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.
ObjectiveTo compare the early clinical outcome of GenesisⅡ high-flexion versus standard prostheses in total knee arthroplasty (TKA), and evaluate whether high-flexion prostheses can improve the postoperative range of motion (ROM). MethodsBetween September 2007 and December 2011, 80 patients (85 knees) consecutively underwent posterior cruciate-sacrificing TKA with GenesisⅡ systems. Finally, we reviewed 60 patients (60 knees) including 32 knees in high-flexion group and 28 knees in standard group. The follow-up time was 2.7 years in average. The postoperative knee ROM and the rate of complication of the two groups were evaluated. ResultsThe mean postoperative knee ROM of 32 knees was 112.8° in the high-flexion group and was 108.9° in the standard group. The mean postoperative HSS score was 86.6 and 84.2, respectively. The postoperative knee ROM, hospital for special surgery (HSS) score and the rate of complication did not show significant difference between the two groups. ConclusionThe high-flexion prosthesis is no better than the ordinary prosthesis in terms of the range of motion. We need more mid to long-term studies to do further research.
ObjectiveTo summarize research progress of the effect of knee flexion position on postoperative blood loss and knee range of motion (ROM) after total knee arthroplasty (TKA).MethodsThe relevant literature at home and abroad was reviewed and summarized from mechanism, research status, progress, and clinical outcome. The differences of clinical results caused by different positions, flexion angles, and keeping time were compared.ResultsKeeping knee flexion after TKA can reduce postoperative blood loss through the angle change of blood vessels and increase knee early ROM by improving flexion muscle strength. When the flexion angle of the knee is large and the flexion position is keeping for a long time, the postoperative blood loss and the knee ROM can be significantly improved. However, the amount of blood loss and ROM are not further improved in the patients with keeping knee flexion for more than 24 hours compared with less than 24 hours.ConclusionKeeping knee flexion after TKA is a simple and effective method to reduce postoperative blood loss and improve knee ROM. However, the optimal knee flexion angle and time are needed to be further explored.
ObjectiveTo probe into the clinical value of supine cervical vertebra traction with neck flexion in treating cervical spondylotic radiculopathy. MethodsFrom August 2011 to December 2013, 71 patients were divided randomly into a treatment group of 36 cases and a control group of 35 cases. They were treated respectively with supine cervical vertebra traction with neck flexion, and cervical vertebra traction on a sitting position. Both groups had acupuncture, moxibustion, massage and medium frequency electrotherapy. The period of observation was 15 days. We evaluated the results by surveying physiological curvature of the cervical spine on lateral radiograph, and visual analogue scale (VAS), neck disability index (NDI), criteria of diagnosis and therapeutic effect of syndromes in traditional Chinese medicine syndrome and clinical assessment scale for cervical spondylosis (CASCS) were also used. ResultsPhysiological curvature of cervical spine was much improved in both groups after treatment (P<0.05). The distance of cervical vertebra arc between vertebral anterior edge sequences in treatment group before treating was (4.07±3.63) mm and it was (9.03±4.31) mm after treatment. For the control group, those two numbers were respectively (4.13±3.02) and (8.87±3.97) mm. There was no significant difference in the distance of cervical vertebra arc and its increase between vertebral anterior edge between the two groups after treatment. There was significant difference in the efficiency rate between the two groups (P<0.05) (treatment group 100.00%, control group 97.14%). When cured rate and cured-markedly effective rate were added, the treatment group (80.56%) was much better than the control group (51.43%) (P<0.01). As to VAS score, NDI and CASCS scores, both groups got much better after treatment (P<0.01). For VAS, the treatment group decreased from 8.43±0.75 before treatment to 1.40±0.61 after treatment, while the control group from 8.35±0.78 before treatment to 2.55±0.59 after treatment. For NDI, the treatment group decreased from 54.13±7.44 before treatment to 10.78±4.55 after treatment, while the control group from 55.85±8.72 to 12.66±5.48. For CASCS, the treatment group rose from 34.88±5.39 before treatment to 74.65±6.73 after treatment, while the control group from 34.77±4.89 to 69.03±6.21. After treatment, VAS score of the treatment group was much lower than the control group (P<0.01). There was no difference between the two groups on NDI (P>0.05). CASCS score of the treatment group was significantly higher than the control group after the treatment (P<0.01). There was no significant difference in the increase of CASCS score between the two groups after treatment (P>0.05). ConclusionVertebra traction combined with acupuncture, moxibustion, massage and medium frequency electrotherapy is therapeutic for cervical spondylotic radiculopathy and traction at a supine and flexing position is better.
