BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many p...BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(P<0.001).THA patients had significantly decreased operative time only when the same sized implant was utilized(P=0.025).The vast majority(93.3%)of patients were discharged to the same type of location following their second surgery.However,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second TJA.This may be the result of increased confidence and decreased anxiety,and it supports the theory that enhanced patient education pre-operatively may improve outcomes.For the surgical team,the second procedure of a staged THA is more efficient,although this finding did not hold for TKA.展开更多
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 thro...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.展开更多
Periprosthetic joint infection(PJI)is a rare but terrible complication in hip and knee arthroplasty,and the use of topical vancomycin powder(VP)has been investigated as a tool to potentially reduce its incidence.Howev...Periprosthetic joint infection(PJI)is a rare but terrible complication in hip and knee arthroplasty,and the use of topical vancomycin powder(VP)has been investigated as a tool to potentially reduce its incidence.However,there remains no consensus on its efficacy.Therefore,the aim of this review is to provide an overview on the application of topical vancomycin in orthopaedic surgery focusing on the recent evidence and results in total joint arthroplasty.Several systematic reviews and meta-analyses on topical VP in hip and knee arthroplasty have been recently published reporting sometimes conflicting results.Apart from all being limited by the quality of the included studies(mostly level III and IV),confounding variables are often included potentially leading to biased conclusions.If taken into consideration the exclusive use of VP in isolation,the available data,although very limited,suggest that it does not reduce the infection rate in routine primary hip and knee arthroplasty.Therefore,we still cannot advise for a routinary application.A properly powered randomized-controlled trial would be necessary to clarify the role of VP in hip and knee arthroplasty.Based on the analysis of the current evidence,the use of topical VP appears to be safe when used locally in terms of systemic adverse reactions,hence,if proven to be effective,it could bring great benefits due to its low cost and accessibility.展开更多
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...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.展开更多
BACKGROUND Presepsin is an emerging biomarker in the diagnosis of sepsis.In the field of orthopaedics,it could be useful in diagnosing and managing periprosthetic joint infections.AIM To define the normal postoperativ...BACKGROUND Presepsin is an emerging biomarker in the diagnosis of sepsis.In the field of orthopaedics,it could be useful in diagnosing and managing periprosthetic joint infections.AIM To define the normal postoperative presepsin plasmatic curve,in patients undergoing primary cementless total hip arthroplasty(THA).METHODS Patients undergoing primary cementless THA at our Institute were recruited.Inclusion criteria were:Primary osteoarthritis of the hip;urinary catheter time of permanence<24 h;peripheral venous cannulation time of permanence<24 h;no postoperative homologous blood transfusion administration and hospital stay≤8 d.Exclusion criteria were:The presence of other articular prosthetic replacement or bone fixation devices;chronic inflammatory diseases;chronic kidney diseases;history of recurrent infections or malignant neoplasms;previous surgery in the preceding 12 mo;diabetes mellitus;immunosuppressive drug or corticosteroid assumption.All the patients received the same antibiotic prophylaxis.All the THA were performed by the same surgical and anaesthesia team;total operative time was defined as the time taken from skin incision to completion of skin closure.At enrollment,anthropometric data,smocking status,osteoarthritis stage according to Kellgren and Lawrence,Harris Hip Score,drugs assumption and comorbidities were recorded.All the patients underwent serial blood tests,including complete blood count,presepsin(PS)and C-reactive protein 24 h before arthroplasty and at 24,48,72 and 96 h postoperatively and at 3,6 and 12-mo follow-up.RESULTS A total of 96 patients(51 female;45 male;mean age=65.74±5.58)were recruited.The mean PS values were:137.54 pg/mL at baseline,192.08 pg/mL at 24 h post-op;254.85 pg/mL at 48 h post-op;259 pg/mL at 72 h post-op;248.6 pg/mL at 96-h post-op;140.52 pg/mL at 3-mo follow-up;135.55 pg/mL at 6-mo follow-up and 130.11 pg/mL at 12-mo follow-up.In two patients(2.08%)a soft-tissue infection was observed;in these patients,higher levels(>350 pg/mL)were recorded at 3-mo follow-up.CONCLUSION The dosage of plasmatic PS concentration is highly recommended in patients undergoing THA before surgery to exclude the presence of an unknown infection.The PS plasmatic concentration should be also assessed at 72 h postoperatively,evaluate the maximum postoperative PS value,and at 96 h post-operatively when a decrease of presepsin should be found.The lack of a presepsin decrease at 96 h post-operatively could be a predictive factor of infection.展开更多
Background: Total joint arthroplasty is a commonly performed procedure for end-stage osteoarthritis. Preoperative anemia is a well-characterized and potentially modifiable risk factor for morbidity and mortality in no...Background: Total joint arthroplasty is a commonly performed procedure for end-stage osteoarthritis. Preoperative anemia is a well-characterized and potentially modifiable risk factor for morbidity and mortality in non-cardiac surgery. This retrospective cohort study identified the prevalence of anemia in our total joint arthroplasty population and investigated if there was an association with all-cause mortality. Study Design and Methods: Using an electronic medical record, we examined all patients who underwent a primary unilateral total joint arthroplasty at Dartmouth-Hitchcock Medical Center from January 1, 2011 through July 1, 2015. Preoperative anemia thresholds were defined according to the World Health Organization as 12 mg/dl for women and 13 mg/dl for men. Kaplan-Meier survival analyses were performed to examine the relationship between preoperative anemia and all-cause mortality. Cox proportional hazards were calculated for various models adjusting for potential confounders. Results: 439 of the 3247 patients (13.5%) that underwent total joint arthroplasty met the preoperative definition for anemia. 48 patients (1.48%) died during 6470 patient years of follow up, generating an incidence rate of 7.4 deaths per 1000 patient years. The crude hazard ratio for death in anemic patients was 3.42 (95% CI 1.89, 6.82). In multiple models adjusting for various health related confounders, preoperative anemia was associated with a roughly two-fold increase risk of death compared to non-anemic patients. Conclusion: Preoperative anemia is prevalent in our population and it is associated with increased postoperative mortality in total joint arthroplasty patients, even when adjustments are made for significant co-morbidities.展开更多
