BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the nativ...BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.展开更多
BACKGROUND Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years,as they enhance precision compared to conventional hardware.The expansion of computer assistance is evolvi...BACKGROUND Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years,as they enhance precision compared to conventional hardware.The expansion of computer assistance is evolving with the employment of augmented reality.Yet,the accuracy of augmented reality navigation systems has not been determined.AIM To examine the accuracy of component alignment and restoration of the affected limb’s mechanical axis in primary total knee arthroplasty(TKA),utilizing an augmented reality navigation system and to assess whether such systems are conspicuously fruitful for an accomplished knee surgeon.METHODS From May 2021 to December 2021,30 patients,25 women and five men,under-went a primary unilateral TKA.Revision cases were excluded.A preoperative radiographic procedure was performed to evaluate the limb’s axial alignment.All patients were operated on by the same team,without a tourniquet,utilizing three distinct prostheses with the assistance of the Knee+™augmented reality navigation system in every operation.Postoperatively,the same radiographic exam protocol was executed to evaluate the implants’position,orientation and coronal plane alignment.We recorded measurements in 3 stages regarding femoral varus and flexion,tibial varus and posterior slope.Firstly,the expected values from the Augmented Reality system were documented.Then we calculated the same values after each cut and finally,the same measurements were recorded radiolo-gically after the operations.Concerning statistical analysis,Lin’s concordance correlation coefficient was estimated,while Wilcoxon Signed Rank Test was performed when needed.RESULTS A statistically significant difference was observed regarding mean expected values and radiographic mea-surements for femoral flexion measurements only(Z score=2.67,P value=0.01).Nonetheless,this difference was statistically significantly lower than 1 degree(Z score=-4.21,P value<0.01).In terms of discrepancies in the calculations of expected values and controlled measurements,a statistically significant difference between tibial varus values was detected(Z score=-2.33,P value=0.02),which was also statistically significantly lower than 1 degree(Z score=-4.99,P value<0.01).CONCLUSION The results indicate satisfactory postoperative coronal alignment without outliers across all three different implants utilized.Augmented reality navigation systems can bolster orthopaedic surgeons’accuracy in achieving precise axial alignment.However,further research is required to further evaluate their efficacy and potential.展开更多
In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023;14:784-790.It is well known that patients who have undergone a liver transplant(LT)may need to have a to...In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023;14:784-790.It is well known that patients who have undergone a liver transplant(LT)may need to have a total hip arthroplasty(THA)or total knee arthroplasty(TKA)implanted.Ahmed et al stated that the mortality rate in these patients was similar to the one of the general population.However,there are three articles previously published that found higher mortality in LT patients who experienced THA/TKA than in the general population(individuals without LT).Therefore,in this Editorial I would like to point out that there is controversy in the literature regarding whether LT patients undergoing THA/TKA have higher mortality than the general population.Therefore,future research should attempt to resolve this controversy.展开更多
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
BACKGROUND Prophylactic antibiotics have significantly led to a reduction in the risk of postoperative surgical site infections(SSI)in orthopaedic surgery.The aim of using antibiotics for this purpose is to achieve se...BACKGROUND Prophylactic antibiotics have significantly led to a reduction in the risk of postoperative surgical site infections(SSI)in orthopaedic surgery.The aim of using antibiotics for this purpose is to achieve serum and tissue drug levels that exceed,for the duration of the operation,the minimum inhibitory concentration of the likely organisms that are encountered.Prophylactic antibiotics reduce the rate of SSIs in lower limb arthroplasty from between 4%and 8%to between 1%and 3%.Controversy,however,still surrounds the optimal frequency and dosing of antibiotic administration.AIM To evaluate the impact of introduction of a weight-adjusted antibiotic prophylaxis regime,combined with a reduction in the duration of administration of post-operative antibiotics on SSI incidence during the 2 years following primary elective total hip and knee arthroplasty METHODS Following ethical approval,patients undergoing primary total hip arthroplasty(THA)/total knee arthroplasty(TKA)with the old regime(OR)of a preoperative dose[cefazolin 2 g intravenously(IV)],and two subsequent doses(2 h and 8 h),were compared to those after a change to a new regime(NR)of a weight-adjusted preoperative dose(cefazolin 2 g IV for patients<120 kg;cefazolin 3g IV for patients>120 kg)and a post-operative dose at 2 h.The primary outcome in both groups was SSI rates during the 2 years post-operatively.RESULTS A total of n=1273 operations(THA n=534,TKA n=739)were performed in n=1264 patients.There was no statistically significant difference in the rate of deep(OR 0.74%(5/675)vs NR 0.50%(3/598);fishers exact test P=0.72),nor superficial SSIs(OR 2.07%(14/675)vs NR 1.50%(9/598);chi-squared test P=0.44)at 2 years postoperatively.With propensity score weighting and an interrupted time series analysis,there was also no difference in SSI rates between both groups[RR 0.88(95%CI 0.61 to 1.30)P=0.46].CONCLUSION A weight-adjusted regime,with a reduction in number of post-operative doses had no adverse impact on SSI incidence in this population.展开更多
BACKGROUND Over the past years,patient specific instrumentation(PSI)for total knee arthroplasty(TKA)has been implemented and routinely used.No clear answer has been given on its associated cost and cost-effectiveness ...BACKGROUND Over the past years,patient specific instrumentation(PSI)for total knee arthroplasty(TKA)has been implemented and routinely used.No clear answer has been given on its associated cost and cost-effectiveness when compared to conventional instrumentation(CI)for TKA.AIM To compare the cost and cost-effectiveness of PSI TKA compared to CI TKA.METHODS A literature search was performed in healthcare,economical healthcare,and medical databases(MEDLINE,EMBASE,CINAHL,Web of Science,Cochrane Library,EconLit).It was conducted in April 2021 and again in January 2022.Relevant literature included randomised controlled trials,retrospective studies,prospective studies,observational studies,and case control studies.All studies were assessed on methodological quality.Relevant outcomes included incremental cost-effectiveness ratio,quality-adjusted life years,total costs,imaging costs,production costs,sterilization associated costs,surgery duration costs and readmission rate costs.All eligible studies were assessed for risk of bias.Meta-analysis was performed for outcomes with sufficient data.RESULTS Thirty-two studies were included into the systematic review.Two were included in the metaanalysis.3994 PSI TKAs and 13267 CI TKAs were included in the sample size.The methodological quality of the included studies,based on Consensus on Health Economic Criteria-scores and risk of bias,ranged from average to good.PSI TKA costs less than CI TKA when considering mean operating room time and its associated costs and tray sterilization per patient case.PSI TKA costs more compared to CI TKA when considering imaging and production costs.Considering total costs per patient case,PSI TKA is more expensive in comparison to CI TKA.Meta-analysis comparing total costs for PSI TKA,and CI TKA showed a significant higher cost for PSI TKA.CONCLUSION Cost for PSI and CI TKA can differ when considering distinct aspects of their implementation.Total costs per patient case are increased for PSI TKA when compared to CI TKA.展开更多
