Objective To investigate a modified robotized hydraulictensor for management of the ligament balance in the total knee arthroplasty. Methods The effect of the modified robotized hydraulic tensor on the mechanical behaviour of the ligament system balance in the total knee arthroplasty was analyzed andthe related information was obtained. Results The robotized hydraulic tensor acted as a tensorsensor system, which could assist the surgeon by providing thequantitative information to align the lower limb in extension, equalize the articular spaces in extension and flexion, balance the internal and external forces, and define the femoral component rotation, and by providing the information toplan the releasing of the soft tissues and the rotating of the femoral component. Conclusion The modified robotized hydraulic tensor can enable the surgeon to properly manage the ligament balance in the total knee arthroplasty.
ObjectiveTo evaluate the early effectiveness of one-stage total knee arthroplasty (TKA) with tibial stem extender for knee arthritis complicated with tibial stress fractures. MethodsBetween January 2014 and November 2016, 12 patients (12 knees) with knee arthritis and tibial stress fractures underwent one-stage TKA with tibial stem extender. There were 5 males and 7 females with an average age of 71.5 years (range, 60-77 years). There were 8 cases with osteoarthritis and 4 cases with rheumatoid arthritis. The radiographic examination showed the 6 cases of intra-articular fractures and 6 of extra-articular fractures (including transverse fractures in 4 cases and short oblique fractures in 2 cases); 2 cases complicated with middle and upper fibular fractures; 12 cases of varus deformities. Preoperative Knee Society Score (KSS) clinical score was 31.5±8.4 and functional score was 33.3±9.0. The preoperative range of motion (ROM) of the knee was (65.6±9.6)°. ResultsAll incisions healed primarily and no wound infection or skin necrosis occurred. All patients were followed up 36.5 months on average (range, 6-52 months). X-ray films showed that all fractures healed at 3-7 months (mean, 4 months); the position of the prosthesis was good, and no loosening or signs of infection occurred. At last follow-up, the KSS clinical score was 90.5±8.9 and functional score was 92.1±7.8; the ROM of the knee was (115.0±9.8)°. All indexes were significantly improved than those before operation (t=40.340, P=0.000; t=32.120, P= 0.000; t=8.728, P=0.000). ConclusionOne-stage TKA with tibial stem extender for patients with knee arthritis and tibial stress fractures can restore limb alignment, facilitate fracture healing, and obtain the satisfactory early effectiveness.
Objective To analyse the results of posterior cruciate l igament-retained mobile-bearing total knee arthroplasty (TKA) in treatment of rheumatoid arthritis (RA) and to solve the problems often encountered during surgery. Methods From February 1999 to August 2005, the cl inical data from 73 patients with RA undergoing TKA were analysed retrospectively. In 73 patients, 38 patients were treated with posterior cruciate l igament-retained mobile-bearing prosthesis (group A), while 35 patients were treated with posterior stabil ized fixed-bearing prosthesis (group B). Another 70 patients with osteoarthritis (OA) treated with an posterior cruciate l igament-retained mobile-bearing prosthesis served as controls (group C). In group A, there were 8 males and 30 females with an average age of 56.5 years and an average diseasecourse of 16.8 years. In group B, there were 6 males and 29 females with an average age of 57.3 years and an average disease course of 17.1 years. In group C, there were 37 males and 33 females with an average age of 65.4 years and an average disease course of 10.8 years. There was no significant difference (P gt; 0.05) in general data between groups A and B, but there were significant differences (P lt; 0.05) when compared with group C. Results In groups A and B, 2 cases (5.3%) and 1 case (2.9%) had poor heal ing of incision, respectively; in group C, all cases had good heal ing of incision. There were significant differences in heal ing rate of incision between groups A, B and group C (P lt; 0.05). All patients were followed up 7.6 years on average (range, 3.5-10.5 years). Deep infection occurred in 1 case respectively in 3 groups, showing no significant difference (P gt; 0.05). Posterior instabil ity occurred in 1 case (2.6%) 5 years after operation in group A and 2 cases (2.9%) 9 years after operation in group C, and no posterior instabil ity occurred in group B; showing significant differences between groups A, C and group B (P lt; 0.05). There were significant differences (P lt; 0.05) in knee score, Feller patellar score, and anterior knee pain score between pre- and postoperative values among groups A, B, and C. There were significant differences (P lt; 0.05) in the function scores between pre- and post-operative values in 3 groups, between groups A, B and group C pre- and post-operatively. Conclusion Posterior cruciate l igament-retained mobile-bearing TKA can yield satisfactory cl inical results in treatment of RA at intermediate-term followup. This mobile-bearing prosthesis has a low prevalence of posterior instabil ity and a good outcome for anterior knee function without patellar resurfacing.
