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Article in Chinese | WPRIM | ID: wpr-928269


OBJECTIVE@#To evaluate of the clinical effects of mobile-bearing(MB) and fixed-bearing(FB) unicompartmental knee arthroplasty(UKA) in the treatment of knee osteoarthritis by Meta-analysis.@*METHODS@#The literature on FB UKA and MB UKA in the treatment of knee osteoarthritis in PubMed, CNKI, Wanfang, Cochrane and EMBASE database were searched by computer from January 2000 to April 2020. According to the inclusion and exclusion criteria, two authors were selected independently and the selected literature was evaluated for quality.After literature data were extracted, Review Manager 5.3 software was used to analyze knee function score, postoperative activity, revision rate, polyethylene wear rate, pad dislocation, aseptic loosening, postoperative pain, knee arthritis progression, mechanical shaft alignment of lower limbs, and imaging clarity line respectively.@*RESULTS@#A total of 13 literatures were included in this meta-analysis, including 2 randomized controlled studies and 11 cohort studies. A total of 1 871 patients were included, including 913 in FB UKA group and 958 in MB UKA group. Meta analysis results showed that:postoperative knee joint function score[MD=-0.84, 95%CI(-1.46, -0.21), P=0.008] and postoperative knee joint range of motion [MD=-1.51, 95%CI(-2.84, -0.18), P=0.03] in FB UKA group were better than those in MB UKA group. Compared with FB UKA group, MB UKA group had a higher lower limb mechanical axis alignment rate[OR=2.08, 95%CI(1.27, 3.39), P=0.003], and the wear rate of polyethylene [OR=0.11, 95%CI(0.01, 0.91), P=0.04] was lower. There were no differences between two groups in the renovation rate [OR=1.16, 95%CI(0.75, 1.80), P=0.50), liner dislocation rate[OR=3.78, 95%CI(0.93, 15.29), P=0.06], aseptic loosening [OR=2.11, 95%CI(0.81, 5.51), P=0.13], postoperative pain[OR=1.13, 95%CI(0.37, 3.43), P=0.83], osteoarthritis progression[OR=1.28, 95%CI(0.67, 2.47), P=0.46)and imaging radiolucent line[OR=1.62, 95%CI(0.09, 30.22), P=0.75].@*CONCLUSION@#FB UKA has a higher postoperative functional score and range of motion.MB UKA has more advantages in the correction of lower limb mechanical axis, and the wear rate of polyethylene is also lower. There was no significant difference between the two groups in revision rate, dislocation of the liner, aseptic loosening, postoperative pain, progression of osteoarthritis, and postoperative translucency.

Arthroplasty, Replacement, Knee , Humans , Knee Joint/surgery , Knee Prosthesis , Osteoarthritis, Knee/surgery , Prosthesis Design , Reoperation , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-928266


OBJECTIVE@#To investigate the effect of tibial coronal curvature on the alignment of tibial prosthesis in patients undergoing total knee arthroplasty (TKA).@*METHODS@#From July 2019 to April 2021, 100 patients with knee osteoarthritis were treated with total knee arthroplasty. Before operation, the full-length films of lower limbs were taken and the tibial bowing angle(TBA) was measured. TBA more than 2° was tibial bending, which was divided into tibial bending group and non bending group. There were 40 cases in tibial bending group, 9 males and 31 females, aged 56 to 84 years old with an average of (69.22±7.10) years. There were 60 cases in the non bending group, 19 males and 41 females, aged from 51 to 87 years old with an average of (70.80±7.21) years. The preoperative tibial length (TL) and medial proximal tibial angle (MPTA) were measured and compared between the two groups. The full-length X-rays of the lower limbs were taken again 3 days to 1 week after operation. The medial angle of the tibial component coronal aligement angle (TCCA) and the outilier rate of force line of the tibial prosthesis were measured and compared between the two groups. Pearson method was used to analyze the correlation between TCCA and age, TCCA and height, TCCA and weight, TCCA and BMI, TCCA and TBA, TCCA and TL, TCCA and MPTA; Spearman method was used to analyze the correlation between TCCA and gender, TCCA and Kellgren-Lawrence(K-L) grade.@*RESULTS@#All 100 patients successfully completed the operation and obtained satisfactory full-length X-rays in standing position. There was no significant difference in TL, MPTA and TCCA between bending group and non bending group(P>0.05). The outilier rate of force line in tibial bending group was 22.5%, and that in non bending group was 6.67%, the difference was statistically significant(P<0.05). The correlation study found that TCCA was strongly correlated with TBA(r=-0.702, P<0.01), weakly correlated with MPTA(r=0.311, P<0.01), and had no correlation with other parameters(P>0.05).@*CONCLUSION@#In patients with knee osteoarthritis undergoing total knee arthroplasty, tibial bending will lead to poor force line of tibial prosthesis. During operation, attention should be paid to osteotomy of proximal tibial vertical tibial mechanical axis and correct installation of prosthesis to avoid poor alignment of prosthesis.

Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee/adverse effects , Female , Humans , Knee Joint/surgery , Knee Prosthesis/adverse effects , Male , Middle Aged , Osteoarthritis, Knee/surgery , Retrospective Studies , Tibia/surgery
Article in Chinese | WPRIM | ID: wpr-928264


OBJECTIVE@#To investigate the effect of computer navigation gap balance technology on the recovery of lower limb function after total knee arthroplasty.@*METHODS@#The clinical data of 106 patients with knee osteoarthritis (OA) who underwent total knee arthroplasty from July 2018 to June 2019 were analyzed retrospectively. They were divided into measurement osteotomy group and space balance group according to different osteotomy techniques during total knee arthroplasty. There were 61 cases in osteotomy group, 24 males and 37 females;The age ranged from 45 to 77(63.35±4.26) years;According to K-L classification, 41 cases were grade Ⅲ and 20 cases were grade Ⅳ. intraoperative measurement osteotomy was performed. There were 45 cases in the gap balance group, 17 males and 28 females;Age 45 to 78(64.03±4.31) years;According to K-L classification, 29 cases were classified as grade Ⅲ and 16 cases as grade Ⅳ. computer navigation gap balance technology was implemented. The amount of intraoperative bleeding, operation time, incision length, hospital stay and postoperative complications were compared between two groups. The clinical efficacy was evaluated by Knee Society score(KSS) before operation and 12 months after operation.@*RESULTS@#Total of 106 patients were followed up for 12 to 18(20.38±3.25) months. There were significant differences in intraoperative bleeding and operation time between two groups(P<0.05). There was no significant difference in incision length and hospital stay between the two groups(P>0.05). At 12 months after operation, the total score of KSS in the gap balance group (173.59±14.50) was better than that in the osteotomy group (164.95±12.10)(P<0.05). There were no serious complications of poor prosthesis loosening between two groups during follow-up, and there was no significant difference in the incidence of other complications between two groups(P>0.05).@*CONCLUSION@#The application of computer navigation gap balance technology in total knee arthroplasty is conducive to the recovery of lower limb function in patients with OA, and there are no serious adverse complications and high safety.

Aged , Arthroplasty, Replacement, Knee , Computers , Female , Humans , Knee Joint/surgery , Knee Prosthesis , Lower Extremity , Male , Middle Aged , Osteoarthritis, Knee/surgery , Retrospective Studies , Technology , Treatment Outcome
Chinese Journal of Surgery ; (12): 268-272, 2022.
Article in Chinese | WPRIM | ID: wpr-927611


Component malrotation is one of the major causes of failure in total knee arthroplasty.Based on previous researches,Insall line has excessive external rotation tendency.Although Akagi line is the most recognized anatomical axis at present,it still has a certain tendency of internal rotation.The tibial posterior condylar axis is not suitable for symmetrical component and yet the Curve-on-Curve technique is not suitable for anatomic component.In addition,reference to any fixed anatomical markers cannot ensure the rotation consistency of tibiofemoral component in extension position.Although range of motion technique is beneficial to tibiofemoral rotation synchronization,its clinical effect seems to be unstable.Nevertheless,Patients can obtain good postoperative results with all major techniques.Before the recognized "gold standard" is defined,orthopedic surgeons can determine the rotation alignment of tibial component according to their most accustomed surgical method.With a deeper understanding of knee anatomy,biomechanics and kinematics,digital assistive technology may be expected to become a breakthrough in the tibial rotational alignment.

Arthroplasty, Replacement, Knee/methods , Femur/surgery , Humans , Knee Joint/surgery , Knee Prosthesis , Osteoarthritis, Knee/surgery , Range of Motion, Articular , Tibia/surgery
Rev. colomb. ortop. traumatol ; 36(1): 32-37, 2022. ilus.
Article in Spanish | LILACS, COLNAL | ID: biblio-1378778


Objetivo El genu valgo artrósico severo (> 20°) puede presentar distintos grados de insuficiencia del ligamento colateral medial e inestabilidad articular. El objetivo de este trabajo retrospectivo evalúa nuestra experiencia en el tratamiento del genu valgo severo con prótesis de estabilidad aumentada y propone un método para la evaluación y clasificación del genu valgo artrósico. Material y métodos A 27 pacientes (28 rodillas) con genu valgo artrósico severo se les realizó una artroplastia total de rodilla primaria con un implante de estabilidad aumentada, y un seguimiento promedio de 6.2 años. Se confeccionó una nueva clasificación del genu valgo artrósico que contempla la suficiencia ligamentaria y por lo tanto relaciona el tipo de rodilla con el tipo de implante necesario. Resultados Se utilizó una prótesis constreñida en 17 pacientes con un eje promedio de 22,7° y el ligamento colateral medial atenuado. En 11 casos con un eje promedio de 28,1°, LCM incompetente y/o recurvatum, se optó por bisagras rotatorias. Se confeccionó una nueva clasificación del genu valgo artrósico que considera el desgaste y estabilidad articular, el grado de deformidad de la rodilla y la suficiencia ligamentaria. Discusión Las prótesis constreñidas deben utilizarse en pacientes que presenten inestabilidad exclusivamente en el plano coronal, aún en genu valgo severo, con LCM atenuado. Debe reservarse el uso de bisagras rotatorias a aquellos pacientes que presentan incompetencia ligamentaria, inestabilidad combinada (recurvatum) y/o déficit neuro-muscular severo.

Purpose This retrospective level 2 analysis evaluates the prosthesis type selected in our department for the treatment of the severe valgus knee and proposes a new classification for the valgus knee osteoarthritis. Material and methods A total knee arthroplasty with a constrained or hinged knee prosthesis was performed in 28 valgus knees. The average follow-up was 6.2 years. A new classification that considerates the ligament sufficiency status was developed in order to relate the different knee types with the different type of eventually needed implants. Results Constrained prosthesis was used in 17 patients with an attenuated medial collateral ligament, and a rotating hinge in 11 patients with incompetent medial collateral ligament and/or recurvatum. The postoperatory Knee Society Score was of 85 points. The valgus knee was classified in 5 types considering the knee valgus deformity, the ligament sufficiency and joint stability and wear. Discussion The classification proposed clearly defines the ligament status and valgus knee types, and it seems to be a comprehensive tool to select the appropriate prosthesis. Constrained prosthesis must be used on patients who present coronal instability with attenuated medial collateral ligament. Rotating hinges must be reserved for those patients who have medial collateral ligament incompetence, recurvatum, combined instability and/or severe muscular deficiency.

