Evaluation of early effectiveness of local infiltration anesthesia with compound betamethasone in total knee arthroplasty / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the early effectiveness of local infiltration anesthesia (LIA) with compound betamethasone in total knee arthroplasty (TKA).@*METHODS@#The clinical data of 102 patients with knee osteoarthritis who were treated by TKA and met the selection criteria between May 2022 and March 2023 were retrospectively analyzed. They were divided into control group and study group according to whether LIA preparation was added with compound betamethasone, with 51 cases in each group. There was no significant difference of baseline data, such as age, gender, body mass index, operative side, preoperative range of motion (ROM), Knee Society Score (KSS), white blood cell (WBC), and hematocrit between the two groups ( P>0.05). The intraoperative total blood loss and hidden blood loss were recorded, and WBC was recorded on the 1st, 2nd, and 3rd days after operation. Pain was assessed by visual analogue scale (VAS) score on the 1st, 2nd, and 3rd days after operation and morphine intake milligrames equivalent within 48 hours after operation. Passive ROM, maximum extension and flexion angles of knee joint were measured on the 3rd day after operation; the early postoperative complications were recorded.@*RESULTS@#There was no significant difference in total blood loss and hidden blood loss between the two groups ( P>0.05). The postoperative pain levels in both groups were relatively mild, and there was no significant difference in VAS scores in the first 3 days after operation and in morphine intake milligrams equivalent within 48 hours after operation between the two groups ( P>0.05). The WBC in the first 3 days after operation was significantly improved in both groups ( P<0.05). The WBC in the study group was significantly higher than that in the control group on the 1st and 2nd days after operation ( P<0.05), but there was no significant difference between the two groups on the 3rd day after operation ( P>0.05). On the 3rd day after operation, the maximum extension angle of knee joint in the study group was smaller than that in the control group, while the maximum flexion angle and passive ROM of knee joint in the study group were larger than those in the control group, and the differences were significant ( P<0.05). There were 6 cases of fever and 17 cases of deep venous thrombosis in the control group, and 1 case and 14 cases in the study group, respectively. There was no poor wound healing and periprosthetic joint infection in the two groups, and there was no significant difference in the incidence of complications between the two groups ( P>0.05).@*CONCLUSION@#The application of compound betamethasone in LIA during TKA is a safe and optimal strategy to promote the early postoperative rehabilitation of patients.

Radiografía al acceso en artroplastia de rodilla entre los beneficiarios del Fondo Nacional de Salud entre 2004 y 2021 / Access to knee arthroplasty among National Health Fund beneficiaries in Chile between 2004 and 2021

Introducción La artrosis de rodilla es una patología que afecta la calidad de vida, siendo la artroplastía de rodilla un tratamiento costo-efectivo para la etapa severa de esta enfermedad. El acceso a artroplastia de rodilla es un indicador de salud de la Organización de Cooperación y Desarrollo Económico. Los objetivos de este estudio son determinar la incidencia de artroplastia de rodilla entre 2004 y 2021 en los beneficiarios del Fondo Nacional de Salud en Chile, la proporción que se operaron en el sistema privado y estimar el gasto del bolsillo del paciente para operarse. Método Estudio transversal. Se utilizó la base de datos del Departamento de Estadística e Información de Salud. Se pesquisaron pacientes que egresaron de un centro de salud chileno que fueron intervenidos por artroplastia rodilla entre 2004 y 2021. Se analizó la proporción de pacientes por tramo del Fondo Nacional de Salud y si se realizó su cirugía en establecimiento de la red pública o privada. Resultados De las 31 526 intervenciones de artroplastia de rodilla, 21 248 (67,38%) fueron realizadas en pacientes del Fondo Nacional de Salud y 16 238 en instituciones públicas (51,49%). Los pacientes de dicho fondo presentan un alza sistemática en el volumen de artroplastías de rodilla hasta 2019, pero disminuyeron en 2020 y 2021 un 68% y un 51%. Del total de pacientes del sistema público operados de artroplastia de rodilla, 856 (9%) pertenecían al tramo A1, al tramo B 12 806 (60%), al tramo C 2044 (10%) y al tramo D 4421 (21%). Se estimó que el gasto incurrido por estos pacientes varía entre el 24,4 y 27,2%. Las proporciones históricas de acceso en instituciones privadas a esta cirugía son en el tramo A 7%, tramo B 13%, tramo C 24% y tramo D 52%. Conclusión El 50% de las cirugías de artroplastía de rodilla se realizan en instituciones públicas y dos tercios se realizan en pacientes del Fondo Nacional de Salud. El 46% de los tramos C y D se operaron en el sistema privado. La pandemia ha aumentado la brecha de acceso, lo que ha provocado un alza significativa en la proporción de pacientes del Fondo Nacional de Salud de los tramos B, C y D que han migrado al sistema privado para acceder a esta cirugía.

