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1.
Rev. bras. ortop ; 58(4): 544-550, July-Aug. 2023. tab, graf
Article in English | LILACS | ID: biblio-1521810

ABSTRACT

Abstract Objective This study evaluated and compared the tibial component migration in cemented and uncemented total knee arthroplasty (TKA) with no hydroxyapatite coating 2, 5, and 10 years after surgery. Methods This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) based on PubMed and MeSH database queries from June to July 2022. Results The meta-analysis included eight randomized clinical studies evaluating 668 knees undergoing TKA. The maximum total point motion (MTPM) in cemented TKAs was higher in 5 years, with a mean value of 0.67 mm (95% confidence interval [CI], 0.52 to 0.87). Uncemented TKAs also presented higher mean MTPM in 5 years (1 mm; 95% CI, 0.82 to 1.22). Uncemented coated ATKs had a higher mean MTPM in 10 years (1.30 mm; 95% CI, 0.70 to 2.39). MTPM was statistically similar in the short- and long-term for cemented and uncemented techniques, with a standardized mean difference of -0.65 (95% CI, -1.65 to 0.35). Conclusion Tibial component migration in TKA was statistically similar at 2, 5, and 10 years in cemented and uncemented techniques, either with or without coating. However, due to the scarce literature, further studies are required with a longer follow-up time.


Resumo Objetivo Avaliar e comparar a migração obtida pelo componente tibial na Artroplastia Total de Joelho (ATJ) cimentada, não cimentada sem revestimento e não cimentada com revestimento de hidroxapatita aos 2, 5 e 10 anos pós operatório. Métodos Esta metanálise foi conduzida de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Foi realizada busca a partir das bases de dados PubMed e MeSH no período de junho a julho de 2022. Resultados Oito ensaios clínicos randomizados foram incluídos. Um total de 668 joelhos submetidos a ATJ foram avaliados. Observou-se que a média de Maximun Total Point Motion (MTPM) nas ATJ cimentada foi maior em experimentos com cinco anos com média de 0,67 mm (IC95% - 0,52 a 0,87), as ATJ não cimentadas com revestimento de hidroxapatita também obtiveram maior média neste período (1mm; IC95% - 0,82 a 1,22). Em ATJ não cimentada sem revestimento o maior MTPM médio ocorreu no período de 10 anos (1,30mm; IC95% - 0,70 a 2,39). O MTPM foi estatisticamente semelhante no curto e longo prazo ao comparar as técnicas cimentada e não cimentada, com diferença média padronizada -0,65 (IC95%, -1,65 a 0,35). Conclusão A migração obtida pelo componente tibial na artroplastia total de joelho (ATJ) foi estatisticamente semelhante em 2, 5 e 10 anos ao comparar as técnicas cimentada e não cimentada (com e sem revestimento). Entretanto, devido ao pequeno número de artigos existentes, são necessários mais estudos clínicos sobre tais técnicas e com maior tempo de acompanhamento.


Subject(s)
Humans , Prognosis , Bone Cements , Durapatite , Arthroplasty, Replacement, Knee
2.
Rev. bras. ortop ; 58(4): 599-603, July-Aug. 2023. tab, graf
Article in English | LILACS | ID: biblio-1521808

ABSTRACT

Abstract Objective: To identify blood transfusion requirements and postoperative complications in patients undergoing total knee arthroplasty (TKA) with no tourniquet and intraoperative intravenous administration of tranexamic acid. Methods: This retrospective observational study analyzed 49 preopeative and postoperative medical records of patients undergoing TKA. A paired t-test compared changes in hemoglobin (HB) and packed cell volume (PCV), and an independent t-test with Welch correction compared HB and PCV changes between genders. A Spearman correlation test determined associations between age and days of postoperative hospitalization with HB and PCV changes. The significance level adopted was p < 0.05. Results: The patients' mean age was 71.9 ± 6.7 years; most subjects were women (73.5%). The right side (59.2%) was the most affected. Only one participant required a blood transfusion, while three subjects had complications during the postoperative follow-up. No patient had a thromboembolic event. The median length of postoperative hospital stay was 2 days (interquartile range [IQR] = 1.0). There were reductions in HB and PCV levels between the pre-operative and postoperative period, and female patients had a higher HB reduction. Conclusion: TKA with tranexamic acid and no tourniquet did not cause significant postoperative complications or require blood transfusions.


Resumo Objetivo: Identificar a necessidade de transfusão sanguínea e intercorrências inerentes ao pós-operatório de pacientes submetidos à artroplastia total de joelho (ATJ), a partir de manejos realizados sem o uso de torniquete e com administração de ácido tranexâmico endovenoso intra-operatório. Métodos: Trata-se de um estudo observacional retrospectivo, a partir da observação de 49 prontuários médicos de pacientes submetidos à ATJ em pré e pós-operatório. Foi utilizado o teste t pareado para fazer comparações das modificações de hemoglobina (HB) e hematócrito (HT) e o teste t independente com correção de Welch para comparar as modificações de HB e HT entre os sexos. As associações de idade e dias de internação no pós-operatório com as modificações de HB e HT foram testadas pela correlação de Spearman. O nível de significância adotado foi p < 0,05. Resultados: Os pacientes apresentaram idade média de 71,9 ± 6,7 anos. A maioria da amostra foi composta por mulheres (73,5%) e o lado direito (59,2%) foi o mais acometido. Apenas um participante necessitou de transfusão de sangue e três participantes apresentaram intercorrências durante o seguimento pós-operatório. Nenhum paciente apresentou evento tromboembólico. A mediana da duração da internação no pós-operatório foi de dois dias (IIQ= 1,0). Verificaram-se reduções nas dosagens de HB e HT entre o pré e pós-operatório, e pacientes do sexo feminino apresentaram maior redução de HB. Conclusão: ATJ com uso de ácido tranexâmico e sem uso de torniquete não acarretou complicações pós-operatórias ou necessidade de transfusão sanguínea significativas.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Postoperative Period , Tranexamic Acid/therapeutic use , Retrospective Studies , Arthroplasty, Replacement, Knee
3.
Rev. bras. ortop ; 58(3): 443-448, May-June 2023. tab, graf
Article in English | LILACS | ID: biblio-1449826

ABSTRACT

Abstract Objective We studied the microbiological profile of periprosthetic knee infections treated in a Brazilian tertiary hospital. Methods The study included all patients undergoing revision surgery for total knee arthroplasty (RTKA) between November 2019 and December 2021, with a diagnosis of periprosthetic infection confirmed per the 2018 International Consensus Meeting (ICM) criteria. Results Sixty-two patients had a periprosthetic joint infection (PJI) per the 2018 ICM criteria. Cultures were monomicrobial in 79% and polymicrobial in 21% of cases. The most frequent bacterium in microbiological tissue and synovial fluid cultures was Staphylococcus aureus, observed in 26% of PJI patients. Periprosthetic joint infection with negative cultures occurred in 23% of patients. Conclusion Our results show the following: i) a high prevalence of Staphylococcus as an etiological agent for knee PJI; ii) a high incidence of polymicrobial infections in early infections; iii) the occurrence of PJI with negative cultures in approximately one fourth of the subjects.


