Arthroscopic cartilage regeneration facilitating procedure can modify the clinical course of knee osteoarthritis.

BACKGROUND: The effectiveness of arthroscopic treatment for knee osteoarthritis (OA) has been controversial. This study compares the clinical outcomes of the arthroscopic cartilage regeneration facilitating procedure (ACRFP) and conservative treatment. METHODS: During the year of 2016, 524 patients (882 knees) who were older than 40 years of age and diagnosed with different stages of knee OA were scheduled for ACRFP under the protocol of knee health promotion option (KHPO) for knee OA. Of those, 259 patients (413 knees) eventually received ACRFP (the ACRFP group), and 265 patients (469 knees) didn't receive ACRFP but received conservative treatment (the non-ACRFP group). A telephone questionnaire was used to evaluate the subjective satisfaction and the incidence of receiving arthroplasty for these patients. RESULTS: After the mean follow-up period of 61.6 months (SD 4.5), there were 220 patients (374 knees, 90.6%) in the ACRFP group and 246 patients (431 knees, 90.0%) in the non-ACRFP group completed the outcome study. The satisfactory rate was statistically higher for the ACRFP group (90.64%) than for the non-ACRFP group (70.3%) and the difference in subjective satisfaction was more obvious in patients with more advanced knee OA. As for the incidence of patients having subsequently received arthroplasty, it was higher (13.46%) in the non-ACRFP group than in the ACRFP group (4.28%). CONCLUSION: Compared with conservative treatment, ACRFP could satisfy more patients with knee OA and modify their natural course by decreasing the incidence of subsequent arthroplasty.

Arthroscopic cartilage regeneration facilitating procedure: A decompressing arthroplasty for knee osteoarthritis.

The effectiveness of arthroscopic treatment for knee osteoarthritis (OA) has always been a subject of debate. This study presents an innovative concept for the arthroscopic management of knee OA and investigates its clinical outcomes. An arthroscopic cartilage regeneration facilitating procedure (ACRFP) was performed on 693 knees of 411 patients with knee OA, with a mean age of 60 years (34-90 years), to eliminate the medial abrasion phenomenon (MAP) and decompress the patellofemoral joints. The Knee Society Score (KSS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to determine the subjective outcome. Roentgenographic changes in all cases and magnetic resonance imaging (MRI) variations in 20 randomly selected cases were evaluated for objective outcomes. We evaluated 634 knees in 369 patients (93.7%) with more than 3 years of follow-up (mean, 40 months; SD, 9) and found that the overall subjective satisfaction rate was 91.1%. Scores for KSS and all KOOS subscales improved statistically. Reversal of cartilage degeneration was observed in 80.1% of the entire series (radiographic outcome study) and 72.2% of the 18 randomly selected cases (1-year MRI outcome study). We found significant association between gender and OA severity, with regards to the subjective outcomes. Age, body mass index, pre-operative hyaluronic acid injection, OA severity, and type and severity of the medial plica were found to be important predictors of radiographic outcomes. An analysis of failed cases reaffirmed the need for early ACRFP and skilled post-operative care. ACRFP is an effective treatment for knee OA. It can benefit most patients and modify their degeneration processes if performed in time. However, further investigations are needed to confirm our concept of treatment.

Medial abrasion syndrome: a neglected cause of persistent pain after knee arthroplasty.

INTRODUCTION: Persistent post-operative pain (PPOP) has detracted from some otherwise successful knee arthroplasties. This study investigated medial abrasion syndrome (MAS) as a cause of PPOP after knee arthroplasty. The surgical techniques and outcomes of incorporating this concept into the management of both primary arthroplasty cases and patients suffering from unknown causes of PPOP after arthroplasties were presented. MATERIALS AND METHODS: In a 1-year period, the author performed unicompartmental or total knee arthroplasty (the UKA or TKA group) that also eliminated medial abrasion phenomenon (MAP) on 196 knees of 150 patients at advanced stages of knee osteoarthritis (OA). During the same year, 16 knees of 16 patients with unknown causes of PPOP after knee arthroplasties were referred to the author for the arthroscopic medial release procedure (the AMR group) after being diagnosed as MAS. Subjective satisfaction, Knee Society Score (KSS), and Knee injury and Osteoarthritis Outcome Score (KOOS) evaluations were used for outcome study. RESULTS: All 166 patients were followed for more than 3 years (mean 3.7 years, 3.1-4.2) for the outcome study. All knees receiving arthroplasty showed medial plicae with MAP at the time of surgery. Only 2 of them suffered from PPOP: one was a neglected tibial plateau fracture with residual varus deformity after UKA, and the other was a late infection after TKA and received revision. The satisfactory rate was 98.8% in the UKA group, 99.1% in the TKA group, and 100% in the AMR group. The Knee Society Scores and all subscales of KOOS were statistically improved in all groups. CONCLUSIONS: MAS is a cause of pain in patients who have received knee arthroplasties, and MAP should be eliminated to ensure a successful knee arthroplasty. PPOP after knee arthroplasty can be caused by MAS, which can be managed by AMR.

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study.

BACKGROUND: With an increase in the elderly population, the occurrence of hip fractures, femoral neck fractures, and intertrochanteric fractures (ITFs) is also increasing. It is important to establish effective perioperative methods that would help reduce the morbidity and mortality rates associated with ITFs. The purpose of this study was to determine the effects of ITFs according to the AO classification for perioperative hemoglobin drop. METHODS: Seventy-six patients with ITFs classified as AO 31-A1 or A2 and fixated with intramedullary nails participated in this retrospective cohort study. Medical records of these patients were retrospectively reviewed from September 2016 to August 2018. The perioperative hemoglobin drop was chosen as the main outcome measure and calculated as the difference between pre- and postoperative hemoglobin levels. Multivariate linear regression analysis was performed and included the following variables: AO classification (A1.1-A2.1 [stable] vs. A2.2-A2.3 [unstable]), time interval between injury and surgery, age, body mass index, and the use of anticoagulants. RESULTS: Among the 76 patients who met the inclusion criteria, a significantly higher hemoglobin drop was observed in the AO 31 A2.2-A2.3 (unstable) group than in the AO 31 A1.1-A2.1 (stable) group (p = 0.04). The multivariate analysis also showed a greater hemoglobin drop in the unstable group (p < 0.05). CONCLUSIONS: Patients with unstable ITFs exhibited a greater hemoglobin drop and a hidden blood loss was suspected around the fracture site. We believe that this should be taken into consideration when presurgical blood transfusion is being planned for patients with unstable ITFs, to reduce associated postoperative complications, especially in patients with severe anemia or high risk of mortality.