Introduction Knee osteoarthritis affects the quality of life, with knee arthroplasty being a cost-effective treatment for the severe stage of this disease. Access to knee arthroplasty is a health indicator of the Organisation for Economic Co-operation and Development. The objectives of this study are to determine the incidence of knee arthroplasty between 2004 and 2021 in beneficiaries of the National Health Fund in Chile, the proportion of patients who underwent surgery in the private system, and to estimate the patient's out-of-pocket expenditure for surgery. Methods Cross-sectional study. We used the Department of Statistics and Health Information database. Patients discharged from a Chilean health center who underwent knee arthroplasty surgery between 2004 and 2021 were investigated. We analyzed the proportion of patients by their National Health Fund category and whether their surgery was performed in public or private network facilities. Results Of the 31 526 knee arthroplasty procedures, 21 248 (67.38%) were performed on National Health Fund patients and 16 238 in public institutions (51.49%). Patients from the National Health Fund showed a systematic increase in knee arthroplasty volume until 2019 but decreased in 2020 and 2021 by 68% and 51%. Of the total number of patients in the public system operated on for knee arthroplasty, 856 (9%) belonged to group A1, 12 806 (60%) to group B, 2044 (10%) to group C, and 4421 (21%) to group D. The expenditure incurred by these patients was estimated to vary between 24.4% and 27.2%. The historical proportions of access to this surgery in private institutions are 7% in group A, 13% in group B, 24% in group C, and 52% in group D. Conclusion Fifty percent of knee arthroplasty surgeries are performed in public institutions, and two-thirds are performed on patients of the National Health Fund. Forty-six percent of the C and D groups were operated in the private system. The pandemic has increased the access gap, leading to a substantial increase in the proportion of patients from the National Health Fund of the B, C, and D groups who have migrated to the private system to access this surgery.

Early mobilization after total hip or knee arthroplasty: a substudy of the POWER. 2 study

Abstract Background Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization. Methods This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery. Results A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16-30]. 4,222 (69.3%) patients moved in ≤ 24 hours after surgery. Local anesthesia [OR = 0.80 (95% confidence interval [CI]: 0.72-0.90); p= 0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55-0.60); p< 0.001], mean adherence to ERAS items [OR = 0.93 (95% CI: 0.92-0.93); p< 0.001], and preoperative hemoglobin [OR = 0.97 (95% CI: 0.96-0.98); p< 0.001] were associated with shorter time to mobilization. Conclusions Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.

Effect of Pin Holes Location of Unicompartmental Knee Arthroplasty on Postoperative Tibial Plateau Mechanical Properties / 中国医疗器械杂志

OBJECTIVE@#The purpose of this study is to explore the biomechanical characteristics of the tibia after unicompartmental knee arthroplasty with different distributions of two-pin holes, and to optimize the two-pin holes scheme to reduce the risk of tibial fractures after unicompartmental knee arthroplasty.@*METHODS@#Lower limbs model is segmented and reconstructed from computed tomography images. Four combinations of two pin holes created for tibial cutting guide placement are simulated with finite element analysis.@*RESULTS@#In the third mode, the positioning hole at the proximal medial edge of the tibial plateau has the highest stress value, and the position of the positioning hole near the medial edge of the proximal tibial plateau appears stress concentration.@*CONCLUSIONS@#The present study revealed that placing tibial cutting guide holding pins centrally would lower the risks of periprosthetic fracture of the medial tibial plateau.