Resumo Objetivo Identificar o perfil microbiológico das infecções periprotéticas do joelho tratadas em um hospital terciário brasileiro. Métodos Todos os pacientes submetidos à cirurgia de revisão de artroplastia total do joelho (RATJ), no período compreendido entre novembro de 2019 e dezembro de 2021, e que tiveram o diagnóstico de infecção periprotética confirmado de acordo com critérios do International Consensus Meeting (ICM) 2018, foram incluídos no estudo. Resultados Sessenta e dois pacientes foram diagnosticados com infecção periprotética (IAP) pelos critérios do International Consensus Meeting 2018. Culturas monomicrobianas foram identificadas em 79% e polimicrobianas em 21% dos casos. A bactéria mais frequentemente identificada nas culturas microbiológicas de tecidos e líquido sinovial foi o Staphylococcus aureus, presente em 26% dos pacientes com infecção periprotética. Infecções periprotéticas com culturas negativas ocorreram em 23% dos pacientes. Conclusão Nossos resultados evidenciam: i) alta prevalência de bactérias do gênero Staphylococcus como causadores da IAP do joelho; ii) a alta incidência de infecções polimicrobianas nas infecções precoces e iii) IAP com culturas negativas ocorre em, aproximadamente, um quarto dos pacientes.


Subject(s)
Humans , Male , Female , Postoperative Complications , Prosthesis-Related Infections , Arthroplasty, Replacement, Knee , Injections, Intra-Articular
4.
Rev. bras. ortop ; 58(3): 435-442, May-June 2023. tab
Article in English | LILACS | ID: biblio-1449825

ABSTRACT

Abstract Objective To assess the risk factors involving longer hospital stays and early postoperative complications (first 30 days after surgery) in patients undergoing total knee arthroplasty (TKA). Materials and Methods Across-sectional study was conducted with collection of data of patients who underwent TKA in a private hospital between 2015 and 2019. The following data were collected: age, gender, body mass index, and clinical comorbid-ities. We also collected intraoperative data such as the grade on the classification of the American Society of Anesthesiologists (ASA), the duration of the surgery, the length of stay, the postoperative complications, and readmission within 30 days. Statistical models were used to investigate the possible risk factors associated with longer hospital stays and postoperative complications. Results There was evidence of an increase in the length of hospital stay in older patients, with higher grades on the ASA classification or who suffered postoperative complications. For each increase in 1 year of age, we expect the length of stay to be multiplied by 1.008 (95% confidence interval [95%CI]: 1.004 to 1.012; p < 0,001). In patients who were ASA grade III, the time is expected to be multiplied by 1.297 (95%CI: 1.083 to 1.554; p = 0,005) when compared with grade-I patients. In patients who suffered postoperative complications, the time is expected to be multiplied by 1.505 (95%CI: 1.332 to 1.700; p < 0.001) compared with patients without complications. Conclusion The present study demonstrated that, in patients who underwent primary TKA, preoperative characteristics such as older age and ASA grade > III, as well as the development of postoperative complications, independently predict the increase in the length of hospital stay.


Resumo Objetivo Avaliar os fatores de risco relacionados a um tempo de internação mais longo e às complicações pós-operatórias precoces (primeiros 30 dias após a cirurgia) em pacientes submetidos a artroplastia total do joelho (ATJ). Materiais e Métodos Este é um estudo transversal com coleta de dados de pacientes submetidos a ATJ em um hospital privado entre 2015 e 2019. Os seguintes dados foram coletados: idade, gênero, índice de massa corporal, e comorbidades clínicas. Também coletamos dados intraoperatórios, como o grau na classificação da American Society of Anesthesiologists (ASA) e a duração da cirurgia, além do tempo de internação, as complicações pós-operatórias, e a readmissão em 30 dias. Os possíveis fatores de risco associados a um tempo de internação mais longo e às taxas de complicações pós-operatórias foram investigados por meio de modelos estatísticos. Resultados Os pacientes mais velhos, com graus mais elevados na classificação da ASA ou que sofreram complicações pós-operatórias, ficaram internados por mais tempo. Para cada aumento em um ano de idade, esperamos que o tempo de internação seja multiplicado por 1,008 (intervalo de confiança de 95% [IC95%]: 1,004 a 1,012; p < 0,001). Em pacientes de grau III na classificação da ASA, espera-se que o tempo seja multiplicado por 1,297 (IC95%: 1,083 a 1,554; p = 0,005) em comparação com pacientes de grau I. Em pacientes com complicações pós-operatórias, espera-se que o tempo seja multiplicado por 1,505 (IC95%: 1,332 a 1,700; p < 0,001) em comparação com pacientes sem complicações. Conclusão Este estudo demonstrou que, em pacientes submetidos a ATJ primária, características pré-operatórias, como idade avançada e grau ≥ III na classificação da ASA, e o desenvolvimento de complicações pós-operatórias predizem o aumento do tempo de internação hospitalar de forma independente.


Subject(s)
Humans , Postoperative Complications , Outcome Assessment, Health Care , Arthroplasty, Replacement, Knee , Length of Stay
5.
Rev. bras. ortop ; 58(3): 428-434, May-June 2023. tab, graf
Article in English | LILACS | ID: biblio-1449812

ABSTRACT

Abstract Objectives This study aims to analyze the safety of a simultaneous bilateral total knee arthroplasty (SBTKA) and to investigate patients' satisfaction with the procedure performed concomitantly. Methods In a prospective study, we evaluated 45 patients undergoing SBTKA performed by two surgical teams. The mean age of the patients was 66.9 years; 33 subjects were female (73.3%) and 12 (26.6%) were male. We followed a protocol of intra- and postoperatively measures to ensure the safety of this procedure. We evaluated the surgery time and blood loss by hematocrit (Ht) and hemoglobin (Hb) levels on the first postoperative day, the percentage of patients who received a transfusion of packed red blood cells, and the number of required units. We also recorded perioperative complications, and, at the end of 3 months, we asked patients about their preference between the simultaneous or staged procedure. Results The mean surgery time was 169 minutes. In the postoperative period, there was an average decrease of 28.2% in Htc and 27.0% in Hgb. A total of 16 patients (35.5%) received a transfusion of packed red blood cells (mean, 1.75 units per patient requiring a transfusion). There were 12 minor complications (26.6%) and 2 major complications (4.4%); furthermore, no patient had a clinical diagnosis of deep vein thrombosis, and there were no deaths. Conclusions The SBTKA procedure may be considered safe if performed in selected patients and with a care protocol to prevent complications. This type of procedure was unanimously approved by patients.


