Different squatting positions after total knee arthroplasty: A retrospective study

BACKGROUND Total knee arthroplasty(TKA)has been shown to improve quality of life and reduce pain.High-flexion activities such as squatting,kneeling,and floor transfers are mainly listed as demanding tasks.Among them,squatting is an important position.AIM To provide a new squat position classification and evaluate the different squatting positions of a series of patients after primary TKA.METHODS From May 2018 to October 2019,we retrospectively reviewed 154 video recordings of the squatting-related motions of patients after TKA.Among the included patients,119 were women and 35 were men.Their mean age at the index surgery was 61.4 years(range,30 to 77).RESULTS The median follow-up was 12 mo(range,6 to 156 mo).We classified those squatting-related motions into three major variations according to squatting depth:Half squat,parallel squat,and deep squat.The angles of hip flexion,knee flexion,and ankle dorsiflexion were measured in the screenshots captured from the videos at the moment of squatting nadir.A total of 26 patients were classified as half squats,75 as parallel squats,and 53 as deep squats.The angles of hip flexion,knee flexion,and ankle dorsiflexion all differed significantly among the three squatting positions(P<0.001).In the parallel squat group,the mean knee flexion angle(°)was 116.5(SD,8.1;range,97 to 137).In the deep squat group,the mean knee flexion angle(°)was 132.5(SD,9.3;range,116 to 158).CONCLUSION Among the three squatting positions,deep squat showed the highest hip,knee,and ankle flexion angles,followed by the parallel squat.With the improvement of squatting ability,the patient's postoperative satisfaction rate was also significantly enhanced.However,the different squatting abilities of the patients cannot be effectively distinguished from the scoring results(P>0.05).Our squatting position classification offers a pragmatic approach to evaluating patients’squatting ability after TKA.

Is the transperineal ultrasonography approach effective for the diagnosis of rectocele?

Background Transperineal ultrasonography has been used as a diagnostic imaging modality for rectocele for many years.However,the consistency of ultrasonography and defecography in evaluating the severity of rectocele was not satisfactory.This study aimed to evaluate the agreement in the measurement of rectocele parameters between the two methods in different positions and provide clinical implications for the diagnosis of rectocele.Methods In this pilot study,participants were recruited in an outpatient clinic of a tertiary hospital between December 2017 and December 2019.All participants separately underwent defecation proctography at sitting and squatting positions,and undertook transperineal ultrasonography at left lateral,sitting,and squatting positions.The consistency of ultrasonography and defecography was evaluated.Results Thirty female volunteers with rectocele were included in this study.The degree of anorectal angle was significantly larger at rest and during contraction,maximal Valsalva,and evacuation;the depth of the rectocele was significantly deeper during maximal Valsalva and evacuation;and the length of the perineumdescending was significantly longer during contraction and maximal Valsalva in using squatting position compared to the sitting position when performing the defecation proctography.The degree of anorectal angle,the depth of rectocele,the area of levator hiatus,and the volume of the rectocele were significantly different in using squatting,sitting,and left lateral positions when performing the transperineal ultrasonography.Bland-Altman semi-quantitative plots showed good consistency in the measurement of the anorectal angle and the depth of the rectocele between proctography and ultrasonography in both sitting and squatting positions.Conclusions The findings of our study may be considered as the preliminary evidence to support the use of transperineal ultrasonography with sitting and squatting positions as the imaging test of choice for evaluating patients with rectocele.