【Abstract】 Objective To investigate the qual itative rotation al ignment of components in total knee arthroplastyand the accuracy and the effectiveness of Bone Morphing computer assisted system when qual itatively practicing. MethodsFrom November 2002 to June 2003, 21 patients with three compartments osteoarthritis(21 knees) were treated by primarytotal knee arthroplasty after the conservative medical treatment failed, with the assistance of a “Bone Morphing” CeravisionSystem, implanted posterior stabil ized total knee prosthesis. Twenty-one patients included 5 males (5 knees) and 16 females (16knees) with an average age of 72.4 years (64-79 years) . The locations were left knee in 10 cases and right knee in 11 cases. Thepatients suffered from knee pain and l imitation of movement from 2 to 10 years. There were 14 genu varum and 7 genu valgumpreoperatively. The relative preoperative, intraoperative and postoperative data from cl inical check-up, the X-ray films and theintraoperative components rotational al ignment real-time records in CD Rom were analyzed. Results All operative incisionshealed up by first intension. Twenty-one patients were followed up 12-16 months(mean 13.3 months). For the achievement ofproper lower l imb al ignment and normal frontal laxity of knee, rotational al ignment of femoral components was from internalrotation (IR)1° to external rotation (ER) 5°, tibial components from IR 0° to ER 5°. In patients with genu varum, the rotationalal ignment of the femoral components was ER 1°- ER 5°, of tibial components ER 2°- ER 5°. In patients with genu valgum, the rotationalal ignment of femoral components was IR 1°- ER 4°, of tibial components IR 0°-ER 4°. After 3 months of operation, themean flexion angle measured as range of motion (ROM) was 115°(105-130°), the frontal laxsity measured as 0.2-0.5 cm (mean0.27 cm) of internal laxity and 1.0-2.5 cm (mean 1.7 cm) for external laxity, there were no knee pain, paterllar instabil ity or dislocationand abnormal knee frontal laxity. Conclusion Using Bone Morphing computer-assisted system can optimise theindividual components rotation al ignment accurately.
Objective To investigate the rotational mismatch of total kneereplacement with medial 1/3 of tibial tuberosity as bony landmark in osteoarthritic patients with varus or valgus deformity. Methods Axial images on computed tomography of 62 knees (including 55 varus deformities and 7 valgus deformities) in 32 Chinese osteoarthritic patients who had total knee arthroplasty were analyzed, compared with that of 10 healthy knees. On images of the distal femur, the angle between the lines of surgical epicondylar axis(SEA) and posterior condylar axis was measured as posterior condylar angle (PCA), and on images of the proximal tibia, a baseline for the anteriorposterior axis of each component was drawn based on the SEA for the femur and the medial 1/3 of the tibial tuberosity for the tibia. The angle between these lines (Angle α) was defined as therotational mismatch between the components when they were aligned to the anatomic landmarks of each bone. Results The sulcus of medial epicondyle of femur could be identified on CT images of over 80% osteoarthritic knees; the median value of PCA was +2.36°, with an individual variation of 0° to +7.5°. Angle α was +6.45±3.68°(range, 0° to +11.8°) in 10 healthy knees, which increased significantly to +10.85±10.47°(range, 0° to +28.1°)in 55 varus knees (P＜0.05), which also increased significantly to +11.6±7.3°(range, -6.5° to +26.8°) in 7 valgus knees (P＜ 0.05). Conclusion With the medial 1/3 of the tibial tuberosity as the rotational landmark for the tibial component, there was a tendency to align the tibial component in external rotational position relative to the femoral component in knees with normal alignment, the rotational mismatch increased in Chinese osteoarthritic knees with varus and valgus deformity.
A software and hardware platform for gait simulation and system evaluation for lower limb intelligent prosthesis is proposed and designed, in order that the wearable symmetry effect of the intelligent knee prosthesis can be quantitatively analyzed by machine test instead of human wear test. The whole-body three-dimensional gait and motion analysis system instrument, a device to collect gait data such as joint angle and stride of adults, was used for extracting simulated gait characteristic curve. Then, the gait curve was fitted based on the corresponding joint to verify the feasibility of the test platform in the experiment. Finally, the developed artificial knee prosthesis was worn on the prosthetic evaluation system to quantitatively analyze the gait symmetry effect. The results showed that there was no significant difference in gait symmetry between the developed knee joints at different speeds, which could reach more than 88%. The simulation and evaluation of the prosthetic gait have good effects on the functional simulation and evaluation of the lower limb intelligent prosthesis.
