ABSTRACT
INTRODUCTION: Knee flexion angle (KFA) is one of the most critical factors for evaluating patient functional outcomes after total knee arthroplasty (TKA). Preoperative KFA and intraoperative drop leg test are both accepted as predictors of postoperative KFA after TKA. Preoperative testing performed after anesthesia helps overcome pain-related limitations; however, the KFA measurement timepoint that best predicts KFA at 6 months after TKA has not yet been established. METHODS: This prospective cohort study recruited patients who underwent unilateral primary TKA at Siriraj Hospital (Bangkok, Thailand) during August 2012 to August 2017. We recorded KFA at the pre-anesthetic phase, post-anesthetic phase, intraoperation using drop leg test, and at 6-months post-operation. Pearson's correlation coefficient was used to evaluate correlation between different measurement timepoints and 6 months after surgery. Those same relationships were evaluated for overall patients, and for patients with KFA <90° (poor KFA), 90-120° (average KFA), and >120° (high KFA). RESULTS: A total of 165 patients with a mean age of 68.7 years were recruited. Pre-anesthetic KFA measurement had the highest positive correlation with the 6-month KFA (r = 0.771, p<0.05). Post-anesthetic measurement and intraoperative drop leg KFA measurement had moderate positive correlation (r = 0.561, p<0.05) and low positive correlation (r = 0.368, p<0.05) with the 6-month KFA, respectively. The average KFA group had the highest positive correlation between pre-anesthetic KFA measurement and the 6-month KFA (r = 0.711, p<0.05). Predicted 6-month KFA (degrees) adjusted for pre-anesthetic KFA is 45.378 + [0.596 x pre-anesthetic KFA (degrees)] (r = 0.67, p <0.05). CONCLUSIONS: Pre-anesthetic KFA demonstrated the highest correlation with the final KFA at six months after unilateral primary TKA, especially in the patients who had a preoperative KFA within 90-120°.
Subject(s)
Anesthetics , Arthroplasty, Replacement, Knee , Osteoarthritis, Knee , Humans , Aged , Knee Joint/surgery , Prospective Studies , Thailand , Range of Motion, ArticularABSTRACT
BACKGROUND: Osteonecrosis of the femoral head is a deficiency of blood supply resulting in femoral head collapse and joint destruction. This usually found in young adults as the leading cause of hip arthroplasty. Core decompression has been reported to reduce the bone marrow pressure for treatment of stage I and II of disease. Later, addition of concentrated bone marrow injection was proposed and reported good result. The purpose of the present study was to report the result of core decompression and concentrated bone marrow injection. MATERIAL AND METHOD: Twelve patients with osteonecrosis of femoral head underwent a core decompression and concentrated autologous bone marrow injection. Data of age, sex, underlying disease, risk of osteonecrosis were collected. Patients were followed at 3 months, 6 months, 1 year and then yearly. Radiographic data were recorded. RESULTS: Thirteen hips in 12 patients underwent the procedure. Two cases were excluded due to loss of follow-up. Mean age was 36.2 (12-56). One hip were in stage I, five in stage II and five in stage III. Risk factor included steroid usage in 6 hips and alcohol consumption in 3 hips. Underlying diseases were SLE (5), dermatitis (1), post-traumatic (1). Average nucleated cell from marrow was 91.58 x 10(6)/ml (+/- 55.9). CD34 was 17.25 x 10(6)/ml cells and percentage of recovery of mononuclear cell was 70.4%. Mean follow-up time was 3.6 years (range 1-7 years). All cases had good pain relief initially. At the last followup 8 hips (72%) had progression and 2 underwent surgery. No infection occurred. No adverse effect detected. CONCLUSION: This report showed low success rate of core decompression with concentrated autologous bone marrow grafting. The effect of delayed progression is not clear. However, the procedure appeared to be safe without immediate complication.
