Effective postoperative pain management in patients undergoing total knee arthroplasty is an important part of the realization of enhanced recovery after surgery. Peripheral nerve block is of great significance to the control of postoperative pain, and clinicians are committed to finding a nerve block that has little impact on muscle strength and is conducive to the early recovery of motor function after total knee arthroplasty. Infiltration between the popliteal artery and capsule of the knee block can selectively block the sensory branch of the posterior end of the knee joint without affecting the motor branch of the common peroneal nerve, so that the muscle strength can be minimally affected under the condition of adequate analgesia. This article reviews the proposal of infiltration between the popliteal artery and capsule of the knee block, the approach and method of the block, and the advantages of combining with different nerve blocks for analgesia after total knee arthroplasty.
Objective To compare the efficacy and safety of aspirin and rivaroxaban in the prevention of venous thromboembolism (VTE) after total knee arthroplasty (TKA). Methods Eight databases were searched, including Cochrane Library, Embase, Web of Science, PubMed, SinoMed, Wanfang, Chongqing VIP, and China National Knowledge Infrastructure. The search period was from the establishment of databases to June 2023. All randomized controlled trials of aspirin and rivaroxaban for the prevention of VTE after TKA were collected, and meta-analysis was conducted using RevMan 5.3 software. Results A total of 7 articles were included, with a publication period from 2014 to 2022, including a total of 714 patients, including 356 in the aspirin group and 358 in the rivaroxaban group. The meta-analysis results showed that the incidence of deep venous thrombosis in the lower limbs of the aspirin group was higher than that of the rivasarb group [relative risk (RR)=1.53, 95% confidence interval (CI) (1.09, 2.16), P=0.01], and the incidence of bleeding complications was lower than that of the rivaroxaban group [RR=0.66, 95%CI (0.52, 0.82), P=0.0003]. There was no statistically significant difference in the incidence of wound complications between the two groups (P>0.05). Conclusion The efficacy of rivaroxaban in preventing VTE after TKA is better than that of aspirin, but there is an increased risk of bleeding complications.
ObjectiveTo explore the gait trajectory characteristics and effectiveness after unicompartmental knee arthroplasty (UKA).MethodsThirty patients (30 knees) with anterior medial compartment osteoarthritis who were treated with UKA between January 2017 and December 2018 were selected as subjects (UKA group). According to age, gender, and side, 30 patients (30 knees) with knee osteoarthritis treated with total knee arthroplasty (TKA) were selected as control (TKA group). In addition to the range of motion (ROM) before operation showing significant difference between the two groups (t=4.25, P=0.00), there was no significant difference in gender, age, disease duration, sides, body mass index, and preoperative hip-knee-ankle angle (HKA), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between the two groups (P>0.05). The incision length, drainage volume within 24 hours after operation, and the changes of hemoglobin and albumin were recorded. The WOMAC score, ROM, and HKA before and after operation were compared between the two groups. At 1 year after operation, the gait trajectory characteristics of two groups were analyzed by Vicon three-dimensional gait capture system, and the absolute symmetry index (ASI) of the lower limbs of the two groups was calculated.ResultsThe incisions of the two groups healed by first intention, with no complications. The incision length, drainage volume within 24 hours, and the changes of hemoglobin and albumin after operation in the UKA group were significantly smaller than those in the control group (P<0.05). All patients were followed up completely, the follow-up time ranged from 13 to 20 months of UKA group (mean, 18 months) and 16 to 24 months of control group (mean, 20 months). The imaging review showed that the lower limb alignment of the two groups were restored to a neutral position, and the position of prosthesis was good. At 1 year after operation, the WOMAC score, HKA, and ROM of two groups were significantly improved when compared with those before operation (P<0.05); the postoperative WOMAC score and ROM of the UKA group were significantly better than those of the control group (P<0.05), and there was no significant difference in HKA between the two groups (t=1.54, P=0.13). Gait analysis at 1 year after operation showed that the walking speed, stride length, knee extension at mid-stance, and flexion at swing in the UKA group were significantly better than those in the TKA group (P<0.05); there was no significant difference in cadence, knee flexion at initial contact, and knee flexion at loading response between the two groups (P>0.05). The ASI of bilateral knee flexion in the UKA group was significantly greater than that in the TKA group during the initial contact and loading response period (P<0.05).ConclusionCompared with TKA, UKA has the advantages of small incision, less blood loss, and quicker functional recovery. The early gait after UKA is mainly manifested as the increase in walking speed, stride length, knee flexion at swing, and extension at mid-stance phase. From the analysis of gait symmetry, during the initial contact and loading response phase, the operation side after UKA undertakes more shock absorption and joint stabilization functions than the contralateral side.