Comparison of outcomes of mixed unicompartmental knee arthroplasty and total knee arthroplasty in the treatment of medial osteoarthritis of the knee / 中国骨伤

OBJECTIVE@#To evaluate outcomes of mixed unicompartmental knee arthroplasty(UKA) and total knee arthroplasty(TKA) in the treatment of medial osteoarthritis(OA) of the knee.@*METHODS@#Retrospective analysis of 156 patients, 44 males and 112 females, aged from 50 to 75 years old with an average of(58.76±4.97) years old, who underwent knee arthroplasty from October 2017 to October 2019. The patients were divided into two groups:81 cases(81 knees) underwent TKA, including 23 males and 58 females, aged from 51 to 75 years old with an average of (58.60±5.01) years old, and 75 case (75 knees) underwent UKA with mixed phase 3 Oxford, including 21 males and 54 females, aged from 50 to 72 years old with an average of (58.92±4.95) years old. The two groups were compared regarding to the clinical outcomes, assessed using surgical information and complications, American Knee Society score(AKSS) clinical score and functional score. Radiographs were assessed using hip-knee-ankle angle(HKA), tibial component valgus/varus angle(TCVA), tibial component posterior slope angle(TCPSA), femoral component valgus/varus angle(FCVA), femoral component posterior slope angle(FCPSA), looking for bearing dislocation, prosthesis loosening, progression of OA in lateral compartment.@*RESULTS@#Intraoperative bleeding, operative time and hospital days were significantly better in the UKA group than in the TKA group (P<0.05), and there were no postoperative complications in either group. Patients in both groups were enrolled with an average follow-up time of (38.01±8.90) months, ranged from 24 to 54 months. AKSS functional, AKSS clinical, HKA in both groups significantly improved at the final follow-up compared with those before operation. At the final follow-up, the UKA group was significantly better than the TKA group in AKSS functional and AKSS clinical, whereas HKA in the TKA group was better. At the final follow-up. TCVA and FCVA between the two groups were not significantly different, while TCPSA and FCPSA in the UKA group were significantly greater than the TKA group. No signs of progression of OA to the lateral compartment were observed.@*CONCLUSION@#Mixed phase 3 Oxford UKA in medial unicompartmental knee osteoarthritis was considerably better than TKA for less blood loss, shorter operation time, shorter hospital stay, rapid postoperative recovery, helping achieve satisfactory function, provided satisfactory outcome.

Short- and mid-term effectiveness of unicompartmental knee arthroplasty for post-traumatic arthritis of knee / 中国修复重建外科杂志

OBJECTIVE@#To investigate the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA) for post-traumatic arthritis (PTA) of knee.@*METHODS@#The clinical data of 30 patients with PTA of unilateral knee between March 2014 and September 2021 was retrospectively analyzed. There were 14 males and 16 females with an average of 64.5 years (range, 33-81 years). The average body mass index was 26.7 kg/m 2 (range, 19.8-35.6 kg/m 2). The types of injuries that caused PTA included intra-articular fracture in 16 cases, extra-articular fracture in 8 cases, and soft tissue injury in 6 cases. The initial injuries were treated by conservative therapy in 12 cases and by surgical therapy in 18 cases. Ten cases were medial compartment osteoarthritis and 20 cases were lateral compartment osteoarthritis. According to Kellgren-Lawrence staging, there were 19 cases of grade Ⅲ and 11 cases of grade Ⅳ. The operative time, the length of hospital stay, complications, and subjective satisfaction were recorded. The Oxford Knee Function Score (OKS), Hospital for Special Surgery (HSS) score, and knee range of motion (ROM) were used to evaluate knee function. Weight-bearing X-ray films were taken to measure the femoro-tibial angle (FTA) and to assess alignment correction of the lower limb.@*RESULTS@#The operative time ranged from 50 to 95 minutes (mean, 63.7 minutes), the length of hospital stay ranged from 3 to 8 days (mean, 6.9 days). Superficial infection occurred in 2 patients, while the remaining incisions healed by first intention. There was no deep vein thrombosis or neurovascular injury. All patients were followed up 17-109 months (median, 70 months). At last follow-up, OKS score, HSS score, and ROM in 30 cases significantly improved when compared with those before operation (P<0.05). Lower limb alignment was significantly corrected and there was significant difference in FTA of the varus and valgus knees between pre- and post-operation ( P<0.05). The patient satisfaction rate was 86.7% (26/30). Two cases developed contralateral osteoarthritis progression during follow-up. No bearing dislocation, prosthesis loosening or sinking occurred and none required further revision.@*CONCLUSION@#For patients with PTA of knee, UKA can obtain definite short- and mid-term effectiveness with high patient satisfaction.

