ABSTRACT
Objective:To investigate the early- and mid-term clinical, functional and radiographic outcomes of patellofemoral arthroplasty (PFA).Methods:A retrospective analysis was conducted in 64 patients (80 knees) who suffered from severe patellofemoral osteoarthritis (PFOA) and underwent PFA from January 2013 to December 2020. These patients were aged 60.50±8.82 (range from 27 to 82) years, including 9 males (12 knees) and 55 females (68 knees). All enrolled individuals presented typical PFOA. Unilateral PFA was performed in 48 cases, bilateral PFA in 16 cases, including one-stage PFA in 9 cases and two-stage PFA in 7 cases. The visual analogue scale (VAS), Hospital for Special Surgery (HSS) knee score and Oxford knee score (OKS) of patients with more than 5 years' follow-up were assessed to evaluate the clinical effects of PFA at the time before surgery, 1 year and 5 years after surgery. In addition, the patellar tilt angle (PTA) and hip-knee-ankle (HKA) angle were measured and analyzed to evaluate the improvement of patellar tracking and progression of tibiofemoral osteoarthritis, based on axial X-ray imaging (skyline view) of knee and the full length standing X-ray imaging of the lower limbs at before surgery and 5 years after surgery. Meanwhile, the complications of all patients that related to the operation were recorded.Results:A total of 64 patients were followed up for 4.31±1.79 (range, 1.5 to 8.2) years. Twenty-five patients (32 knees) who followed up more than 5 years were analyzed. The VAS, HSS and OKS improved from 5.91±0.82, 68.06±6.03 and 21.22±3.46 preoperatively to 0.88±1.01, 90.09±3.30 and 39.06±3.37 at 1 year after surgery, and to 0.41±0.76, 94.53±2.99 and 42.13±3.17 at 5 years after surgery, respectively ( F=89.38, 81.47, 56.73, P<0.001). Additionally, comparing to the preoperative radiological data, the patellar tract was improved with the PTA decreased from 8.21°±3.14° preoperatively to 3.58°±4.48°at 5 years after surgery ( t=4.96, P<0.001). The HKA angle changed from 179.01°±1.43° preoperatively to 178.77°±1.67° at 5 years follow up ( t=1.71, P=0.096). There was no case of prosthesis loosening or wear and no case of obvious progression of tibiofemoral osteoarthritis that needed revision in all patients. Conclusion:Satisfied early- and mid-term clinical outcomes could be achieved by PFA in treating severe PFOA patients. PFA could relieve pain and improve function of knee joint.
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
BACKGROUND:Col agen type II and proteoglycan loss are two most obvious manifestations of cartilage damage in the onset of osteoarthritis. Changes in col agen type II and proteoglycan as the main components of cartilage matrix directly lead to cartilage degeneration and subsequently result in osteoarthritis. How to reverse or prevent the development of this process becomes the focus of medical research. OBJECTIVE:To observe the effect of warming yang and benefiting marrow recipe on the expression of col agen type II and proteoglycan in the articular cartilage of knee osteoarthritis rabbits as wel as to further explore the mechanism underlying chondrocyte protection. METHODS:Ninety-six New Zealand rabbits, aged 9 months old, male and female, were selected to prepare osteoarthritis models in extension position using cast immobilization method, and were randomly divided into four groups:blank group (untreated), model group (simple modeling), Chinese medicine group (intragastric administration of extracts of warming yang and benefiting marrow recipe, 24 mL/kg/d) and western medicine group (intragastric administration of glucosamine hydrochloride, 24 mL/kg/d). Intragastric administration was done once a day for 6 weeks. RT-PCR technology was used to observe the effect of warming yang and benefiting marrow recipe on the expression of col agen type II and proteoglycans in the articular cartilage, and pathological examination was also done. RESULTS AND CONCLUSION:The cartilage surface was smooth in the blank group and Chinese medicine group, with uniform toluidine blue staining, but in the model group and western medicine group, the cartilage surface was rough and the toluidine blue staining was extremely uneven with obvious loss of surface and middle layer dying. The expressions of cartilage proteoglycan and col agen type II in the model group were significantly lower than those in the blank group (P<0.01) as wel as in the Chinese medicine group and western medicine group (P<0.05). In addition, the expressions of cartilage proteoglycan and col agen type II in the Chinese medicine group were higher than those in the western medicine group (P<0.05). These findings indicate that the recipe of warming yang and benefiting marrow can enhance the expressions of col agen type II and proteoglycan, which can maintain the normal col agen phenotype and protect the articular cartilage.
