs showed similar kinematic patterns to the normal knee using both the test apparatus. The patient-specific UKR showed good results and with the other benefits it shows potential to dramatically improve clinical outcomes of knee replacement surgery.
基金This work was funded by a grant from National Natural Science Foundation of China （No. 81273972）.
文摘Background： Controversies about the rational positioning of the tibial component in unicompartmental knee arthroplasty （UKA） still exist. Previous finite element （FE） studies were rare, and the results varied. This FE study aimed to analyze the influence of the tibial component coronal alignment on knee biomechanics in mobile-bearing UKA and find a ration range of inclination angles. Methods： A three-dimensional FE model of the intact knee was constructed from image data of one normal subject. A 1000 N compressive load was applied to the intact knee model for validating. Then a set of eleven UKA FE models was developed with the coronal inclination angles of the tibial tray ranging from 10° valgus to 10° varus. Tibial bone stresses and strains, contact pressures and load distribution in all UKA models were calculated and analyzed under the unified loading and boundary conditions. Results： Load distribution, contact pressures, and contact areas in intact knee model were validated. In UKA models, von Mises stress and compressive strain at proximal medial cortical bone increased significantly as the tibial tray was in valgus inclination 〉4°, which may increase the risk of residual pain. Compressive strains at tibial keel slot were above the high threshold with varus inclination 〉4°, which may result in greater risk of component migration. Tibial bone resection comer acted as a strain-raiser regardless of the inclination angles. Compressive strains at the resected surface slightly changed with the varying inclinations and were not supposed to induce bone resorption and component loosening. Contact pressures and load percentage in lateral compartment increased with the more varus inclination, which may lead to osteoarthritis progression. Conclusions： Static knee biomechanics after UKA can be greatly affected by tibial component coronal alignment. A rauge from 4° valgus to 4° varus inclination oftibial component can be recommended in mobile-bearing UKA.
基金National Natural Science Foundation of China(81802210 and 81672219)Key Project of Sichuan Science&Technology Department(2018SZ0223 and 2018SZ0250)National Clinical Research Center for Geriatrics,West China Hospital,Sichuan University(Z20191008 and Z2018B20)
文摘Background:Patellofemoral joint(PFJ)degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty(UKA).More recently,some researchers have proposed that PFJ degeneration can be ignored in medial UKA,and others have proposed that this change should be reviewed in PFJ degenerative facets and severity.This study aimed to systematically evaluate the effect of PFJ degeneration on patient-reported outcome measures(PROMs)and revision rates after medial UKA.Methods:Electronic databases(PubMed,Embase,Web of Science,etc.)were searched for studies assessing the influence of PFJ degeneration on medial UKA.A random-effects meta-analysis was conducted for the Oxford knee score(OKS),Knee society score(KSS),and revision rates and stratified by PFJ degenerative facets(medial/lateral/trochlear/unspecified),severe PFJ degeneration(bone exposed),and bearing type(mobile/fixed).Heterogeneity was assessed by the Cochran Q test statistic and chi-squared tests with the I-squared statistic.Results:A total of 34 articles with 7007 knees(2267 with PFJ degeneration)were included(5762 mobile-bearing and 1145 fixed-bearing and 100 unspecified).Slight to moderate degenerative changes in the medial and trochlear facets did not decrease the OKS and KSS,and only lateral facets significantly decreased the OKS(mean difference[MD]=-2.18,P<0.01)and KSS(MD=-2.61,P<0.01).The severity degree of PFJ degeneration had no additional adverse effect on the OKS,KSS,or revision rates.For mobile-bearing UKA,only lateral PFJ degeneration significantly decreased the OKS(MD=-2.21,P<0.01)and KSS(MD=-2.44,P<0.01).For fixed-bearing UKA,no correlation was found between PROMs/revision rates and PFJ degeneration.Conclusion:For medial mobile-bearing UKA,slight to moderate degenerative changes in the PFJ,except lateral facet,did not compromise PROMs or revision rates.For medial fixed-bearing UKA,although it might not be conclusive enough,PROMs or revision rates were not adversely affected by PFJ degeneration(regardless of the facet).
文摘目的建立初学者学习曲线,探讨LINK-Sled固定平台单髁置换手术的安全性及早期效果,总结技术要点、术中容易出现的操作失误并提出改进方法,为缩短学习曲线提供临床经验。方法回顾性分析2022年3月至11月由同一位高年资关节外科医生完成的学习曲线初期的32例LINK-Sled固定平台单髁置换手术病例,记录患者术前及术后4周、6周和3个月时膝关节疼痛视觉模拟评分(visual analogue scale,VAS)和美国特种外科医院(Hospital for Special Surgery,HSS)评分,并观察术后并发症发生情况。采用改良Price膝关节单髁置换术后影像学评分系统评价假体情况。结果32例患者术前VAS平均(3.0±0.7)分、术后4周(1.8±0.5)分,6周(0.9±0.8)分,3个月(0.8±0.7)分;术前HSS评分平均(65.0±7.2)分,术后4周(93.0±2.1)分,6周(94.0±2.4)分,3个月(95.0±2.7)分。术后各随访时间点VAS和HSS评分均较术前有显著性差异(P<0.05);术后4周、6周、3个月的VAS和HSS评分两两比较均无显著性差异(P>0.05)。术后并发症有切口感染2例,术侧小腿肿胀3例,膝关节周围张力性水泡2例,膝关节积血、积液5例,膝关节周围麻木8例。改良Price膝关节单髁置换术后影像学评分平均(28.4±1.3)分。结论LINK-Sled固定平台单髁置换手术对学习曲线早期的病例具有较好的临床疗效,容错率高,并发症少,无垫片脱位风险。初学者应注意术中胫骨截骨后倾角的把控,避免后倾角过大;同时还应注意对间隙松紧度的把控,坚持宁松勿紧的原则,避免因对侧间室压力增高而导致退行性变。
文摘目的比较OxfordⅢ代单髁置换(unicompartmental knee arthroplasty,UKA)和全膝关节置换术(total knee artgroplasty,TKA)治疗膝关节内侧胫股关节炎的早期疗效。方法 2013年4月至2014年8月我院收治内侧胫股关节炎患者31例32膝,UKA组15例16膝,TKA组16例16膝。术前对UKA组和TKA组患者膝关节的功能评价采用膝关节评分(keen society score,KSS),分别为55.94分和56.47分;美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)分别为57.25分和59.37分;分别进行单髁置换和全膝关节置换。结果两组患者术后2周的功能改善情况UKA组较TKA组好,膝关节活动度更大;两组的手术时间UKA组较TKA组短。结论人工单髁置换治疗膝内侧胫股关节炎是一种行之有效的方法,与全膝置换早期效果类似,但手术时间短,恢复快。