Resumo Objetivos Os objetivos deste estudo foram analisar a segurança da artroplastia total bilateral de joelho simultânea (ATJBS) e investigar a satisfação dos pacientes com o procedimento realizado de forma concomitante. Métodos Em um estudo prospectivo, avaliamos 45 pacientes submetidos à ATJBS feita por duas equipes cirúrgicas. A idade média dos pacientes foi 66,9 anos, sendo 33 do gênero feminino (73,3%) e 12 (26,6%) do gênero masculino. No período intra- e pós-operatório foi seguido um protocolo de medidas visando a segurança do procedimento. Avaliamos o tempo de cirurgia, a perda sanguínea pelo hematócrito (Ht) e hemoglobina (Hb), obtidos no primeiro dia de pós-operatório, a porcentagem de pacientes que receberam transfusão de concentrado de hemácias e quantidade de unidades que foram necessárias. Verificamosascomplicaçõesnoperíodo periopera-tório e, ao final de três meses, inquirimos aos pacientes sobre a preferência entre o procedimento simultâneo ou estagiado. Resultados O tempo médio de cirurgia foi de 169 minutos; no pós-operatório houve um decréscimo médio de 28,2% do Ht e de 27,0% da Hb. Ao todo, 16 pacientes (35,5%) receberam transfusão de concentrado de hemácias (média de 1,75 unidades por paciente que precisou de reposição). Tivemos 12 complicações menores (26,6%) e 2 complicações maiores (4,4%); além disso, nenhum paciente teve o diagnóstico clínico de trombose venosa profunda e não houve mortes. Conclusões A ATJBS pode ser considerada um procedimento seguro, se realizada em pacientes selecionados e com um protocolo de cuidados para prevenir complicações. Esse procedimento teve a aprovação unânime dos pacientes.


Subject(s)
Humans , Patient Satisfaction , Arthroplasty, Replacement, Knee , Knee/surgery
6.
Rev. bras. ortop ; 58(2): 320-325, Mar.-Apr. 2023. tab
Article in English | LILACS | ID: biblio-1449804

ABSTRACT

Abstract Objective The objective of this work is to compare blood loss during primary knee arthroplasty with the use of intravenous and intraarticular (IV + IA) tranexamic acid versus intraarticular (IA) tranexamic acid alone. Methods This is a randomized, double-blind clinical trial. Patients with indication for primary total knee arthroplasty were recruited in a specialized clinic, where they were operated by the same surgeon, always using the same surgical technique. Thirty patients were allocated in the IV + IA tranexamic acid group and 30 patients in the IA tranexamic acid group, according to randomization. Blood loss was compared through hemoglobin, hematocrit, drain volume, and blood loss estimation (Gross and Nadler calculus). Results After collection, data from 40 patients were analyzed, 22 in the IA group and 18 in the IV +IA group. There were 20 losses due to collection error. Between groups IA and IV + IA, there were no significant differences in 24 hours between hemoglobin levels (10.56 vs. 10.65 g/dL; F1.39 = 0.63, p =0.429), erythrocyte (3.63 vs. 3.73 million/mm³; F1.39 = 0.90, p = 0.346); hematocrit (32.14 vs. 32.60%; F1.39 = 1.39, p = 0.240); drainage volume (197.0 vs. 173.6 mL; F1.39 = 3.38 p = 0.069); and estimated blood loss (1,002.5 vs. 980.1; F1.39 =0.09, p = 0.770). The same occurred in comparisons conducted after 48 hours postoperatively. Time was a significant factor for the change of all outcome variables. However, the treatment did not modify the effect of time on these outcomes. No individual presented any thromboembolic event during the work period. Conclusions The use of IV + IA tranexamic acid showed no advantage in reducing blood loss when compared to the use of IA tranexamic acid alone in primary knee arthroplasties. This technique proved to be safe, since no thromboembolic event occurred during the development of the work.


Resumo Objetivo O objetivo desse trabalho é comparar a perda sanguínea durante a artroplastia primária de joelho, com a utilização do ácido tranexâmico endovenoso e intra-articular (EV + IA) versus intra-articular (IA) isolado. Métodos Trata-se de um ensaio clínico randomizado, duplo cego. Pacientes com indicação de artroplastia total primária de joelho foram captados em clínica especializada, onde foram operados pelo mesmo cirurgião, utilizando sempre a mesma técnica cirúrgica. Trinta pacientes foram alocados no grupo ácido tranexâmico EV + IA e 30 pacientes, no grupo IA, conforme randomização. Foi comparada a perda sanguínea através dos níveis de hemoglobina, hematócrito, volume do dreno e estimativa da perda sanguínea (EBL) (cálculo de Gross e Nadler). Resultados Após a coleta, foram analisados os dados de 40 pacientes, sendo 22 do grupo IA isolado e 18 do grupo EV + IA. Ocorreram 20 perdas por erro de coleta. Entre os grupos IA e EV + IA, não ocorreram diferenças significativas em 24 horas entre os níveis de hemoglobina (10,56 vs. 10,65 g/dL; F1,39 =0,63, p = 0,429), eritrócito (3,63 vs. 3,73 milhões/mm3; F1,39 = 0,90, p =0,346), hematócrito (32,14 vs. 32,60%; F1,39 = 1,39; p=0,240), volume de dreno (197,0 vs. 173,6 mL; F1,39 = 3,38; p =0,069) e estimativa de perda sanguínea (EBL) (1.002,5 vs. 980,1; F1,39 = 0,09; p =0,770). O mesmo ocorreu nas comparações realizadas 48 horas pós-operatório. O tempo foi fator significativo para a mudança de todas as variáveis de desfecho. Porém, o tratamento não modificou o efeito do tempo nesses desfechos. Nenhum indivíduo apresentou qualquer evento tromboembólico durante o período do trabalho. Conclusões O uso do ácido tranexâmico EV + IA não demonstrou vantagem em redução de perda sanguínea quando comparado ao uso de ácido tranexâmico IA isolado nas artroplastias primárias de joelho. Esta técnica demonstrou-se segura, visto que nenhum evento trombo-embólico ocorreu durante o desenvolvimento do trabalho.