Many orthopedic surgeons require that their patients obtain dental clearance before elective total joint arthroplasty(TJA).However,there is no consensus substantiating the practice.To this end,a systematic review on t...Many orthopedic surgeons require that their patients obtain dental clearance before elective total joint arthroplasty(TJA).However,there is no consensus substantiating the practice.To this end,a systematic review on the prevalence of dental pathology in TJA patients,risk factors for failing dental screening,and impact of dental evaluations was performed.Literature was sourced from PubMed and Scopus databases.Six papers were sourced from the initial search,one study was extracted from the references of the original six manuscripts,and one new publication was retrieved from a second search conducted after the first.The prevalence of dental pathology ranged from 8.8%to 29.4%across studies.Two of four papers reported lower than average or improvements in postoperative infection with pre-operative dental evaluations while two found no such association.There is insufficient evidence to support universal dental clearance before TJA.展开更多
BACKGROUND Elective total joint arthroplasty(TJA)procedures have been postponed as part of the coronavirus disease 2019(COVID-19)response to avert healthcare system collapse.Total hip arthroplasty(THA)and total knee a...BACKGROUND Elective total joint arthroplasty(TJA)procedures have been postponed as part of the coronavirus disease 2019(COVID-19)response to avert healthcare system collapse.Total hip arthroplasty(THA)and total knee arthroplasty(TKA)procedures comprise the highest volume of elective procedures performed at health care facilities worldwide.AIM To determine the demand for TJA despite the pandemic and the impact of surgery postponement on physical and mental health.METHODS We conducted a prospective cross-sectional telephonic interview-based study on patients awaiting THA and TKA at an academic institution in South Africa.The questionnaire consisted of four sections.The first section recorded baseline demographic data and medical co-morbidities,the length of time spent awaiting TJA,and the patients’desire to undergo elective surgery despite the COVID-19 pandemic.Section 2 and Section 3 assessed the patients’current physical and mental health,respectively,as a consequence of deferred surgical intervention.The last section established the patients’perception of the healthcare system’s response to the COVID-19 pandemic and necessity to postpone elective surgery.Patients received counseling and education on the current state of surgery during the COVID-19 pandemic and associated risks.Thereafter,patients were once again asked about their desire to undergo TJA during the COVID-19 pandemic.RESULTS We included 185 patients(65.95%female;mean age:50.28 years)awaiting TJA for a mean of 26.42±30.1 mo.Overall,88.65%of patients wanted TJA despite the COVID-19 pandemic.Patients awaiting TJA for 1-3 years were 3.3-fold more likely to want surgery than those waiting<1 year(P<0.000).Patients with comorbidities were 8.4-fold less likely to want TJA than those with no comorbidities(P=0.013).After receiving education,the patients wanting TJA decreased to 54.05%.Patients who changed their opinion after education had less insight on the increased morbidity(P=0.046)and mortality(P=0.001)associated with COVID-19.Despite awaiting TJA for shorter period(24.7±20.38 mo),patients who continued to demand TJA had greater pain(P<0.000)and decreased function(P=0.043)since TJA postponement.CONCLUSION There is deterioration in health for patients,who have had elective procedures postponed during the COVID-19 pandemic.Waiting lists should be prioritized for urgency with the re-initiation of elective surgery.展开更多
<span style="font-family:Verdana;">Aggressive anticoagulation following total joint arthroplaty (TJA) is well known to increase the risk of both wound leakage and hematoma formation. Despite this there...<span style="font-family:Verdana;">Aggressive anticoagulation following total joint arthroplaty (TJA) is well known to increase the risk of both wound leakage and hematoma formation. Despite this there are no guidelines for orthopaedic surgeons undertaking major primary and revision surgery in patients with high risk of venous thromboembolic events, who may present with complications directly linked to anticoagulant use. Hence the authors felt the need for this narrative review. They have tried to answer few questions that are commonly faced in clinical practice. Balanced anticoagulation is a difficult task to achieve. The potential consequences of over anticoagulation on the outcome of TJA and revision TJA are live changing and devastating. On the contrary falling short of adequate anticoagulation is fatal leading to recurrent thromboembolic events. Robust risk stratification tools and a multidisciplinary approach </span><span style="font-family:Verdana;">are</span><span style="font-family:Verdana;"> certainly the way forward. There is an urgent need for specialty specific guidelines for managing patient on anticoagulation undergoing TJA, and revision arthroplasty procedures</span><span style="font-family:Verdana;">.展开更多
Introduction: The instability of the joint is classified roughly into mechanical and functional. It is reported that the postoperative dislocation often occurs by the posterior approach of the THA and may be caused by...Introduction: The instability of the joint is classified roughly into mechanical and functional. It is reported that the postoperative dislocation often occurs by the posterior approach of the THA and may be caused by functionality instability due to the injury of the periarticular soft tissue. We analyzed the joint position sense of the hip according to an approach of the THA and examined effect to give postoperative dislocation. Materials & Methods: 92 patients (184 hip joints) who received THA in our hospital were selected in the study. Cases in which position sensation measurements were insufficient were excluded. As for the classification, the posterior approach (PL groups) was 39 hips, anterolateral approach (AL groups) was 30 hips, and control group was 37 hips. Results: There was no significant difference between the AL group and PL group in the absolute reproduction angle error score (ARAES). The relative reproduction angle error scores (RRAES) for passive internal and external rotations and active internal rotation were significantly lower in the AL and control groups than the PL group. Discussion: This study was suggested that the hip joint position sense in the AL group was better retained for the preservation of the soft tissue.展开更多
BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a PJI.Alth...BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a PJI.Although the incidence of PJI is very low(0.69%)in our department,with an average follow-up of 595 d,this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after healing.AIM To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential infection.METHODS We counted 583 THR for 578 patients and observed only 4 cases of infection(0.69%)with a mean follow-up of 596 d(min 30,max 1451).We reviewed all medical records to collect the data:duration and time of the surgery,presence,type and duration of the antibiotic therapy,preoperative diagnosis,blood values before and after surgery,transfusions,presence of preoperative drugs(in particularly anticoagulants and antiaggregant,corticosteroids and immunosuppressants),presence of some comorbidities(high body mass index,blood hypertension,chronic obstructive pulmonary disease,cardiac ischemia,diabetes,rheumatological conditions,previous local infections).RESULTS No preoperative,intraoperative,or postoperative analysis showed a higher incidence of PJI.We did not find any class with evident major odds of PJI.In our study,we did not find any border value to predict PJI and all patients had similar values in both groups(non-PJI and PJI).Only some categories,such as female patients,showed more frequency of PJI,but this difference related to sex was not statistically significant.CONCLUSION We did not find any category with a higher risk of PJI in THR,probably due to the lack of few cases of infection.展开更多
The purpose of this review is to examine the validity of positive claims regarding the direct anterior approach(DAA) with a fracture table for total hip arthroplasty. Recent literature regarding the DAA was searched a...The purpose of this review is to examine the validity of positive claims regarding the direct anterior approach(DAA) with a fracture table for total hip arthroplasty. Recent literature regarding the DAA was searched and specific claims investigated including improved early outcomes, speed of recovery, component placement, dislocation rates, and complication rates. Recent literature is positive regarding the effects of total hip arthroplasty with the anterior approach. While the data is not definitive at present, patients receiving the anterior approach for total hip arthroplasty tend to recover more quickly and have improved early outcomes. Component placement with the anterior approach is more often in the "safe zone" than with other approaches. Dislocation rates tend to be less than 1% with the anterior approach. Complication rates vary widely in the published literature. A possible explanation is that the varianceis due to surgeon and institutional experience with the anterior approach procedure. Concerns remain regarding the "learning curve" for both surgeons and institutions. In conclusion, it is not a matter of should this approach be used, but how should it be implemented.展开更多
In this article, a concise description of the recent advances in the field of osteoarthritis management is presented. The main focus is to highlight the most promising techniques that emerge in both biological joint r...In this article, a concise description of the recent advances in the field of osteoarthritis management is presented. The main focus is to highlight the most promising techniques that emerge in both biological joint replacement and artificial joint arthroplasty. A critical view of high quality evidence regarding outcome and safety profile of these techniques is presented. The potential role of kinematically aligned total knee replacement, navigation, and robotic-assisted surgery is outlined. A critical description of both primary and stem cell-based therapies, the cell homing theory, the use of biologic factors and recent advancements in tissue engineering and regenerative medicine is provided. Based on the current evidence, some thoughts on a realistic approach towards answering these questions are attempted.展开更多
BACKGROUND A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip(DDH)and a drainage sinus is a rare condition.There are no previous reports of this condit...BACKGROUND A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip(DDH)and a drainage sinus is a rare condition.There are no previous reports of this condition,and it is a complex challenge for surgeons to develop a treatment scheme.CASE SUMMARY We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month.Approximately 40 years ago,a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy.After the sinus healed,gradual pain occurred in the left hip for 40 years.Approximately one month prior,hip pain was sharply aggravated,and a drainage sinus reoccurred in the left hip.The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur,as well as an acetabular deformity.The results of Mycobacterium tuberculosis antibody and Xpert were positive.Therefore,the patient was diagnosed with advanced TH combined with Crowe type IV DDH.After 22 d of treatment with anti-tuberculosis chemotherapy,the sinus healed,and the patient underwent one-stage total hip arthroplasty(THA)surgery consisting of debridement,osteotomy,and joint replacement.After surgery,the patient received anti-tuberculosis chemotherapy drugs for nine months,with no recurrent infection.After one year of follow-up,the Harris score of the patient increased from 21 pre-THA to 86.CONCLUSION Although drainage sinuses are a contraindication to one-stage THA,one-stage THA is still an effective and safe surgical method after the sinus heals.展开更多