BACKGROUND Metallosis is the result of metallic wear debris in the soft tissues and is associated to both local and systemic inflammatory response.Metallosis has been reported after total hip and total knee arthroplas...BACKGROUND Metallosis is the result of metallic wear debris in the soft tissues and is associated to both local and systemic inflammatory response.Metallosis has been reported after total hip and total knee arthroplasty(TKA),but rarely after a unicompartimental knee arthroplasty(UKA).In the context of UKA metallosis,surgeons often opt for revision using a TKA.However,in this paper,the authors successfully treated UKA revising the metal back only.CASE SUMMARY Prior to treat our patient we conducted a literature research through which we identified eleven cases of metallosis after UKA,ten(90.9%)were treated revising using though a TKA.Only one case was managed through a uni-on-uni revision,reporting high knee function.Our patient complained worsening pain and function after a snap occurred at 16 mo after UKA implantation.At 18 mo following surgical debridment and uni-on-uni revision surgery,our patient exhibited a relevant improvement in Oxford Knee Score and a reduction of metal ion levels in the blood.CONCLUSION Our study highlights that in case of metallosis after UKA,the treatment may be based on surgical debridement and just revising the mobilized components.展开更多
BACKGROUND The study sought to understand the self-management strategies used by patients during the postponement of their total knee arthroplasty(TKA)procedure,as well as the associations between the length of waitin...BACKGROUND The study sought to understand the self-management strategies used by patients during the postponement of their total knee arthroplasty(TKA)procedure,as well as the associations between the length of waiting time,pain,and physical frailty and function.The study focused on individuals aged 50 years and above,as they are known to be more vulnerable to the negative impacts of delayed elective surgery and rehabilitation.This study hypothesizes that delayed TKR due to coronavirus disease 2019(COVID-19)will bear negative effect in self-management,pain,and physical frailty and function in older adults.AIM To investigate the effects of COVID-19 pandemic on self-management,pain,and physical function in older adults awaiting TKA in Malaysia.METHODS This cross-sectional study has the data of participants,who matched the criteria and scheduled for TKA for the first time,extracted from the TKA registry in the Department of Orthopaedics and Traumatology,Hospital Canselor Tuanku Mukhriz.Data on pain status,and self-management,physical frailty,and instrumental activities daily living were also collected.Multiple linear regression analysis with a significant level of 0.05 was used to identify the association between waiting time and pain on physical frailty and functional performance.RESULTS Out of 180 had deferred TKA,50%of them aged 50 years old and above,80%were women with ethnic distribution Malay(66%),Chinese(22%),Indian(10%),and others(2%)respectively.Ninety-two percent of the participants took medication to manage their pain during the waiting time,while 10%used herbs and traditional supplements,and 68%did exercises as part of their osteoarthritis(OA)self-management.Thirty-six participants were found to have physical frailty(strength,assistance with walking,rising from a chair,climbing stairs,and falls questionnaire score>4)which accounted for 72%.Increased pain was associated with physical frailty with odds ratio,odds ratio(95%confidence interval):1.46(1.04-2.05).This association remained significant even after the adjustment according to age and self-management.CONCLUSION While deferring TKA during a pandemic is unavoidable,patient monitoring for OA treatment during the waiting period is important in reducing physical frailty,ensuring the older patients’independence.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
Objective: To investigate the clinical efficacy of the cement-screw technique in repairing tibial plateau bone defects in total knee arthroplasty (TKA) recipients and summarize the preoperative prehabilitation strateg...Objective: To investigate the clinical efficacy of the cement-screw technique in repairing tibial plateau bone defects in total knee arthroplasty (TKA) recipients and summarize the preoperative prehabilitation strategies for such surgeries. Methods: A total of 33 TKA recipients (45 knees) in our department underwent repair of unilateral or bilateral tibial defects using the cement-screw technique. The subjects were divided into two groups based on the differences in preoperative interventions. The control group received routine preoperative health education according to the consensus, while the observation group received instructive and standardized prehabilitation exercises for four weeks in addition to the routine education. Scale scores, intraoperative parameters, and postoperative recovery indicators were recorded at different time pointsand subjected to statistical analysis for intra-group and inter-group differences. All subjects underwent long-term follow-up for at least 24 months. Results: Within each group at different time points, there were statistically significant differences in VAS, ROM, and HSS scores (p Conclusions: Cement-screw technique for repairing tibial plateau bone defects in TKA recipients can significantly relieve pain, and improve joint function. Prehabilitation can improve preoperative rehabilitation reserves in these patients, accelerate postoperative recovery, and contribute to better short-term clinical outcomes.展开更多
Mechanically aligned total knee arthroplasty (TKA) for valgus knee is considered a “challenging surgery.” Recently, the kinematic alignment (KA) method has gained attention. This study aimed to present objective cli...Mechanically aligned total knee arthroplasty (TKA) for valgus knee is considered a “challenging surgery.” Recently, the kinematic alignment (KA) method has gained attention. This study aimed to present objective clinical data, such as intraoperative balance assessment and radiographic evaluation of postoperative lower extremity alignment after TKA using the KA method for valgus deformity. Twenty-one TKA knees (mean age, 74 years;2 males, 19 females) with KA for severe valgus deformity (hip-knee-ankle-angle ≥ 10°) performed at our department in the past 3 years were included in this study. Intraoperative gap and balance measurements and postoperative radiographic evaluation were performed. A total arc of range of motion was achieved up to 98% of preoperative values at 3 weeks postoperatively. Intraoperative gap and balance were stable throughout the entire range of motion. In addition, there were no statistically significant differences in either balance or gap values at each flexion angle. KA TKA is a “simple surgery” rather than a “challenging surgery” because additional soft tissue procedures are not required, operative time is short, intraoperative and postoperative balance is very stable, and a good alignment is achieved. This procedure may relieve surgeons of the stress of TKA for valgus deformities.展开更多
<span style="font-family:""><span style="font-family:Verdana;">Unicondylar Knee Arthroplasty (UKA) is an early alternative surgical procedure for the unicondylar osteoarthritis or ...<span style="font-family:""><span style="font-family:Verdana;">Unicondylar Knee Arthroplasty (UKA) is an early alternative surgical procedure for the unicondylar osteoarthritis or damaged knee joint with artificial </span><span style="font-family:Verdana;">prosthesis for the release of disabling painful condition and restoring the</span><span style="font-family:Verdana;"> normal knee functions. Minimally UKA is one of the recent and the majority successful procedures in modern orthopedics for the osteoarthritis which is spreading throughout the worldwide. Recently, many orthopedic surgeons are expanding their abilities in this field. However, it needs good knowledge and well experience for the successful clinical outcomes. The minimal invasive approach is more efficient for short hospital stay and faster postoperative recovery with low morbidity of the patients after UKA. The aim of this article is to emphasize the steps in UKA based on modern facts: function of knee joint, diagnosis, less invasive approach for medial condylar replacement, radiographic evaluation, and earlier recovery, selecting the patient and implant survivorship with review of surgery.展开更多