Research progress of anterior cutaneous nerve injury and repair in knee arthroplasty / 中国修复重建外科杂志

OBJECTIVE@#To summarize the research progress of anterior cutaneous nerve injury and repair in knee arthroplasty.@*METHODS@#The relevant literature at home and abroad in recent years was reviewed and summarized from the anatomy of anterior cutaneous nerve, nerve injury grade, clinical manifestations, prevention and treatment of anterior cutaneous nerve.@*RESULTS@#The anterior cutaneous nerve injury is a common complication of knee arthroplasty. Because the anterior cutaneous nerve branches are many and thin, and mainly run between the first and second layers of fascia, this level is often ignored during surgical exposure. In addition, the knee arthroplasty does not routinely perform the exploration and repair of the cutaneous nerve. So the anterior cutaneous nerve injury is difficult to avoid, and can lead to postoperative skin numbness and knee pain. At present, studies have explored the feasibility of preventing its occurrence from the aspects of improved incision and intraoperative separation of protective nerve. There is no effective prevention and treatment measures for this complication. For patients with skin numbness after knee arthroplasty, the effectiveness of drug treatment is not clear. Local nerve block or nerve excision can be used to treat patients with painful symptoms after knee arthroplasty considering cutaneous pseudoneuroma.@*CONCLUSION@#Knee arthroplasty is widely used and anterior cutaneous nerve injury is common in clinic. In the future, more high-quality clinical studies are needed to further explore the prevention and treatment measures of this complication and evaluate the clinical benefits obtained.

Progress of injection sites of local infiltration analgesia in total knee arthroplasty / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of injection sites of local infiltration analgesia (LIA) in total knee arthroplasty (TKA).@*METHODS@#The relevant domestic and foreign literature in recent years was extensively reviewed. The neuroanatomy of the knee, and the research progress of the selection and the difference of effectiveness between different injection sites of LIA in clinical studies were summarized.@*RESULTS@#Large concentrations of nociceptors are present throughout the various tissues of the knee joint. Patellar tendon, subpatellar fat pad, lateral collateral ligament insertions, iliotibial band insertions, suprapatellar capsule, and posterior capsule were more sensitive to pain. Most current studies support injections into the lateral capsule, collateral ligament, retinaculum, quadriceps tendon, fat pad, and subcutaneous tissue. Whether to inject into the back of the knee and subperiosteum is controversial.@*CONCLUSION@#The relative difference of knee tissue sensitivity to pain has guiding significance for the selection of LIA injection site after TKA. Although researchers have conducted clinical trials on injection site and technique of LIA in TKA, there are certain limitations. The optimal scheme has not been determined yet, and further studies are needed.

A comparative study of short-term effectiveness of "SkyWalker" robot-assisted versus traditional total knee arthroplasty / 中国修复重建外科杂志

OBJECTIVE@#To compare the short-term effectiveness of "SkyWalker" robot-assisted total knee arthroplasty (TKA) and traditional TKA.@*METHODS@#A clinical data of 54 patients (54 knees) with TKA who met the selection criteria between January 2022 and March 2022 was retrospectively analyzed. Among them, 27 cases underwent traditional TKA (traditional operation group) and 27 cases underwent "SkyWalker" robot-assisted TKA (robot-assisted operation group). There was no significant difference between the two groups ( P>0.05) in terms of gender, age, body mass index, osteoarthritis side, disease duration, and preoperative Knee Society Score (KSS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), visual analogue scale (VAS) score, hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and posterior proximal tibial angle (PPTA). The operative time, intraoperative bleeding volume, surgery-related complications, the KSS, WOMAC, and VAS scores before operation and at 6 months after operation, and Forgotten Joint Score (FJS) at 6 months after operation were recorded. X-ray films were taken to review the prosthesis position and measure HKA, LDFA, MPTA, and PPTA. The differences of the clinical and imaging indicators between before and after operation were calculated and statistically analyzed.@*RESULTS@#The operations were completed successfully in both groups. There was no significant difference in the operative time and intraoperative bleeding volume between the two groups ( P>0.05). After operation, 1 case of incision nonunion and 1 case of heart failure occurred in the traditional operation group, while no surgery-related complications occurred in the robotic-assisted operation group. The incidences of surgical complications were 7.4% (2/27) in the traditional operation group and 0 (0/27) in the robotic-assisted operation group, with no significant difference ( P=0.491). Patients in both groups were followed up 6 months. KSS score, WOMAC score, VAS score, and ROM significantly improved in both groups at 6 months after operation when compared with preoperative ones ( P<0.05). There was no significant difference between the two groups ( P>0.05) in the differences between the pre- and post-operative values of the clinical indicators and FJS scores at 6 months after operation. X-ray films showed that the lower extremity force lines of the patients improved and the knee prostheses were in good position. Except for LDFA in the robot-assisted operation group, HKA, LDFA, MPTA, and PPTA significantly improved in both groups at 6 months after operation when compared with the preoperative ones ( P<0.05). There was no significant difference between the two groups in the differences between the pre- and post-operative values of the radiological indicators ( P>0.05).@*CONCLUSION@#The "SkyWalker" robot-assisted TKA is one of the effective methods for the treatment of knee osteoarthritis and had good short-term effectiveness. But the long-term effectiveness needs to be further studied.

