How to choose kinematic or mechanical alignment individually according to preoperative characteristics of patients?

BACKGROUND: Making decisions in alignment techniques in total knee arthroplasty (TKA) remains controversial. This study aims to identify the potential patients who were suitable for the kinematic (KA) or mechanical alignment (MA). METHODS: We reviewed 296 consecutive patients (296 TKAs, including 114 KA-TKAs and 182 MA-TKAs) who underwent unilateral TKA using a computer-assisted navigation from 2016 to 2018 in our prospectively maintained database. The minimum followup was 1 year. Clinical outcomes including the range of motion (ROM) and knee society score (KSS) were compared between KA-TKAs and MA-TKAs. Multiple regression models were used to evaluate the relationship between alignment techniques and KSS at the 1-year followup. Interaction and stratified analyses were conducted according to gender, age, body mass index (BMI), preoperative hip-knee-ankle (HKA) angle, ROM and KSS. RESULTS: ROM and KSS at the 1-year followup didn't differ between MA-TKAs and KA-TKAs (all p > 0.05). Alignment techniques did not associate with postoperative ROM (Adjusted ß = 0.4, 95% confidence interval [CI]: - 0.3, 1.6; p = 0.752) or 1-year KSS (Adjusted ß = 2.2, 95%CI: - 0.7, 5.6; p = 0.107). Patients with a BMI more than 30 kg/m^2 achieved better 1-year KSS when using MA than KA (p for interaction< 0.05). Additionally, patients with preoperative HKA angle more than 10 degrees varus benefited more from KA than MA (p for interaction< 0.05). CONCLUSIONS: Patients with severe varus deformity may be suitable for the KA technique, whereas MA should be used in obese patients.

[Clinical observations of negative pressure wound therapy and basic fibroblast growth factor in the treatment of intractable pressure ulcer].

OBJECTIVE: To observe the clinical efficacies and costs of negative pressure wound therapy (NPWT) and basic fibroblast growth factor (bFGF) in the treatment of stage III or IV pressure ulcer (PU). METHODS: From July 2008 to December 2011, 48 patients fulfilling the study inclusion or exclusion criteria at Weihai Municipal Hospital were divided randomly into experiment and control groups (n=24 each). On the basis of routine treatment and NPWT of each inpatient, the patients in the experiment group were treated with bFGF. The changes of healing rate of PU were measured at Days 7 and 14 post-treatment in each group. Meanwhile, the granulation duration, preoperative time and total preoperative cost were compared. RESULTS: The granulation duration, healing rate of Days 7 and 14, preoperative time and total preoperative cost in the experiment group was (10.8±2.7) days, 10.1%±2.9%, 22.3%±3.1%, (18.2±2.6) days and (7946±245) yuan RMB versus (16.3±3.9) days, 6.9%±1.9%, 13.4%±2.8%, (27.1±3.3) days and (10,951±285) yuan RMB in the control group respectively. The differences between two groups were statistically significant (all P<0.01). CONCLUSION: As a preoperative therapeutic modality of intractable PU, NPWT and bFGF offer better therapeutic efficacies and lower therapeutic costs as compared with NPWT alone.