ABSTRACT
BACKGROUND: Total knee arthroplasty is effective in managing end-stage knee disease. Measured resection and gap balancing are two different techniques. Both of two have advantages and disadvantages. A technique has been developed that combines the benefits of measured resection and gap balancing to optimize the clinical effect of total knee arthroplasty. OBJECTIVE: To evaluate the operation and early clinical effect in total knee arthroplasty about the combination of measured resection and gap balancing technique used in femoral component rotation. METHODS: Totally 30 patients were treated with the combination of measured resection and gap balancing technique in total knee arthroplasty from September 2016 to December 2018, including 4 males and 26 females, at the age of 46-81 years. There were 24 cases of osteoarthritis with varus and 2 cases of osteoarthritis with valgus. There were 4 cases of rheumatoid arthritis with valgus. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Effects were evaluated by Visual Analogue Scale, Hospital for Special Surgery score, femorotibial angle and range of motion before surgery and during final follow-up. RESULTS AND CONCLUSION: (1) The incision healed in the first stage after operation. No early complications occurred, such as infection, vascular nerve injury, deep venous thrombosis of the lower extremities and periprosthetic fracture. (2) Totally 30 patients were followed up for 6-30 months. (3) Visual Analogue Scale, Hospital for Special Surgery score, range of motion and femorotibial angle were improved during final follow-up compared with those before surgery (P < 0.05). (4) Surgeons should be familiar with measured resection and gap balancing technique in total knee arthroplasty, and then use the combination of two techniques based on the specific situation of patients to obtain better soft tissue balance and prosthesis position. The combination technique is easy to master and can be operated with traditional osteotomy tools. Thus, good short-term effect can be achieved.
ABSTRACT
BACKGROUND: Closed osteotomy of distal femur has a good effect in the treatment of genu valgus osteoarthritis, but the angle of osteotomy cannot be measured directly during the operation. It is necessary to correct the force line through repeated fluoroscopy and adjustment of osteotomy amount. Improper operation may cause iatrogenic rotation deformity. OBJECTIVE: To compare the effect of 3D printing assisted osteotomy of distal femur with conventional osteotomy of distal femur in the treatment of knee osteoarthritis. METHODS: From January 2014 to February 2018, 28 patients (37 knees in total) with osteoarthritis caused by genu valgus aged 28-60 years were enrolled from the First Hospital of Putian City. All patients were randomly divided into two groups. Patients in the control group (11 cases, 16 knees) were treated with conventional closed osteotomy of distal femur combined with locking compression plate implantation. Patients in the experimental group (17 cases, 21 knees) were treated with 3D printing module assisted with closed osteotomy of distal femur combined with locking compression plate. The operation time and times of fluoroscopy were recorded. The KOOS score, femorotibial angle, lateral angle of distal femur and fracture healing time were compared between the two groups before and after treatment. The experiment was approved by the Ethics Committee of the First Hospital of Putian City. RESULTS AND CONCLUSION: (1) Operation time and the times of fluoroscopy in the experimental group were less than those in the control group (P 0.05). (3) Femorotibial angle and lateral angle of distal femur in both groups were larger than those before operation (P 0.05). (4) There was no significant difference in the healing time between the two groups (P > 0.05). (5) The results showed that closed osteotomy of the distal femur can achieve good results in the treatment of genu valgus osteoarthritis. 3D printing technology can simplify the osteotomy operation, reduce the operation time, and the times of fluoroscopy.
ABSTRACT
@#Introduction: Periprosthetic fractures are a devastating complication following total knee arthroplasty. Little is known about the effect of mechanical factors on the incidence of periprosthetic fractures. The aim of this study was to examine the correlation between pre-operative mechanical factors, like side of surgery, coronal alignment and pre-operative range of motion and intra-operative factors, and the incidence of a periprosthetic fracture, following primary total knee arthroplasty (TKA). Materials and Methods: Forty-two patients with periprosthetic fractures (PPF) after primary TKA were identified from our hospital arthroplasty registry. These patients were matched two-to-one for gender and age at primary knee arthroplasty to 84 patients without PPF. The incidence of periprosthetic fracture with regards to laterality, coronal alignment and pre-operative range of motion was analysed. Intra-operative factors like implant type, patellar resurfacing and notching were also analysed using logistic regression. Results: Coronal alignment, pre-operative range of motion and patella resurfacing were not significant predictors of periprosthetic fractures. Anterior femoral notching was found to be significantly higher in the fracture group with an odds ratio of 17. Left sided surgery was also significantly higher in the periprosthetic fracture group. Conclusion: Periprosthetic fractures are 17 times more likely to occur in a knee with anterior femoral notching. Preoperative factors like coronal alignment and poor preoperative range of motion do not seem to increase the risk of periprosthetic fractures after TKA.
