Profile of total knee replacement patients and short term outcome in the sanglah public hospital 2018: a case reports

Total knee replacement (TKR) is considered to be among the most successful type of orthopedic surgery, with 15-year-survival-rate of implant exceeding 95%; furthermore, the improvement in quality of life is very significant. This study aims to describe the demographics, length of hospitalization and short-term outcome observed in patients undergoing TKR at Sanglah Hospital in 2018. All patients undergoing TKR at Sanglah Hospital in 2018 have been prospectively entered into our database. A total of 59 patients were recorded on 2018 for this study and 1 revision TKR patient and 2 patients with incomplete data were excluded. At baseline, 78.6% patients were female, 72.3% were Balinese and 84.1% were housewives. The mean age of patients was 63 years old. Authors also record that 44 (78.6%) patients are Overweight patients (BMI 25.00-29.99 kg/m2), 11 (19.6%) patients are at Obese Class I (30.00-34.99 kg/ m2) range, and only 1 (1.8%) patients have normal weight (18.50-24.99 kg/m2). As many as 51.8% patients had right TKR and 49.2% left TKR. The modus of patient’s length of stay is 7 days with 27 (48.2%) patients started to walk on the 4th day. VAS was recorded at level 4/10 on 92.9% patient. Drain was removed after 3 days on 42 (75%) patients. 15 patients (26.8%) had PRC transfusion due to anemia after operation.

Instrumentation with 3D printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis / 中华创伤骨科杂志

Objective@#To compare instrumentation with 3D-printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis.@*Methods@#A retrospective analysis was done of the 21 patients with varus ankle osteoarthritis who had been treated at Department of Orthopaedics, Shanghai JiaoTong University Affiliated Sixth People's Hospital from January 2017 to December 2018. They were divided into 2 groups by their treatment methods. In the 9 patients treated by instrumentation with 3D-printed patient-specific guides, there were 6 males and 3 females with an age of 54.6±8.6 years, 4 left and 5 right sides involved, and one case of Takakura stage 1, 3 cases of Takakura stage 2 and 5 cases of Takakura stage 3a. In the 12 patients treated by conventional techniques, there were 7 males and 5 females with an age of 53.0±6.5 years, 7 left and 5 right sides involved, and one case of Takakura stage 1, 5 cases of Takakura stage 2 and 6 cases of Takakura stage 3a. The 3D printed guide group and the conventional group were compared in terms of operation time, intraoperative blood loss and frequency of intraoperative fluoroscopy, tibial anterior surface angle (TAS), talar tilt angle (TT), and tibial lateral surface angle (TLS). The differences in TAS, TT and TLS between pre- and post-operation in the 3D printed guide group were also evaluated.@*Results@#There were no significant differences in the preoperative general data between the 2 groups (P>0.05), indicating they were comparable. All the patients were available for follow-up for an average of 7.8 months (from 3 to 15 months). The 3D printed guide group incurred significantly shorter operation time (106.2±10.6 min), less intraoperative blood loss (207.2±16.0 mL) and lower fluoroscopy frequency (2±0) than the conventional osteotomy group (all P<0.01). The post-operative TAS (94.3°±3.2°) and TT (3.8°±0.8°) angles in the 3D guide group were significantly different from their preoperative values (84.6°±3.5° and 7.6°±1.6°) (P<0.01). The 3D printed guide group was not significantly different from the conventional group in postoperative TAS (94.3°±3.2° versus 92.4°±5.9°), TT (3.8°±0.8° versus 4.2°±1.1°) or TLS (83.7°±3.4° versus 84.2°±2.2°) angles (P>0.05).@*Conclusions@#Compared with conventional techniques, instrumentation with 3D-printed patient-specific guides can shorten operation time and reduce intraoperative blood loss and fluoroscopy frequency. The 3D printed patient-specific guides in osteotomy can facilitate accurate correction of varus deformity, leading to similar efficacy compared with conventional osteotomy.

