RESUMEN
Objective:To assess the early clinical outcomes of Oxford cementless unicompartmental knee arthroplasty (UKA) in the management of anteromedial osteoarthritis of the anterior medial knee (AMOA).Methods:A retrospective review was conducted on a cohort of 90 patients who underwent primary UKA for AMOA at the Fuzhou Second Hospital between January 2020 and June 2021. The patients were divided into two groups based on the type of prosthesis used: the cementless UKA group and the cemented UKA group. The cementless UKA group included 45 patients (22 males and 23 females), with a mean age of 65.6±7.0 years (ranging from 52 to 81 years). The cemented UKA group consisted of 45 patients, including 21 males and 24 females, with a mean age of 67.9±6.1 years (ranging from 55 to 79 years). The study compared various parameters between the two groups, including the duration of surgery, amount of blood loss, length of hospitalization, pain visual analogue scale (VAS) scores, Hospital for Special Surgery (HSS) scores, and forgotten joint score (FJS). Additionally, radiolucency around the prosthesis, medial proximal tibial angle (MPTA), and mechanical axis deviation (MAD) were observed and measured before and after surgery to assess prosthesis stability, improvement of knee deformity, and knee joint mobility, respectively.Results:Both groups were followed up for a minimum of 18 months. No statistically significant differences were found in demographic data such as gender, age, and body mass index between the two groups. The cementless UKA group demonstrated superior results in terms of shorter duration of surgery (97.8±21.1 min) and less blood loss (70.8±37.6 ml) compared to the cemented UKA group ( P<0.05). However, no significant difference in length of stay was observed between the groups. Postoperative VAS scores, HSS scores, MPTA, and MAD were significantly improved compared to preoperative values in both groups ( P<0.05). The median VAS scores for the cementless UKA group at 6, 12, and 18 months postoperatively were 4.0(3.0, 5.0), 2.0(2.0, 3.0), and 2.0(1.0, 3.0) respectively. The corresponding median HSS scores for the cemented UKA group were 78(75, 82), 85 (80, 89), and 86(82, 90) preoperatively and at 6, 12, and 18 months postoperatively, respectively. The median FJS scores for the cementless UKA group were 73.0(70.5, 76.0), 76.0(74.0, 78.0), and 66.0(63.0, 68.0) preoperatively and at 6, 12, and 18 months postoperatively, respectively. There was no statistically significant relationship between preoperative VAS scores and preoperative FJS scores ( P>0.05). However, there was a significant difference in VAS scores between the two groups at 6 months postoperatively ( P<0.05). The cementless UKA group consistently exhibited better VAS scores and HSS scores compared to the cemented UKA group at 6, 12, and 18 months postoperatively ( P<0.05). The median MPTA values for the cementless UKA group were 85.41°(84.22°, 86.54°), 85.80°(84.74°, 87.41°), 86.51°(85.47°, 88.14°), and 86.80°(86.09°, 88.27°) preoperatively and at 6, 12, and 18 months postoperatively, respectively. The median MAD values for the cementless UKA group were 2.29(1.79, 2.65) cm, 1.11(0.69, 1.75) cm, 1.02(0.65, 1.66) cm, and 0.91(0.61, 1.63) cm preoperatively and at 6, 12, and 18 months postoperatively, respectively. There were no significant differences in MPTA and MAD between the two groups at all time points, except for the preoperative MPTA and postoperative MAD at 6 and 12 months. The incidence of physiological radiolucency around the prosthesis was significantly lower in the cementless UKA group 3 than in the cemented UKA group 28 ( P<0.05). However, no complete radiolucency was observed in either group. Conclusion:Oxford cementless UKA is a highly effective treatment for relieving joint pain and correcting knee deformity in patients with knee AMOA. It offers the advantages of shorter surgical duration, reduced blood loss, and improved subjective outcomes for patients after the operation.
