Total knee arthroplasty for extension ankylosing deformity / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the outcomes and complications of total knee arthroplasty (TKA) for extension ankylosing deformity of the knee.</p><p><b>METHODS</b>From January 1996 to June 2006, total knee arthroplasty was performed on 8 patients (9 knees) with extension ankylosing deformity. The preoperative ROM of all patients was 0 degrees . Preoperative knee and function score of KSS were 44 points (from 10 to 68) and 17 points (from -10 to 55) respectively.</p><p><b>RESULTS</b>The complications of all TKAs included patellar tendon avulsion in 1 knee, partial fracture of inferior patella in 1 knee, hematoma in 1, superficial infection in 1. All patients were followed up for an average of 40.4 months (from 7.0 to 120.0). The average postoperative ROM was 89 degrees (from 50 degrees to 120 degrees ). Postoperative knee and function score of KSS were 81 points (from 55 to 93) and 79 points (from 50 to 90) respectively. Extension lag occurred in 2 knees, one was 10 degrees and the other was 25 degrees . One knee had undergone re-revision of changing the thicker tibial spacer for the reason of instability of joint 1 year after revision.</p><p><b>CONCLUSIONS</b>TKA performed in extension ankylosing deformity can get less satisfactory clinical results comparing with fixed flexion deformity. Exposure of the knee joint and separation of the fused bones, providing a mobile joint space plays crucial procedure for the next step of surgery. Preservation of sufficient bone stock of patella, protection of patellar tendon and blood supply of the knee and proper soft tissue balance are the key to TKA for extension ankylosing deformity.</p>

Total knee replacement in valgus knee / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the methods and clinical results of total knee replacement (TKA) in patients with valgus knee deformity.</p><p><b>METHODS</b>Between January 1996 and August 2004, 87 TKAs were performed by means of medial parapatellar approach, standard osteotomy and only lateral soft tissue release with posterior stabilized implants on 74 patients (11 men and 63 women) with valgus deformity. The average age at the time of operation was 62.93 years (range, 26-80 years). Clinical and radiographic evaluations including range of motion (ROM), Knee Society Score System (KSS) and the tibial and femur angle (T-F angle) were performed at follow-up.</p><p><b>RESULTS</b>After a mean follow-up of 33.8 months (range, 5 months-9 years), the average ROM improved from 91 degrees (range, 70 degrees-120 degrees) preoperatively to 112.4 degrees (range, 80 degrees-130 degrees) postoperatively, the average KSS improved from 22.7 points (0-48 points) preoperatively to 81.7 points (range, 71-93 points) postoperatively. The average function score improved from 26.5 points preoperatively to 86.3 points postoperatively, the average T-F angle was corrected from 21.59 degrees (range, 12 degrees-40 degrees) of valgus preoperatively to 8.7 degrees (0 degrees-11 degrees) of valgus postoperatively. One knee had lightly instability at follow-up, one knee with patellar dislocation preoperatively had subdislocation postoperatively, no other complication occurred.</p><p><b>CONCLUSIONS</b>The techniques of medial parapatellar approach, standard osteotomy and only lateral soft tissue release with posterior stabilized implants can correct a fixed valgus deformity very successfully in patients undergoing primary total knee replacement, and provides excellent results.</p>

Early diagnosis and treatment of pulmonary embolism after total joint replacement: report of five cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the early diagnosis and treatment of pulmonary embolism (PE) after total joint replacement (TJR).</p><p><b>METHODS</b>>From April 1987 to December 2001, we performed 1,336 total knee replacements (TKR(s)) in 926 patients and 1,745 total hip replacements (THR(s)) in 1,566 patients. In this group there were 5 PE patients after operation. Two patients died (all after TKR), and 3 patients salvaged successfully (2 after TKR, 1 after THR).</p><p><b>RESULTS</b>The total incidence of PE after TJR was 0.2% (5/2,492), the incidence of PE after TKR was 0.4% (4/926), and the incidence of PE after THR was 0.06% (1/1,556). In the patients who suffered PE, 2 died. The incidence of PE before 2000 was 0%.</p><p><b>CONCLUSIONS</b>Death after total joint replacement is due to pulmonary embolism (PE), especially massive PE. The incidence of PE after TKR is higher than that after THR. Pulmonary angiography is the gold standard for the diagnosis of PE. With more understanding on PE and more popularity of joint replacement, the diagnosis of PE after TJR is increased. More attention should be paid to PE in the patients with high risk after TJR.</p>