Subject(s)
Humans , Tranexamic Acid/therapeutic use , Blood Loss, Surgical , Arthroplasty, Replacement, Knee
7.
Rev. bras. ortop ; 58(1): 30-35, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1441331

ABSTRACT

Abstract Objective To compare the level of quality of life and satisfaction after two years of total knee arthroplasties between individuals above and below 65 years of age and to identify predictor factors of poor clinical outcome and low level of satisfaction in patients undergoing arthroplasty. Methods This is a retrospective cohort with data from patients diagnosed with knee osteoarthritis submitted to primary total knee arthroplasty from 2014 to 2018 (n= 190). Clinical outcomes were assessed using the following scores: visual analog scale (VAS) of pain, EQ-5D-3L and EUROQOL-VAS (quality of life scales), patient satisfaction level, and functional scale of the Knee Injury and Osteoarthritis Outcome Score (KOOS), collected through a questionnaire applied preoperatively, as well as 1, 3, 12 and 24 months after surgery. Results Patients < 65 years old presented significantly lower values (clinical worsening) in KOOS-pain and KOOS-symptoms. There are no differences in the principal clinical scores that assess pain, function, and quality of life after the procedure, as well as in the rate of satisfaction with the procedure, among patients < 65 years old when compared with patients ≥ 65 years old. It was also observed that patients who were not satisfied with the procedure in the 24-month evaluation presented clinical results in some analyzed scores (KOOS-pain and EQ-VAS) similar to patients who declared themselves satisfied. Conclusion Scores that assess pain, function, quality of life, as well as satisfaction rate are similar between patients < 65 years old and those ≥ 65 years old.


Resumo Objetivo Comparar a qualidade de vida e satisfação 2 anos após a artroplastia total de joelho em indivíduos com idade ≥ e < 65 anos e identificar fatores preditivos de pior evolução clínica e baixo nível de satisfação nestes pacientes. Métodos Trata-se de uma coorte retrospectiva de dados de pacientes com diagnóstico de osteoartrite de joelho submetidos a artroplastia total primária de joelho entre 2014 e 2018 (n= 190). Os resultados clínicos foram avaliados de acordo com os seguintes escores: escala visual analógica (EVA) de dor, EQ-5D-3L e EUROQOL-VAS (escalas de qualidade de vida), nível de satisfação do paciente e escala funcional do Knee Injury and Osteoarthritis Outcome Score (KOOS, na sigla em inglês). Estes dados foram coletados por meio de questionário aplicado no período pré-operatório e 1, 3, 12 e 24 meses após a cirurgia. Resultados Os pacientes < 65 anos apresentaram valores significativamente menores (piora clínica) nas escalas KOOS-dor e KOOS-sintomas. Não houve diferenças nas principais pontuações clínicas de dor, função e qualidade de vida após o procedimento, nem no índice de satisfação com a cirurgia, entre pacientes < 65 anos em comparação com aqueles ≥ 65 anos. Observamos também que os pacientes não satisfeitos com o procedimento à avaliação de 24 meses apresentaram resultados clínicos em alguns escores analisados (KOOS-dor e EQ-VAS) semelhantes aos dos pacientes que se declararam satisfeitos. Conclusão Os escores que avaliam dor, função, qualidade de vida e índice de satisfação são semelhantes entre os pacientes < 65 anos e aqueles ≥ 65 anos.


Subject(s)
Humans , Aged , Aged, 80 and over , Quality of Life , Patient Satisfaction , Arthroplasty, Replacement, Knee , Osteoarthritis, Knee/surgery
8.
Rev. bras. ortop ; 58(1): 67-71, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1441342

ABSTRACT

Abstract Objective To compare the measurement of patellar height in the pre- and postoperative period of total knee arthroplasties (TKAs) and its variation in patients with and without patellar replacement. Methods Retrospective evaluation of radiographs of patients submitted to TKA between 2014 and 2020. Profile radiographs were evaluated using the modified Caton-Deschamps patellar height index, comparing the pre- and postoperative measurements of 90 patients, with a total of 100 knees. Next, two groups were compared with a different surgical technique, considering the replacement or not of the patella. All patients who had x-rays evaluated had indication of TKA by osteoarthrosis without previous procedures that could interfere at patellar height. Results The statistical analysis showed a statistically significant difference, with the preoperative index superior to the postoperative rate, evidencing an overall decrease in patellar height. The Caton-Deschamps index modified for mean preoperative TKA was 1.41 (±0.25), and it was 1.31 (± 0.25), p< 0.001for postoperative TKA. No significant difference was found in the variation of this index when comparing the groups with and without patellar replacement. The mean difference of the index in the group without patella was 0.11, and 0.08 in the group with patella, and this difference was considered nonsignificant, p= 0.510. Conclusion We can conclude that patellar height had significant variation in the total group, with reduction of patellar height in the postoperative period. However, the height did not vary significantly between the postoperative groups with and without patellar replacement, regardless of the choice of the surgeon.


Resumo Objetivo Comparar a medida da altura patelar no pré- e pós-operatório das artroplastias totais do joelho (ATJs) e sua variação nos pacientes com e sem substituição patelar. Métodos Avaliação retrospectiva de radiografias de pacientes submetidos a ATJ entre 2014 e 2020. Foi feita a avaliação de radiografias em perfil, usando o índice de altura patelar de Caton-Deschamps modificado, comparando as medidas do pré- e pós-operatório de 90 pacientes, totalizando 100 joelhos. A seguir, foi feita a comparação de dois grupos, com técnica cirúrgica distinta, considerando a substituição ou não da patela. Todos os pacientes que tiveram radiografias avaliadas tiveram indicação de ATJ por osteoartrose sem procedimentos prévios que pudessem interferir na altura patelar. Resultados A análise estatística demonstrou uma diferença estatisticamente significativa, sendo o índice pré-operatório superior ao pós-operatório; evidenciando um abaixamento global da altura patelar. O índice Caton-Deschamps modificado para ATJ pré-operatório médio foi de 1,41 (±0,25), e o pós foi de 1,31 (±0,25), p< 0,001. Não foi encontrada diferença significativa na variação deste índice quando comparados os grupos com e sem substituição patelar. A diferença média do índice no grupo sem patela foi de 0,11 e no grupo com patela foi de 0,08, sendo esta diferença considerada não significativa, p= 0,510. Conclusão Podemos concluir que a altura patelar teve variação significativa no grupo total, com redução da altura patelar no pós-operatório. Entretanto, a altura não variou de forma significativa entre os grupos pós-operatórios com e sem substituição patelar, independentemente da opção do cirurgião.


