Short- and mid-term effectiveness of unicompartmental knee arthroplasty for post-traumatic arthritis of knee / 中国修复重建外科杂志

OBJECTIVE@#To investigate the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA) for post-traumatic arthritis (PTA) of knee.@*METHODS@#The clinical data of 30 patients with PTA of unilateral knee between March 2014 and September 2021 was retrospectively analyzed. There were 14 males and 16 females with an average of 64.5 years (range, 33-81 years). The average body mass index was 26.7 kg/m 2 (range, 19.8-35.6 kg/m 2). The types of injuries that caused PTA included intra-articular fracture in 16 cases, extra-articular fracture in 8 cases, and soft tissue injury in 6 cases. The initial injuries were treated by conservative therapy in 12 cases and by surgical therapy in 18 cases. Ten cases were medial compartment osteoarthritis and 20 cases were lateral compartment osteoarthritis. According to Kellgren-Lawrence staging, there were 19 cases of grade Ⅲ and 11 cases of grade Ⅳ. The operative time, the length of hospital stay, complications, and subjective satisfaction were recorded. The Oxford Knee Function Score (OKS), Hospital for Special Surgery (HSS) score, and knee range of motion (ROM) were used to evaluate knee function. Weight-bearing X-ray films were taken to measure the femoro-tibial angle (FTA) and to assess alignment correction of the lower limb.@*RESULTS@#The operative time ranged from 50 to 95 minutes (mean, 63.7 minutes), the length of hospital stay ranged from 3 to 8 days (mean, 6.9 days). Superficial infection occurred in 2 patients, while the remaining incisions healed by first intention. There was no deep vein thrombosis or neurovascular injury. All patients were followed up 17-109 months (median, 70 months). At last follow-up, OKS score, HSS score, and ROM in 30 cases significantly improved when compared with those before operation (P<0.05). Lower limb alignment was significantly corrected and there was significant difference in FTA of the varus and valgus knees between pre- and post-operation ( P<0.05). The patient satisfaction rate was 86.7% (26/30). Two cases developed contralateral osteoarthritis progression during follow-up. No bearing dislocation, prosthesis loosening or sinking occurred and none required further revision.@*CONCLUSION@#For patients with PTA of knee, UKA can obtain definite short- and mid-term effectiveness with high patient satisfaction.

Reemplazo total de rodilla en pacientes menores de 55 años con gonartrosis. Seguimiento de 2 a 13 años / Total knee arthroplasty for gonarthrosis in patients <55 years old. A 2 to 13-year follow-up study

Introducción: Los reemplazos totales de rodilla en jóvenes siguen aumentando. Se publicaron resultados inconstantes sobre la función y las complicaciones, inclusive en pacientes con artritis reumatoide. El propósito de este estudio fue analizar un grupo de reemplazos totales de rodilla en pacientes <55 años para evaluar la sobrevida de la prótesis, las fallas radiológicas y los resultados funcionales. Materiales y Métodos: Se analizaron retrospectivamente 53 reemplazos totales de rodilla en 46 pacientes (promedio de edad: 49 años [rango 26-54]) y un seguimiento promedio de 6.5 años (rango 2-15). Los diagnósticos preoperatorios fueron: 46 gonartrosis idiopáticas, 5 postraumáticas y 2 osteonecrosis. Veintidós tenían cirugías previas. Se utilizaron 49 implantes importados y 4 nacionales. Los resultados clínico-funcionales se evaluaron mediante el Knee Society Score y el WOMAC, la evaluación radiológica se efectuó con el sistema de la Knee Society. Resultados: El puntaje KSS funcional mejoró de 49,3 a 92,6 en promedio y el puntaje propio de rodilla pasó de 46,8 a 91,4 en el posoperatorio. El puntaje WOMAC promedio fue de 2,3 para dolor, 2,6 para rigidez y 27,3 para capacidad funcional. El 16% presentó líneas de radiolúcidas <1 mm que no progresaron. Hubo tres infecciones que requirieron una revisión en dos tiempos, con evolución favorable, y cuatro casos de rigidez tratados mediante movilización artroscópica. La sobrevida de la prótesis fue del 94,34%. Conclusiones: El reemplazo total de rodilla en pacientes <55 años fue un procedimiento confiable en cuanto a la mejoría de la función, con una aceptable sobrevida de la prótesis considerando los antecedentes quirúrgicos. No se observaron fallas radiológicas al final del seguimiento. Nivel de Evidencia: IV