Humans , Genu Valgum , Joint Instability , Knee Prosthesis
Rev. bras. ortop ; 56(1): 104-108, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1288657


Abstract Objective This study aims to evaluate and correlate the nutritional status with potential complications during the immediate postoperative period of elderly patients surgically treated for proximal femoral fractures. Methods A prospective, cross-sectional analytical study with a quantitative approach, targeting patients aged 60 years old or more who were admitted to a hospital in Amazonas, Brazil, for surgical treatment of proximal femoral fractures. Surgical complications during the immediate postoperative period and their relationship with the nutritional status of the patient were determined using the mini nutritional assessment (MNA); in addition, the lymphocyte numbers and serum albumin levels were determined and correlated with the length of hospital stay. Results The sample consisted of 19 elderly patients, of both genders, with a mean age of 70.8 years. Most of the subjects (68.4%) were female. Malnutrition was diagnosed in 15.8% of the subjects using the body mass index (BMI) as, an anthropometric variable, and the MNA identified 31.6% of the subjects with malnutrition. Regarding total lymphocyte count, 100% of the sample showed a positive association with malnutrition in varying degrees; using serum albumin level as a parameter, malnutrition was identified in 89.4% of the subjects. Malnourished patients had the highest average length of stay. Surgical complications as surgical site infections occurred in 10.5% of the patients at risk of malnutrition. Conclusion This study revealed a higher rate of postoperative complications in elderly patients diagnosed with malnutrition.

Resumo Objetivo Avaliar e correlacionar o estado nutricional com possíveis complicações no pós-operatório imediato de pacientes submetidos a tratamento cirúrgico de fraturas de fêmur proximal. Métodos Estudo transversal prospectivo analítico e de abordagem quantitativa, tendo como população-alvo pacientes com idade igual ou superior a 60 anos, internados em uma instituição hospitalar no Amazonas, submetidos a tratamento cirúrgico de fraturas de fêmur proximal. Foram avaliadas as complicações cirúrgicas no pós-operatório imediato e sua relação com o estado nutricional através da mini avaliação nutricional (MAN), assim como a mensuração da contagem de linfócitos e albumina e a sua correlação com o tempo de internação. Resultados A amostra foi composta por 19 pacientes idosos, de ambos os sexos, com média de idade de 70,8 anos. A maioria dos pacientes (68,4%) eram do sexo feminino. Por meio da variável antropométrica índice de massa corporal (IMC), identificou-se a presença de desnutrição em 15,8% dos pacientes e, por meio da MAN, de 31,6%. Na avaliação do cálculo da contagem total de linfócitos, 100% da amostra apresentou associação positiva com desnutrição em graus variáveis e, fazendo-se uso da albumina sérica como parâmetro, a desnutrição foi identificada em 89,4%. Os pacientes desnutridos apresentaram a maior média de tempo de internação. As complicações cirúrgicas, por infecções do sítio cirúrgico, ocorreram em 10,5% nos pacientes em risco nutricional. Conclusão Neste estudo, observou-se maior índice de complicações no pós-operatório em idosos diagnosticados com desnutrição.

Postoperative Complications , Prosthesis Design , Surgical Wound Infection , Prosthesis Failure , Arthroplasty, Replacement, Knee , Fractures, Bone , Knee Prosthesis
Rev. bras. ortop ; 56(1): 42-46, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1288655


Abstract Objective To evaluate the wear of polyethylene in a Brazilian ultracongruent knee prosthesis with a rotating platform (Rotaflex, Víncula, Rio Claro, SP, Brasil). Methods We used the test method with the loading and preparation parameters mentioned in the standards regulation ISO 14243-1:2009, and the measurement methods mentioned in the standards regulation ISO 14243-2:2009, for the evaluation of the wear behavior of a Brazilian prosthesis with a rotating platform. The equipment used for the wear test was the ISO 14243-1 gait simulator (EndoLab, Riedering, Germany). Results After 10 million cycles, the evaluation of the polyethylene wear showed a regular appearance of surface wear at a mean rate of 2.56 mg per million cycles. Conclusion The wear of the polyethylene of the evaluated prosthesis was minimal after the tests performed and with safety limits higher than those recommended by biomechanical engineering.

Resumo Objetivo Avaliar o desgaste do polietileno de uma prótese de joelho brasileira ultracongruente de base rotatória (Rotaflex, Víncula, Rio Claro, SP, Brasil). Métodos Utilizou-se o método de ensaio com os parâmetros de carregamento e preparação citados na norma ISO 14243-1:2009, e os métodos de medição citados na norma ISO 14243-2:2009, para a avaliação do comportamento de desgaste de uma prótese nacional com base rotatória. O equipamento utilizado para o teste de desgaste foi o simulador de marcha ISO 14243-1 (EndoLab, Riedering, Alemanha). Resultados Após 10 milhões de ciclos, a avaliação do desgaste do polietileno mostrou uma aparência regular do desgaste da superfície com taxa média de 2,56 mg por milhão de ciclos. Conclusão O desgaste do polietileno da prótese avaliada foi mínimo após os ensaios realizados e com os limites de segurança superiores aos preconizados pela engenharia biomecânica.