Subject(s)
Humans , Patella/surgery , Arthroplasty, Replacement, Knee , Knee Prosthesis
9.
Braz. J. Anesth. (Impr.) ; 73(1): 78-84, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1420649

ABSTRACT

Abstract Background There has been a growing interest in the use of ketamine following orthopedic surgeries. We hypothesized that low dose intravenous ketamine during surgery would help in mobilization following total knee replacement (TKR) in oncology patients as assessed by the timed to up and go (TUG) test at 72 hours post-surgery. Our secondary objectives were to compare the opioid requirement at the end of 72 hours, pain scores, satisfaction with pain management, adverse effects, range of joint movement achieved in the post-operative period and the functional recovery at the end of 1 month. Methods After the ethics commitee approval, registration of the trial with the Clinical Trial Registry - India (CTRI), and informed consent, this double-blinded trial was conducted. Using computer generated randomization chart, an independent team randomized the patients into ketamine group which received at induction, a ketamine bolus dose of 0.5 mg.kg-1 before the incision followed by 10 µg.kg-1min-1 infusion which was maintained intraoperatively till skin closure and the saline group received an equivalent volume of saline. Postoperatively, patient controlled morphine pumps were attached and the pain score with morphine usage were recorded for 72 hours. The TUG tests and range of motion were assessed by the physiotherapists until 72 hours. Results Fifty-two patients were enrolled in the trial. Demographics were comparable. No significant intraoperative hemodynamic changes and post-operative adverse events were noted between the groups. A decrease in the TUG test, along with decreased opioid usage with a better range of movements was noted in the ketamine group, but this was not statistically significant. Day of discharge, patient satisfaction score, and functional recovery assessed by Oxford Knee Score (OKS) were comparable between the groups. Conclusion In conclusion, low dose intraoperative ketamine infusion does not provide clinical benefit in perioperative pain management and postoperative rehabilitation following total knee endoprosthetic replacement in oncology.


Subject(s)
Humans , Arthroplasty, Replacement, Knee , Ketamine , Neoplasms/surgery , Neoplasms/complications , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapy , Double-Blind Method , Pain Management , Analgesics , Analgesics, Opioid , Morphine
10.
Braz. J. Anesth. (Impr.) ; 73(1): 54-71, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1420654

ABSTRACT

Abstract Background Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization. Methods This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery. Results A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16-30]. 4,222 (69.3%) patients moved in ≤ 24 hours after surgery. Local anesthesia [OR = 0.80 (95% confidence interval [CI]: 0.72-0.90); p= 0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55-0.60); p< 0.001], mean adherence to ERAS items [OR = 0.93 (95% CI: 0.92-0.93); p< 0.001], and preoperative hemoglobin [OR = 0.97 (95% CI: 0.96-0.98); p< 0.001] were associated with shorter time to mobilization. Conclusions Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.


Subject(s)
Humans , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Early Ambulation , Postoperative Complications/etiology , Hemoglobins , Prospective Studies , Length of Stay
11.
Chinese journal of integrative medicine ; (12): 253-257, 2023.
Article in English | WPRIM | ID: wpr-971317

ABSTRACT

OBJECTIVE@#To evaluate the effect of wrist-ankle acupuncture (WAA) in pain and functional recovery after total knee arthroplasty (TKA).@*METHODS@#From June to September 2020, 94 participants were included from the Second Hospital of Tangshan and randomly assigned to the WAA group (47 cases) and the sham WAA group (47 cases) by a random number table, receiving real or sham WAA treatment, respectively. The primary outcome measure involved the visual analogue scale (VAS) scores at rest and in motion. The secondary outcomes involved the range of motion (ROM) of the knee joints, straight-leg raising time, postoperative weight-bearing time, sufentanil consumption within 48 h of patient-controlled analgesia (PCA) pump, length of hospital stay, and postoperative complications.@*RESULTS@#The VAS scores on the 3rd, 5th, and 7th postoperative days at rest and in motion was significantly lower in the WAA group than that of the sham WAA group (P<0.01). The ROM on the 1st, 2nd, and 3rd PODs was significantly higher in the WAA group than that of the sham WAA group (P<0.01). In comparison to the sham WAA group, the sufentanil consumption within 48 h of PCA pump was significantly less in the WAA group (156.3 ± 12.2 µg vs. 128.8 ± 9.8 µg, P<0.01). There was no significant difference in active straight-leg raising time, postoperative weight-bearing time, length of hospital stay, and postoperative complications between the two groups (P>0.05).@*CONCLUSIONS@#WAA could alleviate post-TKA pain, improve knee joint function, and reduce the sufentanil consumption within 48 h of PCA pump. WAA is a safe and effective treatment in the perioperative analgesic management for TKA.


Subject(s)
Humans , Arthroplasty, Replacement, Knee/adverse effects , Ankle , Wrist , Sufentanil , Pain, Postoperative/therapy , Acupuncture Therapy/adverse effects , Analgesia , Knee Joint
12.
Chinese Medical Journal ; (24): 1478-1484, 2023.
Article in English | WPRIM | ID: wpr-980926

ABSTRACT

BACKGROUND@#Total knee arthroplasty (TKA) can reduce severe joint pain and improve functional disability in hemophilia. However, the long-term outcomes have rarely been reported in China. Therefore, this study aimed to evaluate the long-term outcomes and complications of TKA in Chinese patients with hemophilic arthropathy.@*METHODS@#We retrospectively reviewed patients with hemophilia who underwent TKA between 2003 and 2020, with at least 10 years of follow-up. The clinical results, patellar scores, patients' overall satisfaction ratings, and radiological findings were evaluated. Revision surgery for implants during the follow-up period was recorded.@*RESULTS@#Twenty-six patients with 36 TKAs were successfully followed up for an average of 12.4 years. Their Hospital for Special Surgery Knee Score improved from an average of 45.8 to 85.9. The average flexion contracture statistically significantly decreased from 18.1° to 4.2°. The range of motion (ROM) improved from 60.6° to 84.8°. All the patients accepted patelloplasty, and the patients' patellar score improved from 7.8 preoperatively to 24.9 at the last follow-up. There was no statistically significant difference in clinical outcomes between the unilateral and bilateral procedures, except for a better ROM at follow-up in the unilateral group. Mild and enduring anterior knee pain was reported in seven knees (19%). The annual bleeding event was 2.7 times/year at the last follow-up. A total of 25 patients with 35 TKAs were satisfied with the procedure (97%). Revision surgery was performed in seven knees, with 10- and 15-year prosthesis survival rates of 85.8% and 75.7%, respectively.@*CONCLUSIONS@#TKA is an effective procedure for patients with end-stage hemophilic arthropathy, which relieves pain, improves knee functions, decreases flexion contracture, and provides a high rate of satisfaction after more than ten years of follow-up.