Instrumentation with 3D printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis / 中华创伤骨科杂志

Objective To compare instrumentation with 3D-printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis.Methods A retrospective analysis was done of the 21 patients with varus ankle osteoarthritis who had been treated at Department of Orthopaedics,Shanghai JiaoTong University Affiliated Sixth People's Hospital from January 2017 to December 2018.They were divided into 2 groups by their treatment methods.In the 9 patients treated by instrumentation with 3D-printed patient-specific guides,there were 6 males and 3 females with an age of 54.6 ±8.6 years,4 left and 5 right sides involved,and one case of Takakura stage 1,3 cases of Takakura stage 2 and 5 cases of Takakura stage 3a.In the 12 patients treated by conventional techniques,there were 7 males and 5 females with an age of 53.0 ± 6.5 years,7 left and 5 right sides involved,and one case of Takakura stage 1,5 cases of Takakura stage 2 and 6 cases of Takakura stage 3a.The 3D printed guide group and the conventional group were compared in terms of operation time,intraoperative blood loss and frequency of intraoperative fluoroscopy,tibial anterior surface angle (TAS),talar tilt angle (TT),and tibial lateral surface angle (TLS).The differences in TAS,TT and TLS between pre-and post-operation in the 3D printed guide group were also evaluated.Results There were no significant differences in the preoperative general data between the 2 groups (P ＞ 0.05),indicating they were comparable.All the patients were available for follow-up for an average of 7.8 months (from 3 to 15 months).The 3D printed guide group incurred significantly shorter operation time (106.2 ± 10.6 min),less intraoperative blood loss (207.2 ± 16.0 mL) and lower fluoroscopy frequency (2 ± 0) than the conventional osteotomy group (all P ＜ 0.01).The post-operative TAS (94.3° ± 3.2°) and TT (3.8° ± 0.8°) angles in the 3D guide group were significantly different from their preoperative values (84.6°±3.5° and 7.6°± 1.6°) (P ＜ 0.01).The 3D printed guide group was not significantly different from the conventional group in postoperative TAS (94.3°± 3.2° versus 92.4°±5.9°),TT (3.8° ± 0.8° versus 4.2° ± 1.1°) or TLS (83.7° ± 3.4° versus 84.2° ± 2.2°) angles (P ＞0.05).Conclusions Compared with conventional techniques,instrumentation with 3D-printed patient-specific guides can shorten operation time and reduce intraoperative blood loss and fluoroscopy frequency.The 3D printed patient-specific guides in osteotomy can facilitate accurate correction of varus deformity,leading to similar efficacy compared with conventional osteotomy.

Inhibition of nicotine on apoptosis of chondrocytes induced by monosodium iodoacetate / 中国比较医学杂志

Objective To explore inhibition of nicotine on apoptosis of chondrocytes induced by monosodium iodoacetate ( MIA) .Methods Rat primary chondrocytes were isolated by enzyme digestion, and the cells were treated with 10 -8 , 10 -7 , 10 -6 , 10 -5 mol/L nicotine for 48 h.The cases were randomly divided into five groups, except for normal group, the other four groups were treated with 4μmol/L MIA 24 h, and three groups were treated 10 -8 , 10 -7 , 10 -6 mol/L nicotine.The viability of chondrocytes was detected by MTT assay.The apoptosis of chondrocytes was examed by Annexin V-FITC/PI flow dual-staining method.The activity of cysteinyl aspartate specific proteinase 3 ( Caspase 3 ) was measured by spectrophotography method.The activation of phosphatidylinositol 3 kinase ( PI3K)/protein kinase B ( AKT) and the expression of down-stream molecule Bax, Bcl-2 was assayed by western blot.Results 10 -7 , 10 -6 mol/L nicotine increased chondrocytes' viability (P0.05).10 -8, 10 -7, 10 -6 mol/L nicotine could increase MIA-induced chondrocytes' viability (P<0.05), suppress MIA-induced chondrocytes' apoptosis and the activity of MIA-induced Caspase 3 (P <0.05).Moreover, 10 -7, 10 -6 mol/L nicotine could increase the expression of PI3K and phosphorylation of AKT ( P<0.05) , down-regulate the expression of Bax and up-regulate the expression of Bcl-2 in MIA-induced rat chondrocytes ( P<0.05 ) .Conclusion These results suggested nicotine could exert anti-apoptosis in MIA-induced rat chondrocytes, which might be related to PI3K/AKT signal pathway.