Prostheses and Implants , Prosthesis Failure , Arthroplasty, Replacement, Knee , Equipment and Supplies , Knee Prosthesis
Article in Chinese | WPRIM | ID: wpr-942268


OBJECTIVE@#To evaluate the relationship between postoperative knee function and the sagittal position of tibial component in unicompartmental knee arthroplasty (UKA).@*METHODS@#We retrospectively enrolled the patients who underwent UKA from January 2016 to May 2020. They were assigned into 2 groups according to postoperative posterior tibial slope (PTS): the normal PTS group (PTS≥3° and PTS < 8°) and the abnormal PTS group (PTS < 3° or ≥8°). The patients were followed up for at least 12 months. The postoperative Knee Society Clinical Score (KSS-C), Knee Society Functional Score (KSS-F) and knee range of motion (ROM) were compared between the two groups.@*RESULTS@#A total of 72 patients (82 knees) were included with 51 patients (58 knees) in PTS normal group and 21 patients (24 knees) in PTS abnormal group. All the patients were followed up with median of 23.6 months. There was no significant difference in the general data [gender, age, body mass index (BMI)], pre-operative knee range of motion, preoperative KSS-C score and KSS-F score (P > 0.01). The KSS-C score, KSS-F score, and knee range of motion significantly improved after surgery (P < 0.01) for all the patients. The postoperative KSS-C score in normal PTS group (88.76±2.79) was significantly higher than the KSS-C score in abnormal PTS group (84.42±3.35, P < 0.01), but no significant difference between the 2 groups was observed in postoperative KSS-F score and knee range of motion (P > 0.01). In addition, there was no correlation between the change of PTS and postoperative KSS-C score (r=-0.034, 95%CI: -0.247 to 0.186, P = 0.759), KSS-F score (r = -0.014, 95%CI: -0.238 to 0.198, P = 0.901) and knee range of motion (r= 0.045, 95%CI: -0.214 to 0.302, P = 0.686).@*CONCLUSION@#The posterior tibial slope between 3° and < 8° can be recommended to improve knee joint function in mobile UKA, and excessive or insufficient PTS should be avoided.

Arthroplasty, Replacement, Knee , Humans , Knee Joint/surgery , Knee Prosthesis , Osteoarthritis, Knee/surgery , Range of Motion, Articular , Retrospective Studies , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-942176


OBJECTIVE@#To analyze the preoperative influencing factors of varus after Oxford unicompartmental knee arthroplasty.@*METHODS@#A total of 660 patients (767 knees) undergoing Oxford unicompartmental knee arthroplasty in adult joint reconstruction surgery department of Beijing Jishuitan Hospital from January 2018 to December 2019 were retrospectively analyzed. Inclusive criteria: diagnosis was osteoarthritis, single compartment lesions in the medial side of the knee; preoperative flexion deformity was less than 10°, active range of motion was greater than 90°; preoperative X-ray full-length images of both lower limbs showed less than 15° varus (Noyes method); anterior cruciate ligament was well functioned, The cartilage of lateral compartment of knee joint was intact.@*EXCLUSION CRITERIA@#combined with other inflammatory arthropathy; combined with extraarticular deformity; previous knee surgery history. The average age of the patients was (64.4±8.1) years, including 153 males and 497 females. The degree of post-operative varus was measured with Noyes method. The total patients were divided into varus group (Noyes≥3 °) and normal group (Noyes < 3 °). Gender, age, body mass index (BMI), range of motion (ROM), preoperative flexion deformity (FD), American Knee Society pain score (AKS) and American Knee Society function score (AKS function) were recorded. The standard anteroposterior and lateral X-ray films of knee joint and full-length lower extremity kinematic line films were taken by Sonialvision Safine Ⅱ (Shimadzu, Japan) multi-function digital tomography system. The image was measured by picture archiving and communication system (PACS). The following angles were measured preoperative Noyes angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and joint line converge angle (JLCA) were measured and analyzed.@*RESULTS@#Gender(P=0.346), operative side (P=0.619), age (P=0.746), BMI (P=0.142), preoperative ROM (P=0.102), preoperative knee pain score (P=0.131) and functional score (P=0.098) were not risk factors for postoperative varus. The influencing factors of postoperative varus were preoperative MPTA < 84 ° (P= 0.018, OR= 3.712, 95%CI: 1.250-11.027), preoperative Noyes > 5°(P=0.000, OR= 3.105, 95%CI: 1.835-5.254), preoperative FD > 5° (P= 0.001, OR=1.976, 95%CI: 1.326-3.234). Pre-operative LDFA (P=0.146) and preoperative JLCA (P= 0.709) had no significant effect on postoperative kinematic line.@*CONCLUSION@#Patients with severe preoperative varus, especially those with varus deformity mainly from the tibial side, and those with preoperative flexion deformity are more prone to get varus lower extremity kinematic line after Oxford unicompartmental knee arthroplasty.

Adult , Aged , Arthroplasty, Replacement, Knee , Female , Humans , Knee Joint/surgery , Knee Prosthesis , Male , Middle Aged , Multivariate Analysis , Osteoarthritis, Knee/surgery , Range of Motion, Articular , Retrospective Studies
Article in Chinese | WPRIM | ID: wpr-879395


Femorotibial mechanical axis (FTMA) is one of important factors influencing clinical effect after total knee arthroplasty (TKA). It is generally believed that the range of lower limb alignment after TKA is controlled within neutral FTMA ± 3 °, which has more advantages in improving joint function, prolonging prosthesis survival rate and reducing revision rate, and obtain better clinical results. Therefore, neutral FTMA is also considered to be the gold standard for TKA. However, with the application of computer-assisted surgery and other technologies, the alignment of FTMA is more accurate than before, but the clinical effect after surgery has not significantly improved. Some scholars have begun to question the necessity of neutral alignment of FTMA, and proposed alignment methods such as kinematics and retained residual deformity, which could achieve better clinical effects. In recent years, it has been reported that FTMA might not be the most important factor influencing postoperative clinical effects, and it is suggested that the arrangement and measurement of lower limbs and the effects on adjacent joint functions could affect clinical effect after TKA. The paper reviews neutral FTMA alignment is still an important factor for success of TKA. After a thorough evaluation according to the patient's condition, it should be appropriately applied in the case of neutral FTMA alignment; the operator should explore other factors which affect clinical outcome after TKA, and improve it to achieve the best therapeutic effect.

