Objective To compare the short-term effectiveness of “SkyWalker” robot-assisted total knee arthroplasty (TKA) and traditional TKA. Methods A clinical data of 54 patients (54 knees) with TKA who met the selection criteria between January 2022 and March 2022 was retrospectively analyzed. Among them, 27 cases underwent traditional TKA (traditional operation group) and 27 cases underwent “SkyWalker” robot-assisted TKA (robot-assisted operation group). There was no significant difference between the two groups (P>0.05) in terms of gender, age, body mass index, osteoarthritis side, disease duration, and preoperative Knee Society Score (KSS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), visual analogue scale (VAS) score, hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and posterior proximal tibial angle (PPTA). The operative time, intraoperative bleeding volume, surgery-related complications, the KSS, WOMAC, and VAS scores before operation and at 6 months after operation, and Forgotten Joint Score (FJS) at 6 months after operation were recorded. X-ray films were taken to review the prosthesis position and measure HKA, LDFA, MPTA, and PPTA. The differences of the clinical and imaging indicators between before and after operation were calculated and statistically analyzed. ResultsThe operations were completed successfully in both groups. There was no significant difference in the operative time and intraoperative bleeding volume between the two groups (P>0.05). After operation, 1 case of incision nonunion and 1 case of heart failure occurred in the traditional operation group, while no surgery-related complications occurred in the robotic-assisted operation group. The incidences of surgical complications were 7.4% (2/27) in the traditional operation group and 0 (0/27) in the robotic-assisted operation group, with no significant difference (P=0.491). Patients in both groups were followed up 6 months. KSS score, WOMAC score, VAS score, and ROM significantly improved in both groups at 6 months after operation when compared with preoperative ones (P<0.05). There was no significant difference between the two groups (P>0.05) in the differences between the pre- and post-operative values of the clinical indicators and FJS scores at 6 months after operation. X-ray films showed that the lower extremity force lines of the patients improved and the knee prostheses were in good position. Except for LDFA in the robot-assisted operation group, HKA, LDFA, MPTA, and PPTA significantly improved in both groups at 6 months after operation when compared with the preoperative ones (P<0.05). There was no significant difference between the two groups in the differences between the pre- and post-operative values of the radiological indicators (P>0.05). Conclusion The “SkyWalker” robot-assisted TKA is one of the effective methods for the treatment of knee osteoarthritis and had good short-term effectiveness. But the long-term effectiveness needs to be further studied.
Objective To investigate whether different degrees of primary varus knee affect joint function and stability in patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods A clinical data of 160 patients with primary varus knee, who were admitted between January 2020 and December 2021 and met the selection criteria, was retrospectively analyzed. All patients underwent primary ACL reconstruction using autologous single-bundle hamstring tendon. Patients were divided into three groups based on the hip-knee-ankle angle (HKA): group A (64 patients with HKA 0°-3°), group B (55 patients with HKA 3°-6°), and group C (41 patients with HKA 6°-9°). Except for the significant difference in HKA among the three groups (P<0.05), baseline data such as age, gender, affected side, body mass index, interval between injury and operation, Kellgren-Lawrence grading, posterior tibial slope, proportion of combined meniscal injuries, Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) objective score, anterior drawer test, Lachman test, pivot shift test, and the results of KT1000 (side-to-side difference, SSD) showed no significant difference (P>0.05). At last follow-up, joint stability was assessed through the anterior drawer test, Lachman test, pivot shift test, and SSD; joint function was evaluated using the Tegner score, Lysholm score, and IKDC objective score. Results All incisions in the three groups healed by first intention after operation. All patients were followed up 24-31 months, with an average of 26 months; there was no significant difference in the follow-up time among the three groups (Z=0.675, P=0.714). At last follow-up, the knee stability and functional assessment indicators in each group significantly improved when compared to preoperative ones (P<0.05); there was no significant difference among the three groups (P>0.05) in terms of the anterior drawer test, Lachman test, pivot shift test, IKDC objective scores, and the changes of the Lysholm scores and Tegner scores. The Kellgren-Lawrence grading and HKA at last follow-up were consistent with preoperative results in the three groups. ConclusionVarying degrees of primary varus knee do not affect early knee joint stability and functional recovery after ACL reconstruction, and there is no significant difference in effectiveness between different degrees of varus knee.
