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BACKGROUND: Postoperative pain is a common clinical problem in unicompartmental knee arthroplasty, and severe pain can affect postoperative efficacy. Hormone is a common and effective anti-inflammatory drug, and there is some controversy over whether to add hormone to the local injection of cocktail in unicompartmental knee arthroplasty. OBJECTIVE: To evaluate the effectiveness of adding hormones to the cocktail to promote rapid recovery after unicompartmental knee arthroplasty. METHODS: Osteoarthritis patients receiving unilateral unicompartmental knee arthroplasty from October 2017 to March 2019 were randomly divided into a hormone group (local injection of cocktail + 40 mg triamcinolone acetonide) and a control group (local injection of cocktail + equivalent normal saline). Visual analogue scale score, fentanyl consumption, knee function, inflammatory indicators, adverse reactions and complications were observed in both groups after surgery. RESULTS AND CONCLUSION: (1) Finally, 80 patients were included in the study (n=40 in each group). There was comparability between the two groups (P > 0.05). (2) The static and dynamic visual analogue scale scores of patients in the hormone group at 1, 2 and 3 days after surgery were significantly lower than those in the control group (P 0.05). (6) C-reactive protein levels at 3 days and interleukin-6 levels at 24 hours after surgery in the hormone group were significantly lower than those in the control group (P < 0.05). (7) The incidence of complications in the hormone group was significantly lower than that in the control group (P < 0.05). (8) Addition of hormones in the cocktail can effectively promote the rapid recovery after unicompartmental knee arthroplasty..
ABSTRACT
BACKGROUND: It remains controversial whether patients with ARCO stage III osteonecrosis of the femoral head should be treated with femoreal head preserving surgery, and what the clinical efficacy of femoreal head preserving surgery is. OBJECTIVE: To investigate the clinical efficacy of nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft in the treatment of ARCO stage III osteonecrosis of the femoral head METHODS: From March 2017 to September 2018, 36 patients (32 male and 4 female, 16-58 years old) with ARCO state III osteonecrosis of the femoral head who received treatment in Aviation General Hospital were included in this study. Among these patients, three had bilateral osteonecrosis of the femoral head and 33 had unilateral osteonecrosis of the femoral head. According to ARCO classification, 35 hips fell into stage IIIA, 3 hips in stage IIIB, and 1 hip in stage IIIC. All included paitents underwent nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft. Postoperative follow up was performed. Hip joint function was evaluated using Harris hip score. The degree of collapse of the femoral head was evaluated using X-ray imaging. The osteogenesis in the necrotic area was determined by CT scans. This study was approved by Aviation General Hospital Ethics Committee (Ethics code: HK2019-01-04). RESULTS AND CONCLUSION: (1) Thirty-six patients were followed up for (19.28±6.51) months. At the last follow-up, 4 hips ultimately underwent total hip arthroplasty with the success rate of 89.7%(35/39). (2) Harris hip score revealed that at the last follow-up, the excellent and good rate of hip function was significantly higher than that before surgery (71.8%,17.5%, P=0.000). (3) Last follow-up CT scans revealed obvious osteogenesis was observed in 26 of 35 hips at ARCO stage IIIA and it was observed in neither 3 hips at ARCO stage IIIB nor in 1 hip at ARCO stage IIIC. (4) At the last follow-up, X-ray showed that there was progress in 5 of the 35 hips (IIIA), 3 of which progressed to ARCO stage IIIB, 2 to ARCO stage IV, and the remaining 30 hips were stable without progression; three hips in ARCO stage IIIB progressed, including 2 progressed to ARCO stage IIIC and 1 to ARCO stage IV; 1 hip in ARCOIIIC stage progressed to ARCO stage IV. The results suggest that nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft has a good effect on the treatment of ARCO stage III osteonecrosis of the femoral head.
