Effects of integrated orthopedic rehabilitation pathway on motor function after total knee arthroplasty / 中国康复理论与实践

@#Objective To study the effects of integrated orthopedic rehabilitation pathway on motor function in six months after total knee arthroplasty (TKA), including pain, stiffness, range of motion and muscle strength, etc. Methods From March, 2016 to March, 2019, 180 patients who underwent TKA and treated with integrated orthopedic rehabilitation pathway were enrolled. Age, gender, operation time, time of follow-up, the scores of Hospital for Special Surgery-Knee Scale (HSS-KS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) at preoperative/postoperative/one-month after operation/three-month after operation/six-month after operation time points were collected. The sub items, such as muscle strength, range of motion, flexion deformity, pain, stiffness, functional difficulty were primarily focused on. Results A total of 42 patients were followed up for three months and 22 patients were followed up for six months. There was no significant difference in the scores of HSS-KS and WOMAC before and after operation (P > 0.05). Within three months after operation, the HSS-KS scores gradually increased (P < 0.05) and the WOMAC scores gradually decreased (P < 0.05). The active knee flexion range of motion and knee extensor muscle strength scores of HSS-KS significantly decreased after operation (P < 0.05), and gradually recovered one month and three months after operation (P < 0.05). The flexion deformity scores of HSS-KS increased after operation (P < 0.05), decreased one month after operation (P < 0.05), and got a trend of incensement again three months after operation. The pain score of WOMAC decreased continuously within three months after operation (P < 0.05); the stiffness score of WOMAC did not change after operation (P > 0.05), decreased significantly one month after operation (P < 0.05), and did not change three months after operation (P > 0.05). The degree of functional difficulty of WOMAC decreased after operation (P < 0.05), and improved continuously within six months after operation (P < 0.05). Conclusion The overall function after TKA shows a trend of improvement within three months, and there is no obvious improvement from three to six months after operation. The flexion deformity score showed a downward trend in one month after operation, and it could be improved again after strengthening rehabilitation, which needs more attention in the postoperative rehabilitation.

Post-operative Hypertension following Correction of Flexion Deformity of the Knees in a Spastic Diplegic Child: A Case Report

An adolescent boy with spastic diplegic cerebral palsy presented with crouch gait. He had bilateral severe flexion deformities of knees and hips. He was treated with single event multilevel surgery for the correction of deformities. Surgical procedures included bilateral adductor release, iliopsoas lengthening, bilateral femoral shortening and patella plication. Persistent hypertension was noted in the post-operative period. All causes of secondary hypertension were ruled out. Having persistent hypertension following the femoral shortening procedure is unusual. Antihypertensive medication controlled his blood pressure 15 months after surgery. Hypertension following correction of knee flexion deformity and limb lengthening is well known. Hypertension has not been described with the shortening osteotomy of the femur. Hypertension is a rare complication following the corrective surgery for the treatment of crouch gait. Blood pressure should be monitored during the post-operative period to detect such a rare complication.

Efficacy analysis of total knee arthroplasty for severe genu varus combined with flexion deformity / 临床外科杂志

Objective To analyze the curative effects of total knee arthroplasty(TKA)for severe genu varus combined with flexion deformity.Methods The clinical data of 25 patients(36 knees),who had undergone TKA for severe genu varus combined with flexion deformity from January 2005 to October 2010,were retrospectively analyzed.There were 7 males and 18 females,aged from 55 to 80 years(average 70.5 years).The primary diseases were osteoarthritis in 22 cases and rheumatoid arthritis in 3 cases.HSS knee score was used before and after the operation to assess the efficacy of the TKA.Results All of the patients were followed up for 4 to 9 years(average 6 years).The degree of flexion deformity was reduced from (21 ±63)°to(1.1 ±2.3)°;the degree of the varus decreased from(210 ±4.8)°to(175.6 ±2.1)°;range of motion of the knee joint increased from(70.5 ±20.5)°to(115.1 ±5.3)°;knee score augmen-ted from(33.2 ±10.5)to(90.7 ±8.5);function score added from(35.5 ±14.2)to(85.6 ±10.5);there were 21 cases(8 knees)rated as excellent,2(3 knees)as good and 2(3 knees)as fair,and the excel-lent and good rate was 86%.Most of the patients had normal force line of the knee joint,but 2 patients re-mained varus deformity of 5°~10°.Conclusion Satisfying outcome can be achieved by TKA in treating severe genu varus combined with flexion deformity of the knee.

Effect of Meridian-thumbing Therapy on Flexion Deformity on Knees of Children with Cerebral Palsy / 中国康复理论与实践

@#Objective To observe the effect of meridian-thumbing therapy on flexion deformity on knees of children with cerebral palsy(CP).Methods The therapy of thumbing the points from Chengfu to Chengshan of the meridian of Foot Taiyang Bladder was used for 40 CP children with flexion deformity on knees.Results After three months treatment,the positive flexion of knee joint in 40 children improved significantly than before(P<0.001).Conclusion The therapy of meridian-thumbing has obvious effect on flexion deformity on knees of CP children.