Arthroplasty, Replacement, Knee , Biomechanical Phenomena , Humans , Knee Joint/surgery , Knee Prosthesis , Lower Extremity , Osteoarthritis, Knee/surgery , Prosthesis Failure , Surgery, Computer-Assisted
Article in Spanish | LILACS, BINACIS | ID: biblio-1353998


En 2021, se cumplen 40 años de la publicación original que describió al implante "intracondilar con capacidad rotatoria Endo-Model", evolución del diseño precedente St. George, ahora capaz de proveer doble grado de libertad de movimiento y reducir la tensión en la interfase cemento-hueso. Condición singular es que dicha publicación no es referida en estudios bibliométricos, a pesar de lo cual su indicación electiva está aún vigente tras cuatro décadas. Un trabajo merece la calificación de "clásico" no exclusivamente por el volumen de citaciones, sino fundamentalmente por la confianza que inspira la aplicación de su contenido en el largo plazo. Contemporáneamente, todas las compañías de la industria de implantes que lideran el mercado internacional han incorporado en sus catálogos un modelo propio de implante a bisagra rotacional. La magnitud de constricción comparativa es un dilema y, por ende, materia de discusión. Contemporáneamente aplicando la tecnología de sensores inerciales se ha logrado resolver la cuestión: la bisagra rotacional ofrece menor constricción que el implante de constricción condilar. Nivel de Evidencia: V

The year 2021 marks the 40th anniversary of the original publication describing the "Endo-model intracondylar rotational" implant, the evolution of the previous St Georg design, now providing two-degree-of-freedom motion and reducing stress on the cement-bone interface. A unique condition is that the publication is not reported in bibliometric studies, although its elective indication still exists after four decades. A work deserves the qualification of "classic" not only for the volume of citations but fundamentally for the confidence that the application of its content inspires in the long term. Currently all the leading international companies in the implant industry have included in their catalogs their own rotating hinge implants. The scale of comparative constriction is a dilemma and thus a topic for discussion. Currently, the matter has been solved applying inertial sensors technology: the rotating hinge provides less constriction than the condylar constriction implant. Level of Evidence: V

Orthopedics/history , Knee Prosthesis/history , Knee Prosthesis/trends
Rev. Hosp. Ital. B. Aires (2004) ; 40(4): 171-183, dic. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1145445


Objetivo: comparar los resultados funcionales y de calidad de vida, y algunos indicadores de calidad y satisfacción, entre dos estrategias de cuidados posoperatorios de prótesis total de rodilla: 1) Cuidados protocolizados brindados por la Unidad de Rehabilitación del Hospital Italiano (URED) para pacientes que residen en CABA; 2) Cuidados habituales brindados por el sistema tercerizado de rehabilitación kinésica. Materiales y métodos: cohorte prospectiva de pacientes que fueron sometidos a una cirugía de reemplazo articular de la rodilla en el Hospital Italiano. Fueron evaluados mediante cuestionarios de funcionalidad y calidad de vida percibida, y goniometría, a los 45 días, por kinesiólogos entrenados. Resultados: se incluyeron 81 pacientes en el grupo de cuidados protocolizados y 28 en el de cuidados habituales. Se observaron diferencias estadísticamente significativas en todas las variables evaluadas y destacamos la relevancia clínica de que solamente el 2,43% de los pacientes atendidos en la URED continuaban usando andador a los 45 días frente al 35,71% de los que habían sido atendidos con los cuidados habituales (p = 0,004), así como la menor proporción de pacientes con déficit de flexión (2,47% vs. 46%, respectivamente; p < 0,001) y de extensión (18,52 vs. 75%; p < 0,001) en el mismo lapso, requisitos que son importantes para lograr una marcha funcional. Conclusión: un programa de rehabilitación domiciliaria protocolizada y supervisada por kinesiólogos entrenados mostró ser eficaz para una progresión más rápida hacia una marcha independiente con un menor riesgo de déficit de flexión o de extensión a los 45 días. (AU)

Objective: to compare functionality and quality of life, and some indicators of patient satisfaction, between two postoperative rehabilitation care following total knee replacement: 1) Protocolized care provided by the Italian Hospital Rehabilitation Unit for patients who live in CABA; 2) Usual care provided by the outsourced rehabilitation system. Materials and methods: prospective cohort of patients who underwent total knee replacement at the Italian Hospital were evaluated using questionnaires of functionality and quality of life at 45 days. Results: 81 patients were included in the protocolized care group and 28 in the usual care group. Statistically significant differences were observed in all the variables evaluated, highlighting clinical relevance that only 2.43% of the patients treated by the URED continued using the walker at 45 days vs 35.71% of those who had been treated with the usual care (p = 0.004); as well as the lower proportion of patients with flexion deficit (2.47 vs. 46%, respectively; p < 0.001) and extension (18.52 vs. 75%; p < 0.001) at the same time. Conclusion: a home protocolarized rehabilitation program supervised by a physical therapist proved to be effective for a quicker progression to an independent walk with lower risks of flexion or extension deficits at 45 days. (AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Postoperative Care/rehabilitation , Arthroplasty, Replacement, Knee/rehabilitation , Postoperative Care/statistics & numerical data , Quality of Life , Rehabilitation/methods , Rehabilitation/statistics & numerical data , Walkers/statistics & numerical data , Pain Measurement/statistics & numerical data , Cohort Studies , Physical Therapy Modalities/trends , Treatment Outcome , Arthroplasty, Replacement, Knee/statistics & numerical data , Gait , Home Nursing/statistics & numerical data , Knee Prosthesis
Article in Chinese | WPRIM | ID: wpr-828257


OBJECTIVE@#To analyze the relationship between the distribution of lower limb alignment and short term clinical efficacy in patients with varus-type osteoarthritis after primary total knee arthroplasty (TKA).@*METHODS@#From December 2016 to March 2018, 87 patients (101 knees) with knee osteoarthritis were treated with the first total knee arthroplasty by the same medical group, including 21 males(25 knees) and 66 females(76 knees), ranging in age from 51 to 85 years old, with a mean of (67.6±7.0) years old. According to the difference of hip knee ankle angle (HKA) after total knee arthroplasty, the patients were divided into 4 groups:neutral position group (group A), -3°≤HKA≤3°, 50 knees;slight varus group (group B), 3°0.05). There was no significant difference in knee joint activity among the 4 groups. The score of femoral prosthesis force line within ±3°was better than that of the other group (0.05).@*CONCLUSION@#The short term clinical efficacy of patients with knee varus osteoarthritis after primary total knee arthroplasty is related to the distribution of lower limbs alignment. The short-term clinical efficacy of slight inversion position can be similar to that of neutral position. The force line distribution of femoral prosthesis is related to the short term clinical efficacy after primary knee arthroplasty.

Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee , Female , Humans , Knee , Knee Joint , Knee Prosthesis , Lower Extremity , Male , Middle Aged , Osteoarthritis, Knee , Retrospective Studies
Article in Chinese | WPRIM | ID: wpr-828253


OBJECTIVE@#To compare and analyze the early clinical outcomes of unicompartmental knee arthroplasty with mobile and fixed platform for the treatment of single compartment osteoarthritis of knee.@*METHODS@#From January 2013 to December 2014, 86 cases (92 knees) of knee osteoarthritis with single compartment (medial) were randomly divided into two groups. One group consisted of 42 patients, including 18 males and 24 females, underwent unicompartmental knee arthroplasty with fixed platform prosthesis; the other group consisted of 44 patients, including 20 males and 24 females, underwent unicompartmental knee arthroplasty with mobile platform prosthesis. The surgery was performed by the same group of doctors. The operation time, blood loss, ROM, KSS and HSS scores of knee joint before and after surgery were recorded and the clinical follow up was completed.@*RESULTS@#The follow-up duration of the two groups ranged from 8 to 26 months, with an average of (18.20± 4.23) months. During the follow-up period, the periprosthetic fracture was found in 1 patient in the fixed platform group 1 year after operation, and polyethylene liner dislocation was found in 1 patient in the mobile platform group. No complications such as poor wound healing, periprosthetic infection or sterile prothesis loosening were found in all cases. In the fixed platform group, the operation time was (90.05±6.59) minutes and the blood loss was (53.76±6.04) ml. In the mobile platform group, the operation time was (90.73±6.74) minutes and the blood loss was (54.34±6.27) ml. In the fixed platform group, the ROM of knee increased from preoperative (94.52±4.54) degree to postoperative (104.64±4.42) degree. In the mobile platform group, the ROM of knee increased from preoperative (95.05±4.87) degree to postoperative (105.07±4.33) degree. In the fixed platform group, the KSS score increased from preoperative 48.69±5.68 to postoperative 83.55±5.37. In the mobile platform group, the KSS score increased from preoperative 49.39±5.68 to postoperative 84.11±6.14. In the fixed platform group, the HSS score increased from preoperative 45.45±3.62 to postoperative 84.55±6.08. In the mobile platform group, the HSS score increased from preoperative 45.93±4.01 to postoperative 85.16±6.30. There was no significant difference between the two groups.@*CONCLUSION@#There is no significant difference in the early outcome of unicondylar prosthesis with fixed and mobile platforms in the treatment of single compartmental osteoarthritis of knee. The long-term complications and revision rates of the two prostheses need further multi center and large-sample clinical study.

Arthroplasty, Replacement, Knee , Case-Control Studies , Female , Humans , Knee Joint , Knee Prosthesis , Male , Osteoarthritis, Knee , Range of Motion, Articular , Retrospective Studies , Treatment Outcome
Acta ortop. mex ; 33(5): 297-302, sep.-oct. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1284960


Resumen: Introducción: La estrategia quirúrgica al enfrentarnos a las infecciones periprotésicas de rodilla sigue siendo controvertida. Los objetivos del tratamiento son la erradicación de la infección, la mejoría del dolor y de la función articular. El manejo quirúrgico incluye el desbridamiento y retención del implante, el recambio protésico en un tiempo o el recambio en dos tiempos. Esta última estrategia quirúrgica se considera el «gold standard¼, alcanzando unas tasas de curación hasta de 80%-100%, aunque poco se ha publicado acerca de los resultados funcionales. Material y métodos: Estudio retrospectivo de 65 pacientes, con infección periprotésica de rodilla. En 20 pacientes se realizó un recambio en un tiempo y en 45 pacientes fueron recambios en dos tiempos. Evaluación pre- y postoperatoriamente con la escala modificada HSS. Todos los pacientes fueron tratados con antibioterapia intravenosa, evaluamos la respuesta analítica y clínica para confirmar la erradicación o no de la infección. Resultados: La infección se resolvió en 39 de 65 pacientes, 12 en el grupo de recambio en un tiempo y 27 para el grupo de dos tiempos. Sin diferencia significativa entre los grupos en relación con curación ni resultado funcional. Sin embargo, hay una diferencia estadísticamente significativa entre aquellos pacientes que recibieron tratamiento antibiótico vía oral antes del diagnóstico y aquéllos que no lo recibieron. Conclusión: La tasa de curación es similar en los tratados con recambio en un tiempo y recambio en dos tiempos. No pudimos demostrar superioridad en los resultados funcionales entre los dos grupos.

