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Rev. bras. ortop ; 57(3): 409-414, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1388007


Abstract Objective To develop an evidence-based protocol to guide magnetic resonance imaging (MRI) requests in elderly patients with suspected knee osteoarthrosis and to evaluate its effectiveness after implementation. Methods The institutional protocol was developed after reviewing the literature during the first semester of 2018. The control group was defined as patients cared for in the first semester of 2018, before the implementation/dissemination of the institutional protocol, and the study group was composed by patients cared for during the second semester of 2018 after the standardization of MRI requests for suspected knee osteoarthrosis. Results Our sample included 826 patients undergoing knee MRI, with a mean age of 69.3 years. Protocol implementation decreased MRI requests and increased radiograph requests (p < 0.001). After the implementation of the protocol, the MRI changed the diagnosis or treatment in only 11.2% of the cases. Conclusion Protocol implementation resulted in a 47.5% reduction in the number of requests for knee MRI, with most (89%) patients with alteration in diagnosis or treatment. Level of evidence: case-control study (IIIB).

Resumo Objetivo Desenvolver um protocolo, baseado em evidências, para guiar a solicitação de exames de ressonância magnética (RM) em pacientes idosos com suspeita de osteoartrose do joelho e avaliar a sua eficácia após implementação. Métodos O protocolo institucional foi desenvolvido após revisão da literatura durante o primeiro semestre do ano de 2018. Definiu-se como grupo de controle os pacientes do primeiro semestre de 2018, antes da aplicação/divulgação do protocolo institucional, e o grupo de estudo foi composto por pacientes atendidos no segundo semestre do mesmo ano após a padronização dos pedidos de RM para a suspeita de osteoartrose do joelho. Resultados Nossa amostra contou com 826 pacientes submetidos a RM do joelho, com média de idade de 69,3 anos. Após a implementação do protocolo, houve um decréscimo das solicitações de RM e um aumento no número de solicitações de radiografias (p < 0,001). Após a implementação do protocolo, a RM alterou o diagnóstico ou a conduta do médico em apenas 11,2% dos casos. Conclusão Após a introdução do protocolo, encontrou-se uma redução de 47,5% no número de pedidos de RM do joelho, sendo que a maioria (89%) dos pacientes não tiveram suas condutas ou diagnóstico alterados. Nível de evidência: estudo caso-controle (IIIB).

Humans , Aged , Aged, 80 and over , Magnetic Resonance Imaging , Clinical Protocols , Osteoarthritis, Knee
Arch. pediatr. Urug ; 93(1): e302, jun. 2022. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1383637


Se expone el caso de un recién nacido que desarrolló sepsis connatal precoz a Streptococcus agalactiae, con meningitis aguda supurada y osteoartritis de rodilla izquierda. Como factor de riesgo la madre no tenía realizado el exudado rectovaginal, pesquisa que detecta la colonización por estreptococo del grupo B (EGB). Se aisló el germen en hemocultivo y en líquido de punción articular. Recibió tratamiento antibiótico adecuado a la sensibilidad del microorganismo y según pauta de sepsis con meningitis, evolucionando favorablemente. En este trabajo se describe la epidemiología de la sepsis neonatal y los cambios ocurridos luego de la implementación de la profilaxis antibiótica en el preparto.

We hereby present the case of a newborn with early connatal sepsis due to Streptococcus agalactiae, with acute suppurative meningitis and left knee osteoarthritis. As a risk factor, the mother had not performed the rectus vaginal exudate screening that detects colonization by Group B Streptococcus (GBS). The germ was isolated in blood culture and in joint puncture fluid. The patient received germ-sensitive antibiotic treatment for meningitis sepsis and evolved favorably. This paper describes the epidemiology of neonatal sepsis and the changes that have occurred after the administration of the antibiotic prophylaxis during pregnancy.

Apresentamos o caso de um recém-nascido com sepse neonatal precoce por Streptococcus agalactiae, com meningite supurativa aguda e osteoartrite de joelho esquerdo. Como fator de risco, a mãe não realizou teste de exsudato vaginal do reto que detecta a colonização por estreptococos do grupo B (SGB). O germe foi isolado em hemocultura e líquido de punção articular. A paciente recebeu tratamento com antibióticos germinativos para padrão meningite sepse e evoluiu favoravelmente. Este artigo descreve a epidemiologia da sepse neonatal e as mudanças ocorridas após a administração da profilaxia antibiótica durante a gravidez.