Subject(s)
Humans , Arthroplasty, Replacement, Knee/methods , Hemophilia A/surgery , Follow-Up Studies , Retrospective Studies , Treatment Outcome , Knee Joint/surgery , Range of Motion, Articular , Arthritis/complications , Pain , Contracture/surgery , Surgeons , Knee Prosthesis
13.
Chinese Medical Journal ; (24): 1539-1550, 2023.
Article in English | WPRIM | ID: wpr-980814

ABSTRACT

BACKGROUND@#Patellofemoral joint (PFJ) degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty (UKA). More recently, some researchers have proposed that PFJ degeneration can be ignored in medial UKA, and others have proposed that this change should be reviewed in PFJ degenerative facets and severity. This study aimed to systematically evaluate the effect of PFJ degeneration on patient-reported outcome measures (PROMs) and revision rates after medial UKA.@*METHODS@#Electronic databases (PubMed, Embase, Web of Science, etc.) were searched for studies assessing the influence of PFJ degeneration on medial UKA. A random-effects meta-analysis was conducted for the Oxford knee score (OKS), Knee society score (KSS), and revision rates and stratified by PFJ degenerative facets (medial/lateral/trochlear/unspecified), severe PFJ degeneration (bone exposed), and bearing type (mobile/fixed). Heterogeneity was assessed by the Cochran Q test statistic and chi-squared tests with the I-squared statistic.@*RESULTS@#A total of 34 articles with 7007 knees (2267 with PFJ degeneration) were included (5762 mobile-bearing and 1145 fixed-bearing and 100 unspecified). Slight to moderate degenerative changes in the medial and trochlear facets did not decrease the OKS and KSS, and only lateral facets significantly decreased the OKS (mean difference [MD] = -2.18, P   <  0.01) and KSS (MD = -2.61, P   <  0.01). The severity degree of PFJ degeneration had no additional adverse effect on the OKS, KSS, or revision rates. For mobile-bearing UKA, only lateral PFJ degeneration significantly decreased the OKS (MD = -2.21, P  < 0.01) and KSS (MD = -2.44, P  < 0.01). For fixed-bearing UKA, no correlation was found between PROMs/revision rates and PFJ degeneration.@*CONCLUSION@#For medial mobile-bearing UKA, slight to moderate degenerative changes in the PFJ, except lateral facet, did not compromise PROMs or revision rates. For medial fixed-bearing UKA, although it might not be conclusive enough, PROMs or revision rates were not adversely affected by PFJ degeneration (regardless of the facet).


Subject(s)
Humans , Arthroplasty, Replacement, Knee , Patellofemoral Joint/surgery , Treatment Outcome , Osteoarthritis, Knee/surgery , Knee Prosthesis , Bone Diseases , Knee Joint/surgery , Retrospective Studies
14.
Journal of Peking University(Health Sciences) ; (6): 362-365, 2023.
Article in Chinese | WPRIM | ID: wpr-986862

ABSTRACT

Periprosthetic gout flare is a rare arthritic condition after total knee arthroplasty, but the symptoms of gout may have often been mistaken as acute periprosthetic infection given their similarity. Misdiagnosis as periprosthetic infection can lead to unnecessary surgery, long-term dependence on anti-biotics, and even malfunction of the involved knee joint. Here, we report a case study of a patient with immunodeficiency condition of long-term oral glucocorticoid and diabetes mellitus, who had undergone a knee replacement 8 weeks before. The initial symptoms of fever and joint pain together with the dysfunction of her right knee with elevated inflammatory markers, such as increased serum leukocytes, erythrocyte sedimentation rate, C-reactive protein, and synovial cell counts led to a diagnosis of acute periprosthetic infection. Arthrocentesis and bacterial culture were performed preoperatively. According to the current Musculoskeletal Infection Society (MSIS) criteria for diagnosis of periprosthetic infection, the case was classified as periprosthetic infection and a prosthesis retained debridement surgery was performed. However we got negative culture results in all the pre-operative and intro-operative samples. The symptoms as well as the laboratory inflammatory markers improved shortly after the debridement surgery until the 11th day when all the similar systemic and local symptoms recurred. With a remedial crystal analysis of synovial fluid from the patient, gouty flare was found to be the cause of acute arthritis finally. Accor-dingly, after anti-gout medications were administrated, the symptoms associated with acute arthritis gra- dually subsided, and there was no recurrence during a 24-month follow-up. This article described the cli-nical manifestation, diagnosis and differential diagnosis, treatment of a case of periprosthetic gout. Although relatively rare, gout should be considered as a differential diagnosis in suspected periprosthetic infection. Current criteria for periprosthetic infection can not exclude the diagnosis of periprosthetic gout flare, it is therefore imperative that the analysis of joint aspirate for crystals be conducted to determine the correct course of treatment, or unnecessary surgical procedure may be performed in periprosthetic gout case.


Subject(s)
Humans , Female , Arthroplasty, Replacement, Knee/methods , Gout/complications , Prosthesis-Related Infections/surgery , Symptom Flare Up , C-Reactive Protein/analysis , Biomarkers/analysis
15.
Chinese Journal of Traumatology ; (6): 83-93, 2023.
Article in English | WPRIM | ID: wpr-970967

ABSTRACT

PURPOSE@#Robot-assisted technology is a forefront of surgical innovation that improves the accuracy of total knee arthroplasty (TKA). But whether the accuracy of surgery can improve the clinical efficacy still needs further research. The purpose of this study is to perform three-dimensional (3D) analysis in the early postoperative period of patients who received robot-assisted total knee arthroplasty (RATKA), and to study the trend of changes in gait parameters after RATKA and the correlation with the early clinical efficacy.@*METHODS@#Patients who received RATKA in the Center of Joint Surgery, the First Hospital Affiliated to Army Military Medical University from October 2020 to January 2021 were included. The imaging parameters, i.e., hip-knee-ankle angle, lateral distal femoral angle, medial proximal tibial angle, posterior condylar angle were measured 3 months post-TKA. The 3D gait analysis and clinical efficacy by Western Ontario Mac Master University Index (WOMAC) score were performed pre-TKA, 3 and 6 months post-TKA. The differences in spatiotemporal parameters of gait, kinetic parameters, and kinematic parameters of the operated limb and the contralateral limb were compared. The correlation between gait parameters and WOMAC scores was analyzed. Paired sample t-test and Wilcoxon rank-sum test were used to analyze the difference between groups, and Spearman correlation coefficient was used to analyze the correlation.@*RESULTS@#There were 31 patients included in this study, and the imaging indexes showed that all of them returned to normal post-TKA. The WOMAC score at 3 months post-TKA was significantly lower than that pre-TKA, and there was no significant difference between at 3 and 6 months. The 3D gait analysis results showed that the double support time of the operated limb reduced at 3 and 6 months (all p < 0.05), the maximum extension and maximum external rotation of the knee joint increased at stance phase, and the maximum flexion angle, the range of motion and the maximum external rotation increased at swing phase. Compared with the preoperative data, there were significant improvements (all p < 0.05). Compared with the contralateral knee joint, the maximum external rotation of the knee joint at swing phase was smaller than that of the contralateral side, and the maximum flexion and extension moment was greater than that of the contralateral knee. The maximum external rotation moment of the joint was greater than that of the contralateral knee joint (p < 0.05). There was a negative correlation between the single support time pre-TKA and the WOMAC score at 3 months (p = 0.017), and the single support time at 3 months was negatively correlated with the WOMAC score at 6 months (p = 0.043). The cadence at 6 months was negatively correlated with the WOMAC score at 6 months (p = 0.031). The maximum knee extension at stance phase at 6 months was negatively correlated with the WOMAC score at 6 month (p = 0.048). The maximum external rotation at stance phase at 6 months was negatively correlated with the WOMAC score at 6 months (p = 0.024).@*CONCLUSION@#The 3D gait analysis of RATKA patients is more sensitive than WOMAC score in evaluating the clinical efficacy. Trend of changes in gait parameters shows that the knee joint support, flexion and extension function, range of motion, external rotation and varus deformity moment of the patient were significantly improved at 3 months after surgery, and continued to 6 months after surgery. Compared with the contralateral knee, the gait parameters of the operated limb still has significant gaps in functionality, such as the external rotation and flexion and extension. The single support time, cadence, knee extension, and knee external rotation of the operated limb have a greater correlation with the postoperative WOMAC score. Postoperative rehabilitation exercises should be emphasized, which is of great value for improving the early efficacy of RATKA.