ObjectiveTo evaluate the arthroscopic treatment effectiveness of popliteal cyst excision in combination with debridement of the knee under local anesthesia by comparing with continuous epidural anesthesia. MethodsBetween June 2002 and January 2013,145 patients with popliteal cyst underwent arthroscopic popliteal cyst excision in combination with debridement of the knee under local anesthesia (local anesthesia group).In addition,51 patients with popliteal cyst were treated with the same surgery under continuous epidural anesthesia between February 2000 and August 2005 served as control group.No significant difference was found in gender,age,side,disease duration,or cyst size between 2 groups (P>0.05).Then,anesthesia time,analgesia effect,anesthesia satisfaction,operation time,bleeding volume,and anesthesia complication were compared between 2 groups.The guidelines of Rauschning and Lindgren were used to assess the effectiveness,and recurrence rate was recorded. ResultsAll incisions healed primarily,no neurological or vascular injury was found.The patients were followed up 1 year and 1 month to 8 years (mean,3.7 years) in local anesthesia group,and 8 years to 13 years and 7 months (mean,10.8 years) in control group.Local anesthesia group had shorter anesthesia time,higher visual analogue scale (VAS) score,shorter operation time,and lower bleeding volume (P<0.05) than control group.Anesthesia satisfaction was reduced in local anesthesia group,but there was no significant difference (χ2=0.071,P=1.000).The anesthesia complication incidence of control group (15.7%,8/51) was significantly higher than that of local anesthesia group (0) (P=0.000).Recurrence was found in 12 patients of local anesthesia group (curative ratio 91.7%) and in 5 patients of control group (curative ratio 90.2%),showing no significant difference (χ2=0.111,P=0.774).According to the guidelines of Rauschning and Lindgren,there were 131 cases of grade 0,13 cases of grade I,and 1 case of grade Ⅱ in local anesthesia group,and 37 cases of grade 0,12 cases of grade I,and 2 cases of grade Ⅱ in control group; significant differences in grading were shown between at pre- and post-operation in 2 groups (Z=-10.683,P=0.000; Z=-6.385,P=0.000),and between 2 groups at post-operation (Z=-3.145,P=0.002). ConclusionCompared with under continuous epidural anesthesia,arthroscopic treatment of popliteal cyst excision under local anesthesia can obtain better results.Under local anesthesia,the condition of nerve and vessel can be timely and dynamically observed.Arthroscopic treatment of popliteal cyst excision in combination with debridement of the knee has the advantages of less trauma,lower recurrence rate,and satisfactory results.
Objective To analyze the impact of ivaroxaban on hidden blood loss and blood transfusion rate after primary total knee arthroplasty (TKA) by comparing with the use of low molecular weight heparin. Methods Between December 2009 and January 2011, the clinical data from 90 patients undergoing primary TKA were retrospectively analyzed. At 12 hours after operation, 45 patients were given ivaroxaban (10 mg/d) in the trial group and low molecular weight heparin injection (0.4 mL/d) in the control group for 14 days, respectively. There was no significant difference in gender, age, disease duration, or range of motion between 2 groups (P gt; 0.05). Results The operation time was (92.32 ± 23.13) minutes in the trial group and (89.81 ± 18.65) minutes in the control group, showing no significant difference (t=0.26, P=0.79). The hidden blood loss was (40.18 ± 14.85) g/L in the trial group and (34.04 ± 12.96) g/L in the control group, showing significant difference (t=2.09, P=0.00); the dominant blood loss was (30.60 ± 2.89) g/L and (28.85 ± 8.10) g/L respectively, showing no significant difference (t= 1.37, P=0.17). The blood transfusion rate was 73.33% (33/45) in the trial group and 55.56% (25/45) in the control group, showing no sigificant difference (χ2=3.10, P=0.08); the transfusion volume was (1.44 ± 1.09) U and (1.06 ± 1.17) U respectively, showing no significant difference (t=1.58, P=0.11). Stress ulcer occurred in 1 case of the trial group; symptomatic deep vein thrombosis of lower extremity and asymptomatic muscular venous thrombosis developed in 1 case and 4 cases of the control group respectively. Conclusion Ivaroxaban has effect on the hidden blood loss after primary TKA, which may increase postoperative blood loss and blood transfusion rate. The changes in hemoglobin should be monitored during the anticoagulant therapy, and the blood volume should be added promptly.
