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 pr...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.展开更多
Despite improvements in technique and technology for total knee arthroplasty(TKA),anterior knee pain impacts patient outcomes and satisfaction.Addressing the prosthetic and surgical technique related causes of pain af...Despite improvements in technique and technology for total knee arthroplasty(TKA),anterior knee pain impacts patient outcomes and satisfaction.Addressing the prosthetic and surgical technique related causes of pain after TKA,specifically as it relates to anterior knee pain,can aid surgeons in addressing these issues with their patients.Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing,improper transverse plane component rotation resulting in patellar subluxation/tilt.Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator.As the number of TKA procedures continues to increase,it is increasingly critical to develop improved,evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications.展开更多
Total Knee Arthroplasty has been shown to be a successful procedure for treating patients with osteoarthritis,and yet approximately 5%-10%of patients experience residual pain,especially in the anterior part of the kne...Total Knee Arthroplasty has been shown to be a successful procedure for treating patients with osteoarthritis,and yet approximately 5%-10%of patients experience residual pain,especially in the anterior part of the knee.Many theories have been proposed to explain the etiology of this anterior knee pain(AKP)but,despite improvements having been made,AKP remains a problem.AKP can be described as retropatellar or peripatellar pain,which limits patients in their everyday lives.Patients suffering from AKP experience difficulty in standing up from a chair,walking up and down stairs and riding a bicycle.The question asked was:"How can a‘perfectly’placed total knee arthroplasty(TKA)still be painful:what can cause this pain?".To prevent AKP after TKA it is important to first identify the different anatomical structures that can cause this pain.Greater attention to and understanding of AKP should lead to significant pain relief and greater overall patient satisfaction after TKA.This article is a review of what pain is,how nerve signalling works and what is thought to cause Anterior Knee Pain after a Total Knee Arthroplasty.展开更多
AIM To compare rotating versus fixed-bearing Press-Fit Condylar(PFC) Sigma posterior stabilized(PS) total knee arthroplasty(TKA) with the new "J curve"femoral design in terms of clinical outcomes and anterio...AIM To compare rotating versus fixed-bearing Press-Fit Condylar(PFC) Sigma posterior stabilized(PS) total knee arthroplasty(TKA) with the new "J curve"femoral design in terms of clinical outcomes and anterior knee pain.METHODS We retrospectively analyzed 39 patients who underwent primary total knee replacement surgery for knee osteoarthritis using the PFC Sigma PS TKA with either fixed(FP group, 20 cases) or rotating platform(RP group, 19 cases) treated between 2009 and 2013 by the same surgeon. The two groups were homogeneous for age, gender, weight, American Society of Anesthesiologists status, preoperative clinical and functional scores, and prosthetic alignment at two years after surgery. We analyzed clinical outcomes score at two years follow-up using Knee Society Score(KSS), Knee Injury and Osteoarthritis Outcome Score(KOOS),Knee Performance Score, Short Form(SF) 36, and anterior knee pain assessed by the Hospital for Special Surgery(HSS) patellar score.RESULTS No differences were found in KSS, Knee Performance Score, and SF-36 outcome scores. A statistically significant difference was found in the HSS Patella score objective(FP: 22.36; RP: 28.75; P < 0.05), HSS Patella score total(FP: 73.68; RP:86.50; P < 0.05), and KOOS symptoms(FP: 73.49; RP: 86.44; P < 0.05).CONCLUSION Rotating platform in PFC Sigma PS TKA appears to reduce the short-term incidence of anterior knee pain compared to the fixed platform.展开更多
Background:Dynamic knee valgus(DKV)is an abnormal movement pattern visually characterized by excessive medial movement of the lower extremity during weight bearing.Differences in hip and knee kinematic components of D...Background:Dynamic knee valgus(DKV)is an abnormal movement pattern visually characterized by excessive medial movement of the lower extremity during weight bearing.Differences in hip and knee kinematic components of DKV may explain the emergence of different pain problems in people who exhibit the same observed movement impairment.Using a secondary analysis of exiting data sets,we sought to determine whether hip and knee frontal and transverse plane angles during a functional task differed between women with patellofemoral pain and women with chronic hip joint pain and the relationship between joint-specific kinematics and pain in these 2 pain populations.Methods:In the original studies,3-dimensional hip and knee kinematics during a single-limb squat were obtained in 20 women with patellofemoral pain and 14 women with chronic hip joint pain who demonstrated visually classified DKV.Pain intensity