ABSTRACT
BACKGROUND:There are few reports concerning effects of warming the yang and benefiting the marrow for the knee osteoarthritis on the expression of matrix metal oproteinase. OBJECTIVE:To observe the effect of warming the yang and benefiting the marrow on the expression of matrix metal oproteinase in rabbit models of knee osteoarthritis. METHODS:Of 96 healthy adult New Zealand rabbits, 72 rabbits were randomly selected for making rabbit models of knee osteoarthritis using plaster external fixation. After success model establishment, the rabbits were randomly assigned to three groups. Model group was left intact. Chinese medicine group received daily intragastric administration of drug extract 24 mL/kg. Drug control group was daily intragastrical y administered Puli Capsule (glucosamine hydrochloride) 24 mg/kg, once a day, until the eighth week of success model induction. An additional 24 New Zealand rabbits served as blank controls. RESULTS AND CONCLUSION:Using quantitative PCR, matrix metal oproteinase-1, matrix metal oproteinase-3 and matrix metal oproteinase-13 expression was significantly higher in the model group than that in the other three groups. Matrix metal oproteinase-1, matrix metal oproteinase-3 and matrix metal oproteinase-13 expression was significantly lower in the Chinese medicine group and drug control group than that in the model group. These results indicated that warming the yang and benefiting the marrow for knee osteoarthritis in rabbits could effectively inhibit the expression of matrix metal oproteinase in rabbits.
ABSTRACT
[Objective] To evaluate the efficacy and safety of drainage blood autotransfusion after total knee or hip arthroplasty.[Methods]Drainage blood in the first 6 hours postoperation was collected and reinfused using the ContavacTM CBCⅡ system in 30 patients taken total knee or hip arthroplasty.The efficacy was evaluated basing on the amount of the allogenic transfusion,the decreasing of the hemoglobin level and the morphology of the red blood cells in the drainage blood.The safety was evaluated basing on whether the patients had autotransfusion complications including fever,hemolytic reaction,coagulation disorders,pulmonary embolism and systemic infection.[Results]The volumes of total blood drainage,autotransfusion and allogenic transfusion were(946?433)ml,(622?313)ml and(233?348)ml,respectively.The average hemoglobin level of drainage blood was 99.67g/L and no apparente haemolysis happened.However,the hemoglobin level significantly decreased after operation in the peripheral blood.Only one rheumatoid arthritis patient had an abnormal fever during autotransfusion process,no other complication was observed.[Conclusion]Drainage blood in the first 6 hours postoperation is valid blood content.Drainage blood autotransfusion is an effective and safe way to slow down the hemoglobin reduction and reduce allogenic blood transfusion in patients being treated with total knee or hip arthroplasty.
ABSTRACT
Many studies have proved that the subchondral bone plays an important role in the development of osteoarthritis,and may be the initial factor of the disease,but the exact relationship between articular cartilage degeneration and subchondral bone sclerosis is still unclear.Subchondral bone sclerosis caused by bone remodeling abnormality severely decreases the ability of subchondral bone stress absorption and protective function of articular cartilage,which finally leads to cartilage degeneration and osteoarthritis deterioration.Studying the role of subchondral bone in the pathogenesis of osteoarthritis and developing potential drugs to regulate subchondral bone remodeling will provide a new way of prevention and treatment for osteoarthritis.