BACKGROUND There is a lack of studies on the effects of enhanced recovery after surgery(ERAS)with multidisciplinary collaboration on the nursing outcomes of total knee arthroplasty(TKA).AIM To explore the effect of ER...BACKGROUND There is a lack of studies on the effects of enhanced recovery after surgery(ERAS)with multidisciplinary collaboration on the nursing outcomes of total knee arthroplasty(TKA).AIM To explore the effect of ERAS with multidisciplinary collaboration on nursing outcomes after TKA.METHODS We retrospectively analyzed the clinical data of 80 patients who underwent TKA at a tertiary hospital between January 2021 and December 2022.The patients were divided into two groups according to the nursing mode:the ERAS group(n=40)received ERAS with multidisciplinary collaboration,and the conventional group(n=40)received routine nursing.The following indicators were compared between the two groups:length of hospital stay,hospitalization cost,intraoperative blood loss,hemoglobin level 24 h after surgery,visual analog scale(VAS)score for pain,range of motion(ROM)of the knee joint,Hospital for Special Surgery(HSS)knee score,and postoperative complications.RESULTS The ERAS group had a significantly shorter length of hospital stay,lower hospitalization cost,less intraoperative blood loss,higher hemoglobin level 24 h after surgery,lower VAS score for pain,higher knee joint ROM,and higher HSS knee score than the conventional group(all P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).CONCLUSION Multidisciplinary collaboration with ERAS can reduce blood loss,shorten hospital stay,and improve knee function in patients undergoing TKA.展开更多
Background: Total knee arthroplasty (TKA) is a highly complex and effective surgery even though its perioperative bleeding may increase the need for blood transfusion and its associated infection risk, cardiovascular ...Background: Total knee arthroplasty (TKA) is a highly complex and effective surgery even though its perioperative bleeding may increase the need for blood transfusion and its associated infection risk, cardiovascular overload, increased costs, and mortality. As the tourniquet reduces intraoperative bleeding, it may be associated with postoperative bleeding, venous thrombosis, and distal ischemia. The reperfusion may trigger a local and systemic inflammatory response. Anesthetic preconditioning (APC) with sevoflurane minimizes ischemia-reperfusion syndrome (IRS). This study evaluated the effects of APC with sevoflurane on perioperative bleeding in TKA. Methods: We allocated 30 patients into two groups: a sevo group (sevoflurane 2% for 15 minutes before the tourniquet) and a control group (propofol infusion). Laboratory tests were collected right before the tourniquet (LAB PRE, in the operating room) and after its release at four moments: LAB POST (immediately after), LAB 2 (two hours after), LAB 12 (12 hours after), and LAB 24 (24 hours after). The volume of the suction drain was measured at one, two, 12, and 24 hours after the end of the surgery. Antifibrinolytics were not administered. Results: There was no statistically significant difference in bleeding-related variables, such as drained volume and hemoglobin and hematocrit measurements. Drainage volume was higher in the first two hours after the procedure, while hematocrit decreased pre- to postoperatively and between two and 12 hours post-procedure. Conclusion: Sevoflurane as an anesthetic preconditioning did not reduce postoperative bleeding in TKA surgery.展开更多
Objective: To study the safety and efficacy of concurrent bilateral total knee arthroplasty orstaged bilateral total knee replacement using meta-analysis. Methods: The databases of ChinaWanfang, CNKI, PubMed, Cochrane...Objective: To study the safety and efficacy of concurrent bilateral total knee arthroplasty orstaged bilateral total knee replacement using meta-analysis. Methods: The databases of ChinaWanfang, CNKI, PubMed, Cochrane Library, and Web of Science were searched conducted formeta-analysis of the extracted data using Review Manager 5.3 software. Results: ①A total of 18retrospective cohort studies were included, 72 831 patients in the same period group and 103595 patients in the staging group. ②The results of meta showed that in the staging group, theincidence of postoperative cardiac complications[OR= 1.21, 95%CI=(1.10~1.34), P<0.000 1] ,neurological complications[OR=1.67, 95%CI=(1.29~2.16), P<0.000 1], deep vein thrombosis[OR=1.38, 95%CI(1.27~1.50), P<0.000 01], mortality[OR=2.18, 95%CI=(1.67~2.84),P<0.000 01] and perioperative blood loss [OR=246.75, 95%CI=(233.30~260.20)] were lessthan those in the same period group (P<0.000 01);The postoperative deep infection rate in thesame period group [OR=0.61, 95%CI=(0.52~0.71), P<0.000 01] was lower than that in thestaging group;The postoperative superficial infection rate [OR=0.96, 95%CI=(0.66~1.40)],revision rate of joint replacement [OR= 1.04, 95%CI=( 0.96~1.12)], HSS score [OR=0.10,95%CI=(-0.61~0.80), P=0.79] and knee joint activity score [OR=-0.23, 95%CI=(-1.25~0.78)]were not statistically significant between the two groups(P>0.05).Conclusion: Stagingbilateral total knee replacement can more effectively reduce the incidence of perioperativecomplications and reduce the amount of blood transfusion, while concurrent bilateral total kneereplacement can reduce the rate of deep infection. To further compare the efficacy and safety ofconcurrent or staged bilateral total knee arthroplasty, further studies must be conducted in theform of a randomized clinical trial to evaluate the results mentioned in this meta-analysis.展开更多
BACKGROUND Bilateral one-stage total knee arthroplasty(BTKA)is now in greater use as an alternative option for patients with bilateral end-stage knee arthropathy.However,postoperative pain and disablement during conva...BACKGROUND Bilateral one-stage total knee arthroplasty(BTKA)is now in greater use as an alternative option for patients with bilateral end-stage knee arthropathy.However,postoperative pain and disablement during convalescence from BTKA,and procedure-related complications have been concerning issues for patients and surgeons.Although some studies reported that BTKA in selected patients is as safe as the staged procedure,well-defined guidelines for patient screening,and perioperative care and monitoring to avoid procedure-related complications are still controversial.AIM To compare the perioperative outcomes including perioperative blood loss(PBL),cardiac biomarkers,pain intensity,functional recovery,and complications between unilateral total knee arthroplasty(UTKA)and BTKA performed with a similar perioperative protocol.METHODS We conducted a retrospective study on consecutive patients undergoing UTKA and BTKA that had been performed by a single surgeon with identical perioperative protocols.The exclusion criteria of this study included patients with an American Society of Anesthesiologists score>3,and known cardiopulmonary comorbidity or high-sensitivity Troponin-T(hs-TnT)>14 ng/L.Outcome measures included visual analogue scale(VAS)score of postoperative pain,morphine consumption,range of knee motion,straight leg raise(SLR),length of stay(LOS),and serum hemoglobin(Hb)and hs-TnT monitored during hospitalization.RESULTS Of 210 UTKA and 137 BTKA patients,those in the BTKA group were younger and more predominately female.The PBL of the UTKA vs BTKA group was 646.45±272.26 mL vs 1012.40±391.95 mL(P<0.01),and blood transfusion rates were 10.48%and 40.88%(P<0.01),respectively.Preoperative Hb and body mass index were predictive factors for blood transfusion in BTKA,whereas preoperative Hb was only a determinant in UTKA patients.The BTKA group had significantly higher VAS scores than the UTKA group at 48,72,and 96 h after surgery,and also had a significantly lower degree of SLR at 72 h.The BTKA group also had a significantly longer LOS than the UTKA group.Of the patients who had undergone the procedure,5.71%of the UTKA patients and 12.41%of the BTKA patients(P=0.04)had hs-TnT>14 ng/L during the first 72 h postoperatively.However,there was no difference in other outcome measures and complications.CONCLUSION Following similar perioperative management,the blood transfusion rate in BTKA is 4-fold that required in UTKA.Also,BTKA is associated with higher pain intensity at 48 h postoperatively and prolonged LOS when compared to the UTKA.Hence,BTKA patients may require more extensive perioperative management for blood loss and pain,even if having no higher risk of complications than UTKA.展开更多