AIM To investigate a comprehensive range of factors that contribute to long-term patient satisfaction post-total joint replacement(TJR) in people who had undergone knee or hip replacement for osteoarthritis.METHODS Pa...AIM To investigate a comprehensive range of factors that contribute to long-term patient satisfaction post-total joint replacement(TJR) in people who had undergone knee or hip replacement for osteoarthritis.METHODS Participants(n = 1151) were recruited from Nottinghamshire post-total hip or knee replacement. Questionnaire assessment included medication use, the pain-DETECT questionnaire(PDQ) to assess neuropathic pain-like symptoms(NP) and TJR satisfaction measured on average 4.8 years post-TJR. Individual factors were tested for an association with post-TJR satisfaction, before incorporating all factors into a full model. Data reduction was carried out using LASSO and receiveroperator characteristic(ROC) curve analysis was used to quantify the contribution of variables to post-TJR satisfaction.RESULTS After data reduction, the best fitting model for post-TJR satisfaction included various measures of pain, history of revision surgery, smoking, pre-surgical X-ray severity, WOMAC function scores and various comorbidities. ROC analysis of this model gave AUC = 0.83(95%CI: 0.80-0.85). PDQ scores were found to capture much of the variation in post-TJR satisfaction outcomes: AUC = 0.79(0.75-0.82). Pre-surgical radiographic severity was associated with higher post-TJR satisfaction: OR_(satisfied) = 2.06(95%CI: 1.15-3.69), P = 0.015.CONCLUSION These results highlight the importance of pre-surgical radiographic severity, post-TJR function, analgesic medication use and NP in terms of post-TJR satisfaction. The PDQ appears to be a useful tool in capturing factors that contribute to post-TJR satisfaction.展开更多
BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg...BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure for preventing acute surgical site infection following primary total hip arthroplasty(THA)and total knee arthroplasty(TKA).AIM To investigate the effectiveness of prophylactic intraoperative application of vancomycin(1000 mg/L;2 L)solution vs.plain irrigation in reducing the incidence of acute surgical site infection following primary THA and TKA.METHODS A retrospective review of 2725 consecutive patients undergoing THA or TKA from January 2012–December 2019 was performed.These patients received either intrawound irrigation with normal saline before wound closure between January 2012 and December 2015(group 1,1018 patients;453 undergoing THA and 565 undergoing TKA)or intrawound irrigation with vancomycin solution(1000 mg/L)before wound closure between January 2016 and December 2019(group 2,1175 patients;512 undergoing THA and 663 undergoing TKA).The outcomes were the incidences of postoperative surgical site infection and wound healing complications within 3 mo of primary TJA.RESULTS There were no significant demographic differences between the 2 groups.There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline before wound closure than in those who received intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure(overall incidence of infection:group 1,2.46%vs group 2,0.09%,P<0.001).There was no significant difference in the incidence of wound healing complications between the two groups.CONCLUSION Prophylactic irrigation with vancomycin solution(1000 mg/L;2 L)significantly decreases the incidence of acute surgical site infection after primary TJA.This strategy is a safe,efficacious,and inexpensive method for reducing the incidence of acute surgical site infection after TJA.展开更多
AIM: To investigate knee awareness and functional outcomes in patients treated with simultaneous bilateral vs unilateral total knee arthroplasty(TKA).METHODS: Through a database search, we identified 210 patients who ...AIM: To investigate knee awareness and functional outcomes in patients treated with simultaneous bilateral vs unilateral total knee arthroplasty(TKA).METHODS: Through a database search, we identified 210 patients who had undergone unilateral TKA(UTKA) and 65 patients who had undergone simultaneous bilateral TKA(SBTKA) at our institution between 2010 and 2012. All TKAs were cemented and cruciate retaining. The mean follow-up period was 3.2(2 to 4) years. All the patients had symptomatic and debilitating unilateral or bilateral osteoarthritis for which all conservative and non-surgical treatments were failed, thus preoperatively the patients had poor functionality. All patients were asked to complete Forgotten Joint Score(FJS) and Oxford Knee Score(OKS) questionnaires. The patients were matched according to age, gender, year of surgery, Kellgren-Lawrence score and pre- andpostoperative overall knee alignment. The FJS and OKS questionnaire results of the two groups were then compared. RESULTS: A mixed-effects model was used to analyze differences between SBTKA and UTKA. OKS: The mean difference in the OKS between the patients who had undergone SBTKA and those who had undergone UTKA was 1.5, which was not statistically significant(CI =-0.9:4.0, P-value = 0.228). The mean OKS of the SBTKA patients was 37.6(SD = 9.0), and the mean OKS of the UTKA patients was 36.1(SD = 9.9). FJS: The mean difference in the FJS between the patients who had undergone SBTKA and those who had undergone UTKA was 2.3, which was not statistically significant(CI =-6.2:10.8, P-value = 0.593). The mean FJS of the SBTKA patients was 59.9(SD = 27.5), and the mean FJS of the UTKA patients was 57.5(SD = 28.8). CONCLUSION: SBTKA and UTKA patients exhibited similar joint functionality and knee awareness. Our results support the use of SBTKA in selected patients suffering from clinically symptomatic bilateral osteoarthritis.展开更多
AIM To evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system.METHODS Twenty-one shoulders with a mean follow-up 18 of months were included. On scaled d...AIM To evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system.METHODS Twenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation(CoR) was assessed and compared to the CoR of the prosthesis by using the MediC AD~? software. Additionally, the pre-and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score. RESULTS Both, the Constant and DASH scores improved signifi-cantly from 11% to 75% and from 70 to 30 points, P < 0.01 respectively. There were no significant differences regarding age, etiology, cemented or metal-backed glenoids, etc.(P > 0.05). The pre-and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neckshaft angle showed no significant changes(P > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring.CONCLUSION TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.展开更多
文摘BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(P<0.001).THA patients had significantly decreased operative time only when the same sized implant was utilized(P=0.025).The vast majority(93.3%)of patients were discharged to the same type of location following their second surgery.However,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second TJA.This may be the result of increased confidence and decreased anxiety,and it supports the theory that enhanced patient education pre-operatively may improve outcomes.For the surgical team,the second procedure of a staged THA is more efficient,although this finding did not hold for TKA.