ObjectiveTo compare the application effects between personal specific instrumentation (PSI) and computer-assisted navigation surgery (CAS) in total knee arthroplasty (TKA). MethodsThe literature comparing the application effects of PSI and CAS in TKA in recent years was widely consulted, and the difference between PSI-TKA and CAS-TKA in operation time, lower limb alignment, blood loss, and knee function were compared. ResultsCompared to CAS-TKA, PSI-TKA simplifies operation procedures and shortens operation time but probably has worse lower limb alignment. It is still controversial in comparison of perioperative blood loss and knee function between two techniques. ConclusionPSI-TKA and CAS-TKA both have advantages and disadvantages, and their differences need to be confirmed by further high-quality clinical trial.
Objective To investigate the effect of lateral retinacular release on the clinical outcomes after total knee arthroplasty (TKA) without resurfacing of the patella. Methods A prospective randomized controlled study was performed on 132 patients with unilateral degenerative knee arthritis undergoing TKA bewteen October 2012 and October 2014, who met the selection criteria. During TKA, lateral retinacular release was used in 66 cases (trial group) and was not used in 66 cases (control group). Two patients were excluded from the study due to missing the follow-up in trial group. Four patients were excluded from the study due to lateral retinacular release in control group. Finally, 64 patients and 62 patients were included in the trial group and in the control group. There was no significant difference in gender, age, body mass index, side, disease duration, preoperative patellar morphology, grading of patellofemoral arthritis, grade of patellar cartilage degeneration, patellar malposition, patellar maltracking, patellar score, and Knee Society Score (KSS) between 2 groups (P>0.05). The operation time, postoperative drainage volume, hospitalization time, postoperative complications, and patient satisfaction were recorded. Postoperative anterior knee pain was assessed by visual analogue scale (VAS), and the knee joint function was evaluated by KSS score and patellar score. The femoral angle, tibial angle, femoral flexion angle, and tibial posterior slope angle were measured on the X-ray film for postoperative prosthetic alignment. The postoperative patellar tracking and patellar position, as well as the presence of osteolysis, prosthesis loosening, patellar fracture and patellar necrosis were observed. Results All patients were followed up for 24 months. There was no significant difference in operation time, postoperative drainage volume, hospitalization time, and patient satisfaction between 2 groups (P>0.05). The incidence of anterior knee pain in the trial group was better than that in the control group (P=0.033). KSS score and patellar score were significantly improved in both groups at 24 months after operation when compared with preoperative scores (P<0.05), but no significant difference was found between 2 groups (P>0.05). Complications included hematoma (2 cases in the trial group, and 1 case in the control group), mild wound dehiscence (2 cases in each group respectively), skin-edge necrosis (1 case in the trial group), and superficial wound infection (1 case in each group respectively), which were cured by conservative treatment. No patellar necrosis, patella fracture, or knee lateral pain occurred in 2 groups. There was no significant difference in complication rate between groups (P=0.392). Satisfactory implant alignment was observed in both groups during follow-up. There was no significant difference in femoral angle, tibial angle, femoral flexion angle, and tibial posterior slope angle between 2 groups (P>0.05). No radiolucent line at the bone-implant interface was seen around the tibial components and femoral components in both groups. The patellar maltracking was observed in 3 patients of the trial group and 5 patients of the control group, showing no significant difference (P=0.488). However, the incidence of patellar malposition in the trial group (18.8%) was significantly lower than that in the control group (35.5%) (χ2=0.173,P=0.034). Conclusion Lateral retinacular release during primary TKA without resurfacing of the patella can reduce postoperative knee pain without increasing complications.
【Abstract】 Objective To explore the flexibil ity and rel iabil ity of cementless total knee arthroplasty (TKA) without patellareplacement through a retrospective study of the mid-term therapeutic effect of the treatment of the patients. Methods FromJune 1997 to March 2000, a consecutive series of 152 (152 knees) cementless TKA performed in Hessing-Stiftung was studied. Among them, there were 63 males and 89 females, with 70 left knees and 82 right knees. Their ages ranged from 51 years to 72 years, with an average of 59 years. There were 146 cases of osteoarthritis and 6 cases of traumatic arthritis. The course of the disease lasted for 1.0 years to 3.5 years. The EFK prostheses of German Plus company were used in all the cases. The HSS score before the operation was 41.5 ± 12.3, and the average range of motion was 55º (ranging from 30º to 90º). Results Five patients underwent anterior knee pain, and the pain was released after the appropriate treatment. No deep infection happened in all cases. A total of 145 patients (145 knees) were followed up for 5 years to 8 years. The HSS score was 87.5 ± 8.2 at the end of the follow-up, showing significant difference (P lt; 0.05). The average range of motion was 95º (ranging from 90º to 110º). Partial radiolucencies occurred at the tibia side in 18knees 3 to 6 months after the operation. Among them, the width was less than 2 mm in 15 knees without symptom, and more than 2 mm in 3 knees. There were 2 of the 3 knees which were revised at the tibia side because of the aseptic loosing, while 1 patient had only mild pain in the knee during the follow-up, with no sign of loosing. Conclusion The mid-term effect of cementless TKA is satisfactory. The ingrowth of femur and tibial bones is rel iable. The early stage migration of the component is the main reason of loosing. Satisfying outcomes can also be achieved without patella replacement during TKA.
