A multicenter randomized controlled trial of domestic robot-assisted and conventional total knee arthroplasty / 中国修复重建外科杂志

OBJECTIVE@#To investigate the accuracy, safety, and short-term effectiveness of a domestic robot-assisted system in total knee arthroplasty (TKA) by a multicenter randomized controlled trial.@*METHODS@#Between December 2021 and February 2023, 138 patients with knee osteoarthritis who received TKA in 5 clinical centers were prospectively collected, and 134 patients met the inclusion criteria were randomly assigned to either a trial group ( n=68) or a control group ( n=66). Seven patients had lost follow-up and missing data, so they were excluded and the remaining 127 patients were included for analysis, including 66 patients in the trial group and 61 patients in the control group. There was no significant difference ( P>0.05) in gender, age, body mass index, side, duration of osteoarthritis, Kellgren-Lawrence grading, preoperative Knee Society Score (KSS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between the two groups. The trial group completed the TKA by domestic robot-assisted osteotomy according to the preoperative CT-based surgical planning. The control group was performed by traditional osteotomy plate combined with soft tissue release. Total operation time, osteotomy time of femoral/tibial side, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. The radiographs were taken at 5 and 90 days after operation, and hip-knee-ankle angle (HKA), lateral distal angle of femur (LDFA), and posterior tibial slope (PTS) were measured. The difference between the measured values of the above indexes at two time points after operation and the preoperative planning target values was calculated, and the absolute value (absolute error) was taken for comparison between the two groups. The postoperative recovery of lower limb alignment was judged and the accuracy was calculated. KSS score and WOMAC score were used to evaluate the knee joint function of patients before operation and at 90 days after operation. The improvement rates of KSS score and WOMAC score were calculated. The function, stability, and convenience of the robot-assisted system were evaluated by the surgeons.@*RESULTS@#The total operation time and femoral osteotomy time of the trial group were significantly longer than those of the control group ( P<0.05). There was no significant difference in the tibial osteotomy time and the amount of intraoperative blood loss between the two groups ( P>0.05). The incisions of both groups healed by first intention after operation, and there was no infection around the prosthesis. Nine patients in the trial group and 8 in the control group developed lower extremity vascular thrombosis, all of which were calf intermuscular venous thrombosis, and there was no significant difference in the incidence of complications ( P>0.05). All patients were followed up 90 days. There was no significant difference in KSS score and WOMAC score between the two groups at 90 days after operation ( P>0.05). There was significant difference in the improvement rate of KSS score between the two groups ( P<0.05), while there was no significant difference in the improvement rate of WOMAC score between the two groups ( P>0.05). Radiological results showed that the absolute errors of HKA and LDFA in the trial group were significantly smaller than those in the control group at 5 and 90 days after operation ( P<0.05), and the recovery accuracy of lower limb alignment was significantly higher than that in control group ( P<0.05). The absolute error of PTS in the trial group was significantly smaller than that in the control group at 5 days after operation ( P<0.05), but there was no significant difference at 90 days between the two groups ( P>0.05). The functional satisfaction rate of the robot-assisted system was 98.5% (65/66), and the satisfaction rates of stability and convenience were 100% (66/66).@*CONCLUSION@#Domestic robot-assisted TKA is a safe and effective surgical treatment for knee osteoarthritis, which can achieve favorable lower limb alignment reconstruction, precise implant of prosthesis, and satisfactory functional recovery.

Application of 3D printing technology in the second staged revision of infection after hip replacement / 重庆医学

Objective To explore the application of 3D printing technology in the second staged revision of infection after hip replacement.Methods From July 2014 to July 2016,21 patients with postoperative infection after hip replacement needed for phase Ⅱ revision surgery were selected as the 3D printing group,while 21 patients who underwent hip replacement without 3D printing technique were selected as the control group.The acetabulum,femoral and other related data were obtained by CT scanning,using computer simulation and modeling in vitro,3D printing technology was used to print the model,showed the hip joint model and done the operation,after 2 to 3-year-follow-up,compared the effect and the Harris hip joint function score.Results Compared the operation time of the two groups,3D printing group average operation time was (86.4±31.5) min,while the control group was (131.7±29.6) min,the difference was statistically significant (P＜0.05);the Harris hip joint function score of 3D printing group was (41.4±7.8) point before operation,and after three years follow-up the score was (91.2 ± 6.9) point,the difference was statistically significant (P＜0.05).Conclusion 3D printing technology can be applied in the second stage revision surgery of infection after hip replacement,which has effective result.

Efficacy and safety of tranexamic acid on blood loss in patients with type 2 diabetes mellitus during total knee arthroplasty / 中国组织工程研究