Musculoskeletal multibody dynamics investigation for the different medial-lateral installation position of the femoral component in unicompartmental knee arthroplasty / 生物医学工程学杂志

The surgical installation accuracy of the components in unicompartmental knee arthroplasty (UKA) is an important factor affecting the joint function and the implant life. Taking the ratio of the medial-lateral position of the femoral component relative to the tibial insert (a/A) as a parameter, and considering nine installation conditions of the femoral component, this study established the musculoskeletal multibody dynamics models of UKA to simulate the patients' walking gait, and investigated the influences of the medial-lateral installation positions of the femoral component in UKA on the contact force, joint motion and ligament force of the knee joint. The results showed that, with the increase of a/A ratio, the medial contact force of the UKA implant was decreased and the lateral contact force of the cartilage was increased; the varus rotation, external rotation and posterior translation of the knee joint were increased; and the anterior cruciate ligament force, posterior cruciate ligament force and medial collateral ligament force were decreased. The medial-lateral installation positions of the femoral component in UKA had little effect on knee flexion-extension movement and lateral collateral ligament force. When the a/A ratio was less than or equalled to 0.375, the femoral component collided with the tibia. In order to prevent the overload on the medial implant and lateral cartilage, the excessive ligament force, and the collision between the femoral component and the tibia, it is suggested that the a/A ratio should be controlled within the range of 0.427-0.688 when the femoral component is installed in UKA. This study provides a reference for the accurate installation of the femoral component in UKA.

Research of early outcomes of cementless Oxford unicompartmental knee arthroplasty / 中华骨科杂志

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.

Chinese Medicine Intervention on Deep Vein Thrombosis-related Signaling Pathways After Total Knee Arthroplasty： A Review / 中国实验方剂学杂志

Total knee arthroplasty， as a common treatment option for advanced knee osteoarthritis， can alleviate the clinical symptoms of patients. Deep vein thrombosis of the lower extremity is the most common complication of total knee arthroplasty. Previous studies have shown that the occurrence of deep vein thrombosis after total knee arthroplasty is mostly related to the overexpression of inflammatory factors in vivo. Nuclear transcription factor-κB， Toll-like receptor 4， phosphatidylinositol 3-kinase/protein kinase B， tumor necrosis factor， and nuclear transcription factor E2-related factor 2 are typical signaling pathways related to inflammation. Regulating the expression of the signaling pathways can intervene the formation of inflammatory factors. Inhibiting the formation of inflammatory factors can help suppress the activation of platelets， thereby blocking thrombosis. According to previous research， Chinese medicine monomers， Chinese medicine extract， and compound Chinese medicine prescriptions all directly or indirectly inhibit the expression of inflammatory factors by regulating the above signaling pathways， thereby suppressing the occurrence of deep vein thrombosis after total knee arthroplasty. Therefore， Chinese medicine can reduce postoperative complications and promote postoperative recovery of patients at low cost with small side effects. This article summarizes the research on Chinese medicine intervention on deep vein thrombosis-related signaling pathways after total knee arthroplasty， which is expected to lay a basis for the in-depth study and clinical application of Chinese medicine in deep vein thrombosis.