Abstract: Introduction: Surgical strategy in dealing with periprosthetic knee infections remains controversial. The goals of treatment are to eradicate infection, improve pain and joint function. Surgical management includes implant debridement and retention, prosthetic replacement in one-time, or two-stage replacement. This latest surgical strategy is considered the «gold standard¼, reaching healing rates up to 80%-100%, although little has been published about functional results. Material and methods: Retrospective study of 65 patients with periprosthetic knee infection. In 20 patients a replacement was made in a time and in 45 patients were in two stages. Pre- and post-operative evaluation with the modified HSS scale. All patients were treated with intravenous antibiotherapy, we evaluated the analytical and clinical response to confirm the eradication or not of the infection. Results: The infection was resolved in 39 out of 65 patients, 12 in the replacement group in a time and 27 for the two-stages group. No significant difference between the groups in relation to healing or functional result. However, there is a statistically significant difference between those patients who received oral antibiotic treatment prior to diagnosis and those who did not. Conclusions: The healing rate is similarly treated with replacement in a time and replacement in two times. We were unable to demonstrate superiority in the functional results between the two groups.

Humans , Prosthesis-Related Infections , Arthroplasty, Replacement, Knee , Knee Prosthesis , Reoperation , Retrospective Studies , Treatment Outcome , Debridement , Anti-Bacterial Agents
Rev. méd. panacea ; 8(1): 46-54, ene.-abr. 2019. ilus, tab, graf
Article in Spanish | LILACS, LIPECS | ID: biblio-1016575


Objetivo: realizar una revisión bibliográfica y actualización sobre infección de prótesis total de rodilla. Materiales y métodos: : Es un Estudio bibliométrico, descriptivo transversal realizado mediante búsquedas bibliográficas en pubmed, NCBI, UP TO DATE, y revistas virtuales de Ortopedia y Traumatología del Perú e internacionales. Se seleccionó y consultó el material bibliográfico que tuviera información sobre infección de prótesis total de rodilla. Se excluyó la bibliografía sin relación con el tema y muy antigua. No hubo límites en el idioma. Los artículos seleccionados se clasificaron por relevancia, actualidad y localización. Desarrollo y discusión: La infección de prótesis de rodilla tiene una incidencia entre el 1 a 3% en prótesis primaria y 3.5 a 5% en prótesis de revisión, siendo los principales factores de riesgo principales, artritis reumatoide, cirugía previa, edad avanzada, sexo femenino, obesidad, desnutrición, diabetes e inmunodeficiencias, el diagnóstico es un reto para el médico, los cocos Gram positivos son los gérmenes más frecuentes, llegando a ser el 75% del total, el objetivo principal del tratamiento es erradicar la infección, el tratamiento quirúrgico debe ser agresivo y oportuno, es necesario recibir largos periodos de antibióticos sistémicos a fin de evitar cirugías radicales como la artrodesis y amputación. Conclusiones: la infección de prótesis de rodilla es la complicación más temida, tiene un diagnostico difícil y cuyo manejo demanda largos periodos de incapacidad, estancia hospitalaria, antibióticos de amplio espectro y cuantiosas perdida económicas la entidad prestadora de servicios de salud. (AU)

Objective: to perform a literature review and update on total knee prosthesis infection. Materials and methods: This is a bibliometric, cross-sectional descriptive study conducted through bibliographic searches in pubmed, NCBI, UP TO DATE, and virtual journals of Orthopedics and Traumatology of Peru and international. The bibliographic material that had information on total knee prosthesis infection was selected and consulted. The bibliography unrelated to the subject and very old was excluded. There were no limits in the language. The selected articles were classified by relevance, actuality and location. Development and discussion: Infection of knee prosthesis has an incidence between 1 to 3% in primary prostheses and 3.5 to 5% in revision prostheses, being the main risk factors, rheumatoid arthritis, previous surgery, advanced age, sex female, obesity, malnutrition, diabetes and immunodeficiencies, the diagnosis is a challenge for the doctor, Gram positive cocci are the most frequent germs, reaching 75% of the total, the main objective of the treatment is to eradicate the infection, the treatment surgical should be aggressive and timely, it is necessary to receive long periods of systemic antibiotics in order to avoid radical surgeries such as arthrodesis and amputation. Conclusions: knee prosthesis infection is the most feared complication, it has a difficult diagnosis and its management demands long periods of disability, hospital stay, broad spectrum antibiotics and large economic losses the health service provider entity. (AU)

Humans , Female , Prosthesis-Related Infections , Knee Prosthesis , Epidemiology, Descriptive , Cross-Sectional Studies
Acta ortop. mex ; 33(2): 107-111, mar.-abr. 2019. graf
Article in Spanish | LILACS | ID: biblio-1248643


Resumen: Antecedentes: La articulación patelofemoral (PF) es un sistema biomecánico susceptible a desgaste acelerado, afecta a 25% de las mujeres. Actualmente, el tratamiento de la osteoartrosis patelofemoral (OAPF) ha resurgido gracias a la creación de sistemas anatómicos y biomecánicamente adecuados, con indicaciones precisas, estadios más tempranos y con mejor resultado funcional. Material y métodos: Se analizó una cohorte de 24 pacientes durante el período de 2010 a 2012, tratados con prótesis de resuperficialización patelofemoral (PPF) HemiCap Patelofemoral Resurf (Franklin MA, EUA), colocadas por dos cirujanos. Se evaluaron los pacientes prequirúrgicos y a los dos, cuatro, seis, 12, 18, 24 meses postquirúrgicos con la escala Knee Society Score (KSS). Resultados: Se incluyeron 24 pacientes con seguimiento de dos años en promedio. En 87.5% fueron mujeres, edad promedio de 62 años (45-80 años); una media de 29.5 de índice de masa corporal (IMC), la lateralidad derecha predominó en 54%. Se observó una mejoría en los resultados de la escala KSS: en el aspecto clínico hubo una mejoría de 35.2% y en la escala funcional de 41.62%. Sólo dos pacientes fueron reintervenidos por complicaciones de limitación funcional, uno de ellos tratado con manipulación bajo anestesia y el otro con liberación artroscópica de adherencias. Conclusión: La PPF es una opción como tratamiento de AOPF aislada, pues la tasa de supervivencia a dos años es buena, proporciona alivio del dolor y mejoría en funcionalidad de la rodilla; sin embargo, se requerirá mayor tiempo de seguimiento para evaluar el resultado final de este implante.