during the squat was assessed in both groups.For the secondary analysis,kinematic data were compared between pain groups using their respective control groups as a reference.Within each pain group,correlation coefficients were used to determine the relationship between kinematics and pain during the squat.Results:Hip adduction and contralateral pelvic drop were greater in those with chronic hip joint pain compared to those with patellofemoral pain(effect sizes ≥0.40).Greater knee external rotation(r= 0.47,p= 0.04)was correlated with greater knee pain in those with patellofemoral pain,while greater hip adduction(r = 0.53,p = 0.05)and greater hip internal rotation(r = 0.55,p = 0.04)were correlated with greater hip pain in those with chronic hip joint pain.Conclusion:Hip frontal plane motion was greater in those with chronic hip joint pain compared to those with patellofemoral pain.In both groups,greater abnormal movement at the respective joint(e.g.,knee external rotation in the patellofemoral pain group and hip adduction and internal rotation in the chronic hip joint pain group)was associated with greater pain at that joint during a single-limb squat.展开更多
目的探讨常规松解髌骨外侧支持带对保留髌骨型全膝关节置换术疗效的影响。方法本研究采用随机数字表法分为两组,本治疗组43例采用外侧支持带松解术,对照组为42例患者均未采取松解术治疗。对两组膝前痛、患者的满意程度、美国膝关节外科...目的探讨常规松解髌骨外侧支持带对保留髌骨型全膝关节置换术疗效的影响。方法本研究采用随机数字表法分为两组,本治疗组43例采用外侧支持带松解术,对照组为42例患者均未采取松解术治疗。对两组膝前痛、患者的满意程度、美国膝关节外科协会(Knee Surgery Society,KSS)膝评分和功能评分、髌骨评分以及手术后的并发症发生率等进行评估。结果在术后24个月的随访结果中发现,治疗组明显降低了膝前痛的发生率(P<0.05)。此外,两组在手术后的满意度、并发症的发生率、KSS膝评分、KSS功能评分以及髌骨评分等多个方面进行了比较,差异均无统计学意义(P>0.05)。结论常规松解髌骨外侧支持带对保留髌骨型全膝关节置换术能够减轻膝前疼痛,同时不增加手术后并发症的风险。展开更多
Objective:Total knee arthroplasty(TKA)has become an effective treatment modality for end-stage osteoarthritis and rheumatoid arthritis.Postoperative problems such as anterior knee pain affect postoperative patient sat...Objective:Total knee arthroplasty(TKA)has become an effective treatment modality for end-stage osteoarthritis and rheumatoid arthritis.Postoperative problems such as anterior knee pain affect postoperative patient satisfaction.Patellar denervation has been proposed as a technique to relieve pain,but its efficacy remains controversial.This study evaluated the mid-and long-term effects of patellar denervation on postoperative knee joint functions,hoping to provide better guidance for clinical practice.Methods:This study is a prospective randomized controlled double-blind study.58 patients undergoing bilateral non-resurfaced total knee arthroplasty were included and randomized into two groups.Both groups underwent total knee arthroplasty while patellar denervation was performed only on the experimental group.Information regarding whether if patellar denervation was performed were withheld from all patients and outcome assessors.All surgeries were performed by the same high-level professional physician,and the post-stable knee prosthesis system(PS Scorpio NRG PS,Stryker)was used during the surgeries.The knee joint functions were evaluated by professional assessors before and after surgery.The evaluation indicators mainly include KSS scoring,Western Ontario and McMaster Universities(WOMAC)scoring and Visual Analogue Scale(VAS),FJS scoring,etc.The follow-up period was 3 years and 5 years after surgery.Results:The experimental group had better KSS and FJS scores than the control group,the difference was statistically significant.There was no significant inter-group difference in WOMAC and VAS scores.Conclusion:The patellar denervation in TKA patients has positive effects on the mid-and long-term recovery of knee joint functions,and the postoperative satisfaction is better.展开更多
We report herein a rare case of lateral parapatellar synovial plica that developed simultaneously in both knees. A 15-year-old competitive soccer player visited our institution with a six-month history of anterolatera...We report herein a rare case of lateral parapatellar synovial plica that developed simultaneously in both knees. A 15-year-old competitive soccer player visited our institution with a six-month history of anterolateral pain and catching sensation in both knee joints. On physical examination, he complained of tenderness along the joint line of bilateral patellofemoral joint (PFJ). Visible and palpable popping was observed at the lateral margin of each patella during active knee motion. Magnetic resonance imaging showed obvious synovial soft nodules in the lateral side of the PFJ. On arthroscopy, a yellowish, thick, tongue-shaped tissue extending transversely from the lateral parapatellar synovium was identified in both knees, and parts of this tissue showed avascular hypertrophy. Arthroscopic findings of both knees are almost symmetrical in anatomical location, but no similar in size. After arthroscopic excision, the patient became asymptomatic. At 24-month follow up, he demonstrated full knee function, without evidence of local recurrence.展开更多
基金Supported by the Capital Fund Project for Clinical Diagnosis and Treatment Technology Research and Translational Application,No.Z201100005520091and Beijing Traditional Chinese Medicine Science and Technology Development Fund Project,No.JJ-2020-67.