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<p><b>BACKGROUND</b>The quality of the lateral compartment cartilage is important to preoperative evaluation and prognostic prediction of unicompartmental knee arthroplasty (UKA). Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) enables noninvasive assessment of glycosaminoglycan (GAG) content in cartilage. This study aimed to determine the GAG content of the lateral compartment cartilage in knees scheduled to undergo Oxford medial UKA.</p><p><b>METHODS</b>From December 2016 to May 2017, twenty patients (20 osteoarthritic knees) conforming to the indications for Oxford medial UKA were included as the osteoarthritis (OA) group, and 20 healthy volunteers (20 knees) paired by sex, knee side, age (±3 years), and body mass index (BMI) (±3 kg/m2) were included as the control group. The GAG contents of the weight-bearing femoral cartilage (wbFC), the posterior non-weight-bearing femoral cartilage (pFC), the lateral femoral cartilage (FC), and tibial cartilage (TC) were detected using dGEMRIC. The dGEMRIC indices (T1Gd) were calculated in the middle three consecutive slices of the lateral compartment. Paired t-tests were used to compare the T1Gd in each region of interest between the OA group and control group.</p><p><b>RESULTS</b>The average age and BMI in the two groups were similar. In the OA group, T1Gd of FC and TC was 386.7 ± 50.7 ms and 429.6 ± 59.9 ms, respectively. In the control group, T1Gd of FC and TC was 397.5 ± 52.3 ms and 448.6 ± 62.5 ms, respectively. The respective T1Gd of wbFC and pFC was 380.0 ± 47.8 ms and 391.0 ± 66.3 ms in the OA group and 400.3 ± 51.5 ms and 393.6 ± 57.9 ms in the control group. Although the T1Gd of wbFC and TC tended to be lower in the OA group than the control group, there was no significant difference between groups in the T1Gd in any of the analyzed cartilage regions (P value of wbFC, pFC, FC, and TC was 0.236, 0.857, 0.465, and 0.324, respectively).</p><p><b>CONCLUSIONS</b>The GAG content of the lateral compartment cartilage in knees conforming to indications for Oxford medial UKA is similar with those of age- and BMI-matched participants without OA.</p>
ABSTRACT
<p><b>BACKGROUND</b>Lateral compartmental osteoarthritis (LCOA), a major complication after medial mobile-bearing unicompartmental knee arthroplasty (UKA), is highly associated with the increased stress of the lateral compartment. This study aimed to analyze the effects on the stress and load distribution of the lateral compartment induced by lower limb alignment and coronal inclination of the tibial component in UKA through a finite element analysis.</p><p><b>METHODS</b>Eight three-dimensional models were constructed based on a validated model for analyzing the biomechanical effects of implantation parameters on the lateral compartment after medial Oxford UKA: postoperative lower limb alignment of 3° valgus, neutral and 3° varus, and the inclination of tibial components placed in 4°, 2° valgus, square, and 2° and 4° varus. The contact stress of femoral and tibial cartilage and load distribution were calculated for all models.</p><p><b>RESULTS</b>In the 3° valgus lower limb alignment model, the contact stress of femoral (3.38 MPa) and tibial (3.50 MPa) cartilage as well as load percentage (45.78%) was highest compared to any other model, and was increased by 36.75%, 47.70%, and 27.63%, respectively when compared to 3° varus. In the condition of a neutral position, the outcome was comparable for the different tibial tray inclination models. The inclination did not greatly affect the lateral compartmental stress and load distribution.</p><p><b>CONCLUSIONS</b>This study suggested that slightly varus (undercorrection) lower limb alignment might be a way to prevent LCOA in medial mobile-bearing UKA. However, the inclination (4° varus to 4° valgus) of the tibial component in the coronal plane would not be a risk factor for LCOA in neutral position.</p>
ABSTRACT
<p><b>BACKGROUND</b>The lateral pillar of the femoral head is an important site for disease development such as osteonecrosis of the femoral head. The femoral head consists of medial, central, and lateral pillars. This study aimed to determine the biomechanical effects of early osteonecrosis in pillars of the femoral head via a finite element (FE) analysis.</p><p><b>METHODS</b>A three-dimensional FE model of the intact hip joint was constructed from the image data of a healthy control. Further, a set of six early osteonecrosis models was developed based on the three-pillar classification. The von Mises stress and surface displacements were calculated for all models.</p><p><b>RESULTS</b>The peak values of von Mises stress in the cortical and cancellous bones of normal model were 6.41 MPa and 0.49 MPa, respectively. In models with necrotic lesions in the cortical and cancellous bones, the von Mises stress and displacement of lateral pillar showed significant variability: the stress of cortical bone decreased from 6.41 MPa to 1.51 MPa (76.0% reduction), while cancellous bone showed an increase from 0.49 MPa to 1.28 MPa (159.0% increase); surface displacements of cortical and cancellous bones increased from 52.4 μm and 52.1 μm to 67.9 μm (29.5%) and 61.9 μm (18.8%), respectively. In addition, osteonecrosis affected not only pillars but also adjacent structures in terms of the von Mises stress and surface displacement levels.</p><p><b>CONCLUSIONS</b>This study suggested that the early-stage necrosis in the femoral head could increase the risk of collapse, especially in lateral pillar. On the other hand, the cortical part of lateral pillar was found to be the main biomechanical support of femoral head.</p>