Background:Postoperative care has been evolving since the concept of enhanced recovery after surgery(ERAS)was introduced in China.This study aimed to evaluate the effects of early ambulation within 24h after unilatera...Background:Postoperative care has been evolving since the concept of enhanced recovery after surgery(ERAS)was introduced in China.This study aimed to evaluate the effects of early ambulation within 24h after unilateral total knee arthroplasty(TKA)on postoperative rehabilitation and costs in a Chinese population.Methods:This cohort study of patients with knee osteoarthritis who had undergone TKA at 24 large teaching hospitals between January 2014 and November 2016 involved 2687 patients who began ambulating within 24h(Group A)and 3761 patients who began ambulating later than 24h(Group B).The outcome measurements,such as length of stay(LOS),total hospitalization costs,dynamic pain level,knee flexion range of motion(ROM),results of the 12-Item Short Form Survey(SF-12),incidence of thromboembolic events and other complications,were recorded and compared.Results:The early ambulation group(Group A)had a shorter LOS and lower hospitalization costs and pain levels than the late ambulation group(Group B).There was a favorable effect in enhancing ROM for patients in Group A compared with patients in Group B.In Group A,patients had significantly higher postoperative SF-12 scores than those in Group B.The incidence of deep venous thrombosis(DVT)and pulmonary infection was significantly lower in Group A than in Group B.The incidence of pulmonary embolism(PE)and other complications did not differ between the two groups.Conclusions:Early ambulation within 24h after TKA was associated with reduced LOS,improved knee function,lower hospitalization costs and lower incidence of DVT and pulmonary infection in the Chinese population.展开更多
Porous structure in orthopedic prosthesis may reduce micromotion and increase the service life of implants.The purposes of this study were to compare the influence of the tibial stems with solid and porous structures ...Porous structure in orthopedic prosthesis may reduce micromotion and increase the service life of implants.The purposes of this study were to compare the influence of the tibial stems with solid and porous structures in Total Knee Arthroplasty(TKA)on knee joint and prostheses,and to improve the mechanical stability of the host bone by seeking favorable structure for the tibial stem.The Finite Element(FE)models of TKA knee with four different structures in the middle segment of the tibial stem(i.e.,solid,cubic,truncated cubic,and octahedral structures)were constructed.The distributions of von Mises stress in the knee joint,tibial prosthesis and proximal tibia,and the compressive stresses of the tibial prosthesis and ultra-high-molecular-weight polyethylene for the four FE models were analyzed.The results showed that the tibial stem filled with the octahedral structure has the best mechanical performance among the above four types of tibial stems.It could effectively reduce the stress concentration and stress shielding effects,and provide an improved mechanical environment for knee joint after TKA.This study would shed some lights on the design and fabrication of porous implants targeted to biomedical applications.展开更多
BACKGROUND Patellar tendon rupture after total knee arthroplasty(TKA)is a catastrophic complication.Although the occurrence of this injury is rare,it can lead to significant dysfunction for the patient and is very tri...BACKGROUND Patellar tendon rupture after total knee arthroplasty(TKA)is a catastrophic complication.Although the occurrence of this injury is rare,it can lead to significant dysfunction for the patient and is very tricky to deal with.There has been no standard treatment for early patella tendon rupture after TKA,and long-term follow-up data are lacking.AIM To introduce a direct repair method for early patella tendon rupture following TKA and determine the clinical outcomes and complications of this method.METHODS During the period of 2008 to 2021,3265 consecutive TKAs were retrospectively reviewed.Twelve patients developed early patellar tendon rupture postoperatively and were treated by a direct repair method.Mean follow-up was 5.7 years.Demographic,operative,and clinical data were collected.The clinical outcomes were assessed using the Western Ontario and McMaster Universities(WOMAC)score,the Hospital for Special Surgery(HSS)score,knee range of motion,extensor lag,and surgical complications.Descriptive statistics and paired t test were employed to analyze the data.RESULTS For all 12 patients who underwent direct repair for early patellar tendon rupture,3 patients failed:One(8.3%)for infection and two(17.6%)for re-fracture.The two patients with re-fracture both underwent reoperation to reconstruct the extensor mechanism and the patient with infection underwent revision surgery.The range of motion was 109.2°±10.6°preoperatively to 87.9°±11°postoperatively,mean extensor lag was 21°at follow-up,and mean WOMAC and HSS scores were 65.8±30.9 and 60.3±21.7 points,respectively.CONCLUSION This direct repair method of early patellar tendon rupture is not an ideal therapy.It is actually ineffective for the recovery of knee joint function in patients,and is still associated with severe knee extension lag and high complication rates.Compared with the outcomes of other repair methods mentioned in the literature,this direct repair method shows poor clinical outcomes.展开更多
BACKGROUND Knee osteoarthritis is the most prevalent form of osteoarthritis and is becoming the main reason for progressive pain in knee joints. Arthroscopy combined with unicondylar knee arthroplasty(UKA) is one of t...BACKGROUND Knee osteoarthritis is the most prevalent form of osteoarthritis and is becoming the main reason for progressive pain in knee joints. Arthroscopy combined with unicondylar knee arthroplasty(UKA) is one of the effective methods for the treatment of severe unicompartmental knee arthritis. This surgical approach gives us the capacity to explore all the articular cavities and plays a vital role in UKA patient selection. However, some scholars think that the surgical procedure is traumatic and may increase the rate of surgical infection, and its clinical efficacy needs further study.AIM To compare the clinical effect of arthroscopy combined with UKA and UKA alone for patients suffering from unicompartmental osteoarthritis(OA).METHODS A retrospective study was conducted on patients who were diagnosed with unicompartmental OA(Kellgren–Laurence grade ≥ III) and underwent UKA between October 2012 and November 2006. The patients were followed at 3, 6,and 12 mo and every 2 years thereafter. During each follow-up, the radiographic materials, the range of motion of knee and hospital for special surgery(HSS)score, knee society score and knee function score as recorded, and the modes and time of failure and revision details were collected as well.RESULTS Data on 104 patients(118 knees), including 54 patients(60 knees) in the arthroscopy combined with UKA group(group A) and 51(58 knees) in UKA alone group(group B) were collected during an average follow-up duration of 7.25 years, excluding the cases who were lost to follow-up. At the final follow-up,3(5.0%) of 60 knees in group A compared with 4(6.9%) of 58 knees in group B failed and converted to total knee arthroplasty, with no statistically significant difference between the two groups(P = 0.933). The percentage of patients receiving blood transfusion was 40% in group A, significantly lower than that in group B(67.2%;P = 0.003). Total volume of blood transfusion in group A was also significantly lower than that of group B(P = 0.001). Both groups improved significantly after operation in clinical symptoms and functions. HSS score, knee society score, and knee function score increased significantly at the latest followup compared to pre-operation in group A, from 59.6 ± 10.9 to 82.7 ± 9.3(mean difference [MD], 23.2;95%CI: 19.3-27.0;P = 0.000), 47.3 ± 6.3 to 76.2 ± 13.1(MD,28.9;95%CI: 25.1-32.7;P = 0.000), and 57.5 ± 6.3 to 75.1 ± 19.6(MD, 17.5;95% CI:12.1-23.0;P = 0.000);and in group B, from 59.3 ± 15.6 to 84.3 ± 10.1(MD, 23.7;95%CI: 18.9-28.5;P = 0.000), 49.1 ± 9.2 to 75.1 ± 13.2(MD, 24.7;95%CI: 19.9-29.5;P= 0.000), and 59.3 ± 9.0 to 77.4 ± 13.8(MD, 17.2;95%CI: 12.8-21.6;P = 0.000).CONCLUSION Arthroscopy combined with UKA and UKA alone both provide benefits in clinical symptom improvement and alignment correction. Arthroscopy combined with UKA does not increase the infection probability and surgical complications,and has an advantage in reducing the total volume of blood transfusion and the percentage of patients receiving blood transfusion.展开更多
文摘BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.