Humans , Female , Infant, Newborn , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus agalactiae , Gentamicins/therapeutic use , Ampicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/etiology , Meningitis, Bacterial/drug therapy , Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/etiology , Osteoarthritis, Knee/drug therapy , Neonatal Sepsis/complications , Neonatal Sepsis/diagnosis , Neonatal Sepsis/drug therapy
Rev. méd. Chile ; 150(1): 33-45, ene. 2022. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1389615


BACKGROUND: Telehealth is a novel therapeutic alternative. Aim: To determine the effects of a remote therapeutic physical exercise program (TPEP), based on telehealth, on functional physical capacity in people with knee or hip osteoarthritis. PATIENTS AND METHODS: An eight-week TPEP was undertaken by 36 participants with a mean age of 68 years. The control group received printed exercise instructions, while the experimental group received the same instructions plus TPEP using tutorial videos and voice messaging via WhatsApp. Both groups were evaluated at baseline and the end of the intervention with the Lower Extremity Functional Scale (LEFS), Barthel index (BI), Short Physical Performance Battery (SPPB), senior fitness test and with the Visual Analog Scale for pain (VAS). RESULTS: The experimental group decreased the VAS score and improved tandem balance, three-meter walk, sit and stand 5 times, sit and stand in 30 seconds, push-ups in 30 seconds, two minutes' walk, join the right hand behind the back and SPPB general score. The control group increased the BI score and improved the three meters walking test, sitting, and standing 5 times, sit and stand 30 seconds chair test, 2 minutes walking test and the SPPB general score. No differences between groups were observed for the LEFS scale, BI, VAS and functional capacity. CONCLUSIONS: A TPEP based on telehealth has similar effectiveness than a TPEP based on traditional paper-based intervention to improve functional physical capacity in patients with OA. (Rev Med Chile 2022; 150: 33-45)

Humans , Aged , Telemedicine , Osteoarthritis, Knee/therapy , Exercise , Walking , Exercise Therapy
Rev. méd. Chile ; 150(1): 46-53, ene. 2022. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1389617


BACKGROUND: Osteoarthritis (OA) is a health problem affecting millions of individuals worldwide. Aim: To evaluate risk factors for hip and knee osteoarthritis (OA) in women aged 40 to 59 years. MATERIAL AND METHODS: Analysis of a prospective cohort of 1159 women attending preventive health care programs and followed during 28 years. They underwent a clinical and laboratory evaluation from 1990 to 1993. The diagnosis of OA was retrieved from registries of a special program for osteoarthritis in 2020. RESULTS: Twenty four percent of participants developed osteoarthritis during the follow-up. At the beginning of the study and compared with women without OA, they were older (median [interquartile range or IQR]: 49.6 [8.5] and 47.2 [8.2] years respectively), had a higher body mass index (26.3 [5.3] and 25.1 [5.3] respectively), and a higher frequency of jobs with low qualification (76 and 62% respectively). The presence of type 2 diabetes mellitus, chronic hypertension, a previous history of alcohol or cigarette consumption, postmenopausal status and lipid and glucose blood levels did not differ between women with or without OA. Cox regression showed a final model that incorporates body mass index (hazard ratio (HR): 1.04; 95% confidence intervals (CI): 1.01-1.07), age (HR: 1.05; 95% CI: 1.03-1.08) and having an unqualified job (HR: 1.88; 95% CI: 1.43-2.47) as risk factors for OA. CONCLUSIONS: Obesity and the type of job are the most relevant risk factors found for OD: both may be modified with proper care.

Humans , Female , Middle Aged , Osteoarthritis, Hip/diagnosis , Osteoarthritis, Hip/etiology , Osteoarthritis, Hip/epidemiology , Osteoarthritis, Knee/etiology , Osteoarthritis, Knee/epidemiology , Diabetes Mellitus, Type 2/complications , Prospective Studies , Risk Factors
Rev. bras. ortop ; 57(1): 89-95, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365746


Abstract Objective Our purpose was to facilitate the simulation of preoperative correction to enable shared doctor-patient decision-making in individuals undergoing high tibial osteotomy (HTO). Methods A total of 22 patients underwent high tibial osteotomy using internal or external fixation devices for medial compartment osteoarthritis of the knee. Preoperatively, assessment of deformity parameters and simulation of the corrective osteotomy was done in the presence of the patient, using Bone Ninja. Postoperatively, the patient's satisfaction level with the quality of explanation provided by the use of this software was assessed using the Patient Satisfaction Questionnaire-short (PSQ-18). A comparison of the correction obtained using paper cuttings and the simulation software was performed. Results All patients were satisfied with their role in the decision-making process. They showed a good understanding and comprehension of the proposed surgery. There was no statistically significant difference between simulated preoperative Medial Proximal Tibial Angle (MPTA) obtained by paper cuttings and software-assisted correction. The PSQ-18 mean score for communication was 4.24 (0.88), for technical quality it was 4.11 (0.59) and for general satisfaction it was 3.11 (0.68). Conclusion Bone Ninja is an effective, convenient, user-friendly and cost-effective deformity planning tool that supersedes the arduous traditional method of paper tracings and scissors.