ObjectiveTo compare the cost changes of total knee arthroplasty (TKA) before and after the cancellation of medical consumables addition, so as to provide reference for the national medical reform policy.MethodsThe patients treated with TKA between September 2018 and February 2019 were admitted as objects of study, and 372 of them met the selection criteria and were finally included in the study. According to the time node of cancelling the medical consumables addition (December 24, 2018), all patients were allocated to pre-cancelling and post-cancelling groups (n=186). The clinical data of patients (gender, age, length of stay, disease classification), and various treatment costs (the costs of diagnosis and treatment, examination, laboratory, material, anesthesia, bed, nursing, operation, drug, and others) were collected. And the changes of various costs and proportions before and after cancelling the medical consumables addition were compared.ResultsThere was no significant difference in gender, age, and disease classification between the two groups (P>0.05); the length of stay after cancelling the medical consumables addition was significantly longer than that before cancelling (t=2.114, P=0.035). There was no significant difference in the total cost of TKA before and after cancelling the medical consumables addition (t=0.214, P=0.831). Compared with that before cancelling the medical consumables addition, the cost of material was significantly reduced, and the costs of diagnosis and treatment, anesthesia, nursing, and operation were significantly increased (P<0.05); the costs of examination, laboratory , bed, drug, and others were basically stable, and the differences were not significant (P>0.05).ConclusionThe total cost of TKA is stable, the proportion of material cost is significantly reduced, the proportion of diagnosis and treatment cost reflecting the technical content of medical staff is significantly increased, which is in line with the expectation of the national policy of cancelling the medical consumables addition.
ObjectiveTo review the perioperative blood management (PBM) of total knee arthroplasty (TKA) and total hip arthroplasty (THA).MethodsRecent researches on PBM for TKA and THA were comprehensively read and summarized. Then the advantages and disadvantages of various measures together with the clinical experience of West China Hospital of Sichuan University were evaluated from three aspects, including optimizing hematopoiesis, reducing blood loss and blood transfusion, which could provide a basis for clinical selection.ResultsThere are many PBM methods in TKA and THA, among which the optimization of hematopoiesis mainly includes the application of perioperative iron and erythropoietin. Measures to reduce bleeding include the use of tourniquet, intraoperative controlled hypotension, and perioperative antifibrinolytic agents. Autologous blood transfusion includes preoperative autologous blood donation, hemodilution and cell salvage. Allogeneic blood transfusion is the ultimate treatment for anemia. The application of erythropoietin combined with iron therapy for blood mobilization before surgery together with intraoperative controlled hypotension for bleeding control and the multiple use of tranexamic acid can achieve satisfactory clinical results.ConclusionIn the perioperative period of TKA and THA, single or multiple use of different blood management measures should be considered carefully according to the physical and economic conditions of patients individually, so as to reduce the blood loss and allogeneic blood transfusion optimally, and finally accelerate the recovery of patients.