文摘BACKGROUND Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years,as they enhance precision compared to conventional hardware.The expansion of computer assistance is evolving with the employment of augmented reality.Yet,the accuracy of augmented reality navigation systems has not been determined.AIM To examine the accuracy of component alignment and restoration of the affected limb’s mechanical axis in primary total knee arthroplasty(TKA),utilizing an augmented reality navigation system and to assess whether such systems are conspicuously fruitful for an accomplished knee surgeon.METHODS From May 2021 to December 2021,30 patients,25 women and five men,under-went a primary unilateral TKA.Revision cases were excluded.A preoperative radiographic procedure was performed to evaluate the limb’s axial alignment.All patients were operated on by the same team,without a tourniquet,utilizing three distinct prostheses with the assistance of the Knee+™augmented reality navigation system in every operation.Postoperatively,the same radiographic exam protocol was executed to evaluate the implants’position,orientation and coronal plane alignment.We recorded measurements in 3 stages regarding femoral varus and flexion,tibial varus and posterior slope.Firstly,the expected values from the Augmented Reality system were documented.Then we calculated the same values after each cut and finally,the same measurements were recorded radiolo-gically after the operations.Concerning statistical analysis,Lin’s concordance correlation coefficient was estimated,while Wilcoxon Signed Rank Test was performed when needed.RESULTS A statistically significant difference was observed regarding mean expected values and radiographic mea-surements for femoral flexion measurements only(Z score=2.67,P value=0.01).Nonetheless,this difference was statistically significantly lower than 1 degree(Z score=-4.21,P value<0.01).In terms of discrepancies in the calculations of expected values and controlled measurements,a statistically significant difference between tibial varus values was detected(Z score=-2.33,P value=0.02),which was also statistically significantly lower than 1 degree(Z score=-4.99,P value<0.01).CONCLUSION The results indicate satisfactory postoperative coronal alignment without outliers across all three different implants utilized.Augmented reality navigation systems can bolster orthopaedic surgeons’accuracy in achieving precise axial alignment.However,further research is required to further evaluate their efficacy and potential.
文摘In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023;14:784-790.It is well known that patients who have undergone a liver transplant(LT)may need to have a total hip arthroplasty(THA)or total knee arthroplasty(TKA)implanted.Ahmed et al stated that the mortality rate in these patients was similar to the one of the general population.However,there are three articles previously published that found higher mortality in LT patients who experienced THA/TKA than in the general population(individuals without LT).Therefore,in this Editorial I would like to point out that there is controversy in the literature regarding whether LT patients undergoing THA/TKA have higher mortality than the general population.Therefore,future research should attempt to resolve this controversy.
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BACKGROUND Prophylactic antibiotics have significantly led to a reduction in the risk of postoperative surgical site infections(SSI)in orthopaedic surgery.The aim of using antibiotics for this purpose is to achieve serum and tissue drug levels that exceed,for the duration of the operation,the minimum inhibitory concentration of the likely organisms that are encountered.Prophylactic antibiotics reduce the rate of SSIs in lower limb arthroplasty from between 4%and 8%to between 1%and 3%.Controversy,however,still surrounds the optimal frequency and dosing of antibiotic administration.AIM To evaluate the impact of introduction of a weight-adjusted antibiotic prophylaxis regime,combined with a reduction in the duration of administration of post-operative antibiotics on SSI incidence during the 2 years following primary elective total hip and knee arthroplasty METHODS Following ethical approval,patients undergoing primary total hip arthroplasty(THA)/total knee arthroplasty(TKA)with the old regime(OR)of a preoperative dose[cefazolin 2 g intravenously(IV)],and two subsequent doses(2 h and 8 h),were compared to those after a change to a new regime(NR)of a weight-adjusted preoperative dose(cefazolin 2 g IV for patients<120 kg;cefazolin 3g IV for patients>120 kg)and a post-operative dose at 2 h.The primary outcome in both groups was SSI rates during the 2 years post-operatively.RESULTS A total of n=1273 operations(THA n=534,TKA n=739)were performed in n=1264 patients.There was no statistically significant difference in the rate of deep(OR 0.74%(5/675)vs NR 0.50%(3/598);fishers exact test P=0.72),nor superficial SSIs(OR 2.07%(14/675)vs NR 1.50%(9/598);chi-squared test P=0.44)at 2 years postoperatively.With propensity score weighting and an interrupted time series analysis,there was also no difference in SSI rates between both groups[RR 0.88(95%CI 0.61 to 1.30)P=0.46].CONCLUSION A weight-adjusted regime,with a reduction in number of post-operative doses had no adverse impact on SSI incidence in this population.
文摘BACKGROUND Over the past years,patient specific instrumentation(PSI)for total knee arthroplasty(TKA)has been implemented and routinely used.No clear answer has been given on its associated cost and cost-effectiveness when compared to conventional instrumentation(CI)for TKA.AIM To compare the cost and cost-effectiveness of PSI TKA compared to CI TKA.METHODS A literature search was performed in healthcare,economical healthcare,and medical databases(MEDLINE,EMBASE,CINAHL,Web of Science,Cochrane Library,EconLit).It was conducted in April 2021 and again in January 2022.Relevant literature included randomised controlled trials,retrospective studies,prospective studies,observational studies,and case control studies.All studies were assessed on methodological quality.Relevant outcomes included incremental cost-effectiveness ratio,quality-adjusted life years,total costs,imaging costs,production costs,sterilization associated costs,surgery duration costs and readmission rate costs.All eligible studies were assessed for risk of bias.Meta-analysis was performed for outcomes with sufficient data.RESULTS Thirty-two studies were included into the systematic review.Two were included in the metaanalysis.3994 PSI TKAs and 13267 CI TKAs were included in the sample size.The methodological quality of the included studies,based on Consensus on Health Economic Criteria-scores and risk of bias,ranged from average to good.PSI TKA costs less than CI TKA when considering mean operating room time and its associated costs and tray sterilization per patient case.PSI TKA costs more compared to CI TKA when considering imaging and production costs.Considering total costs per patient case,PSI TKA is more expensive in comparison to CI TKA.Meta-analysis comparing total costs for PSI TKA,and CI TKA showed a significant higher cost for PSI TKA.CONCLUSION Cost for PSI and CI TKA can differ when considering distinct aspects of their implementation.Total costs per patient case are increased for PSI TKA when compared to CI TKA.