文摘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.
基金The Orthopaedic Research Foundation of Western Australia(ORFWA)for providing research support.
文摘Periprosthetic joint infection(PJI)is a rare but terrible complication in hip and knee arthroplasty,and the use of topical vancomycin powder(VP)has been investigated as a tool to potentially reduce its incidence.However,there remains no consensus on its efficacy.Therefore,the aim of this review is to provide an overview on the application of topical vancomycin in orthopaedic surgery focusing on the recent evidence and results in total joint arthroplasty.Several systematic reviews and meta-analyses on topical VP in hip and knee arthroplasty have been recently published reporting sometimes conflicting results.Apart from all being limited by the quality of the included studies(mostly level III and IV),confounding variables are often included potentially leading to biased conclusions.If taken into consideration the exclusive use of VP in isolation,the available data,although very limited,suggest that it does not reduce the infection rate in routine primary hip and knee arthroplasty.Therefore,we still cannot advise for a routinary application.A properly powered randomized-controlled trial would be necessary to clarify the role of VP in hip and knee arthroplasty.Based on the analysis of the current evidence,the use of topical VP appears to be safe when used locally in terms of systemic adverse reactions,hence,if proven to be effective,it could bring great benefits due to its low cost and accessibility.
文摘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.
文摘BACKGROUND Presepsin is an emerging biomarker in the diagnosis of sepsis.In the field of orthopaedics,it could be useful in diagnosing and managing periprosthetic joint infections.AIM To define the normal postoperative presepsin plasmatic curve,in patients undergoing primary cementless total hip arthroplasty(THA).METHODS Patients undergoing primary cementless THA at our Institute were recruited.Inclusion criteria were:Primary osteoarthritis of the hip;urinary catheter time of permanence<24 h;peripheral venous cannulation time of permanence<24 h;no postoperative homologous blood transfusion administration and hospital stay≤8 d.Exclusion criteria were:The presence of other articular prosthetic replacement or bone fixation devices;chronic inflammatory diseases;chronic kidney diseases;history of recurrent infections or malignant neoplasms;previous surgery in the preceding 12 mo;diabetes mellitus;immunosuppressive drug or corticosteroid assumption.All the patients received the same antibiotic prophylaxis.All the THA were performed by the same surgical and anaesthesia team;total operative time was defined as the time taken from skin incision to completion of skin closure.At enrollment,anthropometric data,smocking status,osteoarthritis stage according to Kellgren and Lawrence,Harris Hip Score,drugs assumption and comorbidities were recorded.All the patients underwent serial blood tests,including complete blood count,presepsin(PS)and C-reactive protein 24 h before arthroplasty and at 24,48,72 and 96 h postoperatively and at 3,6 and 12-mo follow-up.RESULTS A total of 96 patients(51 female;45 male;mean age=65.74±5.58)were recruited.The mean PS values were:137.54 pg/mL at baseline,192.08 pg/mL at 24 h post-op;254.85 pg/mL at 48 h post-op;259 pg/mL at 72 h post-op;248.6 pg/mL at 96-h post-op;140.52 pg/mL at 3-mo follow-up;135.55 pg/mL at 6-mo follow-up and 130.11 pg/mL at 12-mo follow-up.In two patients(2.08%)a soft-tissue infection was observed;in these patients,higher levels(>350 pg/mL)were recorded at 3-mo follow-up.CONCLUSION The dosage of plasmatic PS concentration is highly recommended in patients undergoing THA before surgery to exclude the presence of an unknown infection.The PS plasmatic concentration should be also assessed at 72 h postoperatively,evaluate the maximum postoperative PS value,and at 96 h post-operatively when a decrease of presepsin should be found.The lack of a presepsin decrease at 96 h post-operatively could be a predictive factor of infection.