ObjectiveTo compare the dorsiflexion osteotomy (DO) and implant arthroplasty (IA) in terms of clinical and radiographic outcomes for patients with advaced Freiberg disease.MethodsA clinical data of 25 cases of Freiberg disease, who were admitted between July 2012 and July 2016 and met selection criteria, was retrospectively reviewed. According to the Smillie classification, all patients were classified as stage Ⅳ-Ⅴ. Among them, 13 cases were treated with DO (DO group) and 12 cases were treated with IA (IA group). No significant difference was found between the two groups in gender, age, side of the affected metatarsophalangeal (MTP) joint, location, Smillie classification, disease duration, and preoperative visual analogue scale (VAS) score, range of motion of the affected MTP joints, and the American Orthopedic Foot and Ankle Society (AOFAS) score (P>0.05). Total costs for index admissions were compared between the two groups. Clinical outcomes were evaluated in accordance with the VAS score, AOFAS score, and the range of motion of the affected MTP joints.ResultsAll incisions of the two groups healed by first intention. The follow-up time was 12-30 months (mean, 17 months) in DO group and 12-24 months (mean, 16 months) in IA group. The total cost of index admission was significantly higher in IA group than that n DO group (t=2.742, P=0.011). The AOFAS scores, VAS scores, and range of dorsiflexion and plantar flexion at last follow-up were significantly improved when compared with preoperative value in the two groups (P<0.05). There was no significant difference in all indexes between the two groups (P>0.05). X-ray film examination showed that the osteotomy healed within 8-12 weeks (mean, 9.5 weeks) after operation in DO group. None of the patients experienced internal fixator and implant related complications postoperatively.ConclusionDO and IA can provide significant improvement in pain and motion of the MTP joints for advanced Freiberg disease. But the DO may be the more economical method.
our patients with brachial plexus root arulsion, who had undergone various nerve operationswith no functional recovery of the limb, were treated with transfer of sternocledomastoid muscle toreconstruct the function of elbow fleaion. The sternocleidomastoid muscle was datached from itsincertions and was lengthened by fascia lata graft from the thigh , and then , was transferred under theclavicle to the radiai shaft just distal to the radial tuberosity. After the recostruction, The potient...
ObjectiveTo compare the knee flexion degree after high-flexion versus standard total knee arthroplasty (TKA). MethodRelevant randomized controlled trials on comparison of knee flexion degree after high-flexion versus standard TKA were identified from Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure from the establishment of these databases until October 2015. A systematic review was performed to compare knee flexion degree, knee function score and complications between the two types of prostheses. Analyses were conducted using RevMan version 5.2.0 software. ResultsTwenty-one studies were included in this Meta-analysis. The results showed that the knee flexion degree was higher in high-flexion group than that in the standard group[WMD=2.71°, 95%CI (0.96, 4.46)°, P=0.002]; while the difference was not significant leaving out six low-quality literatures[WMD=0.72°, 95%CI (-0.15, 1.60)°, P=0.10]. There was no significant difference in knee function score between the two groups[WMD=-0.54, 95%CI (-1.34, 0.25), P=0.18]. There was no significant difference in complications between the two groups[OR=0.99, 95%CI (0.53, 1.84), P=0.98]. ConclusionsThe important finding from the current study is that there is no evidence to support that the use of high-flexion prostheses is superior to the standard prostheses during total knee arthroplasty.