文摘BACKGROUND Metallosis is the result of metallic wear debris in the soft tissues and is associated to both local and systemic inflammatory response.Metallosis has been reported after total hip and total knee arthroplasty(TKA),but rarely after a unicompartimental knee arthroplasty(UKA).In the context of UKA metallosis,surgeons often opt for revision using a TKA.However,in this paper,the authors successfully treated UKA revising the metal back only.CASE SUMMARY Prior to treat our patient we conducted a literature research through which we identified eleven cases of metallosis after UKA,ten(90.9%)were treated revising using though a TKA.Only one case was managed through a uni-on-uni revision,reporting high knee function.Our patient complained worsening pain and function after a snap occurred at 16 mo after UKA implantation.At 18 mo following surgical debridment and uni-on-uni revision surgery,our patient exhibited a relevant improvement in Oxford Knee Score and a reduction of metal ion levels in the blood.CONCLUSION Our study highlights that in case of metallosis after UKA,the treatment may be based on surgical debridement and just revising the mobilized components.
基金Supported by Fundamental Research Grant Scheme grant from the Malaysia’s Minister of Higher Education,FRGS/1/2021/SKK0/UKM/02/15Ethical approval for this study was obtained from the UKM ethics committee(reference number:JEP-2022-105).
文摘BACKGROUND The study sought to understand the self-management strategies used by patients during the postponement of their total knee arthroplasty(TKA)procedure,as well as the associations between the length of waiting time,pain,and physical frailty and function.The study focused on individuals aged 50 years and above,as they are known to be more vulnerable to the negative impacts of delayed elective surgery and rehabilitation.This study hypothesizes that delayed TKR due to coronavirus disease 2019(COVID-19)will bear negative effect in self-management,pain,and physical frailty and function in older adults.AIM To investigate the effects of COVID-19 pandemic on self-management,pain,and physical function in older adults awaiting TKA in Malaysia.METHODS This cross-sectional study has the data of participants,who matched the criteria and scheduled for TKA for the first time,extracted from the TKA registry in the Department of Orthopaedics and Traumatology,Hospital Canselor Tuanku Mukhriz.Data on pain status,and self-management,physical frailty,and instrumental activities daily living were also collected.Multiple linear regression analysis with a significant level of 0.05 was used to identify the association between waiting time and pain on physical frailty and functional performance.RESULTS Out of 180 had deferred TKA,50%of them aged 50 years old and above,80%were women with ethnic distribution Malay(66%),Chinese(22%),Indian(10%),and others(2%)respectively.Ninety-two percent of the participants took medication to manage their pain during the waiting time,while 10%used herbs and traditional supplements,and 68%did exercises as part of their osteoarthritis(OA)self-management.Thirty-six participants were found to have physical frailty(strength,assistance with walking,rising from a chair,climbing stairs,and falls questionnaire score>4)which accounted for 72%.Increased pain was associated with physical frailty with odds ratio,odds ratio(95%confidence interval):1.46(1.04-2.05).This association remained significant even after the adjustment according to age and self-management.CONCLUSION While deferring TKA during a pandemic is unavoidable,patient monitoring for OA treatment during the waiting period is important in reducing physical frailty,ensuring the older patients’independence.
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Objective: To investigate the clinical efficacy of the cement-screw technique in repairing tibial plateau bone defects in total knee arthroplasty (TKA) recipients and summarize the preoperative prehabilitation strategies for such surgeries. Methods: A total of 33 TKA recipients (45 knees) in our department underwent repair of unilateral or bilateral tibial defects using the cement-screw technique. The subjects were divided into two groups based on the differences in preoperative interventions. The control group received routine preoperative health education according to the consensus, while the observation group received instructive and standardized prehabilitation exercises for four weeks in addition to the routine education. Scale scores, intraoperative parameters, and postoperative recovery indicators were recorded at different time pointsand subjected to statistical analysis for intra-group and inter-group differences. All subjects underwent long-term follow-up for at least 24 months. Results: Within each group at different time points, there were statistically significant differences in VAS, ROM, and HSS scores (p Conclusions: Cement-screw technique for repairing tibial plateau bone defects in TKA recipients can significantly relieve pain, and improve joint function. Prehabilitation can improve preoperative rehabilitation reserves in these patients, accelerate postoperative recovery, and contribute to better short-term clinical outcomes.
文摘Mechanically aligned total knee arthroplasty (TKA) for valgus knee is considered a “challenging surgery.” Recently, the kinematic alignment (KA) method has gained attention. This study aimed to present objective clinical data, such as intraoperative balance assessment and radiographic evaluation of postoperative lower extremity alignment after TKA using the KA method for valgus deformity. Twenty-one TKA knees (mean age, 74 years;2 males, 19 females) with KA for severe valgus deformity (hip-knee-ankle-angle ≥ 10°) performed at our department in the past 3 years were included in this study. Intraoperative gap and balance measurements and postoperative radiographic evaluation were performed. A total arc of range of motion was achieved up to 98% of preoperative values at 3 weeks postoperatively. Intraoperative gap and balance were stable throughout the entire range of motion. In addition, there were no statistically significant differences in either balance or gap values at each flexion angle. KA TKA is a “simple surgery” rather than a “challenging surgery” because additional soft tissue procedures are not required, operative time is short, intraoperative and postoperative balance is very stable, and a good alignment is achieved. This procedure may relieve surgeons of the stress of TKA for valgus deformities.
文摘<span style="font-family:""><span style="font-family:Verdana;">Unicondylar Knee Arthroplasty (UKA) is an early alternative surgical procedure for the unicondylar osteoarthritis or damaged knee joint with artificial </span><span style="font-family:Verdana;">prosthesis for the release of disabling painful condition and restoring the</span><span style="font-family:Verdana;"> normal knee functions. Minimally UKA is one of the recent and the majority successful procedures in modern orthopedics for the osteoarthritis which is spreading throughout the worldwide. Recently, many orthopedic surgeons are expanding their abilities in this field. However, it needs good knowledge and well experience for the successful clinical outcomes. The minimal invasive approach is more efficient for short hospital stay and faster postoperative recovery with low morbidity of the patients after UKA. The aim of this article is to emphasize the steps in UKA based on modern facts: function of knee joint, diagnosis, less invasive approach for medial condylar replacement, radiographic evaluation, and earlier recovery, selecting the patient and implant survivorship with review of surgery.