文摘Background: Total joint arthroplasty is a commonly performed procedure for end-stage osteoarthritis. Preoperative anemia is a well-characterized and potentially modifiable risk factor for morbidity and mortality in non-cardiac surgery. This retrospective cohort study identified the prevalence of anemia in our total joint arthroplasty population and investigated if there was an association with all-cause mortality. Study Design and Methods: Using an electronic medical record, we examined all patients who underwent a primary unilateral total joint arthroplasty at Dartmouth-Hitchcock Medical Center from January 1, 2011 through July 1, 2015. Preoperative anemia thresholds were defined according to the World Health Organization as 12 mg/dl for women and 13 mg/dl for men. Kaplan-Meier survival analyses were performed to examine the relationship between preoperative anemia and all-cause mortality. Cox proportional hazards were calculated for various models adjusting for potential confounders. Results: 439 of the 3247 patients (13.5%) that underwent total joint arthroplasty met the preoperative definition for anemia. 48 patients (1.48%) died during 6470 patient years of follow up, generating an incidence rate of 7.4 deaths per 1000 patient years. The crude hazard ratio for death in anemic patients was 3.42 (95% CI 1.89, 6.82). In multiple models adjusting for various health related confounders, preoperative anemia was associated with a roughly two-fold increase risk of death compared to non-anemic patients. Conclusion: Preoperative anemia is prevalent in our population and it is associated with increased postoperative mortality in total joint arthroplasty patients, even when adjustments are made for significant co-morbidities.
文摘Many orthopedic surgeons require that their patients obtain dental clearance before elective total joint arthroplasty(TJA).However,there is no consensus substantiating the practice.To this end,a systematic review on the prevalence of dental pathology in TJA patients,risk factors for failing dental screening,and impact of dental evaluations was performed.Literature was sourced from PubMed and Scopus databases.Six papers were sourced from the initial search,one study was extracted from the references of the original six manuscripts,and one new publication was retrieved from a second search conducted after the first.The prevalence of dental pathology ranged from 8.8%to 29.4%across studies.Two of four papers reported lower than average or improvements in postoperative infection with pre-operative dental evaluations while two found no such association.There is insufficient evidence to support universal dental clearance before TJA.
文摘BACKGROUND Elective total joint arthroplasty(TJA)procedures have been postponed as part of the coronavirus disease 2019(COVID-19)response to avert healthcare system collapse.Total hip arthroplasty(THA)and total knee arthroplasty(TKA)procedures comprise the highest volume of elective procedures performed at health care facilities worldwide.AIM To determine the demand for TJA despite the pandemic and the impact of surgery postponement on physical and mental health.METHODS We conducted a prospective cross-sectional telephonic interview-based study on patients awaiting THA and TKA at an academic institution in South Africa.The questionnaire consisted of four sections.The first section recorded baseline demographic data and medical co-morbidities,the length of time spent awaiting TJA,and the patients’desire to undergo elective surgery despite the COVID-19 pandemic.Section 2 and Section 3 assessed the patients’current physical and mental health,respectively,as a consequence of deferred surgical intervention.The last section established the patients’perception of the healthcare system’s response to the COVID-19 pandemic and necessity to postpone elective surgery.Patients received counseling and education on the current state of surgery during the COVID-19 pandemic and associated risks.Thereafter,patients were once again asked about their desire to undergo TJA during the COVID-19 pandemic.RESULTS We included 185 patients(65.95%female;mean age:50.28 years)awaiting TJA for a mean of 26.42±30.1 mo.Overall,88.65%of patients wanted TJA despite the COVID-19 pandemic.Patients awaiting TJA for 1-3 years were 3.3-fold more likely to want surgery than those waiting<1 year(P<0.000).Patients with comorbidities were 8.4-fold less likely to want TJA than those with no comorbidities(P=0.013).After receiving education,the patients wanting TJA decreased to 54.05%.Patients who changed their opinion after education had less insight on the increased morbidity(P=0.046)and mortality(P=0.001)associated with COVID-19.Despite awaiting TJA for shorter period(24.7±20.38 mo),patients who continued to demand TJA had greater pain(P<0.000)and decreased function(P=0.043)since TJA postponement.CONCLUSION There is deterioration in health for patients,who have had elective procedures postponed during the COVID-19 pandemic.Waiting lists should be prioritized for urgency with the re-initiation of elective surgery.
文摘<span style="font-family:Verdana;">Aggressive anticoagulation following total joint arthroplaty (TJA) is well known to increase the risk of both wound leakage and hematoma formation. Despite this there are no guidelines for orthopaedic surgeons undertaking major primary and revision surgery in patients with high risk of venous thromboembolic events, who may present with complications directly linked to anticoagulant use. Hence the authors felt the need for this narrative review. They have tried to answer few questions that are commonly faced in clinical practice. Balanced anticoagulation is a difficult task to achieve. The potential consequences of over anticoagulation on the outcome of TJA and revision TJA are live changing and devastating. On the contrary falling short of adequate anticoagulation is fatal leading to recurrent thromboembolic events. Robust risk stratification tools and a multidisciplinary approach </span><span style="font-family:Verdana;">are</span><span style="font-family:Verdana;"> certainly the way forward. There is an urgent need for specialty specific guidelines for managing patient on anticoagulation undergoing TJA, and revision arthroplasty procedures</span><span style="font-family:Verdana;">.
