Treatment of iatrogenic injury to medial collateral ligament in total knee arthroplasty / 中华创伤骨科杂志

Objective:To explore the treatment of iatrogenic injury to the medial collateral ligament (MCL) in total knee arthroplasty (TKA).Methods:From January 2009 to December 2016, 14 patients were treated at Department of Arthropathy, Zhengzhou Orthopedics Hospital for iatrogenic MCL injury in primary TKA (injury group). They were 3 males and 11 females with an age of (72.6±3.9) years. The MCL injury was body rapture in 9 cases and avulsion of femoral insertion in 5 ones. Interlacing suture was used for body rapture and reparative reconstruction with wire anchors or nails was performed for avulsion of femoral insertion. A restrictive condylar prosthesis was used instead in the 4 patients whose medial stability failed to be restored after repair of body rapture. A control group of 21 cases was enrolled who had suffered from no iatrogenic MCL injury in primary TKA at the corresponding period. There were 5 males and 16 females with an age of (73.2±3.9) years. The 2 groups were compared in terms of American Knee Society Score (KSS) and knee flexion.Results:There was no significant difference between the 2 groups in preoperative general data, showing comparability between groups ( P>0.05). The injury group was followed up for 18 to 36 months (mean, 33 months). Joint loosening was observed at 18 months after operation in 3 patients with nonrestrictive prosthesis who had to receive secondary revision. At the 36-month follow-up of the remaining 11 patients, normal knee extension and flexion was observed, the stress test of valgus showed no inner relaxation, their KSS increased significantly from preoperative 50.0±22.7 to 93.3±4.7, and their knee flexion was improved significantly from 90.4°±10.3° to 110.7°±8.8° ( P<0.05). There were no significant differences in KSS score or knee flexion between the 2 groups at 3, 6, 12 or 36 months after operation ( P>0.05). Conclusion:Iatrogenic MCL injury in primary TKA should be repaired and reconstructed by one-stage surgery because the patients can achieve curative results similar to those for the patients free from iatrogenic MCL injury in primary TKA.

Efficacy of different ways of cocktail analgesic mixture injection on total knee arthroplasty / 中南大学学报(医学版)

OBJECTIVES@#To evaluate the efficacy of different ways of cocktail analgesic mixture injection on total knee arthroplasty (TKA).@*METHODS@#A total of 50 patients with knee osteoarthritis treated by TKA from July to September 2018 were randomly divided into two groups (=25). The Group 1 underwent anterior intra-articular injection before prosthesis implanted while the Group 2 underwent posterior intra-articular injection before prosthesis implanted. Visual Analogue Scale (VAS) of all patients for pain during activity and at rest, maximal flexion degree of the knee at the 48th h and the 72th h after surgery, the time of raise leg, usage rate of patient-controlled analgesia (PCA), and complications were evaluated and analyzed.@*RESULTS@#VAS for pain at rest of patients in the Group 1 was significantly less than that in the Group 2 at the 6th, 12th, and 24th h after surgery (all <0.05). Maximal flexion degree of the knee at the 48th h and the 72th h after surgery in the Group 1 was better than that in the Group 2 (both <0.05). The Group 1 costed less time than the Group 2 on the ability to perform an active straight leg raise (=0.027).@*CONCLUSIONS@#The anterior intra-articular cocktail analgesic mixture injection can strongly relieve the pain early after TKA, which can improve knee function and achieve painless rehabilitation in most patients, with safety.

Treatment of periprosthetic femoral fractures with unstable prosthesis by replacement of long-stem femoral prosthesis / 中华创伤骨科杂志

Objective To discuss the treatment of periprosthetic femoral fractures (PFF) with unstable prosthesis by replacement of long-stem femoral prosthesis and internal fixation.Methods From December 2005 to December 2014,15 PFF patients with unstable prosthesis (15 hips) following were treated at our department.They were 10 men and 5 women,aged from 64 to 89 years (mean,76.2 years).Their primary surgeries included total hip arthroplasty in 13 cases and biological bi-polar replacement of femoral head in 2.Two prostheses were cement and 13 biological.By Vancouver classification,9 cases were type B2,and 6 type B3.The unstable prostheses in the 15 cases were replaced by long-stem femoral ones,followed by internal fixation.At the last follow-ups,clinical outcome were evaluated by Harris scoring and images of PFF by Beals & Tower criteria.Complications were documented.Results One died 4 months after operation.The other 14 patients were followed up for an average of 4.5 years (from 6 months to 9 years).Fracture union was achieved in 12 cases after an average of 3.9 months (from 3 to 9 months).Nonunion occurred in 2 cases.Imaging evaluation revealed 9 excellent cases,3 good ones and 2 poor ones.The Harris scores at the last follow-up averaged was 82.3 points (from 50 to 100 points).Deep vein thrombosis occurred preoperatively in one case and posterior tibial vein thrombosis occurred in 2 cases respectively on day 3 and day 10 postoperatively.No such complications occurred as malunion,fixation failure,dislocation or prosthesis loosening.Conclusion Satisfactory outcomes can be achieved by replacement of long-stem femoral prosthesis combined with appropriate fixation for treatment of PFF with unstabrosthesis.