文摘BACKGROUND There is a lack of studies on the effects of enhanced recovery after surgery(ERAS)with multidisciplinary collaboration on the nursing outcomes of total knee arthroplasty(TKA).AIM To explore the effect of ERAS with multidisciplinary collaboration on nursing outcomes after TKA.METHODS We retrospectively analyzed the clinical data of 80 patients who underwent TKA at a tertiary hospital between January 2021 and December 2022.The patients were divided into two groups according to the nursing mode:the ERAS group(n=40)received ERAS with multidisciplinary collaboration,and the conventional group(n=40)received routine nursing.The following indicators were compared between the two groups:length of hospital stay,hospitalization cost,intraoperative blood loss,hemoglobin level 24 h after surgery,visual analog scale(VAS)score for pain,range of motion(ROM)of the knee joint,Hospital for Special Surgery(HSS)knee score,and postoperative complications.RESULTS The ERAS group had a significantly shorter length of hospital stay,lower hospitalization cost,less intraoperative blood loss,higher hemoglobin level 24 h after surgery,lower VAS score for pain,higher knee joint ROM,and higher HSS knee score than the conventional group(all P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).CONCLUSION Multidisciplinary collaboration with ERAS can reduce blood loss,shorten hospital stay,and improve knee function in patients undergoing TKA.
文摘Background: Total knee arthroplasty (TKA) is a highly complex and effective surgery even though its perioperative bleeding may increase the need for blood transfusion and its associated infection risk, cardiovascular overload, increased costs, and mortality. As the tourniquet reduces intraoperative bleeding, it may be associated with postoperative bleeding, venous thrombosis, and distal ischemia. The reperfusion may trigger a local and systemic inflammatory response. Anesthetic preconditioning (APC) with sevoflurane minimizes ischemia-reperfusion syndrome (IRS). This study evaluated the effects of APC with sevoflurane on perioperative bleeding in TKA. Methods: We allocated 30 patients into two groups: a sevo group (sevoflurane 2% for 15 minutes before the tourniquet) and a control group (propofol infusion). Laboratory tests were collected right before the tourniquet (LAB PRE, in the operating room) and after its release at four moments: LAB POST (immediately after), LAB 2 (two hours after), LAB 12 (12 hours after), and LAB 24 (24 hours after). The volume of the suction drain was measured at one, two, 12, and 24 hours after the end of the surgery. Antifibrinolytics were not administered. Results: There was no statistically significant difference in bleeding-related variables, such as drained volume and hemoglobin and hematocrit measurements. Drainage volume was higher in the first two hours after the procedure, while hematocrit decreased pre- to postoperatively and between two and 12 hours post-procedure. Conclusion: Sevoflurane as an anesthetic preconditioning did not reduce postoperative bleeding in TKA surgery.
基金Natural Science Foundation of Xinjiang Uygur Autonomous Region(No.2019D01C244)。
文摘Objective: To study the safety and efficacy of concurrent bilateral total knee arthroplasty orstaged bilateral total knee replacement using meta-analysis. Methods: The databases of ChinaWanfang, CNKI, PubMed, Cochrane Library, and Web of Science were searched conducted formeta-analysis of the extracted data using Review Manager 5.3 software. Results: ①A total of 18retrospective cohort studies were included, 72 831 patients in the same period group and 103595 patients in the staging group. ②The results of meta showed that in the staging group, theincidence of postoperative cardiac complications[OR= 1.21, 95%CI=(1.10~1.34), P<0.000 1] ,neurological complications[OR=1.67, 95%CI=(1.29~2.16), P<0.000 1], deep vein thrombosis[OR=1.38, 95%CI(1.27~1.50), P<0.000 01], mortality[OR=2.18, 95%CI=(1.67~2.84),P<0.000 01] and perioperative blood loss [OR=246.75, 95%CI=(233.30~260.20)] were lessthan those in the same period group (P<0.000 01);The postoperative deep infection rate in thesame period group [OR=0.61, 95%CI=(0.52~0.71), P<0.000 01] was lower than that in thestaging group;The postoperative superficial infection rate [OR=0.96, 95%CI=(0.66~1.40)],revision rate of joint replacement [OR= 1.04, 95%CI=( 0.96~1.12)], HSS score [OR=0.10,95%CI=(-0.61~0.80), P=0.79] and knee joint activity score [OR=-0.23, 95%CI=(-1.25~0.78)]were not statistically significant between the two groups(P>0.05).Conclusion: Stagingbilateral total knee replacement can more effectively reduce the incidence of perioperativecomplications and reduce the amount of blood transfusion, while concurrent bilateral total kneereplacement can reduce the rate of deep infection. To further compare the efficacy and safety ofconcurrent or staged bilateral total knee arthroplasty, further studies must be conducted in theform of a randomized clinical trial to evaluate the results mentioned in this meta-analysis.
文摘BACKGROUND Bilateral one-stage total knee arthroplasty(BTKA)is now in greater use as an alternative option for patients with bilateral end-stage knee arthropathy.However,postoperative pain and disablement during convalescence from BTKA,and procedure-related complications have been concerning issues for patients and surgeons.Although some studies reported that BTKA in selected patients is as safe as the staged procedure,well-defined guidelines for patient screening,and perioperative care and monitoring to avoid procedure-related complications are still controversial.AIM To compare the perioperative outcomes including perioperative blood loss(PBL),cardiac biomarkers,pain intensity,functional recovery,and complications between unilateral total knee arthroplasty(UTKA)and BTKA performed with a similar perioperative protocol.METHODS We conducted a retrospective study on consecutive patients undergoing UTKA and BTKA that had been performed by a single surgeon with identical perioperative protocols.The exclusion criteria of this study included patients with an American Society of Anesthesiologists score>3,and known cardiopulmonary comorbidity or high-sensitivity Troponin-T(hs-TnT)>14 ng/L.Outcome measures included visual analogue scale(VAS)score of postoperative pain,morphine consumption,range of knee motion,straight leg raise(SLR),length of stay(LOS),and serum hemoglobin(Hb)and hs-TnT monitored during hospitalization.RESULTS Of 210 UTKA and 137 BTKA patients,those in the BTKA group were younger and more predominately female.The PBL of the UTKA vs BTKA group was 646.45±272.26 mL vs 1012.40±391.95 mL(P<0.01),and blood transfusion rates were 10.48%and 40.88%(P<0.01),respectively.Preoperative Hb and body mass index were predictive factors for blood transfusion in BTKA,whereas preoperative Hb was only a determinant in UTKA patients.The BTKA group had significantly higher VAS scores than the UTKA group at 48,72,and 96 h after surgery,and also had a significantly lower degree of SLR at 72 h.The BTKA group also had a significantly longer LOS than the UTKA group.Of the patients who had undergone the procedure,5.71%of the UTKA patients and 12.41%of the BTKA patients(P=0.04)had hs-TnT>14 ng/L during the first 72 h postoperatively.However,there was no difference in other outcome measures and complications.CONCLUSION Following similar perioperative management,the blood transfusion rate in BTKA is 4-fold that required in UTKA.Also,BTKA is associated with higher pain intensity at 48 h postoperatively and prolonged LOS when compared to the UTKA.Hence,BTKA patients may require more extensive perioperative management for blood loss and pain,even if having no higher risk of complications than UTKA.
基金the National Health and Family Planning Commission of the People’s Republic of China(CN)program(201302007).