Introduction: Total knee arthroplasty is being performed with increasing frequency in young patients. Published data on the clinical scores and long-term durability for total knee arthroplasty in these patients are limited and most include patients with rheumatoid arthritis. The purpose of this study was to analyze a group of total knee arthroplasties in patients <55 years old, excluding those with rheumatoid arthritis, in order to assess prosthetic survival, radiographic failures and functional outcomes. Methods: A total of 53 total knee arthroplasties were retrospectively analyzed in 46 patients (average age: 49 years [range 26-54]) and a mean follow-up of 6.5 years (range 2-15). The preoperative diagnoses accounted for 46 idiopathic knee osteoathritis, 5 post-traumatic arthritis and 2 osteonecrosis. Twenty-two patients had previous surgeries. The clinical and functional outcomes were assessed using the Knee Society Score and the WOMAC, whereas radiological assessment system of the Knee Society was used. Results: Clinical and functional KSS improved from 49.3 to 92.6 and from 46.8 to 91.4 postoperatively on average, respectively. The average WOMAC score was 2.3 for pain, 2.6 for stiffness and 27.3 for functional capacity. Radiolucent lines <1 mm were observed in 16%, without progression over time. There were 3 infections requiring two-stage revision evolving favorably and 4 cases of stiffness that were manipulated under anesthesia or arthroscopy. The prosthetic survival rate was 94.34%. Conclusions: Total knee arthroplasty in patients <55 years provides functional improvements, with an acceptable prosthetic survival considering previous surgeries. At the end of the follow-up, no radiological failures were observed. Level of Evidence: IV

Total Talus Dislocation: A Case Report / 대한족부족관절학회지

Talar fracture and total dislocation, each known as one of rare injuries mainly caused by high-energy trauma, tend to cause avascular necrosis, post-traumatic arthritis, non-union, skin necrosis and infection because of weak blood supply. The authors have experienced and reports a total talus dislocation of 16 year old male associated with medial malleoalr fracture, who showed relatively good result by early reduction and operation.

Protein Expression Profile of Synovial Fibroblasts in Experimental Post-traumatic Arthritis

OBJECTIVE: To evaluate and compare protein expression profiles of synovial fibroblasts using proteome analysis in swine knee injuries with joint instability, during early post-traumatic arthritis (PTA) development. METHOD: Experimental PTA was induced by transection of the anterior cruciate ligament (ACL) in swine left knee joints. After sacrifice at 8 weeks, cartilage and synovium obtained from both knee joints were prepared for histopathologic examination. Cultured synovial fibroblasts were processed for 2-dimensional electrophoresis and mass spectrometric analysis. Histopathologic examination showed overt arthritic changes that supported the development of early PTA. RESULTS: Proteome analyses led to the identification of more than 1,500 protein spots and of 11 differently expressed protein spots. Of those, six proteins were down-regulated (cytoskeletal beta actin, cofilin-1, destrin, Rho GDP dissociation inhibitor alpha, and unnamed protein product), and five proteins were up-regulated (alpha-B crystallin, smooth muscle protein 22-alpha, and cytoskeletal beta actin) in ACL-transected synovial fibroblasts. That is, proteins related to cellular organization and signal transduction are down-regulated, and those related to cell rescue, defence, and stress are up-regulated. CONCLUSION: These results may suggest that joint instability contributes to the development of PTA and is one of the major etiologic factors of PTA. In addition, this suggests that the proteome analysis of synovial fibroblasts is a useful approach in examining a joint after an injury and can be used to understand the pathogenesis of PTA.