ObjectiveTo investigate the risk factors of skin necrosis around incision after total knee arthroplasty (TKA),and explore the measures of prevention and treatment. MethodsBetween June 2007 and June 2013,7 patients with skin necrosis around incision after TKA were treated.There were 5 males and 2 females with an average age of 69 years (range,59-78 years),including osteoarthritis in 4 cases,traumatic arthritis in 2 cases,and rheumatoid arthritis in 1 case.Two cases complicated by diabetes,and 2 cases by hypertension; 1 case received long-term hormone therapy; and 2 cases had a history of smoking.Scar was seen near knee joint in 2 cases.The skin necrosis ranged from 10 cm×2 cm to 13 cm×8 cm.The time from TKA to debridement was 7-15 days (mean,12 days).After thorough debridement,the saphenous artery skin flap,medial head of gastrocnemius muscle flap,lateral head of gastrocnemius muscle flap were used in 4 cases,2 cases,and 1 case respectively; reconstruction of patellar ligament was performed in 2 cases.Donor sites were repaired by split-thickness skin graft. ResultsAll the flaps and myocutaneous flaps survived well,and all wounds healed by first intention.At donor site,the grafted skins survived and wounds healed by first intention.No early complication occurred.All cases were followed up 6-12 months (mean,7.8 months).The flaps and myocutaneous flaps had good texture and appearance; no prosthetic loosening and displacement happened,no secondary infection was observed after operation.The knee range of motion was 45-110° (mean,85°) at 6 months after operation.According to the Knee Society Score (KSS),the results were excellent in 3 cases,good in 2 cases,general in 1 case,and poor in 1 case at 6 months after operation. ConclusionEarly discovery,thoroughly debridement,and timely repair with axial pattern flap or myocutaneous flap are the key factors to treat skin necrosis around incision after TKA and save the artificial prosthesis.
Objective To review the advance in the researchand clinical application of the tibial rotational alignment technique in the total knee arthroplasty in China and abroad. Methods The recent literature concerned with the tibial rotational alignment technique in the totalknee arthroplasty was extensively reviewed and briefly summarized. Results According to the literature reviewed, the traditional tibial rotational references for the total knee arthroplasty were affected by many factors, so that the references were not accurate enough. There have been no unified references.ConclusionChoosing the range from the medial border of the tibial tubercle to the medial 1/3 of the tibial tubercle, decided by the degrees of the varus deformities and the valgus deformities, to determine the rotaional alignment of the tibial component will create an optimal tibiofemoral rotational alignment.
ObjectiveTo evaluate the risk factors for postoperative indwelling catheter following enhanced recovery after primary unilateral total knee arthroplasty (TKA) under general anesthesia.MethodsPatients who underwent primary unilateral TKA under general anesthesia between January 2017 and August 2018 were enrolled in the study. Among them, 205 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, body mass index, preoperative range of motion, Hospital for Special Surgery (HSS) score, American Society of Anesthesiologists (ASA) score, disease type, comorbidity, hemoglobin, hematocrit, blood volume, length of operation and operation time, whether to keep drainage after surgery, intraoperative blood loss, total blood loss, and preoperative, intraoperative, postoperative fluid infusions, and total fluid infusion on the day of surgery, urine volume on the day of surgery. Univariate analysis and logistic regression analysis were used to screen the risk factors for postoperative indwelling catheter. Length of stay and incidences of complications (intermuscular vein thrombosis, deep vein thrombosis, pulmonary embolism, incision swelling and exudation, electrolyte disorder, nausea and vomiting, and urinary tract infection) were compared between the patients with or without indwelling catheter.ResultsIndwelling catheter occurred in 41 (20%) of 205 patients. Single factor analysis showed that the influence factors were age, gender, keeping drainage after surgery, total fluid infusion and urine volume on the day of surgery (P<0.05). The multiple factors analysis showed that the males and more urine volume on the day of surgery were the significant risk factors for indwelling catheter after primary TKA (P<0.05). In addition, postoperative length of stay was shorter and the incidence of urinary tract infection was lower in non-indwelling catheter group than in indwelling catheter group, showing significant differences (P<0.05).ConclusionThe male patients with more urine on the day of surgery have higher risk for indwelling catheter after primary unilateral TKA under general anesthesia with an enhanced recovery program.