Abstract: Background: The patellofemoral articulation is a biomechanical system susceptible to accelerated wear, affecting 25% of women. Currently, the treatment of osteoarthrosis Patelofermoral has resurfaced thanks to the creation of anatomical and biomechanically appropriate systems, with precise indications, earlier stages and with a better functional result. Material and methods: A cohort of 24 patients was analyzed during the period from 2010 to 2012, treated with a resurfacing prostheses HemiCap Patello Femoral Resurf (Franklin MA, USA), placed by 2 surgeons. Patients were assessed preoperatively and 2, 4, 6, 12, 18, 24 months postoperative with the Knee Society Score. Results: Twenty-four patients with follow-up of 2 years on average were included. 87.5% were women, an average age of 62 years (45-80 years); an average of 29.5 of body mass index, the right laterality predominated in 54%. An improvement in KSS scale results was observed: in clinical appearance there was an improvement of 35.2% and the functional scale 41.62%. Only two patients were revised by complications of functional limitation, treated one with manipulation under anesthesia and the other with arthroscopic adhesion lysis. Conclusion: The patellofemoral prosthesis is an option as a treatment for isolated patellofemoral arthrosis, since the two-year survival rate is good, providing pain relief and improving knee functionality; However, more follow-up time will be required to evaluate the end result of this implant.

Humans , Male , Female , Adult , Arthroplasty, Replacement, Knee , Osteoarthritis, Knee/surgery , Knee Prosthesis , Follow-Up Studies , Treatment Outcome , Middle Aged
Article in English | WPRIM | ID: wpr-763610


BACKGROUND: Various pre- and perioperative risk factors have been reported in association with blood loss in knee arthroplasty. However, the effect of the uncovered cancellous surface on blood loss in simultaneous bilateral total knee arthroplasty (SBTKA) by different prosthetic designs is not well elucidated. Therefore, this study aimed to compare the blood loss and transfusion rate between different knee prostheses in SBTKA and to identify risk factors that influence blood loss and transfusion after SBTKA. METHODS: Demographic and perioperative data of patients who underwent SBTKA using either a closed-box or an open-box femoral component of posterior-stabilized fixed-bearing (PS FB) knee system were retrospectively reviewed. The calculated blood loss (CBL) and blood transfusion rate were compared by using Student t-test and confirmed with multivariate regression analysis. RESULTS: There was no significant difference in preoperative parameters between 54 closed-box and 56 open-box PS FB TKAs. The CBL of the closed-box TKA group was 135.23 mL less (95% confidence interval [CI], −215.30 to −55.16; p = 0.001) than that of the open-box TKA group. However, the blood transfusion rates of the closed- and open-box TKA groups were not significantly different (24.1% and 38.5%, p = 0.11). For each additional minute of total operative time, 3.75 mL (95% CI, 1.75 to 5.76; p < 0.001) of blood loss was anticipated. For each additional mg/dL of preoperative hemoglobin, 71% (p < 0.001) reduction of blood transfusion probability was predicted. CONCLUSIONS: The use of closed- and open-box knee prostheses resulted in a significant difference in blood loss in SBTKA. Prolonged operative time also significantly increased CBL. Therefore, strategies to control the bleeding surface and shorten operative duration may be considered if blood loss is of special concern. The preoperative hemoglobin was the only factor that affects the probability of blood transfusion in SBTKA.

Arthroplasty , Arthroplasty, Replacement, Knee , Blood Transfusion , Hemorrhage , Humans , Knee , Knee Prosthesis , Operative Time , Prostheses and Implants , Prosthesis Design , Retrospective Studies , Risk Factors
Article in Chinese | WPRIM | ID: wpr-773873


Recently, the joint replacement has gradually become a common operation of orthopedics. It's also the hot spot in current investigations. The increasing number of reports about the 3D printing technology such as patient-specific instrumentation(PSI) is applied to hip and knee replacement. It plays an important role in supporting operation especially for complex cases. However, it is still at the primary stage. This article reviews the relevant literature, analyzes and collates the research status of the application of 3D printing PSI in total knee arthroplasty, and summarizes its effectiveness in the application of knee arthroplasty from the aspects of individual preoperative planning, intraoperative operation and postoperative functional recovery, especially complex knee surgery such as obesity and knee deformity. The necessity of clinical application is discussed, and the existing problems and controversies in the current clinical application are summarized in order to provide references for the future research direction and clinical application.

Arthroplasty, Replacement, Knee , Humans , Knee Joint , Knee Prosthesis , Postoperative Period , Printing, Three-Dimensional
Article in Chinese | WPRIM | ID: wpr-781845


A software and hardware platform for gait simulation and system evaluation for lower limb intelligent prosthesis is proposed and designed, in order that the wearable symmetry effect of the intelligent knee prosthesis can be quantitatively analyzed by machine test instead of human wear test. The whole-body three-dimensional gait and motion analysis system instrument, a device to collect gait data such as joint angle and stride of adults, was used for extracting simulated gait characteristic curve. Then, the gait curve was fitted based on the corresponding joint to verify the feasibility of the test platform in the experiment. Finally, the developed artificial knee prosthesis was worn on the prosthetic evaluation system to quantitatively analyze the gait symmetry effect. The results showed that there was no significant difference in gait symmetry between the developed knee joints at different speeds, which could reach more than 88%. The simulation and evaluation of the prosthetic gait have good effects on the functional simulation and evaluation of the lower limb intelligent prosthesis.

Adult , Artificial Limbs , Biomechanical Phenomena , Gait , Humans , Knee Joint , Knee Prosthesis , Prosthesis Design