Objective To investigate the safety and feasibility of preoperative non-indwelling catheter in primary unilateral total knee arthroplasty (TKA) without tourniquet . Methods From January 2016 to January 2017, a total of 60 patients undergoing primary unilateral TKA surgery were randomly divided into preoperative non-indwelling catheter group (group NIC, n=30) and indwelling catheter group (group IC, n=30) . The patients in group NIC were not retained catherter, and the patients in group IC were retained catherter. All patients did not use tourniquet. The time of first urination, the volume of first urination, and the occurrence of urine retention, urinary irritation symptoms and urinary tract infection of patients in two groups were analyzed. The incidence of venous thrombosis of the lower extremity was also recorded. Results There were statistical differences (P<0.05) between group NIC and group IC in the time of first urination [(3.2±0.6) vs. (4.5±1.8) hours] and urine volume [(262.5±29.4) vs. (391.6±50.2) mL], but there was no significant difference (P>0.05) between the two groups in urinary retention (6.7% vs. 16.7%), urinary tract irritation (33.3% vs. 23.3%), or urinary tract infection (0.0% vs. 16.7%). Conclusion Preoperative non-indwelling catheter in primary unilateral TKA without tourniquet is safe and feasible.
Objective To explore the technique of the soft tissue balancing in the total knee arthroplasty (TKA) for the patients of rheumatoid arthritis with flexion contracture. Methods From November 1997 to May 2006, 38 patients with rheumatoid arthritis with flexion contracture underwent primary bilateral TKA and balancing of the soft tissues, among whomthere were 8 males and 30 females, aged 48-71 years old (58.2 on average). The course of disease was 28 months-16 years (7.6 years on average). The preoperative flexion contracture was (38.2 ± 11.3)°. The average range of motion (ROM) and HSS score were (49.1 ± 17.8)° and 23.9 ± 16.9, respectively. According to the preoperative flexion-contracture degree of the knees, these patients were divided into 3 levels: 5 patients with ≤ 20°, 26 patients with 20-60° and 7 patients with ≥ 60°. During the TKA procedure, based on the correct osteotomy, different methods of soft tissue balancing were used for different degrees of flexion contracture. The TKA soft tissue treatment was summed up as the releasing of posterior structures and the balancing between medial collateral ligaments (MCL) and lateral collateral ligaments (LCL), etc. Results The flexion contractures in 38 cases were all improved after the operation, among which 33 patients had a complete correction and only 5 patients had a residual flexion contracture of 5-10°. Eight knees suffered from complications within 1 week after operation, among which 3 had subcutaneous superficial infection and 5 had deep vein thrombus (DVT). These patients obtained good heal ing after active treatment. All the 38 patients were followedup for 10 months to 8 years with the median time of 37 months. The postoperative flexion deformity declined to (2.4 ± 5.7)°, and the ROM and HSS scores were (96.3 ± 14.6)° and 81.7 ± 10.4, respectively. There was statistical difference (P lt; 0.05). According to the HSS score, 27 patients (71.05%)were rated as excellent, 6 good (15.79%) and 5 fair (13.16%), and the choiceness rate was 86.84%. Conclusion The balancing of the soft tissue is a major treatment for correction of the flexion contracture, which can avoid bone over-resection during the surgery of TKA. The proper balancing of the soft tissue can not only achieve an obvious correction of the flexion contracture but also effectively improve the range of motion and the functional recovery of the knee joint after TKA.