Protective effect of diacerein on MIA-induced injury in rat osteoarthritis chondrocytes / 重庆医学

Objective To investigate the protective effect of diacerein on monosodium iodoacetate (MIA) induced injury in rat osteoarthritis chondrocytes .Methods The experiment was divided into five groups ,including the normal group ,model group (4μM MIA) ,diacerein low ,middle and high doses groups (1 ,10 ,100μM) .The viability of chondrocytes was detected by MTT assay . The activity of cysteinyl aspartate specific proteinase‐3 (Caspase‐3) was measured by spectrophotography .The activation of nuclear factor kappa B (NF‐κB) signaling pathway and expression level of downstream target molecule cell Bax ,Bcl‐2 ,matrix metalloprotei‐nase‐9 (MMP‐9) and MMP‐13 were detected by Western blot .Results 1 ,10 ,100μM diacerein could increase the viability of MIA‐induced chondrocytes and reduce the activity of Caspase‐3(P<0 .05) .10 ,100μM diacerein could decrease the phosphorylation level of IκBαand NF‐κB p65 ,furthermore downregulated the level of Bax ,MMP‐9 and MMP‐13 protein ,and upregulated the level of Bcl‐2 protein (P<0 .05) .Conclusion Diacerein could inhibit cell apoptosis and degradation of extracellular matrix in MIA‐induced rat chondrocytes ,which might be related to the NF‐κB signal pathway .

Is it safe the empirical distal femoral resection angle of 5 to 6 of valgus in the Brazilian geriatric population? / É seguro o corte femoral distal em artroplastia total do joelho com 5° a 6° de valgo empiricamente na população geriátrica brasileira?

OBJECTIVE: The purpose of this study is to determine if there is a safe distal femoral resection angle to restore the normal axial alignment of the limb in total knee arthroplasty (TKA) in the Brazilian geriatric population with knee arthrosis. METHOD: This study analyzed 99 pre-operative hip-knee-ankle radiographs of osteoarthritic knees of 66 patients (54 women, 12 men) with knee osteoarthritis. The distal femoral cut angle was determined based on the femoral mechanical-anatomical angle (FMA). Mean, median and standard deviation measurements of the distal femoral cut angle were calculated, differentiated by gender and side. The mean result of the distal femoral resection angle was compared to 5.7°, the mean average angle of previous and similar study based on European population of patients with knee arthrosis. RESULTS: The mean average of the distal femoral resection angle of the study was 6.05 (range 3-9°). The distribution of this angle between genders showed a slight superior average of the male population (6.17°) compared to the female (6.02°), but with no statistically significant difference (p = 0.726). There was no statistically significant difference (p = 0.052) between the mean average of this study (6.05°) compared to the mean average of the literature (5.7°). However, considering 3° as the limit of acceptable error in the coronal plane, this empirical femoral resection angle would not be appropriated for 19.7% of the population. CONCLUSION: The distal femoral resection angle of 5-6° is not completely safe for the Brazilian geriatric population. .

OBJETIVO: Determinar se existe um ângulo seguro para o corte femoral distal, para que o membro resulte alinhado após uma artroplastia total de joelho (ATJ), na população geriátrica brasileira com gonartrose. MÉTODO: Foram feitas radiografias panorâmicas de 99 membros inferiores em 66 pacientes consecutivos (54 mulheres e 12 homens) portadores de gonartrose do joelho. O ângulo do corte femoral distal foi determinado pelo encontro entre o eixo mecânico femoral (EMF) e o eixo anatômico femoral (EAF). Foram calculados os valores da média, o desvio padrão e a mediana do ângulo do corte femoral distal desses pacientes diferenciados por sexo e lado. O valor médio do ângulo de corte do fêmur distal ideal aqui obtido foi comparado com o valor médio de 5,7 obtido em estudo prévio semelhante a esse feito com populações europeias de pacientes osteoartríticos submetidos a ATJ. RESULTADOS: A média do ângulo formado pelos EAF × EMF, considerado o ângulo do corte femoral distal em uma ATJ, do grupo estudado foi de 6,05 (variação de 3° a 9°). A distribuição desse ângulo entre os sexos evidenciou uma média discretamente superior entre os homens (6,17°) em comparação com as mulheres (6,02°), porém sem significância estatística (p = 0,726). Não houve diferença estatística (p = 0,052) entre o valor médio obtido na amostra atual (6,05 - DP 1,27) com o valor médio obtido na literatura (5,7°). Entretanto, se considerarmos aceitável um erro de 3° no plano coronal, 19,7% da população operada se encontrariam fora dessa faixa aceitável se optarmos pelo corte femoral empírico de acordo com o instrumental. CONCLUSÃO: O corte femoral distal na ATJ em 5° ou 6° de valgo não é ...