Long-Term Mechanical Property Prediction of the Proximal Tibia after Knee Arthroplasty / 医用生物力学

Objective To study the short-term variation patterns of graft viscosity after anterior cruciate ligament reconstruction (ACLR) surgery. Methods Six male New Zealand rabbits were selected. The ACLR animal model of unilateral knee was made with Achilles tendon as the graft. The experimental rabbits were euthanized 15 days after ACLR surgery, with removal of the graft, healthy anterior cruciate ligament (ACL) and Achilles tendon. The cross-sectional area and viscosity coefficient of the graft were measured, and the creep experiments were carried out under equilibrium conditions of 0.1 MPa and 1 MPa, respectively. The viscosity coefficent was calculated. Variation patterns of graft viscosity were summarize. The grafts were compared with healthy ACL. Results The cross-sectional area of the graft increased slowly within 15 days after ACLR surgery. The viscosity of ACL and graft changed nonlinearly. The viscosity coefficient was quite different under different stresses. The viscosity coefficient of the graft decreased with the time after ACLR surgery, which was more obviously under the condition of low stress. Conclusions The results are helpful to guide the implementation of early postoperative rehabilitation plan after ACLR surgery .

The influence of UKA Installation Error of Joint Line on Contact Mechanics and Kinematics of Knee Joint / 医用生物力学

Objective Aiming at the medial prosthetic loosening failure and lateral cartilage degeneration after unicompartmental knee arthroplasty ( UKA), the effects of prosthetic installation errors of joint line in UKA on knee contact mechanics and kinematics during different physiologic activities were studied using musculoskeletal multi-body dynamic method. Methods Taking the medial natural joint line as 0 mm error, six installation errors ofjoint line including ±2 mm, ±4 mm and ±6 mm were considered respectively, and seven musculoskeletal multi body dynamic models of medial UKA were established, to comparatively study the variations in knee contact mechanics and kinematics during walking and squatting. Results At 70% of walking gait cycle, compared with 0 mm error, the medial prosthetic contact force was increased by 127. 3% and the contact force of the lateral cartilage was decreased by 12. 0% under 2 mm elevation in joint line, the medial prosthetic contact force was close to 0 N, but the lateral cartilage contact forces were increased by 10. 1% under 4 mm reduction in joint line. The tibiofemoral total contact forces were increased by 19. 7% and decreased by 14. 2% under 2 mm elevation and 2 mm reduction in joint line, respectively. At the 100°knee flexion during squatting, compared with 0 mm error, the medial prosthetic contact force and the tibiofemoral total contact force increased by 31. 6% and 11. 1% under 2 mm elevation in joint line, and decreased by 24. 5% and 8. 5% under 2 mm reduction in joint line, respectively. The change in the lateral cartilage contact force was not marked. Moreover, at 70% of walking gait cycle, the varus angle decreased, the internal rotation and the anterior translation increased along with the elevation of joint line in UKA, while it was just the opposite along with the reduction of joint line in UKA. The trends of the varus valgus movement and anterior-posterior translation during squatting were consistent with those during swing phase of walking, but the trend of the internal-external rotation was opposite. Conclusions In order to reduce the risk of medial prosthetic loosening failure and lateral cartilage degeneration, it is recommended that the installation error of joint line in UKA should be controlled in the range of -2 mm to +2 mm. This study provides theoretical basis for UKA clinical failure caused by changes in joint line

Arterial Complications following Total Knee Arthroplasty (TKA): A Systematic Review and Proposal for Improved Monitoring

@#Introduction: Total knee arthroplasty (TKA) is a common operation and is becoming more common due to population aging and increasing BMI. TKA provides excellent improvement in quality of life but carries risk of arterial complications in the perioperative period. This systematic review aims to provide a greater understanding of the incidence of such complications, and time taken to diagnose arterial injury. Materials and methods: PubMed, Medline, Ovid SP and EMBASE databases were searched with the following MeSH keywords: ‘complication’, ‘vascular injury’, ‘ischaemia’, ‘spasm’, ‘thrombosis’, ‘pseudoaneurysm’, ‘transection’, ‘pulse’, ‘ABPI OR ABI’, ‘Doppler’, ‘amputation’. All arterial vascular events in the perioperative state of the total knee replacement were included. Records were independently screened by two reviewers, and data was extracted according to a pre-determined proforma. Overall incidence and time to diagnosis was calculated for complications. Systematic review registration PROSPERO: CRD42018086643. No funding was received. Results: Twelve studies were selected for inclusion. A total of 3325 cases of arterial complications were recorded across all studies, and were divided into three categories, pseudoaneurysms (0.06%); ischaemia and thrombosis (0.17%); haemorrhage and arterial transections (0.07%). Time taken to reach the diagnosis for each complication was longest in the ischaemia and thrombosis group (6.8 days), followed by pseudoaneurysm (3.5 days) and haemorrhage and transections (3.0 days). Conclusion: TKA post-operative vascular complications are rare, but when they do occur they lead to limb and life threatening complications. This should be discussed with patients during the consent process. Current times to diagnosis represent missed opportunities to recognise arterial injury and facilitate rapid treatment of the complication. A very low threshold for seeking specialist input should be adopted, and any concern for vascular injury, such as unexplained perioperative bleeding, absent lower limb pulses in the post-operative period or unexplained severe pain should warrant immediate review by a vascular surgeon, and in centres where this is not possible, immediate bluelight transfer to the closest vascular centre