Resumo Objetivo Nosso objetivo foi facilitar a simulação da correção no pré-operatório para permitir a tomada de decisão médico-paciente compartilhada em indivíduos submetidos a osteotomia tibial alta (OTA). Método22 pacientes foram submetidos a osteotomia tibial alta usando dispositivos de fixação internos ou externos para osteoartrite do compartimento medial do joelho. No pré-operatório, a avaliação dos parâmetros de deformidade e a simulação da osteotomia corretiva foram realizadas na presença do paciente, utilizando Bone Ninja. No pós-operatório, o nível de satisfação do paciente com a qualidade da explicação fornecida pelo uso deste software foi avaliado usando o Questionário de Satisfação do Paciente (Patient Satisfaction Questionnaire-short, PSQ-18, na sigla em inglês). Foi realizada uma comparação da correção obtida com recortes de papel e com o software de simulação. Resultados Todos os pacientes ficaram satisfeitos com seu papel no processo de tomada de decisão. Eles mostraram uma boa compreensão e entendimento da cirurgia proposta. Não houve diferença estatisticamente significativamente entre o ângulo tibial proximal medial (ATPM) pré-operatório simulado obtido por recortes de papel e correção assistida por software. O escore médio do PSQ-18 para comunicação foi de 4,24 (0,88), para a qualidade técnica foi de 4,11 (0,59) e para a satisfação geral foi de 3,11 (0,68). Conclusão Bone Ninja é uma ferramenta de planejamento de deformidade eficaz, conveniente, fácil de usar e econômica que substitui o método tradicional árduo de traçar no papel e com tesoura.

Humans , Male , Female , Osteotomy , Personal Satisfaction , Surveys and Questionnaires , Radiology Information Systems , Patient Satisfaction , Osteoarthritis, Knee
Artrosc. (B. Aires) ; 29(1): 14-21, 2022.
Article in Spanish | LILACS, BINACIS | ID: biblio-1369635


Objetivos: La osteoartrosis (OA) es una artropatía incurable mono o poliarticular. En la rodilla es la enfermedad degenerativa más común, con gran incidencia de los factores mecánicos. El arsenal terapéutico para el manejo de la OA de rodilla (OAR) comprende medidas no farmacológicas, farmacológicas, medicación de técnicas intraarticulares y cirugía. Los objetivos de este trabajo fueron evaluar la eficacia en términos de dolor, función articular y calidad de vida de los pacientes infiltrados con ácido hialurónico (AH) de alto peso molecular (PM), doblemente reticulado (Cientific Synovial®, en adelante: CS) así como la seguridad de su uso. Adicionalmente se intentó objetivar el tiempo libre de prótesis en pacientes con esta indicación. Materiales y métodos: Se efectuó un diseño pre y post (un solo grupo) para pacientes con gonartrosis. Se analizó una muestra de cuarenta y seis pacientes (n = 46) a quienes se dividió en dos grupos según clasificación de Kellgren-Lawrence (KL). Un grupo KL 1­2 fue infiltrado con AH 40 mg (CS40), y otro grupo KL 3­4 fue infiltrado con AH 60 mg (CS60). A todos los pacientes se les suministró el cuestionario KOOS-12 (Knee injury and Osteoarthritis Outcome Score) pre y postinfiltración y se efectuó estadística descriptiva e inferencial apropiada. Conclusiones: el AH de alto PM y doblemente reticulado (Cientific Synovial®) mejoró estadística y clínicamente todos los parámetros de eficacia analizados por medio del cuestionario KOOS-12. El preparado se mostró seguro y sin aparición de efectos adversos de relevancia. Tanto en los pacientes con indicación previa de reemplazo total de rodilla (RTR) rechazada (n = 12) como en el resto de los pacientes de la muestra se verificó la supervivencia libre de prótesis hasta el final del estudio

Objectives: Osteoarthrosis (OA) is an incurable mono or polyarticular arthropathy and in the knee it is the most common degenerative disease with a high incidence of mechanical factors. The therapeutic arsenal for the management of knee OA (OAR) includes non-pharmacological and pharmacological measures, medication and intra-articular techniques, and surgery. The objectives of this study were to evaluate the efficacy in terms of pain, joint function and quality of life of patients infiltrated with double cross-linked high molecular weight (MW) hyaluronic acid (HA) (Cientific Synovial®, ­CS­) as well as the safety of its use. Additionally, we tried to objectify the prosthesis-free time in patients with this indication. Materials and methods: a pre - post design (single group) was carried out for patients with knee osteoarthritis. A sample of fortysix patients (n = 46) was analyzed who were divided into two groups according to the Kellgren-Lawrence (KL) classification. A group KL 1­2 was infiltrated with HA 40 mg (CS40) and another group KL 3­4 was infiltrated with HA 60 mg (CS60). All patients filled out the KOOS-12 questionnaire (Knee injury and Osteoarthritis Outcome Score) pre and post infiltration and appropriate descriptive and inferential statistics were performed. Conclusions: The double-crosslinked, high-MW HA (Cientific Synovial®) improved statistically and clinically all the efficacy parameters analyzed using the KOOS-12 questionnaire. The preparation was shown to be safe and without the appearance of significant adverse effects. Both in the patients with a previous indication for total knee replacement (TKR) rejected (n = 12), as in the rest of the patients in the sample, prosthesis-free survival was verified until the end of the study

Treatment Outcome , Osteoarthritis, Knee/therapy , Viscosupplementation , Hyaluronic Acid/therapeutic use
Rev. Asoc. Med. Bahía Blanca ; 32(1): 20-26, 2022.
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1398509