文摘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.
文摘Despite improvements in technique and technology for total knee arthroplasty(TKA),anterior knee pain impacts patient outcomes and satisfaction.Addressing the prosthetic and surgical technique related causes of pain after TKA,specifically as it relates to anterior knee pain,can aid surgeons in addressing these issues with their patients.Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing,improper transverse plane component rotation resulting in patellar subluxation/tilt.Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator.As the number of TKA procedures continues to increase,it is increasingly critical to develop improved,evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications.
文摘Total Knee Arthroplasty has been shown to be a successful procedure for treating patients with osteoarthritis,and yet approximately 5%-10%of patients experience residual pain,especially in the anterior part of the knee.Many theories have been proposed to explain the etiology of this anterior knee pain(AKP)but,despite improvements having been made,AKP remains a problem.AKP can be described as retropatellar or peripatellar pain,which limits patients in their everyday lives.Patients suffering from AKP experience difficulty in standing up from a chair,walking up and down stairs and riding a bicycle.The question asked was:"How can a‘perfectly’placed total knee arthroplasty(TKA)still be painful:what can cause this pain?".To prevent AKP after TKA it is important to first identify the different anatomical structures that can cause this pain.Greater attention to and understanding of AKP should lead to significant pain relief and greater overall patient satisfaction after TKA.This article is a review of what pain is,how nerve signalling works and what is thought to cause Anterior Knee Pain after a Total Knee Arthroplasty.
文摘AIM To compare rotating versus fixed-bearing Press-Fit Condylar(PFC) Sigma posterior stabilized(PS) total knee arthroplasty(TKA) with the new "J curve"femoral design in terms of clinical outcomes and anterior knee pain.METHODS We retrospectively analyzed 39 patients who underwent primary total knee replacement surgery for knee osteoarthritis using the PFC Sigma PS TKA with either fixed(FP group, 20 cases) or rotating platform(RP group, 19 cases) treated between 2009 and 2013 by the same surgeon. The two groups were homogeneous for age, gender, weight, American Society of Anesthesiologists status, preoperative clinical and functional scores, and prosthetic alignment at two years after surgery. We analyzed clinical outcomes score at two years follow-up using Knee Society Score(KSS), Knee Injury and Osteoarthritis Outcome Score(KOOS),Knee Performance Score, Short Form(SF) 36, and anterior knee pain assessed by the Hospital for Special Surgery(HSS) patellar score.RESULTS No differences were found in KSS, Knee Performance Score, and SF-36 outcome scores. A statistically significant difference was found in the HSS Patella score objective(FP: 22.36; RP: 28.75; P < 0.05), HSS Patella score total(FP: 73.68; RP:86.50; P < 0.05), and KOOS symptoms(FP: 73.49; RP: 86.44; P < 0.05).CONCLUSION Rotating platform in PFC Sigma PS TKA appears to reduce the short-term incidence of anterior knee pain compared to the fixed platform.