RESUMEN
BACKGROUND:Direct anterior approach has been reported to be associated with a risk of reaming the anterior column of the acetabulum,but there is little evidence supporting this opinion.OBJECTIVE:To reveal differences in the bone stock of the anterior and posterior columns between the direct anterior approach and the posterolateral approach in total hip arthroplasty by CT measurement.METHODS:Sixty cases of primary total hip arthroplasty through direct anterior approach (n=30) or posterolateral approach (n=30) at Fuzhou Second Hospital of Xiamen University from October 2015 to December 2017 were enrolled.The cross-sectional area of the anterior and posterior column of the acetabulum,the height of the anterior and posterior column,acetabular diameter,and anteversion were measured by CT.All researchers had 5-10 years of clinical experience,and the surgeons were associate chief physicians or above.The trial has been approved by the Ethics Committee of Fuzhou Second Hospital of Xiamen University on June 1,2017.All patients signed the written informed consents.RESULTS AND CONCLUSION:(1) The postoperative cross-sectional area of the anterior and posterior column of the acetabulum,and the height of the anterior and posterior column in the two groups were less than those at baseline (P ＜ 0.05),the acetabular diameter was larger than that at baseline (P ＜ 0.01),and the anteversion showed no significant difference (P ＞ 0.05).The area of the anterior column in the direct anterior approach group was higher than that in the posterolateral approach group (P ＜ 0.05),and other parameters were insignificantly different between two groups (P ＞ 0.05).(2) in summary,compared with posterolateral approach in total hip arthroplasty,direct anterior approach leads to increased area of the anterior column,and made no effect on other parameters.Thereafter,direct anterior approach is not a risk factor for eccentric reaming the anterior column of acetabulum,and the conclusion needs to be confirmed by multicenter,prospective randomized controlled trials.
RESUMEN
BACKGROUND: Pseudoachondroplasia is rare heredigary osteopathy, usually accompanied by deformity of the lower limbs, short fingers, and ligamentous laxity, so it is a difficulty in total knee arthroplasty.OBJECTIVE: To evaluate the curative effectiveness of bilateral total knee arthroplasties for a patient with pseudoachondroplasia using three-dimensional (3D) printing technology.METHODS: A retrospective study was done in a case of pseudoachondroplasia undergoing bilateral total knee arthroplasties using 3D printing technology. X-ray examination was conducted to observe the prosthesis location after arthroplasties, and the Knee Society Score outcome measures were used to evaluate the functional outcome.RESULTS AND CONCLUSION: (1) After arthroplasties, X-rays showed good line of force of the lower limbs and prosthesis location, and 1 year later, showed no radiolucent lines in tibia. (2) The right Knee Society Score improved to 94 points, the functional scoring improved to 90 points, and the postoperative flexion was 95°; the left Knee Society Score improved to 93 points, the functional scoring improved to 90 points, and the postoperative flexion was 90°. All patients were very satisfied with the treatment outcomes. (3) These results indicate that the individualized treatment scheme designed using 3D printing technology can reduce the surgical difficulty and trauma with high accuracy, and promote the functional recovery of the knee. Additionally, it obtains good clinical efficacy and patient's satisfaction in orthopaedic surgeries.
RESUMEN
BACKGROUND:Previous studies have shown that apoptosis, a central feature of articular chondrocytes, plays a dominant role in cartilage damage, which is one of the pathological factors of articular cartilage degeneration. OBJECTIVE:To observe the effects of meditcated serum containingDuhuojisheng Decoction on the expression of cytochrome C, proCaspase-9 and proCaspase-3 in rat degenerative chondrocytes in vitro and to investigate the possible molecular biological mechanism ofDuhuojisheng Decoction in the treatment of knee osteoarthritis. METHODS:A cultivation system of degenerative chondrocytes in vitro was established. After treatment with meditcated serum containingDuhuojisheng Decoction or blank serum for 24 and 48 hours, the protein expression of cytochrome C, proCaspase-9 and proCaspase-3 was measured by western blot assay. RESULTS AND CONCLUSION: In the cytoplasm, the release of cytochrome C was reduced gradualy in both groups in a time-dependent manner, and the release amount of cytochrome C was significantly lower in the medicated serum group than the blank serum group (P < 0.05). In mitochondria, cytochrome C leakage was gradualy decreased in both groups, and it was decreased significantly in the medicated serum group compared with the blank serum group (P < 0.05). The protein expression of proCaspase-9 and proCaspase-3 was gradualy increased in both groups, especialy in the medicated serum group; the medicated serum containingDuhuojisheng Decoction could promote the protein expression of proCaspase-9 and proCaspase-3 in a time-dependent manner, and there was a significant difference at 24 and 48 hours (P< 0.01). These findings indicate that the medicated serum containingDuhuojisheng Decoction can inhibit the apoptosis of osteoarthritis chondrocytes through inhibiting the release of cytochrome C and the activation of Caspase-9 and Caspase-3.
RESUMEN
0.05),but FECW was superior to Kirschner tension band at comminuted fracture model(P