Objective To investigate the effectiveness of lateral condyle sliding osteotomy (LCSO) in total knee arthroplasty (TKA) for the treatment of lateral femoral bowing deformity. Methods The clinical data of 17 patients with lateral femoral bowing deformity treated by LCSO during TKA between July 2018 and July 2020 was retrospectively analysed. There were 3 males and 14 females, with an average of 63.2 years (range, 58-68 years). The etiology of lateral femoral bowing deformity included 12 cases of femoral developmental deformity and 5 cases of femoral fracture malunion. Kellgren-Lawrence classification of knee osteoarthritis was 4 cases of grade Ⅲ and 13 cases of grade Ⅳ. The preoperative hip-knee shaft was 9.5°-12.5° (mean, 10.94°). The disease duration was 3-25 years (mean, 15.1 years). The mechanical lateral distal femur angle (mLDFA), hip-knee-ankle angle (HKA), and mechanical axis deviation (MAD) of the distal femur were measured before operation and at last follow-up to evaluate the correction of extra-articular deformities in the joints and the recovery of mechanical force lines of the lower extremities. The knee society score (KSS) knee score and function score, visual analogue scale (VAS) score, knee joint range of motion (ROM) were used to evaluate effectiveness. The knee varus/valgus stress test and osteotomy healing by X-ray films were performed to evaluate the joint stability and the safety of LCSO. Results All incisions of the patients healed by first intention after operation, and there was no early postoperative complication such as infection of the incision and deep vein thrombosis of the lower extremities. All 17 patients were followed up 12-36 months, with an average of 23.9 months. The osteotomy slices all achieved bony healing, and the healing time was 2-5 months, with an average of 3.1 months. After operation, the knee varus/valgus stress tests were negative, and there was no relaxation and rupture of the lateral collateral ligament, instability of the knee joint, loosening, revision and infection of the prosthesis occurred. At last follow-up, mLDFA, HKA, MAD, knee ROM, VAS score, KSS knee score and function score significantly improved when compared with preoperative ones (P<0.05). Conclusion LCSO is effective and safe in TKA with lateral femoral bowing deformity. Extra-articular deformities are corrected intra-articularly. The mechanical force line and joint balance of the lower extremities can be restored simultaneously in an operation.
ObjectiveTo explore whether unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) or bilateral TKAs should be performed in patients with bilateral knee osteoarthritis.MethodsBetween April 2015 and February 2017, 24 patients with bilateral knee osteoarthritis who met the selection criteria were included in the study and randomly divided into 2 groups (n=12). The patients in observation group were treated with TKA of the multicompartmental osteoarthritis knee in the first-stage operation and UKA of the unicompartmental osteoarthritis knee in the second-stage operation; and the patients in control group were treated with bilateral TKAs in staging operation. The operation time, the amount of postoperative drainage, and the time of active flexion of the knee joint at 90° were recorded. The difference of hemoglobin (Hb) before and after the second-stage operation was recorded, and the decrease of Hb was observed. The hospital stay after the second-stage operation was observed. The Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, and range of motion (ROM) were recorded at 7 days after the first-stage operation, and at 15 days, 45 days, and 6 months after the second-stage operation. At 1 year after the second-stage operation, the mean values of the above indexes of both knees were taken as the individual comprehensive evaluation. The X-ray films were taken regularly to examine the prosthesis and lower extremity force line. ResultsThe incisions in both groups were healed by first intention after two stage operations. The differences in the operation time, the amount of postoperative drainage, and the time of active flexion of the knee joint at 90° between the two groups were not significant in the first-stage operation (P>0.05) and were significant in the second-stage operation (P<0.05). The decrease of Hb and hospital stay after the second-stage operation were significantly lower in observation group than in control group (P<0.05). Both groups were followed up, the follow-up time was 12-18 months (mean, 14 months) in observation group and 12-21 months (mean, 16 months) in control group. During the follow-up period, X-ray films showed that the prosthesis positions of both sides were normal as well as the alignment line, and no infection, loosening or dislocation of prosthesis occurred. There was no significant difference in HSS score, VAS score, and ROM of multicompartmental osteoarthritis knee at 7 days after the first-stage operation between the two groups (P>0.05), indicating that the two groups were still comparable. The HSS score, VAS score, and ROM of unicompartmental osteoarthritis knee in observation group were superior to control group (P<0.05) after the second-stage operation. At 1 year, the HSS score, VAS score, and ROM in observation group were also superior to control group (P<0.05).ConclusionOn the premise of strict indications, the patients with bilateral knee osteoarthritis should be treated according to their own pathological changes in order to obtain better short-term effectiveness.