BACKGROUND: Tranexamic acid has been used to reduce bleeding after total knee arthroplasty in patients for the reason of big trauma and blood loss. Diabetes mellitus patients may have the poor ability to resist infection and heal tissue and vascular lesions. There are still no relevant literature reports about whether the application of tranexamic acid will achieve hemostasis and does not increase the risk of venous thrombosis of lower limbs.OBJECTIVE: To evaluate the efficacy and safety of tranexamic acid on perioperative blood loss in osteoarthritis or rheumatoid arthritis patients complicated with type 2 diabetes mellitus during total knee arthroplasty.METHODS: One hundred patients with the diagnosis of osteoarthritis or rheumatoid arthritis patients complicated with type 2 diabetes mellitus were selected between January 2013 and January 2015. Among all the subjects, 46 patients who received the operation before January 2014 served as the control group and 54 patients who received the operation after January 2014 were selected as the treatment group. Patients in the treatment group received 15 mg/kg tranexamic acid dissolved in 250 mL normal saline by fast intravenous infusion before the end of the operation. The patients in the control group just received 250 mL normal saline. Perioperative bleeding, blood transfusion, hemoglobin, hematocrit and coagulation index level were compared between the two groups, and deep venous thrombosis of lower limbs was observed.RESULTS AND CONCLUSION: (1) The postoperative drainage, hidden blood loss, total blood loss, transfusion volume,and transfusion rate in the treatment group were lower than that in control group (P < 0.05). (2) The levels of hemoglobin and hematokrit in the two groups were not significantly different, but decreased at 3 hours, 1 and 3 days after the surgery,and increased at 5 days postoperatively, but still lower than preoperatively. The levels of hemoglobin and hematokrit in the treatment group were significantly higher than that in the control group at different time points postoperatively (P <0.05). (3) Prothrombin time, activated partial thromboplastin time, and fibrinogen were not significantly different preoperatively, during tourniquet removal, at 3 hours, 1 and 5 days postoperatively between the two groups. D-dimer levels were not significantly different preoperatively and during tourniquet removal in both groups, but increased at 3 hours, 1 and 5 days postoperatively; moreover, D-dimer levels were significantly lower in the treatment group than in the control group (P < 0.05). D-dimer levels were not significantly different between the two groups at 5 days after surgery. (4)Deep venous thrombosis of lower limbs was not visible in double lower limb venous ultrasonography in both groups at 5 days and 1 month postoperatively. (5) To decrease the blood loss, intravenous infusion of 15 mg/kg of tranexamic acid during total knee arthroplasty before tourniquet removel is effective and safe in osteoarthritis or rheumatoid arthritis patients complicated with type 2 diabetes mellitus.

A novel integrated patient specific instrumentation system and its application for total knee arthroplasty / 中华骨科杂志

Objective To study the accuracy of preoperative planning and postoperative satisfaction of prosthesis posi?tion by applying the personal surgical cutting guide (PSCG) to total knee arthroscopy (TKA) based on 3D printing technique. Meth?ods In this randomized study, 20 patients were selected from August 2014 to October 2015, who were randomly divided into two groups. In PSCG group, 4 males and 6 females were enrolled, with a mean age of 70.9±6.69 (from 59 to 78) years. In con?ventional instrumentation group, 2 males and 8 females were enrolled, with a mean age of 69.9 ± 6.35 (from 58 to 77) years. The conventional instrumentation group was treated with conventional TKA, while the PSCG group was treated with personal surgical cutting guides. Then the knee valgus angle of patients, the angle between prosthesis components on the coronal and the sagittal plane of two groups were evaluated. Subsequently the correlation of the actual osteotomy amount, the valgus angle, caster angle, external rotation angle between intra? and preoperative planning were compared in the PSCG group. Results Compared with the ideal value of each angle, the mean deviation of the hip?knee?ankle angle 0.77°±0.51°, frontal femoral compo?nent angle 0.37° ± 0.53° and frontal tibial component angle 0.11° ± 0.24° showed statistically significant difference between two groups (P0.05). The actual osteotomy amount, the valgus angle, caster angle, external rotation angle corre?lated well between intra?and preoperative planning (t=-2.547, 3.864, 0.537,-0.040,-1.290, P>0.05). Conclusion TKA assist?ed by PSCG can make lower extremity alignment and accuracy of prosthesis implantation more accurate compared with convention?al TKA, especially in hip?knee?ankle angle, frontal femoral component angle and frontal tibial component angle.

Total knee arthroplasty based on the assistance of three-dimensional-printing personalized surgical navigation template / 中国组织工程研究

BACKGROUND:With significantly individual differences in the anatomy of the knee joint, traditional total knee replacement is difficult to accurately predict the position of locating limb alignment, size of the prosthesis and osteotomy amount of patients during operation. OBJECTIVE:To investigate the clinical effect of total knee replacement based on the assistance of medical image reconstruction, computer-aided design technology and 3D-printing personalized surgical navigation template. METHODS:Medical image data of patients were col ected using CT or magnetic resonance scanning equipment. The three-dimensional reconstruction of the bone was conducted by two-dimensional medical image processing technology. The navigation template was designed by computer-aided design technology. The personalized surgical navigation templates were produced by 3D printing technology, and the clinical total knee replacement was conducted. The postoperative results were evaluated using imageology. RESULTS AND CONCLUSION:Arigin 3D Pro (Arigin Medical Co., Ltd.) can accurately reconstruct a three-dimensional model of the lower limb bones. The three-dimensional design software Arigin Surgical Templating by their independent research and development can precisely pinpoint related lower limb axis, including limb alignment, rotation axis of the femur and osteotomy reference point. The personalized navigation template we researched and produced for knee surgery fitted tightly with femoral condyle and tibial plateau bone anatomy during operation, without significant movement. The deviation of patients’ limb alignment was less than 3° after total knee replacement.

Clinical application of link anatomical distal femoral plate in management of distal femoral fractures / 中华创伤骨科杂志

Objective To investigate the clinical results of Link anatom ical distal femoral plate in treatment of distal femoral fractures. Methods 39 c ases of distal femoral fractures who were admitted after February 2001were treat ed with Link anatomical distal femoral plate. All the 39 cases were followed up for 7 to 26 months. Results All the fractures got united, without complications of no-union, screw loosening or plate breakage. The excellent rate of the knee function was 89.74%. Conclusion Link anatomical distal femoral plate, when used to treat distal femoral fractures, is simple to handle, gives reliable fixation , and facilitates rehabilitation of the knee.