Perioperative transfusion analysis and blood ordering schedule update for total knee arthroplasty / 中国输血杂志

【Objective】 To investigate the perioperative rate of allogeneic red blood cell (RBC) transfusion in patients who underwent total knee arthroplasty (TKA) and its risk factors, and to identify its cross-match to transfusion ratio (C∶T ratio). 【Methods】 Anesthetic data of patients who underwent TKA from January 2014 to October 2019 in Peking Union Medical College Hospital were collected and analyzed retrospectively. Perioperative allogeneic RBC transfusion rate was calculated, and binary Logistic regression analysis was performed to identify its risk factors in these patients. The overall C∶T ratio was calculated and divided into subgroups based on surgery type and age group. 【Results】 The study enrolled 2 903 patients. The perioperative rate of allogeneic RBC transfusion in TKA patients was 10.9% (95% CI 9.8%~12.0%) and overall C∶T ratio was 5.6∶1. The independent risk factors leading to perioperative allogeneic RBC transfusion included advanced age(OR=1.025, 95% CI 1.009~1.042, P<0.01), preoperative hemoglobin level(OR=0.966, 95% CI 0.954~0.978, P<0.001), preoperative anemia(OR=3.543, 95% CI 2.052~6.119, P<0.001), hematological diseases(OR=6.462, 95% CI 2.479~16.841, P<0.001), bilateral surgery(OR=7.681, 95% CI 5.759~10.245, P<0.01) and revision surgery(OR=9.584, 95% CI 4.360~21.065, P<0.001). 【Conclusion】 The risk factors for perioperative allogeneic RBC transfusion in TKA patients included advanced age, preoperative low hemoglobin level, preoperative anemia, hematological diseases, bilateral surgery and revision surgery. Only type and screen tests are recommended if patients receiving unilateral primary TKA surgery are less than 75 years old without anemia and hematological diseases, while at least one to four units of blood should be cross-matched if patients are with preoperative anemia and hematological diseases or will receive bilateral and revision arthroplasty.

Automatic extraction of point cloud on cartilage surface of intraoperative knee using FPFH-PointNet / 解剖学报

Objective The navigation system of robot-assisted knee arthroplasty uses a laser scanner to acquire intraoperative cartilage point clouds and align them with the preoperative model for automatic non-contact space registration. The intraoperative patient knee lesion point cloud contains a large number of irrelevant background point clouds of muscles, tendons, ligaments and surgical instruments. Manual removal of irrelevant point clouds takes up surgery time due to human-computer interaction, so in this study we proposed a novel method for automatic extraction of point clouds from the knee cartilage surface for fast and accurate intraoperative registration. Methods Due to the lack of adequate description of cartilage surface and geometric local information, PointNet cannot extract cartilage point clouds with high precision. In this paper, a fast point feature histogram(FPFH)-PointNet method combined with fast point feature histogram was proposed, which effectively described the appearance of cartilage point cloud and achieved the automatic and efficient segmentation of cartilage point cloud. Results The point clouds of distal femoral cartilage of 10 cadaveric knee specimens and 1 human leg model were scanned from different directions as data sets. The accuracy of cartilage point cloud segmentation by PointNet and FPFH-PointNet were 0.94 ±0.003 and 0.98 ±0, and mean intersection over union(mIOU) were 0.83 ±0.015 and 0.93 ±0.005, respectively. Compared with PointNet, FPFH-PointNet improved accuracy and mIOU by 4% and 10% respectively, while the elapsed time was only about 1.37 s. Conclusion FPFH-PointNet can accurately and automatically extract the knee cartilage point cloud, which meets the performance requirement for intraoperative navigation.