Objective To compare the short-term effectiveness of staged bilateral total hip arthroplasty via different approaches. Methods Thirty-two patients (64 hips) with bilateral hip disease were treated with total hip arthroplasty between January 2012 and December 2014. There were 20 males and 12 females with the mean age of 45.3 years (range, 30-67 years). There were avascular necrosis of femoral head in 14 cases, developmental dislocation of the hip in 12 cases, ankylosing spondylitis in 4 cases, osteoarthritis in 2 cases. All patients were treated with total hip arthroplasty; and the direct anterior approach (DAA) or direct lateral approach (DLA) was chosen for the unilateral hip randomly. The length of incision, operation time, total blood loss volume, the time of first postoperative activity, and the acetabular anteversion angle were compared. The Harris score, visual analogue scale (VAS) score, and incidence of complication were compared between 2 groups. Results All incisions healed at stage Ⅰ. All patients were followed up 20-53 months (mean, 39.6 months). The length of incision, total blood loss volume, the time of first postoperative activity were significantly shorter in DAA group than in DLA group (P<0.05). The operation time was significantly longer in DAA group than in DLA group (P<0.05). There was no significant difference in acetabular anteversion angle between 2 groups (t=1.122, P=0.266). The incidence of complication were 25.00% and 15.63% in DAA group and DLA group, respectively, showing no significant difference (χ2=0.869, P=0.536). The Harris score in DAA group significantly increased at 3 and 9 months after operation than in DLA group (P<0.05); there was no significant difference at 18 months after operation between 2 groups (P>0.05). The VAS score was significantly lower in DAA group than in DLA group at 1 day, 3 days, and 1 week after operation (P<0.05); there was no significant difference at 4 and 8 weeks between 2 groups (P>0.05). The prosthesis did not loosen and sink during the follow-up. Conclusion Total hip arthroplasty via DAA can reduce operation related complication and speed up the recovery of hip function at the early stage after operation. However, the lateral cutaneous nerve injury is the most common complication.
Objective To investigate short-term effectiveness of arthroscopic repair via modified subacromial viewing portal (hereinafter referred to as modified viewing portal) in treatment of LafosseⅠsubscapularis tendon tears. Methods A clinical data of 52 patients with LafosseⅠsubscapularis tendon tears, who underwent the arthroscopic repair via modified viewing portal between October 2020 and November 2022 and met the selective criteria, was retrospectively analyzed. There were 15 males and 37 females with an average age of 63.4 years (range, 41-76 years). Twelve patients had trauma history and the other 40 patients had no obvious inducement. The main clinical symptom was shoulder pain and the hug resistance tests were positive in all patients. The interval between symptom onset and admission ranged from 3 to 26 months (mean, 7.2 months). The shoulder pain and function were evaluated by visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score before operation and at 12 months after operation. The shoulder range of motion (ROM) of forward flexion, abduction, and external rotation and the internal rotation strength were measured before operation and at 3 and 12 months after operation. MRI was performed at 3-6 months after operation to assess the tendon healing and the structural integrity and tension of reattached tendon. Patient’s satisfactions were calculated at last follow-up. Results All incisions healed by first intention, no complication such as incision infection or nerve injury occurred. All patients were followed up 12-37 months (mean, 18.5 months). The VAS, UCLA, and ASES scores at 12 months after operation significantly improved when compared with those before operation (P<0.05). The ROMs of abduction and forward flexion and the internal rotation strength at 3 and 12 months significantly improved when compared with those before operation (P<0.05); and the ROMs at 12 months significantly improved compared to that at 3 months (P<0.05). However, there was no significant difference (P>0.05) in the ROM of external rotation at 3 months compared to that before operation; but the ROM at 12 months significantly improved compared to that before operation and at 3 months after operation (P<0.05). Thirty-one patients underwent MRI at 3-6 months, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing; 3 patients underwent tendon re-tear. At last follow-up, 41 patients (78.8%) were very satisfied with the effectiveness, 7 were satisfied (13.5%), and 4 were dissatisfied (7.7%). Conclusion Arthroscopic repair via modified viewing portal for Lafosse Ⅰsubscapularis tendon tears, which can achieve the satisfactory visualization and working space, can obtain good short-term effectiveness with low overall re-tear risk.