Introducción: El siguiente trabajo presenta una serie de casos con gonartrosis de rodilla tratados con radiofrecuencia entre Agosto del año 2018 y Mayo del año 2020 en el Hospital Naval Puerto Belgrano. Materiales y métodos: Se ha realizado radiofrecuencia a 15 pacientes. La edad media fue de 76 años (67-92), la rodilla mas afectada fue la derecha con 66,66 %, en todos los casos se trato de gonartrosis Ahlback III/IV. Resultados: El 83 % (10 casos) de los pacientes tuvo una mejoría considerable del dolor y manifestó estar satisfecho con el procedimiento y solo 1 caso no tuvo mejoría con el tratamiento. Se observo una disminución significativa en la toma de analgésico, tanto en la dosis como en la frecuencia en todos los casos. Conclusiones: Del trabajo se desprende que, la radiofrecuencia, reduce de manera significativa la intensidad del dolor, siendo un procedimiento mínimamente invasivo y con mínimas complicaciones descriptas. Haciendo de este procedimiento, el ideal para pacientes con dolor crónico refractario de rodilla.

Osteoarthritis, Knee , Radio Waves
Article in Spanish | LILACS, BINACIS | ID: biblio-1411619


Objetivo: Evaluar los resultados clínicos y radiográficos en pacientes sometidos a artroplastia unicompartimental de rodilla, así como la tasa de complicaciones y la supervivencia del implante. Materiales y Métodos: Estudio descriptivo retrospectivo de 68 pacientes consecutivos (70 rodillas) sometidos a artroplastia unicompartimental de rodilla entre 2013 y 2020, con un seguimiento medio de 57.7 meses (rango 24-105) y una media de la edad de 61 años (rango 34-79). El 46,5% eran hombres. El índice de masa corporal medio era de 29,9 (rango 20-39). El diagnóstico más frecuente fue la artrosis del compartimento femorotibial medial con un varo <7°. Los resultados se evaluaron con la escala analógica visual para dolor y el Knee Society Score (KSS). Se evaluó la incidencia de complicaciones y la tasa de supervivencia del implante. Resultados: La disminución media en la escala analógica visual para dolor fue de 4,4 ± 1,9. Las puntuaciones medias posoperatorias en las escalas funcional y clínica del KSS fueron de 77,4 ± 13,7 y 70,2 ± 17,7, respectivamente. La tasa de complicaciones posquirúrgicas fue del 7% (5 casos). La tasa de reintervención quirúrgica fue del 15,5% (11 pacientes): nueve casos por persistencia del dolor, uno por rigidez articular y otro por aflojamiento aséptico. Conclusiones: La artroplastia unicompartimental de rodilla es una opción terapéutica eficaz para pacientes con gonartrosis unicompartimental de rodilla; se logran buenos resultados clínicos con una aceptable tasa de complicaciones; sin embargo, la tasa de revisión del implante es considerable. Nivel de Evidencia: IV

Objective: To assess the clinical and radiological outcomes of patients who underwent a unicompartmental knee arthroplasty (UKA), as well as the complication rate and implant survival. Materials and Methods: We present a retrospective descriptive study of 68 consecutive patients (70 knees) who underwent UKA between 2013 and 2020, with an average follow-up of 57.7 mon-ths (range 24-105) and an average age of 61 years (range 34-79). 46.5% of the patients were male. The average BMI was 29.9 (range 20-39). The most frequent etiology was osteoarthritis of the medial femorotibial compartment with a varus <7°. To assess the outcomes, the visual analog scale (VAS) for pain and the Knee Society Score (KSS) were used. The complication and implant survival rates were evaluated. Results: The average decrease in the VAS pain scale was 4.4±1.9. The average score on the postoperative KSS functional and clinical scales were 77.4±13.7 and 70.2±17.7, respectively. The postoperative complication rate was 7% (5 cases). The surgical reoperation rate was 15.5% (11 patients): nine cases for persistent pain, one case for joint stiffness, and one case for aseptic loosening. Conclusions: UKA is an effective therapeutic option for patients with unicompartmental knee osteoarthritis, providing good clinical results with an acceptable rate of complications; however, it provides a considerable implant revision rate. Level of Evidence: IV

Adult , Middle Aged , Aged , Retrospective Studies , Treatment Outcome , Arthroplasty, Replacement, Knee , Osteoarthritis, Knee
Article in Chinese | WPRIM | ID: wpr-928309


