ABSTRACT
Objective To investigate the efficacy of unicompartmental knee arthroplasty(UKA) on treating elderly patients with knee osteoarthritis in comparison with total knee arthroplasty(TKA),and discuss the indications of the procedure.Methods The clinical data of elderly patients(≥75 years) undergoing UKA in our institute from October 2011 to May 2015 were retrospectively reviewed.Patients treated with UKA were in UKA group.Patients who had no significant difference in the age,gender,BMI (body mass index) and HSS (hospital for special surgery) compared with UKA group and received TKA were selected as TKA group.The outcomes were assessed by HSS and satisfaction score(range,0 ～ 10).Results A total of 29 cases (41 knees) of UKA group were followed up for (30.3 ± 13.6) months (13 ～49 months),29 cases(39 knees) of TKA group.The postoperative HSS(P =0.00),surgery time(P =0.00),perioperative hemorrhage(P =0.00),hospital stay(P =0.04) and satisfaction(P =0.03) of UKA group were all better than those of TKA group.The pain location of the knee (P =0.86) and patellofemoral degeneration (P =0.24) did not affect the postoperative outcomes,11 knees presented with varus ＞ 15° with an average angle of 18.4 ° (15.7 ° ～ 20.1 °),4 knees were with flexion contracture ＞ 15 °,averaging at 18.8 ° (17.7 ° ～ 20.1 °),range of motion measured ＜ 100° in 6 knees with an average range of 79.0° (66.8° ～ 92.1 °).The aforementioned abnormalities were effectively corrected under anesthesia,the range of motion inproved significantly,but there was no significant difference in postoperative HSS among these patients (P =0.85).One case of UKA group had wound dehiscence and superficial infection,recovery occurred after debridement and suturing.Conclusion UKA is effective for elderly patients with satisfactory outcomes,which is superior to TKA with respect to trauma control and preservation of the limb function.Medial patellofemoral degeneration poses no negative effect on postoperative outcomes,medium knee varus (≤20°) and flexion contracture(≤20°) that are corrective under anesthesia among elderly patients might not be considered as contraindications for UKA.
ABSTRACT
<p><b>BACKGROUND</b>Intralesional excision with curettage is the standard method of giant cell tumor (GCT) treatment, but the ideal filling material after curettage remains controversial. The purpose of this study was to compare the oncological and functional outcomes which underwent cementation or bone grafting after GCT curettage around the knee.</p><p><b>METHODS</b>We reported 136 cases with GCTs in distal femur or proximal tibia who accepted curettage from five clinical centers during the last 15 years. All patients were divided into two groups according to filling materials. Recurrence-free survival proportions were used to evaluate oncological outcomes while the Musculoskeletal Tumor Society (MSTS) 93 functional score was used to evaluate functional outcomes. Other parameters including surgical complication, general condition, and radiological classification had been analyzed. The valid statisitical data was analyzed using SPSS 13.0 software.</p><p><b>RESULTS</b>After GCT curettage, 86 patients (63.2%) accepted bone grafting while 50 patients (36.8%) accepted cementation. There was no statistical difference in age, gender, tumor location, radiological classification, fixation, follow-up time, and MSTS 93 functional score between cementation group and bone grafting group. The recurrence-free survival proportions showed that the recurrence rate in bone grafting group was higher than it in cementation group (P = 0.034). Surgical complication was lower in cementation group than that in bone grafting group but without statistically significant difference (P = 0.141).</p><p><b>CONCLUSIONS</b>Parameters including patients' age, gender, tumor location, and radiological classification did not affect surgeons' treatments in cavity filling after GCT curettage. Cementation should be recommended because of easy usage, the similar postoperative knee function with bone grafting, and the better local tumor control than bone grafting.</p>
ABSTRACT
Objective To investigate the value of 99Tcm-methoxyisobutylisonitrile (MIBI) scintigraphy in assessing the preoperative chemotherapy response and multidrug resistance of osteosarcoma.Methods From January 2007 to October 2008, 12 patients (female:4, male:8; mean age:16.3 years,range:8-27 years) underwent early (10min) and delayed (120 min) 99Tcm-MIBI scintigraphy before and after preoperative chemotherapy.Seven cases had osteosarcoma at the distal femurs, 2 at the proximal tibias, 2 at the upper end of humerus and 1 at the fibula.The tumor-to-background ratio (T/B) and washout rate (WR) were calculated.Tumor necrosis was classified according to Huvos criterion after limb salvage surgery.Immunohistochemical staining for P-glycoprotein(gp) was examined.Spearman correlation analysis and t-test were performed.Results According to Huvos criterion, 7 patients were classified as good responders with more than 90% of tumor cell necrosis and 5 as poor responders with less than 90% of tumor cell necrosis.R value (ratio of early phase T/B after and before chemotherapy) was significantly lower in good responders than that in poor responders (0.473 ± 0.21 vs 0.998 ± 0.06, t= 5.342, P= 0.000 ).R value was significantly correlated with the degree of tumor cell necrosis ( rs=- 0.87, P= 0.000 ).WR was significantly higher in patients with positive P-gp expression than that in patients with negative P-gp expression ((38.36 ±18.64)% vs (6.40±5.87)%, t= -3.278, P=0.008).There was significant correlation between the WR and P-gp expression (rs = 0.91, P= 0.001 ).Conclusion 99Tcm-MIBI scintigraphy is a feasible non-invasive technique to assess the chemotherapy response and to detect P-gp expression of osteosarcoma.