Objective To investigate short-term effectiveness of robot-guided femoral neck system (FNS) combined with cannulated compression screw (CCS) fixation in treatment of femoral neck fracture in young and middle-aged patients. Methods A clinical data of 49 young and middle-aged patients with femoral neck fractures, who met the selection criteria and admitted between January 2021 and June 2023, was retrospectively analyzed. After reduction of femoral neck fractures, 27 cases were treated with robot-guided FNS fixation (FNS group) and 22 cases with robot-guided FNS and CCS fixation (FNS+CCS group). There was no significant difference in baseline data such as gender, age, cause of fracture, time from fracture to operation, fracture side, and classification (Garden classification and Pauwels classification) between the two groups (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, the time when the patient began bearing weight, and hip joint pain and functional scores (VAS score and Harris score) at last follow-up for two groups were recorded. Imaging re-examination was taken to evaluate the quality of fracture reduction, fracture healing, as well as the occurrence of fracture non-union, osteonecrosis of the femoral head, and femoral neck shortening. Results All operations were successfully completed and the incisions healed by first intention. There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05), and the intraoperative fluoroscopy frequency in FNS+CCS group significantly increased compared to FNS group (P<0.05). All patients were followed up 12-18 months (mean, 14.1 months). Imaging re-examination showed that there was no significant difference in fracture reduction quality between the two groups (P>0.05), but the fracture healing time was significantly shorter in FNS+CCS group than in FNS group, and weight-bearing began earlier (P<0.05). The incidences of femoral neck shortening, fracture non-union, and osteonecrosis of the femoral head were lower in FNS+CCS group than in FNS group, and there was significant difference in the incidence of femoral neck shortening between groups (P<0.05). At last follow-up, there was no significant difference in VAS scores between the two groups (P>0.05). However, the Harris score was significantly higher in FNS+CCS group than in FNS group (P<0.05). ConclusionCompared with FNS fixation alone, robot-guided FNS combined with CCS fixation in the treatment of femoral neck fractures in young and middle-aged patients has obvious advantages in terms of early weight bearing and fracture healing, improves fracture healing rate, effectively prevents postoperative complications, and can obtain good short-term effectiveness.
Objective To investigate the short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery (UNSES) via crossing midline approach (CMA) in the treatment of free lumbar disc herniation (FLDH). MethodsBetween March 2024 and June 2024, 16 patients with FLDH were admitted and treated with UNSES via CMA. There were 9 males and 7 females with an average age of 55.1 years (range, 47-62 years). The disease duration was 8-30 months (mean, 15.6 months). The pathological segments was L3, 4 in 4 cases, L4, 5 in 5 cases, and L5, S1 in 7 cases. The preoperative pain visual analogue scale (VAS) score was 6.9±0.9 and the Oswestry disability index (ODI) was 57.22%±4.16%. The operation time, intraoperative bleeding volume, postoperative hospital stay, and incidence of complications were recorded. The spinal pain and functional status were evaluated by VAS score and ODI, and effectiveness was evaluated according to the modified MacNab criteria. CT and MRI were used to evaluate the effect of nerve decompression. ResultsAll 16 patients underwent operation successfully without any complications. The operation time was 63-81 minutes (mean, 71.0 minutes). The intraoperative bleeding volume was 47.3-59.0 mL (mean, 55.0 mL). The length of hospital stay after operation was 3-4 days (mean, 3.5 days). All patients were followed up 1-3 months, with 15 cases followed up for 2 months and 14 cases for 3 months. The VAS score and ODI gradually decreased over time after operation, and there were significant differences between different time points (P<0.05). At 3 months after operation, the effectiveness was rated as excellent in 12 cases and good in 2 cases according to the modified MacNab criteria, with an excellent and good rate of 100%. CT and MRI during follow-up showed a significant increase in the diameter and cross-sectional area of the spinal canal, indicating effective decompression of the canal. ConclusionWhen using UNSES to treat FLDH, choosing CMA for nerve decompression has the advantages of wide decompression range, large operating space, and freedom of operation. It can maximize the preservation of the articular process, avoid fracture and breakage of the isthmus, clearly display the exiting and traversing nerve root, and achieve good short-term effectiveness.