OBJECTIVE@#To observe the effect of acupotomy on the morphology and ultrastructure of rectus femoris muscle in rabbits with knee osteoarthritis and to reveal the possible therapeutic mechanism involved in the effect of acupotomology on the treatment of knee osteoarthritis(KOA).@*METHODS@#Twenty-four male New Zealand rabbits aged 6 months and weighed (2.0±0.5) kg were randomly divided into blank group, model group and acupotomy group, 8 rabbits in each group. KOA model was established by modified Videman method with left hind limb extended plaster immobility for 6 weeks. In acupotomy group, the transfascial focal points of quadriceps femoris muscle were released by acupotomy under the guidance of Jingjin theory for 4 times and once a week, and the treatment points include Hedingci, Binwaixia, Binneixia. Blank group and model group were fed normally without intervention. One week after the end of the intervention, the pennation angle(PA), muscle thickness(MT), cross-sectional area(CSA) and strain ratio(SR) of rectus femoris were measured by ultrasound. HE staining was used to observe the changes of the tissue morphology, the number of muscle fibers and the average area of muscle fibers. The myofibril of rectus femoris, sarcomere and myofilament were observed by transmission electron microscope.@*RESULTS@#The PA of rectus femoris muscle in the blank group was (9.05±0.21)°. The MT was(1.09±0.09) cm and the CSA was(1.30±0.01) cm2. The PA of rectus femoris muscle in the model group was (3.06±0.15)°. The MT was (0.71±0.02) cm and the CSA was(0.77±0.02) cm2. The PA of rectus femoris muscle in the acupotomy group was (6.94±0.28)°. The MT was (0.80±0.05) cm and the CSA was(0.94±0.03) cm2. The muscle PA, MT and CSA of rectus femoris in the model group were significantly smaller than those in the blank group (P<0.05). Those in acupotomy group were significantly increased compared with those in model group (P<0.05). The SR of rectus femoris muscle was 1.19±0.02 in the blank group, 3.50±0.05 in the model group and 1.99±0.07 in the acupotomy group. The elastic SR of the model group was significantly higher than that of the blank group (P<0.05). These in acupotomy group was significantly lower than that in model group(P<0.05). The results of HE staining showed:in blank group, the fascicles of rectus femoris were arranged neatly, the number of beam of muscle fibers within the fixed visual field was 94.38±3.50 and the average CSA was(0.75±0.22) mm2. In model group, the fascicles of rectus femoris with different sizes were disorganized with a small amount of inflammatory cell infiltration, the number of beam of muscle fibers within the fixed visual field was 196.63±2.62 and the average CSA was(0.26±0.03) mm2. Compared to the blank group, a significant increase in the number of muscle fibers in the fixed field in the model group (P<0.05) and the average CSA decreased significantly(P<0.05). In acupotomy group, the rectus femoris fascicles in the acupotomy group tended to be arranged in a more orderly manner, with the inflammatory cells decreased, the number of beam of muscle fibers within the fixed visual field was 132.88±4.61 and the average CSA was(0.70±0.07) mm2. Compared to the model group, a significant decrease in the number of muscle fibers in the fixed field in the model group(P<0.05) and the average CSA increased significantly(P<0.05). The results of transmission electron microscope showed:compared with the blank group, the overall arrangement of the myofibrils of the rectus femoris in the model group was less structured. There was fracture between the muscle fibers and the sarcomere, the myofilaments were disordered, and the fracture of the Z line was discontinuous. Compared with the model group, the myofibrillar texture of rectus femoris in acupotomy group was clearer, and the Z line was more continuous.@*CONCLUSION@#Based on the jingjin theory, the release of quadriceps femoris by acupotomy can effectively improve the morphology and structure of rectus femoris, and promote the repair and reconstruction of chronic skeletal muscle injury in rabbits with KOA, which may be one of the mechanisms of acupotomy in the treatment of KOA.

Acupuncture Therapy , Animals , Humans , Male , Muscle, Skeletal , Osteoarthritis, Knee/therapy , Quadriceps Muscle , Rabbits , Ultrasonography
Article in Chinese | WPRIM | ID: wpr-928302


OBJECTIVE@#Based on the anatomical differences between discoid lateral meniscus(DLM) and normal lateral meniscus (NLM), this study aims to setting up the ultrasound examination parameters to distinguish DLM and NLM and explore the diagnostic value of these parameters on DLM.@*METHODS@#According to the inclusion, exclusion and matching criteria, 66 DLM patients(DLM group) and 132 NLM patients with other knee joint diseases(NLM group), hospitalized from October 2019 to June 2020, were included in this study. There were 18 males and 48 females in the DLM group, ranging in age from 3 to 60 years old, with a mean of (36.9±12.1) years old;36 males and 96 females in the NLM group, ranging in age from 3 to 60 years old, with a mean of (40.0±12.2) years old. Philips high frequency(3.0 to 12.0 MHz) linear array ultrasound probe was used to examine the lateral meniscus of all patients in two groups. Nine parameters including the thickness, width and the included angle of the anterior angle, body and posterior angle respectively in the lateral meniscus were measured. The included angke is formed by the chords of the upper and lower curved surfaces of the meniscus at the free edge. The independent t test was used to analyze the difference of the measured parameters between the DLM group and the NLM group. The receiver operating characteristic(ROC) curve was used to evaluate the cut-off value of each parameter for diagnosing DLM and the corresponding sensitivity, specificity, positive predictive value, negative predictive value, and area under the ROC curve(AUC).@*RESULTS@#The above 9 ultrasound measurement parameters between the DLM group and the NLM group had significant statistical differences(P<0.001). The ROC curve analysis method evaluated the cut-off value and diagnostic capabilities of these nine ultrasound parameters for DLM. The results showed that the cut-off value of the included angle of anterior part, body and posterior part were 25.85°, 24.85° and 29.15 °, respectively;and the sensitivity, specificity, negative predictive value, positive predictive value and AUC were significantly higher than other parameters, which were 88%, 91%, 79%, 95%, 0.94;89%, 94%, 82%, 97%, 0.96; 92%, 97%, 86%, 98%, 0.97, respectively.@*CONCLUSION@#Ultrasound diagnosis of DLM is feasible and reliable. The diagnostic ability of the included angle of the anterior part, body and posterior part in the lateral meniscus measured by ultrasound to diagnose DLM are significantly better than other ultrasound measurement parameters, and the sensitivity and specificity of those parameters are close to MRI. Therefore, ultrasound can be used as a reliable method for preliminary diagnosis of DLM.