Subject(s)
Humans , Arthroplasty, Replacement, Knee , Gait Analysis , Robotics , Osteoarthritis, Knee/surgery , Knee Joint/surgery , Treatment Outcome , Range of Motion, Articular , Biomechanical Phenomena
16.
China Journal of Orthopaedics and Traumatology ; (12): 151-156, 2023.
Article in Chinese | WPRIM | ID: wpr-970837

ABSTRACT

OBJECTIVE@#To investigate the clinical efficacy of unicompartmental knee arthroplasty (UKA) in the treatment of knee osteoarthritis in patients over 75 years old.@*METHODS@#The clinical efficacy of primary fixed platform UKA in patients with osteoarthritis, was retrospectively analyzed from October 2014 to November 2020. Age, body mass index (BMI), range of motion (ROM), preoperative joint function score, the quality of life score and other preoperative indicators were measured by propensity score matching (PSM). The patients were divided into elderly group (≥75 years old) and control group (<75 years old). Oxford knee score(OKS), Western Ontario McMaster Universities osteoarthritis index(WOMAC), Short Form-12 including physical component summary (PCS), mental component summary(MCS), minimal clinically important difference(MCID ) and clinical complications were evaluated preoperatively and postoperatively.@*RESULTS@#A total of 514 patients were analyzed, 428 patients fulfilled the inclusion criteria. A propensity-score matching study was conducted to eliminate confounding factors. After 1∶2 propensity match, there were 84 patients in elderly group (≥75 years), age ranged from 75 to 88 years old, with an average of (78.79±3.08) years old, and 168 patients in control group (<75 years), age ranged from 47 to 74 years old, with an average of (64.10±5.96)years old. The follow-up duration of two groups ranged from 12 to 84 months with an average of (29.35±16.52) months in elderly group, and 12 to 85 months with an average of (31.83±17.34) months in control group. There was only significant difference in age between the elderly and control groups preoperatively (P<0.01). Postoperatively, the elderly group showed significantly higher WOMAC (P<0.01) and lower SF-12 PCS scores (P<0.01) as compared to the control group. There was no significant difference between the elderly group and the control group in knee range of motion, OKS and the proportion of each scoring system reaching the minimum clinical difference value (P>0.05). In the aspect of preperative complications, the elderly group exhibited more surgical site complications and postoperative delirium compared to control group(P<0.05). The differences in other indicators including deep vein thrombosis, acute urinary retention, cardiovascular events, cerebrovascular events and radiolucent lines around prothesis were not statistically significant(P>0.05).@*CONCLUSION@#UKA in the treatment of elderly patients over 75 years old with knee osteoarthritis was safe and feasible, and could obtain satisfactory short-term efficacy.


Subject(s)
Humans , Aged , Aged, 80 and over , Middle Aged , Osteoarthritis, Knee/surgery , Knee Prosthesis , Retrospective Studies , Propensity Score , Quality of Life , Knee Joint/surgery , Arthroplasty, Replacement, Knee/methods , Treatment Outcome
17.
China Journal of Orthopaedics and Traumatology ; (12): 133-139, 2023.
Article in Chinese | WPRIM | ID: wpr-970834

ABSTRACT

OBJECTIVE@#To investigate the early efficacy of Mako robot-assisted total knee arthroplasty (TKA) in the treatment of knee osteoarthritis (KOA) and summarize the initial application experience.@*METHODS@#Retrospective analysis of 73 patients with KOA treated with Mako robot-assisted TKA from June 2021 to December 2021. There were 16 males and 57 females, aged from 54 to 81 years old with an average of (67.8±6.6) years old. The hip knee and ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), lateral femoral component angle (LFCA) and lateral tibial component angle (LTCA) were recorded and analyzed. WOMAC score and KSS were used to compare the functional recovery of patients preoperatively, 3 and 6 months postoperatively.@*RESULTS@#All the 73 patients were successfully treated without serious complications such as vascular and nerve injury, and all the incisions healed well at stageⅠwithout infection. The patients were followed up from 4 to 11 months with an average of (7.0±2.7) months, and the satisfaction rate of the last follow-up was 90.41% (66/73). WOMAC scores were (23.1±5.4) at 3 months and (14.8±4.1) at 6 months postoperatively. KSS clinical scores were ( 76.1±4.0) at 3 months and (82.1±3.7) at 6 months postoperatively;KSS functional scores were (74.3±3.1) at 3 months and (78.6±2.1) at 6 months after operation. Postoperative imaging showed good position of the prosthesis, HKA angle was (178.5±2.1)°, LDFA was (91.2±1.8)°, MPTA was(89.9±1.5) °, LFCA was (7.6±3.1)°, LTCA was (88.2±1.1)°. The mechanical axis within ±3° in sixty cases(82.2%), and the mechanical axis within ±6° in all the patients.@*CONCLUSION@#Mako robot-assisted TKA is a safe and effective surgery in the treatment of knee osteoarthritis, which exhibited good efficacy in the correction of lower limb alignment, soft tissue balance and improvement of knee function. The long-term efficacy needs further follow-up observation.


Subject(s)
Male , Female , Humans , Middle Aged , Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee/methods , Osteoarthritis, Knee/surgery , Retrospective Studies , Robotics , Knee Joint/surgery
18.
Chinese Medical Journal ; (24): 73-81, 2023.
Article in English | WPRIM | ID: wpr-970050

ABSTRACT

BACKGROUND@#Synovectomy has been introduced into total knee arthroplasty (TKA) with the aim of relieving pain and inflammation of the synovium. However, there are no long-term, comparative data to evaluate the effect of synovectomy in TKA. This study was aimed at assessing pain, function, and complications in patients undergoing synovectomy during TKA for osteoarthritis (OA) at long-term follow-up.@*METHODS@#This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA. Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA. The overall efficacy of both strategies was evaluated by determination of blood loss, the Knee Society score (KSS), and knee inflammation conditions during a 3-month postoperative period. The postoperative pain, range of motion (ROM), and complications were sequentially evaluated to compare the two groups until 10 years after surgery.@*RESULTS@#At the 10-year follow-up, both groups had a similarly significantly improved ROM (114.88 ± 9.84° vs. 114.02 ± 9.43°, t  = 0.221, P  = 0.815) and pain relief with no differences between the two groups (1.0 [1.0] vs. 1.0 [1.5], U  = 789.500, P  = 0.613). Similar changes in total blood loss, KSS, and knee inflammation were found in both groups during 3 months postoperatively ( P  > 0.05). Additionally, there was no significant difference regarding complications and satisfaction between the two groups ( P  > 0.05).@*CONCLUSIONS@#Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain, ROM, and satisfaction during a 10-year follow-up. In addition, it may not result in more blood loss and increased incidence of long-term complications. Based on our long-term findings, it should not be performed routinely.@*TRIAL REGISTRATION@#Chinese Clinical Trial Registry, ChiCTR-INR-16008245; https://www.chictr.org.cn/showproj.aspx?proj=13334 .