ObjectiveTo investigate the effectiveness of internal and external lysis combined with Ilizarov external fixation technology for severe knee pathological flexion contracture deformity in children.MethodsA retrospective analysis was made on 12 children (12 knees) with severe knee pathological flexion contracture deformity who were treated with internal and external lysis and Ilizarov external fixation between August 2012 and January 2017. There were 9 boys and 3 girls with an age of 3-12 years (mean, 8.4 years). There were 8 cases of tuberculosis, 3 cases of haemophilia A, and 1 case of residual deformity after extensive hemangioma drug injection. The disease duration ranged from 5 months to 4 years, with an average of 20.3 months. The degree of knee contracture was (67.42±23.30)°, and the range of motion of knee was (38.33±14.98)°. The preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score was 78.42±15.57. The complication was observed after operation, and the degree of knee contracture, range of motion, and WOMAC score at 3 months and 1 year after operation were recorded and compared with those before operation.ResultsThe operations completed successfully in all children. All the 12 cases were followed up 9-24 months (mean, 14.5 months). All incisions healed by first intention after operation. The knee function of all children improved significantly and the weight-bearing walking function of the lower limbs restored. The degree of knee contracture, range of motion, and WOMAC score were significantly improved at 3 months and 1 year after operation (P<0.05), but there was no significant difference between 3 months and 1 year after operation (P>0.05).ConclusionFor severe knee pathological flexion contracture deformity in children, application of internal and external lysis combined with Ilizarov external fixation has advantages, such as small trauma, rapid recovery, and early postoperative knee function training, and good effectiveness.
ObjectiveTo summarize the research progress of the difference between high-flexion prosthesis and conventional prosthesis in total knee arthroplasty, so as to offer a reference for clinical choice of prosthesis. MethodsThe relevant literature on high-flexion prosthesis and conventional prosthesis in recent years was extensively reviewed and analyzed. ResultsThere are some controversies in range of motion and complications between high-flexion prosthesis and conventional prosthesis; while no obvious difference is found in knee function and satisfaction. ConclusionComprehensive evaluation should be considered when high-flexion prosthesis is selected; and the effectiveness needs further follow-up.
ObjectiveTo investigate the best knee flexion angle by analyzing the length and orientation of the femoral tunnel through anteromedial portal (AM) at different flexion angles during anterior cruciate ligament (ACL) reconstruction. MethodsTwelve fresh cadaveric knees were selected to locate the center of ACL femoral footprint through AM using the improved hook slot vernier caliper, and to locate the posterior bone cortex using a diameter 3 mm ball at flexion of 90, 100, 110, 120, and 130°. The femoral tunnel length, standard coronal and sagittal plane angles, and the position relation between exit point and the lateral epicondyle were measured; the tunnel orientation on the anteroposterior and lateral X-ray films was also measured. ResultsWith increasing flexion of the knee, the femoral tunnel length showed a first increasing and then stable tendency; significant difference was found between at flexion of 90°and at flexions of 100, 110, 120, and 130°, and between flexions of 100°and 120°(P<0.05). The femoral tunnel showed a trend of decreasing with coronal angle, whereas gradually increasing with sagittal angle. The knee flexion angle had significant difference either among flexions of 90, 110, and 130°or between flexions of 100°and 120°(P<0.05). The exit point of the femoral tunnel located at the lateral epicondyle of the femur proximal to posterior region at flexion of 90°in all knees, and at flexion of 100°in 7 knees, but it located at the lateral epicondyle of the femur proximal to anterior region at flexion of 110, 120, and 130°in all knees. As the knee flexion angle increasing, the angle between femoral tunnel with the tangent of internal-external femoral condyle on anteroposterior X-ray films showed a trend of decreasing gradually, but a trend of increasing gradually on lateral X-ray films. On the anteroposterior X-ray films, significant differences were found in the angle either among flexions of 90, 110, and 130°or between flexions of 100°and 120°(P<0.05). On the lateral X-ray films, there were significant differences in the angle among flexions of 90, 100, 110, 120, and 130°(P<0.05). ConclusionDuring ACL reconstruction by AM, 110°is the best flexion angle, which can get the ideal femoral tunnel.