Adolescent , Adult , Child , Child, Preschool , Female , Humans , Knee Joint/diagnostic imaging , Magnetic Resonance Imaging/methods , Male , Menisci, Tibial/diagnostic imaging , Middle Aged , Osteoarthritis, Knee , Ultrasonography , Young Adult
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
Article in Chinese | WPRIM | ID: wpr-928261


OBJECTIVE@#To explore clinical effect of arthroscopic debridement combined with platelet-rich plasma (PRP) injection for Kellgren-Lawrence(K-L) gradeⅠ-Ⅲ knee osteoarthritis (KOA) .@*METHODS@#Totally 117 patients with KOA who underwent arthroscopic debridement combined with injection from November 2015 to January 2019 were retrospectively analyzed. According to different injection drugs, the patients were divided into sodium hyaluronate group(group A) and PRP group(group B). In group A, there were 60 patients, including 27 males and 33 females, aged from 49 to 67 years old with an average age of (54.1±4.8) years old;12 patients with gradeⅠ, 23 patients with gradeⅡand 25 patients with grade Ⅲ according to K-L clssification, 2 ml(20 g) sodium hyaluronate was injected into knee joint after intraoperative, 1, 2, 3 weeks after operation for 4 times. In group B, there were 57 patients, including 25 males and 32 females, aged from 47 to 70 years old with an average of (55.8±5.0) years old, 10 patients with gradeⅠ, 20 patients with gradeⅡand 27 patients with grade Ⅲ according to K-L classification, injected 5 ml PRP at the same time. Postoperative complications was recorded between two groups. Postoperative visual analogue scale(VAS) and Lysholm score at 3, 6, 12 months were used to evaluate improvement of knee pain and joint function.@*RESULTS@#All patients were followed up for 12 to 19 months with an average of (14.1±1.6) months. There was no significant difference in postopertaive complications between group A and group B (P>0.05). Postoperative VAS score in group A at 3, 6, 12 months were 3.0±0.8, 2.0±0.8, 2.6±0.9 respectively, and 2.9±0.8, 1.9±0.7, 2.2±0.8 in group B respectively; and no differnece at 3 and 6 months after operation between two groups (P<0.05), while VAS score in group B was higher than group A at 12 months after operation(P<0.05). Postoperative Lysholm score in group A at 1, 6, 12 months (86.6±1.8, 93.1±2.0, 86.7±1.7) were lower than group B(88.9±1.9, 95.0±2.0, 89.0±1.9)(P<0.05).@*CONCLUSION@#Arthroscopic debridement combined with sodium hyaluronate or PRP injection for K-L gradeⅠ-Ⅲ KOA could effectively relieve pain and improve joint function with higher safety in short term, but the medium-long-term effect of PRP injection is stable.

Aged , Debridement , Female , Humans , Injections, Intra-Articular , Male , Middle Aged , Osteoarthritis, Knee/surgery , Platelet-Rich Plasma , Retrospective Studies , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-927895


Objective: To investigate the repair effect and JNK/NF-κB,SOX9 mechanisms of vibration exercise with different frequencies on articular cartilage in rats with early knee osteoarthritis. Methods: Forty-eight adult male SD rats were randomly divided into six groups(n=8):model control group(MC),high frequency vibration group 1 (GP1,60 Hz),high frequency vibration 2 group (GP2,40 Hz),medium frequency vibration group (ZP,20 Hz),minor frequency group(DP,10 Hz)and normal control group(NC). Except for NC group,the rats in each group were made into early knee osteoarthritis model after six weeks of knee joint cavity injection of papain solution and 2% mixture l-cysteine on the 1st,4 th and 7th day. Each exercise group was subjected vibration to 40 minutes a day with amplitude of 2~5 mm and 5 days a week. Four weeks later, the articular cartilage of the lateral femoral condyle of the both back leg knee joints were detected by HE staining,serine O staining and Mankin scores for morphological observation. The expression levels of JNK,NF-κB p65 and Sox9 mRNA in articular cartilage of the medial femoral condyle were detected by RT-qPCR,and the protein expressions of JNK,NF-κB p65 and Sox9 were detected by Western blot. Results: Compared with the NC group,the Mankin score in other groups was significantly higher (P<0.01). Compared with the MC group,the Mankin score of each vibration group was significantly lower(P<0.05),the mRNA and protein expressions of JNK and NF-κB p65 in each vibration training group were significantly lower (P<0.01),the expressions of Sox9 mRNA and protein in vibration training group were increased significantly (P<0.01). Compared with the higher frequency group,the Mankin score,the mRNA and protein expressions of JNK and NF-κB p65 of lower frequency group were significantly lower (P<0.05 or P<0.01). But the expressions of Sox9 mRNA and protein were significantly higher (P< 0.05 or P<0.01). Conclusion: Vibration exercise of different frequencies may present varying degrees of cartilage repair impact in rats with early knee osteoarthritis,and the cartilage repair by low-frequency vibration training is better than that by high-frequency vibration. This can be one of the mechanisms on controlling collagen synthesis by down-regulating JNK/NF-κB expression and increasing SOX9 activity of OA articular cartilage.