文摘Introduction: The instability of the joint is classified roughly into mechanical and functional. It is reported that the postoperative dislocation often occurs by the posterior approach of the THA and may be caused by functionality instability due to the injury of the periarticular soft tissue. We analyzed the joint position sense of the hip according to an approach of the THA and examined effect to give postoperative dislocation. Materials & Methods: 92 patients (184 hip joints) who received THA in our hospital were selected in the study. Cases in which position sensation measurements were insufficient were excluded. As for the classification, the posterior approach (PL groups) was 39 hips, anterolateral approach (AL groups) was 30 hips, and control group was 37 hips. Results: There was no significant difference between the AL group and PL group in the absolute reproduction angle error score (ARAES). The relative reproduction angle error scores (RRAES) for passive internal and external rotations and active internal rotation were significantly lower in the AL and control groups than the PL group. Discussion: This study was suggested that the hip joint position sense in the AL group was better retained for the preservation of the soft tissue.
文摘BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a PJI.Although the incidence of PJI is very low(0.69%)in our department,with an average follow-up of 595 d,this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after healing.AIM To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential infection.METHODS We counted 583 THR for 578 patients and observed only 4 cases of infection(0.69%)with a mean follow-up of 596 d(min 30,max 1451).We reviewed all medical records to collect the data:duration and time of the surgery,presence,type and duration of the antibiotic therapy,preoperative diagnosis,blood values before and after surgery,transfusions,presence of preoperative drugs(in particularly anticoagulants and antiaggregant,corticosteroids and immunosuppressants),presence of some comorbidities(high body mass index,blood hypertension,chronic obstructive pulmonary disease,cardiac ischemia,diabetes,rheumatological conditions,previous local infections).RESULTS No preoperative,intraoperative,or postoperative analysis showed a higher incidence of PJI.We did not find any class with evident major odds of PJI.In our study,we did not find any border value to predict PJI and all patients had similar values in both groups(non-PJI and PJI).Only some categories,such as female patients,showed more frequency of PJI,but this difference related to sex was not statistically significant.CONCLUSION We did not find any category with a higher risk of PJI in THR,probably due to the lack of few cases of infection.
文摘The purpose of this review is to examine the validity of positive claims regarding the direct anterior approach(DAA) with a fracture table for total hip arthroplasty. Recent literature regarding the DAA was searched and specific claims investigated including improved early outcomes, speed of recovery, component placement, dislocation rates, and complication rates. Recent literature is positive regarding the effects of total hip arthroplasty with the anterior approach. While the data is not definitive at present, patients receiving the anterior approach for total hip arthroplasty tend to recover more quickly and have improved early outcomes. Component placement with the anterior approach is more often in the "safe zone" than with other approaches. Dislocation rates tend to be less than 1% with the anterior approach. Complication rates vary widely in the published literature. A possible explanation is that the varianceis due to surgeon and institutional experience with the anterior approach procedure. Concerns remain regarding the "learning curve" for both surgeons and institutions. In conclusion, it is not a matter of should this approach be used, but how should it be implemented.
文摘In this article, a concise description of the recent advances in the field of osteoarthritis management is presented. The main focus is to highlight the most promising techniques that emerge in both biological joint replacement and artificial joint arthroplasty. A critical view of high quality evidence regarding outcome and safety profile of these techniques is presented. The potential role of kinematically aligned total knee replacement, navigation, and robotic-assisted surgery is outlined. A critical description of both primary and stem cell-based therapies, the cell homing theory, the use of biologic factors and recent advancements in tissue engineering and regenerative medicine is provided. Based on the current evidence, some thoughts on a realistic approach towards answering these questions are attempted.
基金Basic Public Welfare Research Project of Zhejiang Province,No.GF20H200021Luqiao Science and Technology Bureau Foundation,No.2019A23005.
文摘BACKGROUND A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip(DDH)and a drainage sinus is a rare condition.There are no previous reports of this condition,and it is a complex challenge for surgeons to develop a treatment scheme.CASE SUMMARY We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month.Approximately 40 years ago,a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy.After the sinus healed,gradual pain occurred in the left hip for 40 years.Approximately one month prior,hip pain was sharply aggravated,and a drainage sinus reoccurred in the left hip.The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur,as well as an acetabular deformity.The results of Mycobacterium tuberculosis antibody and Xpert were positive.Therefore,the patient was diagnosed with advanced TH combined with Crowe type IV DDH.After 22 d of treatment with anti-tuberculosis chemotherapy,the sinus healed,and the patient underwent one-stage total hip arthroplasty(THA)surgery consisting of debridement,osteotomy,and joint replacement.After surgery,the patient received anti-tuberculosis chemotherapy drugs for nine months,with no recurrent infection.After one year of follow-up,the Harris score of the patient increased from 21 pre-THA to 86.CONCLUSION Although drainage sinuses are a contraindication to one-stage THA,one-stage THA is still an effective and safe surgical method after the sinus heals.
