Objective To make a retrospective analysis on an early clinical outcome of total knee arthroplasty (TKA) for the knees with different degrees of flexion-contracture deformities. Methods Ninety-seven knees of 65 patients undergoing total knee arthroplasty with the Scorpio posterior-stabilized knee prosthesis from January 2000 to December 2003 were reviewed, including 51 osteoarthritis patients (74 knees) and 14 rheumatoid arthritis patients (23 knees). Thirtythree patients underwent unilateral TKA, and 32 patients underwent bilateral TKA. The average range of motion (ROM) before operation was 82.8°(range, 5-140°).According to the preoperative flexion-contracture degrees of the knees, these patients were divided into 2 groups, group A and group B. Group A consisted of the patients with flexioncontracture less than 20° (range, 0-15°), and group B consisted of the patients with flexion-contracture not less than 20° (range, 20-60°). In group A, the average flexion-contracture degree, ROM, KSS (knee society score), and function score were 10.7±8.0°, 104.6±20.0°, 29.1±18.0, and 32.6±20.7, respectively. But the corresponding data were much worse ingroup B than in group A, which were 28.2±7.8°, 60.8±26.6°, 12.1±13.2, and 26.8±18.1. All the operations were primary total knee arthroplasty, and they were performed by the same group of surgeons. The time for the prosthesis installed lasted for 25.6 minutes, and the average tourniquet time was 34.7 minutes. Three or four days after operation, the patients began the continuous passive motion (CPM) and active functional exercise of the knee.Results The patients were followed up for an average of 2 years and 7 months(range, 8 mon-3.5 yr). During the follow-up period, the average flexion-contracture degree, ROM, KSS, and function score in group A were 0.4±2.1°, 108.6±19.0°, 82.1±13.8, and 72.3±29.1, respectively; and the corresponding data in group B were 1.3±3.2°, 986±16.4°, 75.9±8.2, and 81.4±26.9, respectively. There was no significant difference between the 2 groups. No revision or deep infection was found. Conclusion The curative effect is mainly determined by the surgeon’s good operational skills, rich clinical experience, and familiarity with the prosthesis, and it is not influenced by severity of the knee flexioncontracture deformity. The knee ROM after TKA, which has a “toward middle ROM”phenomenon, is influenced by many clinical factors. It is very important for the patientto perform a functional exercise of the knee as early as possible after operation.
ObjectivesTo systematically review the efficacy and safety of controlled hypotension for total hip or knee replacement.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on controlled hypotension for total hip or knee replacement from inception to September 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 15 RCTs involving 854 patients were included. The results of meta-analysis showed that compared with no controlled hypotension during surgery, controlled hypotension could reduce intraoperative blood loss (MD=−267.35, 95%CI −314.54 to −220.16, P<0.000 01), allogeneic blood transfusion (MD=−292.84, 95%CI −384.95 to −200.73, P<0.000 01), and 24 h postoperative mini-mental state examination (MMSE) score (MD=−1.08, 95%CI −1.82 to −0.34, P=0.004). However, there were no significant differences in 96 h postoperative MMSE score (MD=−0.11, 95%CI −0.50 to 0.28, P= 0.57) and intraoperative urine volume (MD=57.93, 95%CI −152.57 to 268.44, P=0.59).ConclusionsThe current evidence shows that controlled hypotension during total hip or knee replacement can reduce intraoperative blood loss and allogeneic blood transfusion. Furthermore, there is no obvious effect on the maintenance of blood perfusion in important organs, despite certain effects on the postoperative cognitive function, which can be recovered in short term. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To analyze the effect of the posterior cruciate ligament (PCL) retaining or not on knee-joint proprioception by comparing the proprioceptive difference between PCL retaining and no PCL retaining in total knee arthroplasty (TKA). Methods Between June 2009 and June 2010, 38 osteoarthritis patients meeting the inclusion criteria were divided into PCL retaining group (group A, n=19) and PCL-substituting group (group B, n=19) according to the random number table. There was no significant difference in gender, age, disease duration, the range of motion of the knee between 2 groups (P gt; 0.05). The effectiveness and the knee-joint proprioception were separately assessed by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score and the passive angle reproduction test (30, 60, and 90° of knee flexion) preoperatively and 12 months postoperatively. Results All incisons healed by first intention, without complications of infection, fracture, and deep vein thrombosis of lower limb. The patients were followed up 12-17 months (mean, 14.1 months). The knee function after operation was obviously improved when compared with preoperative one; significant differences were observed in the WOMAC scores and the results of passive angle reproduction test between at preoperation and at 12 months after operation (P lt; 0.05), but no significant difference was found between group A and group B (P gt; 0.05). Conclusion Whether PCL retaining or not in TKA both can improve knee-joint proprioception, and no obvious difference between them.