基金supported by the Washington University Institute of Clinical and Translational Sciences (No. UL1 TR000448) (Schmidt)the National Center for Advancing Translational Sciences (No. TLl TR000449) (Schmidt)+1 种基金the National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development, and National Institute of Neurological Disorders and Stroke (No. K23 HD067343,K12 HD055931) (Harris-Hayes)the National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development (No. R15HD059080)
文摘Background:Dynamic knee valgus(DKV)is an abnormal movement pattern visually characterized by excessive medial movement of the lower extremity during weight bearing.Differences in hip and knee kinematic components of DKV may explain the emergence of different pain problems in people who exhibit the same observed movement impairment.Using a secondary analysis of exiting data sets,we sought to determine whether hip and knee frontal and transverse plane angles during a functional task differed between women with patellofemoral pain and women with chronic hip joint pain and the relationship between joint-specific kinematics and pain in these 2 pain populations.Methods:In the original studies,3-dimensional hip and knee kinematics during a single-limb squat were obtained in 20 women with patellofemoral pain and 14 women with chronic hip joint pain who demonstrated visually classified DKV.Pain intensity during the squat was assessed in both groups.For the secondary analysis,kinematic data were compared between pain groups using their respective control groups as a reference.Within each pain group,correlation coefficients were used to determine the relationship between kinematics and pain during the squat.Results:Hip adduction and contralateral pelvic drop were greater in those with chronic hip joint pain compared to those with patellofemoral pain(effect sizes ≥0.40).Greater knee external rotation(r= 0.47,p= 0.04)was correlated with greater knee pain in those with patellofemoral pain,while greater hip adduction(r = 0.53,p = 0.05)and greater hip internal rotation(r = 0.55,p = 0.04)were correlated with greater hip pain in those with chronic hip joint pain.Conclusion:Hip frontal plane motion was greater in those with chronic hip joint pain compared to those with patellofemoral pain.In both groups,greater abnormal movement at the respective joint(e.g.,knee external rotation in the patellofemoral pain group and hip adduction and internal rotation in the chronic hip joint pain group)was associated with greater pain at that joint during a single-limb squat.
文摘目的探讨常规松解髌骨外侧支持带对保留髌骨型全膝关节置换术疗效的影响。方法本研究采用随机数字表法分为两组,本治疗组43例采用外侧支持带松解术,对照组为42例患者均未采取松解术治疗。对两组膝前痛、患者的满意程度、美国膝关节外科协会(Knee Surgery Society,KSS)膝评分和功能评分、髌骨评分以及手术后的并发症发生率等进行评估。结果在术后24个月的随访结果中发现,治疗组明显降低了膝前痛的发生率(P<0.05)。此外,两组在手术后的满意度、并发症的发生率、KSS膝评分、KSS功能评分以及髌骨评分等多个方面进行了比较,差异均无统计学意义(P>0.05)。结论常规松解髌骨外侧支持带对保留髌骨型全膝关节置换术能够减轻膝前疼痛,同时不增加手术后并发症的风险。
文摘Objective:Total knee arthroplasty(TKA)has become an effective treatment modality for end-stage osteoarthritis and rheumatoid arthritis.Postoperative problems such as anterior knee pain affect postoperative patient satisfaction.Patellar denervation has been proposed as a technique to relieve pain,but its efficacy remains controversial.This study evaluated the mid-and long-term effects of patellar denervation on postoperative knee joint functions,hoping to provide better guidance for clinical practice.Methods:This study is a prospective randomized controlled double-blind study.58 patients undergoing bilateral non-resurfaced total knee arthroplasty were included and randomized into two groups.Both groups underwent total knee arthroplasty while patellar denervation was performed only on the experimental group.Information regarding whether if patellar denervation was performed were withheld from all patients and outcome assessors.All surgeries were performed by the same high-level professional physician,and the post-stable knee prosthesis system(PS Scorpio NRG PS,Stryker)was used during the surgeries.The knee joint functions were evaluated by professional assessors before and after surgery.The evaluation indicators mainly include KSS scoring,Western Ontario and McMaster Universities(WOMAC)scoring and Visual Analogue Scale(VAS),FJS scoring,etc.The follow-up period was 3 years and 5 years after surgery.Results:The experimental group had better KSS and FJS scores than the control group,the difference was statistically significant.There was no significant inter-group difference in WOMAC and VAS scores.Conclusion:The patellar denervation in TKA patients has positive effects on the mid-and long-term recovery of knee joint functions,and the postoperative satisfaction is better.
文摘We report herein a rare case of lateral parapatellar synovial plica that developed simultaneously in both knees. A 15-year-old competitive soccer player visited our institution with a six-month history of anterolateral pain and catching sensation in both knee joints. On physical examination, he complained of tenderness along the joint line of bilateral patellofemoral joint (PFJ). Visible and palpable popping was observed at the lateral margin of each patella during active knee motion. Magnetic resonance imaging showed obvious synovial soft nodules in the lateral side of the PFJ. On arthroscopy, a yellowish, thick, tongue-shaped tissue extending transversely from the lateral parapatellar synovium was identified in both knees, and parts of this tissue showed avascular hypertrophy. Arthroscopic findings of both knees are almost symmetrical in anatomical location, but no similar in size. After arthroscopic excision, the patient became asymptomatic. At 24-month follow up, he demonstrated full knee function, without evidence of local recurrence.