文摘Background:Postoperative care has been evolving since the concept of enhanced recovery after surgery(ERAS)was introduced in China.This study aimed to evaluate the effects of early ambulation within 24h after unilateral total knee arthroplasty(TKA)on postoperative rehabilitation and costs in a Chinese population.Methods:This cohort study of patients with knee osteoarthritis who had undergone TKA at 24 large teaching hospitals between January 2014 and November 2016 involved 2687 patients who began ambulating within 24h(Group A)and 3761 patients who began ambulating later than 24h(Group B).The outcome measurements,such as length of stay(LOS),total hospitalization costs,dynamic pain level,knee flexion range of motion(ROM),results of the 12-Item Short Form Survey(SF-12),incidence of thromboembolic events and other complications,were recorded and compared.Results:The early ambulation group(Group A)had a shorter LOS and lower hospitalization costs and pain levels than the late ambulation group(Group B).There was a favorable effect in enhancing ROM for patients in Group A compared with patients in Group B.In Group A,patients had significantly higher postoperative SF-12 scores than those in Group B.The incidence of deep venous thrombosis(DVT)and pulmonary infection was significantly lower in Group A than in Group B.The incidence of pulmonary embolism(PE)and other complications did not differ between the two groups.Conclusions:Early ambulation within 24h after TKA was associated with reduced LOS,improved knee function,lower hospitalization costs and lower incidence of DVT and pulmonary infection in the Chinese population.
基金the National Natural Science Foundation of China(Nos.11872095,11702110)the Natural Science Foundation of Jilin Province(No.20200201260JC)the Graduate Innovation Fund of Jilin University(No.101832018C194)for financial support.
文摘Porous structure in orthopedic prosthesis may reduce micromotion and increase the service life of implants.The purposes of this study were to compare the influence of the tibial stems with solid and porous structures in Total Knee Arthroplasty(TKA)on knee joint and prostheses,and to improve the mechanical stability of the host bone by seeking favorable structure for the tibial stem.The Finite Element(FE)models of TKA knee with four different structures in the middle segment of the tibial stem(i.e.,solid,cubic,truncated cubic,and octahedral structures)were constructed.The distributions of von Mises stress in the knee joint,tibial prosthesis and proximal tibia,and the compressive stresses of the tibial prosthesis and ultra-high-molecular-weight polyethylene for the four FE models were analyzed.The results showed that the tibial stem filled with the octahedral structure has the best mechanical performance among the above four types of tibial stems.It could effectively reduce the stress concentration and stress shielding effects,and provide an improved mechanical environment for knee joint after TKA.This study would shed some lights on the design and fabrication of porous implants targeted to biomedical applications.
文摘BACKGROUND Patellar tendon rupture after total knee arthroplasty(TKA)is a catastrophic complication.Although the occurrence of this injury is rare,it can lead to significant dysfunction for the patient and is very tricky to deal with.There has been no standard treatment for early patella tendon rupture after TKA,and long-term follow-up data are lacking.AIM To introduce a direct repair method for early patella tendon rupture following TKA and determine the clinical outcomes and complications of this method.METHODS During the period of 2008 to 2021,3265 consecutive TKAs were retrospectively reviewed.Twelve patients developed early patellar tendon rupture postoperatively and were treated by a direct repair method.Mean follow-up was 5.7 years.Demographic,operative,and clinical data were collected.The clinical outcomes were assessed using the Western Ontario and McMaster Universities(WOMAC)score,the Hospital for Special Surgery(HSS)score,knee range of motion,extensor lag,and surgical complications.Descriptive statistics and paired t test were employed to analyze the data.RESULTS For all 12 patients who underwent direct repair for early patellar tendon rupture,3 patients failed:One(8.3%)for infection and two(17.6%)for re-fracture.The two patients with re-fracture both underwent reoperation to reconstruct the extensor mechanism and the patient with infection underwent revision surgery.The range of motion was 109.2°±10.6°preoperatively to 87.9°±11°postoperatively,mean extensor lag was 21°at follow-up,and mean WOMAC and HSS scores were 65.8±30.9 and 60.3±21.7 points,respectively.CONCLUSION This direct repair method of early patellar tendon rupture is not an ideal therapy.It is actually ineffective for the recovery of knee joint function in patients,and is still associated with severe knee extension lag and high complication rates.Compared with the outcomes of other repair methods mentioned in the literature,this direct repair method shows poor clinical outcomes.
文摘BACKGROUND Knee osteoarthritis is the most prevalent form of osteoarthritis and is becoming the main reason for progressive pain in knee joints. Arthroscopy combined with unicondylar knee arthroplasty(UKA) is one of the effective methods for the treatment of severe unicompartmental knee arthritis. This surgical approach gives us the capacity to explore all the articular cavities and plays a vital role in UKA patient selection. However, some scholars think that the surgical procedure is traumatic and may increase the rate of surgical infection, and its clinical efficacy needs further study.AIM To compare the clinical effect of arthroscopy combined with UKA and UKA alone for patients suffering from unicompartmental osteoarthritis(OA).METHODS A retrospective study was conducted on patients who were diagnosed with unicompartmental OA(Kellgren–Laurence grade ≥ III) and underwent UKA between October 2012 and November 2006. The patients were followed at 3, 6,and 12 mo and every 2 years thereafter. During each follow-up, the radiographic materials, the range of motion of knee and hospital for special surgery(HSS)score, knee society score and knee function score as recorded, and the modes and time of failure and revision details were collected as well.RESULTS Data on 104 patients(118 knees), including 54 patients(60 knees) in the arthroscopy combined with UKA group(group A) and 51(58 knees) in UKA alone group(group B) were collected during an average follow-up duration of 7.25 years, excluding the cases who were lost to follow-up. At the final follow-up,3(5.0%) of 60 knees in group A compared with 4(6.9%) of 58 knees in group B failed and converted to total knee arthroplasty, with no statistically significant difference between the two groups(P = 0.933). The percentage of patients receiving blood transfusion was 40% in group A, significantly lower than that in group B(67.2%;P = 0.003). Total volume of blood transfusion in group A was also significantly lower than that of group B(P = 0.001). Both groups improved significantly after operation in clinical symptoms and functions. HSS score, knee society score, and knee function score increased significantly at the latest followup compared to pre-operation in group A, from 59.6 ± 10.9 to 82.7 ± 9.3(mean difference [MD], 23.2;95%CI: 19.3-27.0;P = 0.000), 47.3 ± 6.3 to 76.2 ± 13.1(MD,28.9;95%CI: 25.1-32.7;P = 0.000), and 57.5 ± 6.3 to 75.1 ± 19.6(MD, 17.5;95% CI:12.1-23.0;P = 0.000);and in group B, from 59.3 ± 15.6 to 84.3 ± 10.1(MD, 23.7;95%CI: 18.9-28.5;P = 0.000), 49.1 ± 9.2 to 75.1 ± 13.2(MD, 24.7;95%CI: 19.9-29.5;P= 0.000), and 59.3 ± 9.0 to 77.4 ± 13.8(MD, 17.2;95%CI: 12.8-21.6;P = 0.000).CONCLUSION Arthroscopy combined with UKA and UKA alone both provide benefits in clinical symptom improvement and alignment correction. Arthroscopy combined with UKA does not increase the infection probability and surgical complications,and has an advantage in reducing the total volume of blood transfusion and the percentage of patients receiving blood transfusion.