Objective To investigate the management of extention apparatus and cl inical results of total knee arthroplasty (TKA) of osteoarthritis. Methods Between June 2007 and June 2009, 386 patients (460 knees) with osteoarthritis received TKA, including 216 left knees and 244 right knees. There were 125 males (145 knees) and 261 females (315 knees) with an average age of 60.3 years (range, 58-85 years). The disease duration was 4-12 years (mean, 6.7 years). The X-ray films and CT scanning showed that all patients had femur-tibia joint degeneration and osteophyte formation at the edgeof joint. According to modified Burnett patellar resurfacing indication, whether or not to replace the patellar was determined, and the patellar track was determined by combining no thumb test and towel clamp traction test. Patella resurfacing was performed in 53 cases (56 knees, resurfacing group), no patella resurfacing in 333 cases (404 knees, non-resurfacing group), and lateral retinacular releasing 68 cases (72 knees). The postoperative imaging and knee society score (KSS), patellofemoral compl ications were analyzed. Results All wounds healed by first intention. All the patients were followed up 1-3 years (mean, 26 months). Deep infection occurred in 3 cases (1 case of resurfacing group and 2 cases of non-resurfacing group) at 3-7 months and they were cured after two-stage reversion. Patellofemoral compl ications occurred in 2 cases of resurfacing group (2/56, 3.57%) and in 9 cases of non-resurfacing group (9/404, 2.23%), showing no significant difference (χ2=0.38, P=0.54). There were significant differences in KSS and visual analogue scale (VAS) at 2 and 3 year after operation when compared with before operation (P lt; 0.05). No significant difference in KSS and VAS of resurfacing group and non-resurfacing group were observed at 3 years after operation (P gt; 0.05). Conclusion It is benefit for selective patellar resurfacing and the patellar tract improvement to select patellar resurfacing indication according to the multi-factor assessment and to determine the patellar tract by combining no thumb test and towel clamp traction test, which can reduce the patellofemoral compl ication rate after TKA.
Objective To investigate interleukin-1β (IL-1β), IL-6, and IL-17 levels in both synovial fluid and serum of patients with primary knee medial osteoarthritis (OA) after high tbial osteotomy (HTO). Methods Twenty-six patients with primary knee medial OA undergoing HTO between January 2011 and June 2014 (experimental group) and 30 healthy individuals (control group) were recruited into the study. There was no significant difference in gender, age, and body mass index between 2 groups (P>0.05). The X-ray film was taken to record healing time at osteotomy site, to measure the tibiofemoral angle, and to assess limb alignment after HTO. Visual analogue scale (VAS) pain score and knee society score (KSS) were used to evaluate pain level and function of the knee. The IL-1β, IL-6, and IL-17 concentrations in both plasma and synovial fluid were measured before operation and at 6, 12, and 18 months after operation in the experimental group using ELISA method; the levels in plasma were measured in control group. Results Primary healing of incisions was achieved in patients. All patients were followed up 18-24 months (mean, 21 months). The X-ray film showed osseous healing at osteotomy site at 9-14 weeks (mean, 11.5 weeks). The average tibiofemoral angle was 167.5° (range, 165-170°) after bone healing. Satisfactory limb alignment was obtained in all patients. The postoperative VAS pain score was significantly decreased and KSS score was significantly improved when compared with preoperative scores (P<0.05), but no significant difference was found between different time points after operation (P>0.05). The preoperative plasma and synovial fluid IL-1β, IL-6, and IL-17 concentrations were significantly higher in patients than controls (P<0.05). The postoperative IL-1β, IL-6, and IL-17 concentrations in plasma and synovial fluid were significantly lower than preoperative ones in patients (P<0.05), but the concentrations were significantly higher than those in controls (P<0.05). The postoperative plasma and synovial fluid IL-1β, IL-6, and IL-17 concentrations were significantly declined in patients, but there was no significant difference between different time points after operation (P>0.05). Conclusion HTO can significantly improve the pain symptom and joint function and reduce IL-1β, IL-6, and IL-17 levels in both plasma and synovial fluid of patients with medial compartment knee OA, but these cytokines can not return to normal level.
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.