Subject(s)
Humans , Arthroplasty, Replacement, Knee/methods , Synovectomy/methods , Osteoarthritis, Knee/surgery , Prospective Studies , Pain, Postoperative , Inflammation/etiology , Range of Motion, Articular , Knee Joint/surgery , Treatment Outcome , Knee Prosthesis/adverse effects
19.
Chinese Acupuncture & Moxibustion ; (12): 144-148, 2023.
Article in Chinese | WPRIM | ID: wpr-969963

ABSTRACT

OBJECTIVE@#To investigate the clinical effect of aconite-isolated moxibustion at Yongquan (KI 1) combined with rivaroxaban for lower extremity venous thrombosis after total knee arthroplasty and the influence on hypercoagulation.@*METHODS@#Seventy-three patients of knee osteoarthritis with lower extremity venous thrombosis after total knee arthroplasty (KOA) were randomly divided into an observation group (37 cases, 2 cases dropped off) and a control group (36 cases, 1 case dropped off). The patients in the control group took orally rivaroxaban tablets, 10 mg a time, once a day. On the basis of the treatment as the control group, the aconite-isolated moxibustion was applied to Yongquan (KI 1) for the patients of the observation group, once daily and 3 moxa cones were used in each treatment. The duration of treatment was 14 days in both groups. Before treatment and 14 days into treatment, the ultrasonic B test was adopted to determine the conditions of lower extremity venous thrombosis in the two groups. Before treatment, 7 and 14 days into treatment, the coagulation indexes (platelet [PLT], prothrombin time [PT], activated partial prothrombin time [APTT], fibrinogen [Fib] and D-dimer[D-D]), the blood flow velocity of the deep femoral vein and the circumference of the affected side were compared between the two groups separately, and the clinical effect was evaluated.@*RESULTS@#Fourteen days into treatment, the venous thrombosis of the lower extremity was relieved in both groups (P<0.05), and that of the observation group was better than the control group (P<0.05). Seven days into treatment, the blood flow velocity of the deep femoral vein was increased compared with that before treatment in the observation group (P<0.05), and the blood flow rate in the observation group was higher than that in the control group (P<0.05). Fourteen days into treatment, PT, APTT and the blood flow velocity of the deep femoral vein were increased in the two groups compared with those before treatment (P<0.05); and PLT, Fib, D-D and the circumference of the limb (knee joint, 10 cm above the patella and 10 cm below the patella) were all reduced in the two groups (P<0.05). Compared with the control group 14 days into treatment, the blood flow velocity of the deep femoral vein was higher (P<0.05), PLT, Fib, D-D and the circumference of the limb (knee joint, 10 cm above the patella and 10 cm below the patella) were all lower in the observation group (P<0.05). The total effective rate was 97.1% (34/35) in the observation group, higher than 85.7% (30/35) in the control group (P<0.05).@*CONCLUSION@#Aconite-isolated moxibustion at Yongquan (KI 1) combined with rivaroxaban can effectively treat lower extremity venous thrombosis after total knee arthroplasty, relieve hypercoagulation, accelerate the blood flow velocity and alleviate swelling of the lower extremity in the patients with knee osteoarthritis.


Subject(s)
Humans , Rivaroxaban , Arthroplasty, Replacement, Knee , Moxibustion , Aconitum , Osteoarthritis, Knee/therapy , Venous Thrombosis/surgery , Lower Extremity
20.
China Journal of Orthopaedics and Traumatology ; (12): 507-513, 2023.
Article in Chinese | WPRIM | ID: wpr-981724

ABSTRACT

OBJECTIVE@#To evaluate outcomes of mixed unicompartmental knee arthroplasty(UKA) and total knee arthroplasty(TKA) in the treatment of medial osteoarthritis(OA) of the knee.@*METHODS@#Retrospective analysis of 156 patients, 44 males and 112 females, aged from 50 to 75 years old with an average of(58.76±4.97) years old, who underwent knee arthroplasty from October 2017 to October 2019. The patients were divided into two groups:81 cases(81 knees) underwent TKA, including 23 males and 58 females, aged from 51 to 75 years old with an average of (58.60±5.01) years old, and 75 case (75 knees) underwent UKA with mixed phase 3 Oxford, including 21 males and 54 females, aged from 50 to 72 years old with an average of (58.92±4.95) years old. The two groups were compared regarding to the clinical outcomes, assessed using surgical information and complications, American Knee Society score(AKSS) clinical score and functional score. Radiographs were assessed using hip-knee-ankle angle(HKA), tibial component valgus/varus angle(TCVA), tibial component posterior slope angle(TCPSA), femoral component valgus/varus angle(FCVA), femoral component posterior slope angle(FCPSA), looking for bearing dislocation, prosthesis loosening, progression of OA in lateral compartment.@*RESULTS@#Intraoperative bleeding, operative time and hospital days were significantly better in the UKA group than in the TKA group (P<0.05), and there were no postoperative complications in either group. Patients in both groups were enrolled with an average follow-up time of (38.01±8.90) months, ranged from 24 to 54 months. AKSS functional, AKSS clinical, HKA in both groups significantly improved at the final follow-up compared with those before operation. At the final follow-up, the UKA group was significantly better than the TKA group in AKSS functional and AKSS clinical, whereas HKA in the TKA group was better. At the final follow-up. TCVA and FCVA between the two groups were not significantly different, while TCPSA and FCPSA in the UKA group were significantly greater than the TKA group. No signs of progression of OA to the lateral compartment were observed.@*CONCLUSION@#Mixed phase 3 Oxford UKA in medial unicompartmental knee osteoarthritis was considerably better than TKA for less blood loss, shorter operation time, shorter hospital stay, rapid postoperative recovery, helping achieve satisfactory function, provided satisfactory outcome.


Subject(s)
Male , Female , Humans , Middle Aged , Aged , Arthroplasty, Replacement, Knee , Osteoarthritis, Knee/surgery , Retrospective Studies , Treatment Outcome , Knee Joint/surgery , Knee Prosthesis
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