Treatment of post-traumatic elbow joint flexion contracture by elbow joint distraction arthroplasty / 中国矫形外科杂志

[Objective]To explore the method and effect of elbow joint distraction arthroplasty in the treatment of post-traumatic elbow joint flexion contracture.[Method]An Ilizarov ring distractor of elbow joint was designed.From March 2003 to July 2005,three cases of elbow joint flexion contracture aged 16～17 years (one male and two females) with a flexion deformity of 70? in one case and 45? in two cases were treated.The joint distractor was applied with the wires in the upper limb and the joint hinge at the rotational centre of the elbow joint.No skin incision was made.To correct the deformity gradually,a continuous distraction force was applied by turning the nut on the distraction bar and periodic X-ray films were taken to confirm the position of the elbow joint.[Result]The elbow joint was finally extended to 0?～10?with an average 45?correction of flexion after an average 32 days of distraction.The range of elbow joint movement increased from pre-operative 75?to post-operative 115?.[Conclusion]The elbow joint distraction arthroplasty is effective in the correcting of the elbow joint flexion contracture and improving of joint function.

Treatment of flexion deformity of the knee joint in adult patients with supracondylar femoral osteotomy and internal fixation / 中国矫形外科杂志

[Objective] To investigate the results and to evaluate the validity of the supracondylar femoral osteotomy and internal fixation for treatment of flexion deformity of the knee joint in adult polio patients.[Methods]From April 2002 to August 2008,141 knees in 127 cases with flexion deformity of knee from poliomyelitis were treated with supracondylar femoral extension osteotomy and internal fixation.They were 14~45 years old with an average of 18.3.Of them,62 knees in 56 cases were male,79 knees in 71 cases were female.Eighty-three cases needed pressing knee on walking.Thirty-five cases walked with a crutch and 9 cases walked with two crutches.It should be treated with soft tissue release and skeletal traction before osteotomy in severe flexion deformity(over 40 degrees).All cases took weight-bearing X-ray films of lower extremities before and after operation.Angle of knee flexion,operative complications,bone healing and final function were recorded.Patients can undertake continuous passive flexion and extension motion from the 2nd day postoperatively.The knee operated was put in 10~20? flexion after operation and extended to full extension gradually in 2 weeks.[Results]All patients felt comfortable after operation and no neurovscular complications and infection happened.Follow-up time was 12-72 months with an average of 18 months.Solid bone union showed in all femoral cutting ends.No mal-union,non-union and implant failure happened.All flexion deformities of knees were corrected.The angle of flexion contracture of knee was from 36.4?(18?～61?)preoperatively to 2.8?(-5?～8?)postoperatively.The amount of correction was 18?to 56?with an average of 32.9?.One hundred and eight patients can walk stably by hinself or with brace,19 cases still need some help for walking(pressing knee in 6 case,one crutch in 10 cases and two crutches in 3 cases)at last follow-up.No ankylosis of knee joint or peroneal nerve paralysis occurred.All cases were satisfying with their range of motion of knee.[Conclusion]Supracondylar femoral osteotomy and rigid internal fixation and early rehabilitation exercise is a safe and effective strategy for the adult flexion deformity of knee joint.

Clinical analysis no curative effect of synthetic surgical therapy treated severe flexion deformity knees / 中国矫形外科杂志

[Objective] To explore the curative effect of synthetic surgical therapy on severe flexion deformity knees.[Methods]There were 22 patients(35 knees)with flexion deformity knees who were treated by synthetic surgical therapy during March 1999 to February 2008.Evaluation with HSS scoring system at preoperative and postoperative period were made.[Results]All patients were followed up.The mean followed-up time was 3.1 years(range 13 months to 7 years).The mean HSS score of knee joint was 23.5 points at preoperative period(range-6 to 35)and it was 79.8 points at postoperative period(range 62~91).The result showed statistical significance(P

Surgical Treatment for the Knee Flexion Deformity in Spastic Cerebral Palsy / 대한정형외과학회잡지

Equinus deformity of ankle, adduction and flexion deformity of hip and flexion contracture of knee are most common deformities in spastic cerebral palsy. There were many surgical treatment methods according to its causes. Authors has analysed 115 patients(224 operation) who had been operated with three procedure (Modified Egger's op, Proximal hamstring elongation, Distal hamstring elongation) and compared the results of these procedure at Sam Yook Rehabilitation Center from Jan. 1980 to Dec. 1987. The following results are obtained: 1. The results of Modified Egger's operation were unsatisfied because of complicaLion and little angle correction ability of flexion contracture of knee joint. 2. Even though there was no differences in angle correction ability of flexion contracture of knee joint between two procedures, the results of proximal hamstring elongation were superior to them of distal elongtion because early walking ability is more easily improved.

The Treatment Selection of Knee Flexion Deformity after Poliomyelitis / 昆明医科大学学报

The 98 cases of knee flexion deformity after poliomyelitis were treated in our department. The treatment selection for diffrent degrees of the flexion deformity are discussed. The flexion less that 20? need plaster cast only. The flexion from 20? to 30? can fully correct with su pracondylar femoral osteotomy. In the flexion more that 30?, the skele(?)al traction into inferior tibia should be done previously, then supracondylar femoral osteotomy carried out to correct the flexion less that 30? siter traction. It is pointed out that the muscle balance operation must be done as soon as the flexion was corrected. The muscle balance operation can prevent from recurrence of the deformity and (?)limilate the factor recurrent.