基金Supported by PhD studentship awarded by the University of Nottingham(to Warner SC)EULAR project grant to AMV,No.108239ARUK Pain Centre,No.18769
文摘AIM To investigate a comprehensive range of factors that contribute to long-term patient satisfaction post-total joint replacement(TJR) in people who had undergone knee or hip replacement for osteoarthritis.METHODS Participants(n = 1151) were recruited from Nottinghamshire post-total hip or knee replacement. Questionnaire assessment included medication use, the pain-DETECT questionnaire(PDQ) to assess neuropathic pain-like symptoms(NP) and TJR satisfaction measured on average 4.8 years post-TJR. Individual factors were tested for an association with post-TJR satisfaction, before incorporating all factors into a full model. Data reduction was carried out using LASSO and receiveroperator characteristic(ROC) curve analysis was used to quantify the contribution of variables to post-TJR satisfaction.RESULTS After data reduction, the best fitting model for post-TJR satisfaction included various measures of pain, history of revision surgery, smoking, pre-surgical X-ray severity, WOMAC function scores and various comorbidities. ROC analysis of this model gave AUC = 0.83(95%CI: 0.80-0.85). PDQ scores were found to capture much of the variation in post-TJR satisfaction outcomes: AUC = 0.79(0.75-0.82). Pre-surgical radiographic severity was associated with higher post-TJR satisfaction: OR_(satisfied) = 2.06(95%CI: 1.15-3.69), P = 0.015.CONCLUSION These results highlight the importance of pre-surgical radiographic severity, post-TJR function, analgesic medication use and NP in terms of post-TJR satisfaction. The PDQ appears to be a useful tool in capturing factors that contribute to post-TJR satisfaction.
文摘BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure for preventing acute surgical site infection following primary total hip arthroplasty(THA)and total knee arthroplasty(TKA).AIM To investigate the effectiveness of prophylactic intraoperative application of vancomycin(1000 mg/L;2 L)solution vs.plain irrigation in reducing the incidence of acute surgical site infection following primary THA and TKA.METHODS A retrospective review of 2725 consecutive patients undergoing THA or TKA from January 2012–December 2019 was performed.These patients received either intrawound irrigation with normal saline before wound closure between January 2012 and December 2015(group 1,1018 patients;453 undergoing THA and 565 undergoing TKA)or intrawound irrigation with vancomycin solution(1000 mg/L)before wound closure between January 2016 and December 2019(group 2,1175 patients;512 undergoing THA and 663 undergoing TKA).The outcomes were the incidences of postoperative surgical site infection and wound healing complications within 3 mo of primary TJA.RESULTS There were no significant demographic differences between the 2 groups.There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline before wound closure than in those who received intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure(overall incidence of infection:group 1,2.46%vs group 2,0.09%,P<0.001).There was no significant difference in the incidence of wound healing complications between the two groups.CONCLUSION Prophylactic irrigation with vancomycin solution(1000 mg/L;2 L)significantly decreases the incidence of acute surgical site infection after primary TJA.This strategy is a safe,efficacious,and inexpensive method for reducing the incidence of acute surgical site infection after TJA.
文摘AIM: To investigate knee awareness and functional outcomes in patients treated with simultaneous bilateral vs unilateral total knee arthroplasty(TKA).METHODS: Through a database search, we identified 210 patients who had undergone unilateral TKA(UTKA) and 65 patients who had undergone simultaneous bilateral TKA(SBTKA) at our institution between 2010 and 2012. All TKAs were cemented and cruciate retaining. The mean follow-up period was 3.2(2 to 4) years. All the patients had symptomatic and debilitating unilateral or bilateral osteoarthritis for which all conservative and non-surgical treatments were failed, thus preoperatively the patients had poor functionality. All patients were asked to complete Forgotten Joint Score(FJS) and Oxford Knee Score(OKS) questionnaires. The patients were matched according to age, gender, year of surgery, Kellgren-Lawrence score and pre- andpostoperative overall knee alignment. The FJS and OKS questionnaire results of the two groups were then compared. RESULTS: A mixed-effects model was used to analyze differences between SBTKA and UTKA. OKS: The mean difference in the OKS between the patients who had undergone SBTKA and those who had undergone UTKA was 1.5, which was not statistically significant(CI =-0.9:4.0, P-value = 0.228). The mean OKS of the SBTKA patients was 37.6(SD = 9.0), and the mean OKS of the UTKA patients was 36.1(SD = 9.9). FJS: The mean difference in the FJS between the patients who had undergone SBTKA and those who had undergone UTKA was 2.3, which was not statistically significant(CI =-6.2:10.8, P-value = 0.593). The mean FJS of the SBTKA patients was 59.9(SD = 27.5), and the mean FJS of the UTKA patients was 57.5(SD = 28.8). CONCLUSION: SBTKA and UTKA patients exhibited similar joint functionality and knee awareness. Our results support the use of SBTKA in selected patients suffering from clinically symptomatic bilateral osteoarthritis.
文摘AIM To evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system.METHODS Twenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation(CoR) was assessed and compared to the CoR of the prosthesis by using the MediC AD~? software. Additionally, the pre-and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score. RESULTS Both, the Constant and DASH scores improved signifi-cantly from 11% to 75% and from 70 to 30 points, P < 0.01 respectively. There were no significant differences regarding age, etiology, cemented or metal-backed glenoids, etc.(P > 0.05). The pre-and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neckshaft angle showed no significant changes(P > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring.CONCLUSION TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.