ABSTRACT
<p>Non-contact anterior cruciate ligament (ACL) injury is one of the most severe knee problems for female athletes. Several studies have reported that the decreased lower limb control of women such as decrease of hip abductions muscle strength increase the risk of ACL injury. Also ACL Injury often occurs as a result of knee valgus collapse during single leg landing or pivoting in sports activities like basketball. Female basketball players often show an excessive knee valgus and hip adduction during the play. The purpose of this study was to analyze the effect of hip abductions muscle strength on knee alignment during a single leg landing. Thirty healthy female basketball players participated in this study. Mean age, height, body weight and plyer career were 17.3 years old±3.7, 162.7cm±17.2, 56.2kg±10.9, 8.9 years±3.8 respectively. All subjects were obtained written consent from after explanation of the procedure. Significant negative correlations showed that greater hip abductor peak torque (hip flexion 0 and 30degrees) exhibited less motion toward the knee valgus direction during single leg landing. And also, dynamic Trendelenburg test showed that all positive reactions cause knee valgus direction. These results suggest keeping proper knee position safety during single leg landing; female basketball player should improve the hip abductions muscle strength. Hip joint control will be a major issue for prevention of the non-contact ACL injury.</p>
ABSTRACT
Currently,independent clinical medial femoral plate is more needed to apply in more complex C3 distal femoral fractures and knee valgus orthopedic surgery.The doctors always pre-bent the contralateral femoral lateral plate in order to achieve close to the natural shape of the bone.The cold deformation of the plate can change the metallographic structure and the biomechanics,and the position of the screw holes in the plate may also affect the healing of fractures.Compared with traditional manufacturing techniques,3D printing technology as a core technology in third industrial revolution,instead prior manufacture of molds,removing the large amount of material in the manufacturing process and the complex process of forging a final product,it is more suitable for difficult to machine materials,manufacture,inspection shape design,assembly,testing and fast reverse engineering.Therefore,a personalized interior distal femoral plate with 3D printing technology was designed,and the application of the plate,the current situation and prospects of 3D printing technology and other aspects were summarized in this article.
ABSTRACT
OBJECTIVE: To investigate the effectiveness of rotating-platform prosthesis for valgus knee deformity in total knee arthroplasty (TKA). METHODS: A retrospective analysis was made on the clinical date of 25 cases (28 knees) of valgus deformity undergoing primary TKA by using Gemini MK II rotating-platform prosthesis. There were 6 males (7 knees) and 19 females (21 knees), aged from 47 to 82 years, with an average age of 64.8 years. The unilateral knee was involved in 22 cases and the bilateral knees in 3 cases. The causes included osteoarthritis in 20 cases (22 knees), rheumatoid arthritis in 4 cases (5 knees), and traumatic arthritis in 1 case (1 knee). The disease duration was 2-22 years (mean, 10.4 years). The main clinical symptoms were arthralgia combined with limited movement. According to the Keblish grade, there were 13 knees of mild deformity, 11 knees of moderate deformity, and 4 knees of severe deformity. RESULTS: All incisions healed by first intension. No complications of infection, cutaneous necrosis, deep venous thrombosis, and pulmonary embolism occurred. The postoperative follow-up duration was 12-60 months (mean, 25.4 months). Medial instability and palsies of nervus peroneus communis occurred in 1 and 2 cases respectively, and all were cured after symptomatic treatment. No patellar and polysthylene insert dislocation, prosthetic loosening or infection was observed. The Hospital for Special Surgery (HSS) score, femoral tibial angle, maximun flexion and extension angles, knee range of motion, and patellar score were significantly improved at last follow-up when compared with preoperative ones (P<0.01). CONCLUSIONS: The rotating-platform prosthesis for valgus deformity can obtain satisfactory effectiveness, but it requires precise soft tissue balancing technology, and the long-term effectiveness remains further observation.
ABSTRACT
Objective To evaluate the clinical efficacy of total knee arthroplasty(TKA)in patients of osteo-arthris with valgus knee deformity after lateral meniscectomy(LMT). Methods Twenty six cases of osteo-arthris with valgus knee deformity after lateral meniscectomy were treated with total knee arthroplasty. Operation evaluations including the range of motion(ROM),the tibial and femur angle(T-F angle),Knee Society Score System(KSS)and the function score were performed as follow-up. Results The median follow-up periods was 22 months and ranged from 5 months to 3 years. The average ROM improved from 96° preoperatively to 116° at postoperatively. The average KSS improved from 22. 5 points preoperatively to 84. 4 points postoperatively. The average function score improved from 25. 5 points preoperatively to 84. 4 points postoperatively,and the average T-F angle was corrected from 22°( 13° - 31°) of valgus preoperatively to 7. 6°( 0° - 9°) of valgus postoperatively. Conclusion The TKA can provide excellent in patients undergoing osteo-arthris with valgus knee deformity after lateral meniscectomy.