Effect of prophylactic anticoagulation duration on venous thrombosis after total hip/knee arthroplasty / 中国临床药理学与治疗学

AIM: By assessing the impact of prolonged prophylactic anticoagulation on venous thromboembolism in patients undergoing total hip/ knee arthroplasty, we dared to hope to further clarify whetherprolonged prophylactic anticoagulation duration can benefit patients undergoing total hip/ knee arthroplasty. METHODS: The incidence of venous thromboembolism and bleeding events within 90 days of total hip/knee arthroplasty in patients who underwent total hip/knee arthroplasty in the department of orthopaedic surgery was retrospectively analyzed from January 2019 to April 2022. The Kaplan-Meier method survival curve was used to determine whether there is a relationship between the duration of prophylactic anticoagulation and the incidence of postoperative bleeding. RESULTS: A total of 115 patients undergoing primary total hip/knee surgery from January 2019 to April 2022, were enrolled in this study. Among them, there were 38 cases in the short-term prophylactic anticoagulation group and 77 cases in the extended prophylactic anticoagulation group. There were 23 cases (20%) of venous thromboembolism within 90 days after surgery, of which 12 cases (31.58%) were in the short-term anticoagulation group and 11 cases (14.29%) were in the extended anticoagulation group, and there was a statistical difference in the incidence of venous thromboembolism within 90 days after surgery between the two groups in terms of the duration of anticoagulation prevention. CONCLUSION: The results show a significant correlation between the duration of prophylactic anticoagulation and the incidence of venous thromboembolism within 90 days after total hip/knee arthroplasty, which suggests that prophylactic anticoagulation for 15-35 days after undergoing total hip arthroplasty or total knee arthroplasty reduces the incidence of postoperative VTE, and there is no significant difference in bleeding risk depending on the duration of anticoagulant prophylaxis.

Research Progress in Application of Patient-Reported Outcome Measures in Total Knee Arthroplasty / 中国医学科学院学报

To summarize the clinical application of patient-reported outcome measures (PROM) in total knee arthroplasty (TKA) and provide reference for the application of PROM in perioperative evaluation of the patients receiving TKA,we reviewed the recent studies about the application of PROM in TKA and analyzed the contents and application characteristics of the PROM.The common PROM in TKA,such as the Western Ontario and McMaster Universities Osteoarthritis Index,Oxford Knee Score,and Forgotten Joint Score,principally focus on patients' subjective feelings about pain,function and other aspects of their knees.However,they have diverse ranges of application and each of them has their own advantages and disadvantages.There is a variety of PROM applied in TKA,which makes it challenging to select the proper measurement for evaluation.The PROM in TKA remains to be improved for broader use.

Effect of Wrist-Ankle Acupuncture on Postoperative Analgesia after Total Knee Arthroplasty / 中国结合医学杂志

OBJECTIVE@#To evaluate the effect of wrist-ankle acupuncture (WAA) in pain and functional recovery after total knee arthroplasty (TKA).@*METHODS@#From June to September 2020, 94 participants were included from the Second Hospital of Tangshan and randomly assigned to the WAA group (47 cases) and the sham WAA group (47 cases) by a random number table, receiving real or sham WAA treatment, respectively. The primary outcome measure involved the visual analogue scale (VAS) scores at rest and in motion. The secondary outcomes involved the range of motion (ROM) of the knee joints, straight-leg raising time, postoperative weight-bearing time, sufentanil consumption within 48 h of patient-controlled analgesia (PCA) pump, length of hospital stay, and postoperative complications.@*RESULTS@#The VAS scores on the 3rd, 5th, and 7th postoperative days at rest and in motion was significantly lower in the WAA group than that of the sham WAA group (P<0.01). The ROM on the 1st, 2nd, and 3rd PODs was significantly higher in the WAA group than that of the sham WAA group (P<0.01). In comparison to the sham WAA group, the sufentanil consumption within 48 h of PCA pump was significantly less in the WAA group (156.3 ± 12.2 µg vs. 128.8 ± 9.8 µg, P<0.01). There was no significant difference in active straight-leg raising time, postoperative weight-bearing time, length of hospital stay, and postoperative complications between the two groups (P>0.05).@*CONCLUSIONS@#WAA could alleviate post-TKA pain, improve knee joint function, and reduce the sufentanil consumption within 48 h of PCA pump. WAA is a safe and effective treatment in the perioperative analgesic management for TKA.