Animals , Cartilage, Articular/metabolism , MAP Kinase Kinase 4 , Male , NF-kappa B/metabolism , Osteoarthritis, Knee/therapy , RNA, Messenger/metabolism , Rats , Rats, Sprague-Dawley , SOX9 Transcription Factor , Vibration
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
Article in Chinese | WPRIM | ID: wpr-927335


OBJECTIVE@#To observe the effect of needle knife on chondrocyte autophagy and expressions of autophagy-related protein and mammalian target of rapamycin (mTOR) in rats with knee osteoarthritis (KOA), and to explore the possible mechanism of needle knife for KOA.@*METHODS@#A total of 42 SD rats were randomly divided into a normal group, a model group and a needle knife group, 14 rats in each group. Except for the normal group, the other two groups were injected with the mixture of papain and L-cysteine into the left hind knee joint to establish the KOA model. After modeling, the rats in the needle knife group were treated with needle knife at strip or nodule around the quadriceps femoris and medial and lateral collateral ligament on the affected side, once a week for 3 times (3 weeks). The changes of left knee circumference in each group were observed; the chondrocytes and ultrastructure of left knee joint were observed by HE staining and electron microscope; the mRNA and protein expressions of autophagy-related genes (Atg5, Atg12, Atg4a), Unc-51 like autophagy activated kinase 1 (ULK1), autophagy gene Beclin-1 and mTOR in left knee cartilage were detected by real-time fluorescence quantitative PCR and Western blot.@*RESULTS@#After modeling, the left knee circumferences in the model group and the needle knife group were increased compared with those before modeling and in the normal group (P<0.05); after intervention, the left knee circumference in the needle knife group was smaller than that in the model group and after modeling (P<0.05). Compared with the normal group, the number of chondrocytes was decreased, and a few cells swelled, nuclei shrank, mitochondria swelled and autophagosomes decreased in the model group; compared with the model group, the number of chondrocytes was increased , and most cell structures returned to normal, and autophagosomes was increased. Compared with the normal group, the mRNA and protein expressions of Atg5, Atg12, Atg4a, Beclin-1 and ULK1 in the knee cartilage in the model group were decreased (P<0.05); compared with the model group, the expressions of the above indexes in the needle knife group were increased (P<0.05). Compared with the normal group, the mRNA and protein expressions of mTOR in the knee cartilage in the model group were increased (P<0.05); compared with the model group, the expressions of the above indexes in the needle knife group were decreased (P<0.05).@*CONCLUSION@#The needle knife intervention could improve knee cartilage injury in rats with KOA, and its mechanism may be related to reducing the expression of mTOR and up-regulating the expressions of Atg5, Atg12, Atg4a, ULK1 and Beclin-1, so as to promote chondrocyte autophagy and delay the aging and degeneration of chondrocytes.

Animals , Autophagy , Autophagy-Related Protein-1 Homolog/genetics , Beclin-1/genetics , Chondrocytes , Osteoarthritis, Knee/therapy , Rats , Rats, Sprague-Dawley , TOR Serine-Threonine Kinases/genetics
Article in Chinese | WPRIM | ID: wpr-927334


OBJECTIVE@#To explore the characteristics and rules of acupoint sensitization phenomena based on knee osteoarthritis (KOA), one of the clinical dominant diseases of acupuncture-moxibustion.@*METHODS@#In combination with literature and expert experiences, the acupoints with the highest use frequency in treatment of KOA were screened, e.g. Heding (EX-LE 2), Liangqiu (ST 34), Mingmen (GV 4), Neixiyan (EX-LE 4), Ququan (LR 8) and Dubi (ST 35). In 814 patients with KOA and 217 healthy subjects, the acupoint temperature, mechanic pain threshold and pressure pain threshold were detected separately. Using machine learning method, the sensitization was judged at each acupoint.@*RESULTS@#Compared with healthy subjects, the acupoint temperature was increased and the mechanic pain threshold and pressure pain threshold were reduced in KOA patients (P<0.05). Besides, the cut-off value was presented to distinguish whether the acupoint was sensitized or not. The results of machine learning showed that the highest prediction accuracy of acupoint sensitization was 86.7% (Shenshu [BL 23]) and the lowest one was 73.9% (Heding [EX LE 2]). The prediction accuracy at the third clinical stage trial was higher, the highest was 93.3% (Ququan [LR 8]) in KOA patients.@*CONCLUSION@#It is confirmed that the acupoint sensitization reflects the characteristics of disease and is correlative with the conditions of illness, which may provide the reference for the auxiliary diagnosis and condition assessment of KOA.