ABSTRACT
BACKGROUND:Valgus knee deformity is rare in the clinic. The therapeutic effects of artificial knee arthroplasty are worse than varus knee deformity. There is no unified opinion for replacement approach, soft tissue release method and procedure and prosthetic choice at present. OBJECTIVE:To summarize case data and to observe clinical effects of total knee arthroplasty for valgus knee deformity. METHODS:Clinical data of 37 cases of valgus knee deformity (42 knees) undergoing total knee arthroplasty, who were treated by the same group of physicians in the First Department of Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine from January 2010 to December 2012 were retrospectively analyzed. There were 11 males (13 knees) and 26 females (29 knees), at the age from 56 to 78 years, with an average age of 63.7 years. The differences in range of motion, femorotibial angle and Hospital for Special Surgery knee score were compared before and after replacement. Clinical effects of total knee arthroplasty for valgus knee deformity were evaluated. RESULTS AND CONCLUSION:The postoperative fol ow-up lasted from 6 to 36 months. Knee joint range of motion increased from preoperative 68.5° to an average of postoperative 108.5°. Femorotibial angle reduced from preoperative 16.82° to postoperative 5.62° on average. The average Hospital for Special Surgery knee score increased from preoperative 39 points to postoperative 88 points (P<0.05). These results suggested that the curative effect of total knee arthroplasty for valgus knee deformity is proved. Total knee arthroplasty is an effective way to improve deformity.
ABSTRACT
Dynamic knee valgus is considered a risk factor of non-contact anterior cruciate ligament (ACL) injury. To identify athletes at a higher risk, we developed a two-dimensional (2D) video-based screening test that determines hip abductor function as well as dynamic hindfoot and knee valgus. The purpose of this study was to validate the accuracy of the indices for dynamic knee valgus derived knee-in distance (KID) and hip-out distance (HOD) from the 2D-video.Twenty healthy university students agreed to participate in this study. Subjects were asked to step off a 30-cm box and land on one leg. This procedure was recorded simultaneously using a 2D video camera in the frontal plane and the Vicon motion capture system. Pearson's correlations examined associations between KID, KID normalized by height (KID/H), HOD, as well as HOD normalized by height (HOD/H) and 3D-valgus (knee valgus) or 3D-IR (tibial internal rotation).Significant correlations were found between the KID and 3D-valgus (r=0.72, p<0.01) and KID/H and 3D-valgus (r=0.73, p<0.01). Associations were not significant between KID and 3D-IR (r=0.08) and between KID/H and 3D-IR (r=0.03). A positive moderate correlation between HOD and 3D-valgus (r=0.46, p<0.05) and HOD/H and 3D-valgus (r=0.50, p<0.05), as well as a negative moderate correlations between HOD and 3D-IR (r=-0.52, p<0.05) and between HOD/H and 3D-IR (r=-0.51, p<0.05) were also observed.We conclude that KID is a reliable alternative for the 3D-valgus and the HOD is for the 3D-valgus and tibial external rotation.
ABSTRACT
Dynamic knee valgus is considered a risk factor of noncontact ACL injuries. The aim of this study was to determine the association between hip and hindfoot dynamic alignment and dynamic knee valgus.This cross-sectional study involved 88 high school female basketball players (175 legs). Subjects performed single-leg squatting and drop landing which provided a hip-out distance (HOD) and a knee-in distance (KID) via 2D video images. Hip and hindfoot dynamic alignment was evaluated by a dynamic Trendelenburg test (DTT) and a heel-floor test (HFT), respectively, during squatting and landing.The DTT-positive group (dynamic hip mal-alignment with lower non-weightbearing pelvis) demonstrated greater HOD and KID values for both squatting (p＜0.001) and landing (p＜0.001) than the DTT-negative group. The HFT-positive group (5<sup>o</sup> or greater hindfoot valgus) demonstrated greater KID values for both squatting (p＜0.01) and landing (p＜0.001), but smaller HOD value for squatting (p＜0.01) than the HFT-negative group.In conclusion, dynamic hip mal-alignment may be associated with both greater HOD and KID, but hindfoot valgus only with greater KID.
ABSTRACT
Objective To evaluate the clinical results of the PCL-retaining total arthroplasty in treatment of knee osteoarthris with valgus.Methods From June 2002 to January 2005,8 cases of osteoarthris with valgus knee were treated with PCL-retaining total knee replacement.The X-ray before operation showed average 21.6 degrees(ranging from 10 to 35 degrees) valgus.The cases were follow-uped from 6 to 36 months,each of them was evaluated with the Special Surgery Knee Scoring System.Results The X-ray after operation showed average 5.7 degrees(ranging from 3 to 9 degrees) valgus.The average HSS scores increased from preoperative 54 to postoperative 91.The range of motion was significantly improved from preoperative 83 degrees to postoperative 118 degrees.All of the cases were no pains after operation,and the function of knees were apparently improved.Conclusions The preliminary clinical results are quite satisfactory for the PCL-retaining total arthroplasty in treatment of osteoarthris with valgus knee.The adequate relaxing and balancing of soft tissue is the key factor to the success of total knee arthroplasty.The follow-up is necessary for further long-term outcome.