ObjectiveTo compare the patient-reported outcomes regarding function, joint amnesia, and the quality of life after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods The clinical data of patients who received UKA or TKA between September 2017 and June 2018 were retrospectively analyzed. After propensity score matching, 40 patients (40 knees) each in TKA group and UKA group were finally included in the study. There was no significant difference between the two groups in gender, age, body mass index, surgical side, preoperative knee range of motion, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, clinical and function scores of knee society score (KSS) (P>0.05). At 2 years after operation, WOMAC score, KSS clinical and function scores were performed on the two groups of patients, and compared with preoperative ones; knee injury and osteoarthritis outcome score-physical function short form (KOOS-PS), short-form 36 health survey scale (SF-36 scale), and forgotten joint score (FJS) were also performed. Results At 2 years after operation, the total score of WOMAC, the clinical and function scores of KSS in the two groups significantly improved when compared with preoperative ones (P<0.05), but there was no significant difference in the total score of WOMAC, the individual score of WOMAC, the clinical and function scores of KSS between the two groups (P>0.05). The total KOOS-PS score in the UKA group was significantly lower than that in the TKA group (t=4.243, P=0.000), and the scores of writhing/knee rotation, kneeling, and squatting in the UKA group were significantly lower than those in the TKA group (P<0.05). The total FJS score in the UKA group was significantly higher than that in the TKA group (t=−6.334, P=0.000). In the UKA group, the scores of 7 items were significantly lower than those of the TKA group (P<0.05) including when walking over 15 minutes, when climbing stairs, when walking on uneven ground, when standing for long periods, when doing housework or gardening, when taking a walk or hiking, and when doing your favorite sport. The SF-36 scales of physiological function, energy, social function, emotional function, and mental health in the UKA group were significantly higher than those in the TKA group (P<0.05). Conclusion Compared with TKA, patients treated with UKA may have better knee function recovery, joint amnesia, and higher quality of life.
Objective To evaluate the effectiveness of the shared decision-making scheme in postoperative out-of-hospital extended care for patients with total hip/knee arthroplasty (THA/TKA). Methods Patients who underwent THA/TKA in the Department of Orthopedic Surgery at West China Hospital of Sichuan University between October 2023 and April 2024 were included using convenience sampling. Patients were divided into the control group (odd-numbered dates) and the intervention group (even-numbered dates) based on the surgical dates. The intervention group was received care guided by a shared decision-making protocol, whereas the control group was followed the standard post-arthroplasty follow-up procedures. Differences between the two groups were compared in terms of decision-making capacity, decision satisfaction, and hip/knee function at the following time points: on the day of discharge, 3 weeks after discharge, 2 months after discharge, and 3 months after discharge. Results A total of 118 patients were included, with 59 cases in each group. There were no significant differences in demographic and clinical characteristics between the two groups (P>0.05). In terms of decision-making, compared with the control group, the experimental group had stronger decision-making ability, lower decision-making conflict, and more satisfaction with the decision-making process (P<0.05). In terms of joint function, the experimental group showed better joint function than the control group at 3 weeks, 2 months, and 3 months after surgery (P<0.05). There was no significant difference in the pain dimension of the Western Ontario and McMaster Universities Osteoarthritis index between the two groups (P=0.199). Conclusions Compared with the traditional follow-up protocol, the shared decision-making protocol can enhance patient engagement in medical decision-making, reduce decisional conflict, improve satisfaction with the decision-making process, and simultaneously promote joint functional recovery and expedite the rehabilitation process.
ObjectiveTo summarize research progress of change in bone mineral density (BMD) after knee arthroplasty and its diagnostic methods, influencing factors, and drug prevention and treatment.MethodsThe relevant literature at home and abroad was reviewed and summarized from research status of the advantages and disadvantages of BMD assessment methods, the trend of changes in BMD after knee arthroplasty and its influencing factors, and the differences in effectiveness of drugs.ResultsThe central BMD and mean BMD around the prosthesis decrease after knee arthroplasty, which is closely associated with body position, age, weight, daily activities, and the fixation methods, design, and material of prosthesis. Denosumab, bisphosphonates, and teriparatide et al. can decrease BMD loss after knee arthroplasty.ConclusionBMD after knee arthroplasty decreases, which is related to various factors, but the mechanism is unclear. At present, some inhibitors of bone resorption can decrease BMD loss after knee arthroplasty. However, its long-term efficacy remains to be further explored.