Objective To compare the effectiveness of one-stage bilateral total hip arthroplasty by direct anterior approach (DAA) and by posterolateral approach, and to investigate the application value of DAA in one-stage bilateral total hip arthroplasty. Methods The clinical data of 65 patients who underwent one-stage bilateral total hip arthroplasty by DAA or posterolateral approach between June 2010 and November 2015 were analyzed retrospectively. DAA was used in 34 cases (group A) and posterolateral approach was used in 31 cases (group B). There was no significant difference in the gender, age, body mass index, preoperative hemoglobin level, etiology, disease duration, preoperative Harris score, and preoperative visual analogue scale (VAS) score between 2 groups (P>0.05) with comparability. The incision length, operation time, intraoperative blood loss, total blood transfusion volume, hospitalization time, early postoperative complications, Harris score, and VAS score were recorded and compared between 2 groups. The simple Likert scale method was applied to evaluate the patient satisfaction, and the imaging evaluation was used. Results The incision length, operation time, intraoperative blood loss, total blood transfusion volume, and hospitalization time of group A were significantly less than those of group B (P<0.05). The patients were followed up 15-48 months (mean, 25.3 months) in group A and 12-51 months (mean, 27.6 months) in group B. The overall incidence of complications related to surgery in group A (10.29%) was significantly lower than that of group B (19.35%) (χ2=8.769, P=0.023). The acetabular anteversion and abduction angle were in the normal range of 2 groups except 1 hip (1.47%) of group A had a higher acetabular anteversion than normal value. Unstable fixed prosthesis happened in 1 hip of groups A and B respectively, and the remaining femoral calcar had no obvious bone resorption and fixed stably. The Harris score and VAS score at each time point after operation of 2 groups were significantly improved when compared with preoperative scores (P<0.05), and the differences between the time points after operation were also significant (P<0.05). The Harris score at 1 and 3 months after operation and the VAS score at 3 days after operation of group A were significantly better than those of group B (P<0.05), but no significant difference was found at last follow-up between 2 groups (P>0.05). According to the simple Likert scale method to analyze patient satisfaction, comprehensive satisfaction of group A (97.1%, 33/34) was significantly higher than that of group B (67.7%, 21/31) (χ2=10.343, P=0.001). Conclusion The application of DAA in one-stage bilateral total hip arthroplasty can significantly relieve the pain, accelerate the recovery of hip joint function, and improve the patient satisfaction. But in clinical application, more attentions should be paid to strictly grasp the indications and prevent the early complications. The long-term effectiveness needs to be further observed.
ObjectiveTo investigate the improvement of femoral rotation alignment in total knee arthroplasty (TKA) by robotic-arm assisted positioning and osteotomy and its short-term effectiveness.MethodsBetween June 2020 and November 2020, 60 patients (60 knees) with advanced osteoarthritis of the knee, who met the selection criteria, were selected as the study subjects. Patients were randomly divided into two groups according to the random number table method, with 30 patients in each group. Patients were treated with robotic-arm assisted TKA (RATKA) in trial group, and with conventional TKA in control group. There was no significant difference in gender, age, side and course of osteoarthritis, body mass index, and the preoperative hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior condylar angle (PCA), knee society score-knee (KSS-K) and KSS-function (KSS-F) scores between the two groups (P>0.05). The clinical (KSS-K, KSS-F scores) and imaging (HKA, LDFA, MPTA, PCA) evaluation indexes of the knee joints were compared between the two groups at 3 months after operation.ResultsAll patients were successfully operated. The incisions in the two groups healed by first intention, with no complications related to the operation. Patients in the two groups were followed up 3-6 months, with an average of 3.9 months. KSS-K and KSS-F scores of the two groups at 3 months after operation were significantly higher than those before operation (P<0.05), but there was no significant difference between the two groups (P>0.05). X-ray re-examination showed that the prosthesis was in good position, and no prosthesis loosening or sinking occurred. HKA, MPTA, and PCA significantly improved in both groups at 3 months after operation (P<0.05) except LDFA. There was no significant difference in HKA, LDFA, and MPTA between the two groups (P>0.05). PCA in trial group was significantly smaller than that in control group (t=2.635, P=0.010).ConclusionRATKA can not only correct knee deformity, relieve pain, improve the quality of life, but also achieve the goal of restoring accurate femoral rotation alignment. There was no adverse event after short-term follow-up and the effectiveness was satisfactory.
