ABSTRACT
Objective To investigate the outcome of a new designed extramedullary femoral osteotomy module and to compare with conventional intramedullary system in clinical study.Methods The extramedullary femoral osteotomy module was designed with the extramedullary alignment rod connecting with the T type rod at right angle,and it had a 5°-7° adjustable valgus design.The positioning module fixation screw was parallel with the epicondylar axis.The coronal plane of the distal femur bone cut was orientated by the extramedullary alignment rod pointing to the inguinal midpoint,and the sagittal plane was orientated by the extramedullary alignment rod keeping parallel with the distal femoral medullary cavity.The terminal distal femoral bone cut was conducted with suitable osteotomy after the orientation.Sixty patients who underwent unilateral total knee arthroplasty (TKA) from October 2015 to March 2016 were randomly divided into intramedullary and extramedullary group for prospective controlled study.Blood loss,drainage and the incidence of deep vein thrombosis (DVT) were evaluated at one week postoperatively.Knee valgus angle and femoral prosthesis flexion angle were analyzed at two weeks postoperatively.Moreover,the extramedullary femoral osteotomy module was used in 273 patients (78 males and 195 females) with an average age of 68.7 (range,57-82 years old) who underwent unilateral TKA from April 2016 to January 2017.Blood loss,operation duration and lower limb ultrasonography preoperatively and at one week postoperatively were recorded.Knee valgus angle and femoral prosthesis flexion angle were measured at 2 weeks postoperatively.Range of knee motion and Hospital for Special Surgery (HSS) knee score at six weeks postoperatively were also reported.Results In the randomized controlled trial,blood loss and drainage in extramedullary group was less than that in intramedullary group (t=-3.330,P=0.004).There was no significant difference in the incidence of DVT at 1 week postoperatively (x2=2.269,P=0.132) and the knee valgus angle and femoral prosthesis flexion angle at 2 weeks postoperatively within the two groups.In the clinical application,operation time was 60.13± 13.69 min,and blood loss and drainage was 109.11±70.73 ml.There were four cases of popliteal vein thrombosis,nine cases of posterior tibial vein thrombosis,and seventeen cases of muscular venous thrombosis at one week postoperatively.The incidence rate of DVT was 11.0％.There was no symptomatic pulmonary embolism at three months postoperatively.Knee valgus angle was 7.34°±0.69°,and 211 knees accounting for 77.3％ were in the range of ±3° error.Femoral prosthesis flexion angle was 6.43°±1.59°,and 273 knees were all in the range of ±10° error.Range of knee motion improved from 54.52±5.96 preoperative to 86.20±4.92 at six weeks postoperative.HSS knee score improved from 100.88°±7.51° preoperative to 110.42°±7.08° at six weeks postoperative.Conclusion The new designed extramedullary femoral osteotomy module used in distal femoral osteotomy during TKA can significantly reduce the risk of bleeding and the incidence rate of DVT postoperatively.Furthermore,patients can obtain as excellent prosthesis position and limb alignment as conventional intramedullary system.
ABSTRACT
Objective To evaluate the clinical effect of exercise therapy on patients with osteoporosis according to osteoporosis quality of life scale(OQOLS)and the changes in biochemical markers of bone metabolism.Methods Totally 94 patients with primary osteoporosis were randomly divided into 2 groups:the intervention group [exercise therapy (Wu Xing Jian Gu Cao) with calcium/vitamin D supplementation for 90 days] and the control group (only calcium/vitamin D supplementation for 90 days].OQOLS and the changes in biochemical markers of bone metabolism were observed before and after treatment.Results Compared with before treatment,25-hydroxy vitamin D[25-(OH) D]levels were increased in control group (33 cases) and intervention group (29 cases) after treatment [(61.2± 11.1) mmol/L vs.(48.1±26.2)mmol/L,both P＜0.001],and the enhanced level was higher in the intervention group than in the control group (P＜0.05).Compared with before treatment,bone alkaline phosphatase (BALP) was decreased in control and intervention group after treatment (both P＜0.05).There were significant differences in OQOLS in both groups between before and after treatment except for the function of physical activities in intervention group (P＜0.05).Conclusions The basic and exercise therapy can both increase [25-(OH) D] level,reduce BALP,and have clinical effects on bone metabolism,while exercise therapy has an improvement in osteoporosis quality of life in patients with osteoporosis.
ABSTRACT
BACKGROUND:The majority of people do not believe that the femoral component flexion in total knee arthroplasty affect or affect little postoperative function and it is the only that the radiographic films is not satisfactory.So it has not caused people's enollgh attention.But the femoral component flexion affects the results of total knee arthroplasty obviously.OnJECTIVE:To investigate the curative effects of femoral component installed in the position of flexion during the operative procedure of total knee arthroplasty(123 knees)on the follow up results in 78 patients.DESIGN:Grouping contrast observation.SETTlNG:First Department of Bone and Joint,Wangjing Hospital of China Academy of Traditional Cllinese Medicine.PARTlCIPANTS:123 knees(78 patients)were given total knee arthroplasty in the First Department of Bone and Joint,Wangjing Hospital of China Academy of Traditional Chinese Medicine from October 2001 to June 2004.Seventeen(13.8%,15 patients)knees were found with femoral component flexion(FCF),in which there were 5 male cases and 10 female cases,aged from 47 to 81 years old.106(63 patients)knees were found without FCF,in which there were 22 male cases and 41 female cases,aged from 47 to 79 years old.METHODS:Total knee arthroplasties about their HSS rating scores,ranges of motion and flexion contractures werecompared in the two groups before operation and after operation,and the degrees of the FCF angle and the distances of femoral component flexion were measured.MAIN OUTCOME MEASURES:①Femoral Drostllesis flexion measurement;②HSS scores and activity:③femoral prosthesis flexion angle and distance buckling;④adverse events and side effects.RESULTS:Follow up lasted for one year above.①The degrees of flexion of femoral components were from 7°to 19°(average 11.3°)and the distance of flexion was from 2 mm to 4 mm(average 2.6 mln)in those 17 knees of total knee arthroplasty.②Differences in HSS rating scores and range of motion were not statistically significant(P＞0.05)before operations between the group of femoral component flexion and the group of femoral component plane.However,after operations the above aspects in the group of femoral component flexion were less than that in the group of femoral component plane significantly(P=0.01,P＜0.01),and were statistically significant(P=0.02,P＜0.01)between post-operations and pre-operations in HSS rating scores and range of motion respectively in the two groups.③The statistic differences in cases and angles of flexion contractures of postperations between the group of femoral component flexion and the group of femoral component plane were significant(P＜0.01),the situation in the group of femornl component flexion were more bad than that in the group of femoral component plane,but were all improved significantly in cases and angles of flexion contractures after operations in the two groups(P＜0.05,P＜0.01).④There was one case with the right deep venous thrombosis and one case with myositis ossifican in non-FCF group,and there was one case in FCF group with impingement sign between patellar and component.CONCLUSION:The findings show that femoral component flexion will increase the incidence of knee flexion contracture and result in knee extension dysfunction after total knee arthroplasty surgery.