Artrodesis tibiotalocalcánea con placa humeral bloqueada / Tibiotalocalcaneal arthrodesis with humeral locking plate

Diversos tipos de fijación han sido utilizados para la artrodesis Tibiotalocalcánea. El propósito de este estudio es analizar retrospectivamente el uso de la placa bloqueada de humero proximal para la fijación de esta artrodesis. Entre Julio 2007 y Julio 2010 se realizaron 12 artrodesis tibiotalocalcánea en 12 pacientes con placa bloqueada de húmero proximal a través de un abordaje lateral extendido previa resección del Peroné distal. Los pacientes presentaban como diagnóstico preoperatorio: artrítis reumatoidea, artropatía de Charcot y osteoartrosis postraumática. Los pacientes fueron seguidos por un periodo de 7 meses y 3 años (media de 19 meses). Todos los pacientes obtuvieron fusión de sus artrodesis en un periodo de 3 a 6 meses. Este estudio demuestra que el uso de placa humeral bloqueada para la fijación de artrodesis tibiotalocalcánea es una excelente opción por la alta incidencia de fusión de la artrodesis y facilidad la lograr correcta alineación del retropié por su forma

There are many options for Tibiotalocalcaneal arthrodesis. The aim of this study is to retrospectively review the role of the inverted proximal humeral locking plate to fix this arthrodesis. Between July 2007 and July 2010, 12 tibiotalocalcaneal arthrodesis were performed in 12 patients with the inverted proximal humeral locking plate thru an extended lateral ankle approach resecting the distal fibula. Patients preoperative diagnosis were : rheumathoid arthritis, Charcot arthropaty and posttraumatic osteoarthrosis. Patients were followed for a period between 7 months and 3 years (19 months). All the patients fused they arthrodesis in a period of 3 to 6 months. This study showed that the inverted proximal humeral locking plate is an excellent option for tibiotalocalcaneal arthrodesis because of the high fusion rate and the facility for correct hindfoot alignment because of the plate shape

Correlación entre los índices radiológicos preoperatorios y la pérdida ósea periprotésica determinada por densitometría ósea en artroplastia de cadera no cementada IAHULA 2007-2009 / Correlation between radiologic index and perioprostethic bone loss determined by bone densiometry in cementless total hip arthroplasty IAHULA 2007-2009

Se realizó un estudio observacional descriptivo en 43 caderas intervenidas por artroplastia total no cementada en el Hospital Universitario de Los Andes entre Enero de 2007 y Agosto de 2009, para determinar la correlación existente entre los índices corticodiafisario (ICD), corticometafisario (ICM) y la relación canal-cálcar (CC) preoperatorios con la pérdida ósea periprotésica evaluada mediante densitometría ósea (DEXA) postoperatoria en las zonas de Gruen. Se incluyó igualmente como variable interviniente el uso del ácido zoledrónico en dosis de 5 mg postoperatorios en 24 de los casos para determinar su asociación al aumento de la densidad mineral ósea periprotésica. Se obtuvo correlación entre el índice corticometafisario y la densidad mineral ósea en las zonas 1 y 7 de Gruen, y entre la relación canal-cálcar y la densidad mineral ósea en la zona 2 de Gruen. Por otra parte, el uso del ácido zoledrónico mostró aumento de la densidad mineral ósea en la zona 1 de Gruen.

This is a descriptive observational study of 43 hips which underwent uncemented total arthroplasty at Los Andes University Hospital since January 2007 to August 2009, to determinate correlation among preoperatory corticodiaphysary index (CDI), corticometaphysary index (CMI) and canal to calcar ratio (CCR) with periprosthetic bone loss evaluated through postoperatory bone densitometry (DEXA) in the seven Gruen´s zones. Use of postoperatory 5 mg of zoledronic acid in 24 cases was included as intervening variant to determinate its association with increase in periprosthetic bone mineral density. Correlation was obtained between corticometaphysary index and bone mineral density in Gruen´s zones 1 and 7, and canal to calcar ratio and bone mineral density in Gruen´s zone 2. Besides, it was show increased bone mineral density in Gruen´s zone 1, in patients who received zoledronic acid.