Objective To investigate the effect of body mass index (BMI) on the short-term effectiveness of high tibial osteotomy (HTO) in the treatment of varus knee arthritis. Methods The clinical data of 84 patients (84 knees) with varus knee arthritis treated with HTO between May 2016 and August 2020 were retrospectively analyzed. According to BMI, the patients were divided into normal group (32 patients in group A, BMI<25 kg/m2), overweight group (27 patients in group B, BMI>30 kg/m2), and obese group (25 patients in group C, BMI>30 kg/m2). The BMI of groups A, B, and C were (23.35±0.89), (26.65±1.03), and (32.05±1.47) kg/m2, respectively. There was no significant difference (P>0.05) in gender, age, surgical side, disease duration, and preoperative Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, knee range of motion, and hip-knee-ankle angle (HKA) between groups. The operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation were recorded and compared between groups. The improvement of knee joint function and pain status were evaluated by knee joint HSS score, knee range of motion, and VAS score before and after operation, and measuring the HKA of patients on X-ray film. During the follow-up, the X-ray films of the knee joint were reexamined to observe the position of the internal fixator and the healing of osteotomy. Results All patients completed the operation successfully and were followed up 8-40 months (mean, 19.3 months). There was no significant difference in follow-up time, operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation between groups (P>0.05). No operative complications such as severe vascular or nerve injury occurred. After operation, deep venous thrombosis of lower extremities occurred in 1 case in groups A and B respectively, and fat liquefaction of surgical incision occurred in 2 cases in group C. There was no significant difference in the incidence of perioperative complications between groups (3.1% vs. 3.7% vs. 8.0%) (P=0.689). During the follow-up, there was no bone nonunion, plate fracture or loosening. At last follow-up, HSS score, VAS score, knee range of motion, and HKA significantly improved in the 3 groups when compared with those before operation (P<0.05), but there was no significant difference in the differences of the above indexes between groups before and after operation (P>0.05). Conclusion BMI does not affect the short-term effectiveness of HTO in the treatment of varus knee arthritis. HTO can be selected for overweight and obese patients after standard medical treatment is ineffective.
Objective To compare the short-term effectiveness of arthroscopic suture of triangular fibrocartilage complex (TFCC), arthroscopic suture of TFCC combined with open reduction and internal fixation, and simple open reduction and internal fixation in the treatment of distal radius fractures combined with ulnar styloid base fractures and TFCC injury. Methods A clinical data of 97 patients with distal radius fractures combined with ulnar styloid base fracture and TFCC injury, who were admitted between September 2019 and September 2022 and met the selective criteria, was retrospectively analyzed. After reduction and internal fixation of distal radius fractures, 37 cases underwent arthroscopic suture of TFCC (TFCC group), 31 cases underwent arthroscopic suture of TFCC combined with open reduction and internal fixation of ulnar styloid base fractures (combination group), and 29 cases underwent simple open reduction and internal fixation of ulnar styloid base fractures (internal fixation group). There was no significant difference in baseline data between groups (P>0.05), such as gender, age, injury side, time from injury to operation, and preoperative radius height, palm inclination, ulnar deviation, grip strength, wrist range of motion (ROM) in rotation, ulnar-radial deviation, and flexion-extension. The differences (change value) in radius height, metacarpal inclination angle, ulnar deviation angle, grip strength, and wrist ROM in rotation, ulnar-radial deviation, and flexion-extension between preoperative and 12 months after operation in 3 groups were compared. The effectiveness was evaluated according to the modified Gartland-Werley score at 12 months after operation. Results All incisions healed by first intention. All patients were followed up 12-18 months (mean, 14 months). X-ray films showed that there were 4 patients with non-union of ulnar styloid base fracture in TFCC group, and the remaining patients had fracture healing at 3 months after operation. The radius height, palm inclination, and ulnar deviation of 3 groups at 12 months after operation were significantly better than those before operation (P<0.05); however, the differences in the change values of the above indexes between groups was not significant (P>0.05). At 12 months after operation, the change values of wrist ROM in rotation, ulnar-radial deviation, and flexion-extension in the TFCC group and the combination group were significantly greater than those in the internal fixation group (P<0.05), and there was no significant difference between the TFCC group and the combination group (P>0.05). The change values of grip strength was significantly greater in the combination group than in the internal fixation group (P<0.05); there was no significant difference between the other groups (P>0.05). The excellent and good rates according to the modified Gartland-Werley score were 91.89% (34/37), 93.54% (29/31), and 72.41% (21/29) in the TFCC group, the combination group, and the internal fixation group, respectively. The excellent and good rates of the TFCC group and the combination group were significantly higher than that of the internal fixation group (P<0.05); there was no significant difference between the TFCC group and the combination group (P>0.05).ConclusionFor ulnar styloid base fractures with TFCC injury, compared with simple open reduction and internal fixation, arthroscopic suture of TFCC or suture TFCC combined with internal fixation treatment are both beneficial for wrist function recovery, and their short-term effectiveness are similar. Therefore, arthroscopic suture of TFCC may be a better choice.