Acupuncture Points , Acupuncture Therapy , Humans , Moxibustion , Osteoarthritis, Knee/therapy , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-939525


OBJECTIVE@#To compare the clinical efficacy and its effect on serum levels of tumor necrosis factor α(TNF-α), interleukin 1β(IL-1β), interleukin 6 (IL-6) and prostaglandin E2 (PGE2) between short needling (close-to-bone needling) and conventional acupuncture for knee osteoarthritis (KOA) with blood stasis obstruction.@*METHODS@#A total of 68 KOA patients with blood stasis obstruction were randomized into a short needling group (34 cases, 3 cases dropped off) and a conventional acupuncture group (34 cases, 3 cases dropped off). The same acupoints (Dubi [ST 35], Neixiyan [EX-LE 4], Binzhong [Extra], Liangqiu [ST 34], etc. on the affected side) were selected in the two groups. In the short needling group, short needling technique was adopted, the needles were slowly inserted and the needle bodies were shaken, thus gradually penetrated to the bone. In the conventional acupuncture group, conventional acupuncture was adopted, the needles were penetrated to the muscle. After qi-arrival, Dubi (ST 35) and Neixiyan (EX-LE 4), Zusanli (ST 36) and Liangqiu (ST 34) were connected with CMNS6-1 electronic acupuncture instrument, with disperse-dense wave, 2 Hz/10 Hz in frequency, the current intensity was based on patients' feeling, the needles were retained for 30 min, at the same time, the knee joint was irradiated for 30 min with a special electromagnetic wave apparatus in the two groups. Once every other day, 3 times a week for 4 weeks. Before and after treatment, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score, knee joint pain visual analogue scale (VAS) score, inflammatory response related indexes (serum TNF-a, IL-1β, IL-6 and PGE2) and knee joint ultrasound were observed,and the clinical effect was evaluated in the two groups.@*RESULTS@#After treatment,the pain, stiffness, function scores and total scores of WOMAC were decreased as compared with those before treatment in the two groups (P<0.05), except for the pain score, the changes of above scores in the short needling group were greater than the conventional acupuncture group (P<0.05). After treatment, the VAS scores, serum levels of TNF-a, IL-1β, IL-6, PGE2 and knee joint synovium thickness, intra-articular effusion were decreased as compared with those before treatment in the two groups (P<0.05), the levels of TNF-a, IL-1β, IL-6 in the short needling group were lower than the conventional acupuncture group (P<0.05). The total effective rate in the short needling group was 87.1% (27/31), which was superior to 83.9% (26/31) in the conventional acupuncture group (P<0.05).@*CONCLUSION@#Short needling could improve the knee joint function, relieve the pain and inflammatory response, improve the knee joint synovium inflammatory response, reduce the knee joint intra-articular effusion for KOA patients, its effect is better than conventional acupuncture.

Acupuncture Points , Humans , Inflammation , Interleukin-6 , Osteoarthritis, Knee/therapy , Pain , Prostaglandins E
Article in Chinese | WPRIM | ID: wpr-936130


OBJECTIVE@#To investigate the expectations of patients for total knee arthroplasty (TKA), and to analyze its influencing factors.@*METHODS@#Experimental design: Single center, retrospective, multiple regression analysis. The data including the age, height, and weight of 108 patients undergoing unilateral TKA due to end-stage osteoarthritis were obtained. The patients' preoperative Hospital for Special Surgery (HSS) knee arthroplasty expectation score, the Western Ontario and McMaster Universities (WOMAC) score, Knee Society score (KSS), the MOS 36-item short-from health survey (SF-36) score, and visual analogue scale (VAS) were evaluated, and the 30-second chair-stand test (30-CST), 40-meter fast-paced walk test (40-FPWT), 12-level stair-climb test (12-SCT), 3-meter timed up-and-go test (TUG), 6-minute walk test (6-MWT), and recorded daily steps for 7 consecutive days were performed. The SPSS 22.0 software was used for statistical analysis. The observed values of various data were described. Pearson correlation analysis was used to evaluate the correlation between various parameters, and the multi-factor linear regression analysis was used to investigate the influencing factors of the patients preoperative expectation scores.@*RESULTS@#The average expectation score of this group of patients was 58.98±5.44. In the Pearson correlation analysis, the patient's preoperative expectation had a weak correlation to the result of the patient's 12-SCT, TUG, 6-MWT, KSS function score, and SF-36 mental component score (correlation coefficient 0.1-0.3). The patient's preoperative expectation had a moderate correlation to the patient's daily average steps, 30-CST, 40-FPWT, KSS, WOMAC and its pain, stiffness, function scores, SF-36 physical functioning, role-physical, bodily pain, vitality, and physical component score (correlation coefficient 0.3-0.6). In the multivariate linear regression analysis, only the results of 30-CST and the role-physical, bodily pain and vitality in the SF-36 scale were related to the patient's expectation score (P < 0.05).@*CONCLUSION@#The estimated expectation score of patients before TKA is not high. Patients with more severe preoperative pain, worse physical function, and lower overall health are more eager to improve after surgery. Thus surgeons must communicate fully with patients with unrealistic expectations before surgery in order to obtain more satisfactory results postoperatively.

Arthroplasty, Replacement, Knee , Humans , Knee Joint/surgery , Motivation , Osteoarthritis, Knee/surgery , Retrospective Studies , Treatment Outcome