【Abstract】 Objective To explore the cause of the perioprative period compl ication of scandinavian total anklereplacement(STAR) and to summarize the experience in the treatment and prevention. Methods From March 1999 toNovember 2006, 35 patients were given total ankle replacement(TAR) with STAR system. There were 19 males and 16 femaleswith an average age of 50.5 years (27 to 68 years), including 12 cases of posttraumatic arthritis, 8 cases of osteoarthritis and 15cases of rheumatoid arthritis. All patients had pain of ankle joint, swell ing and l imitation of joint motion. The disease coursewas 9-64 months. The curative effect was estimated by Kofoed total ankle scoring system. The mean preoperative ankle scorewas 29(6-48); the mean pain score was 18.3(0-35); the mean function score was 11.7(6-18); and the mean activity score was9.2(3-12). The type of all compl ications were record, and its cause, prevetion and treatment were analyszed. Results Thirtythreepatients achieved heal ing by first intention, 2 achieved delayed union because of infection. Twenty-eight patients werefollowed up 3-80 months (mean 43.5 months). Medial malleolus fracture occurred in 2 cases, unstable ankle joint introversion in2 cases, l imitation of ankle dorsiextension in 1 case and 1 case had hypoesthesia at intermediate dorsal skin of foot and 3rd-5thmetatarsal skin without obvious dysfunction; all were treated with symptomatic medication. The postoperative mean ankle scorewas 85.5 (58-95); the mean pain score was 48.3(35-50); the mean function score was 20.7(18-30); the mean activity score was17.2(16-20). There were statistically significant differences when compared with preoperative score(P lt; 0.01). The cl inical resultswere excellent in 16 patients, good in 9 patients and fair in 3 patients. The X-ray films showed no loosening and subsidence ofprosthesis. Conclusion Although STAR can retain the functions of the operated joint, it has its special compl ications. It isimportant to obey operation principle with proficient operative technique, to strictly control surgical indication and to intensifyperioperative period treatment so as to decrease the compl ications.
Objective To summarize the effect of biofilm (BF) on the occurrence of prosthetic joint infection (PJI). Methods The domestic and abroad original l iterature in recent years about the relationship between BF and PJI was reviewed. Results Infection is a critical compl ication for prosthetic joint replacement. Basic research showes one of the reasons for PJI is BF. After adherence of the bacteria to the surface of prosthetic joint, BF forms through a series of regulation andcontrol system. And it lead to the occurrence of PJI. Recently a lot of progress have been made in the research fields of BF related PJI, which have covered aetiology, diagnosis, treatment, and prevention. Different studies show that BF has close relationship with PJI. Conclusion BF is proved to have close relationship with PJI. It is important on cl inical significances to diagnose, treat, and prevent PJI.
Objective To evaluate the mid-term effectiveness of two-stage hip prosthesis revision in the treatment of infection after hip arthroplasty. Methods Between April 2002 and November 2006, 12 cases of infection after hip arthroplasty were treated. There were 5 males and 7 females, aged from 47 to 72 years (mean, 59.8 years). The femoral head arthroplasty wasperformed in 2 cases and total hip arthroplasty in 10 cases. Infection occurred 1 to 67 months after arthroplasty. According to the Segawa classification criteria, infections included type 2 in 1 case, type 3 in 2 cases, and type 4 in 9 cases. The preoperative Harris score was 36.7 ± 6.1. Nine cases had elevated C reactive protein and 10 cases had elevated erythrocyte sedimentation rate. The results of bacterial culture were positive in 8 cases and negative in 4 cases. After the removal of the infected prosthesis and thorough debridement, antibiotic-loaded cement spacers or infected therapeutic temporary prosthesis were used as placeholders, and then the anti-infection treatments were given after operations; two-stage hip prosthesis revisions were performed 3 to 10 months after debridement. Results In 1 patient who failed to control infection after debridement, infection was controlled after the second debridement and the antibiotic-loaded cement spacer as placeholder. Other patients achieved heal ing of incision by first intention, and no compl ication such as deep venous thrombosis and nerve injury occurred. All patients were followed up 3 to 8 years after revision (mean, 5.4 years). During the follow-up, no infection recurrence and joint dislocation occurred. Dull pain was present in 2 cases during activity and mild claudication in 3 cases at last follow-up. The Harris score was 81.6 ± 4.5, showing significant difference (t=52.696, P=0.000) when compared with preoperative score. The X-ray films showed that noprosthesis loosening and obvious subsidence were observed, and bone graft healed. Conclusion The two-stage hip prosthesis revision has good infection control rate and mid-term effectiveness in treatment of infection after hip arthroplasty.
Objective Use the method of Cochrane systematic review to evaluate the difference of two fixation methods of femoral component in hip arthroplasty in order to choose the most appropriate fixation method. Methods Searches was applied to the following electronic databases: Chinese Bimedical Database (CBM) (1979 to Dec. 2004), MEDLINE (1966 to Feb. 2005), EMBASE (1984 to 2004) and The Cochrane Library (Issue 4, 2004). We handsearched Chinese Journal of Orthopaedy, the Journal of Bone and Joint Injury and Orthopaedic Journal of China (from establishment to Feb. 2005). Randomized controlled trials (RCT) were indentified and we applied RevMan 4.2 for statistical analysis. Results Nine RCTs involving 1 075 hips were included. The combined results of meta-analysis showed that the embolization occurred more commonly in the first and second generation cemented group (OR 0.02, 95%CI 0 to 0.11, P＜0.000 01), but this difference was not seen between the third generation cemented group and uncemented group (OR 0.80, 95%CI 0.36 to 1.78, P=0.58); The subsidence of femoral component (OR 12.20, 95%CI 3.58 to 41.54, P＜0.000 1) and the cortical hypertrophy (OR 69.97, 95%CI 27.88 to 175.57, P＜0.000 01) were more commonly found in uncemented group; the thigh pain occurrence, the revision for the femoral component’s cause and heterotopic ossification were found no significant difference in the two groups. Conclusions Compared with noncemented group, we found that cemented fixation may be more associated with embolism in the first and second generation cemented technique and less with femoral subsidence and cortical hypertrophy. There was no significant difference in embolization between the third generation cemented technique group and noncemented group. However, more randomized controlled trials to evaluate the occurrence of the postoperative thigh pain, revision and heterotopic ossification are needed.