Objective To explore the technique of the soft tissue balancing inthe total knee arthroplasty (TKA) for the patients with the knees of varus deformity and flexion contracture. Methods From January 2001 to December 2005, 86 patients (19 males, 67 females; age, 57-78 years;average, 66 years) with the knees of varus deformity and flexion contracture underwent primary TKA and the balancing of the soft tissues. All the patients had suffered from osteoarthritis. The unibilateral affection was found in 68 patients and the bilateral affection in 18. The varus deformity angle was averaged 12.3° (range, 6-34°). The soft tissue varus accounted for 56.7% and the bony varus accounted for 43.3%. The flexion contracture lt; 10° was found in 21 knees, 10-19° in 45 knees, 20-29° in 22 knees, and gt;30° in 16 knees, with an average angle of 18.9°. Results The flexion contractures were improved. Before operation the average angle ofthe flexion contracture was 18.9° but after operation only 4 patients had a residual flexion contracture of 5° and the remaining patients had a complete correction. The follow-up for 37 months (range, 6-72 months) in all the patients revealed that only 6 patients had a residual flexion contracture of 5-10° and the others had a full extension. Before operation the average varus angle was 12.3°(range, 6-34°) and the average tibiofemoral angle was 174.7° (range, 70.3-175.6°), but after operation the residual varus angle gt; 3° was only found in 2 patients. The complications occurring during operation and after operation were found in 6 patients, injuries to the attachment of the medial collateral ligaments in 2, patellar clunk syndromes in 2, cerebral embolism in 1, and lacunar infarction in 1, with no nerve disorders left after the medical treatment. No skin necrosis, the cut edge infection or deep infection occurred. Conclusion The balancing of the soft tissues is a major management for correction of the varus deformity and the flexion contracture. The proper balancing of the softtissues can achieve an obvious recovery of the function and correction of the varus deformity after TKA.
Objective To investigate a modified robotized hydraulictensor for management of the ligament balance in the total knee arthroplasty. Methods The effect of the modified robotized hydraulic tensor on the mechanical behaviour of the ligament system balance in the total knee arthroplasty was analyzed andthe related information was obtained. Results The robotized hydraulic tensor acted as a tensorsensor system, which could assist the surgeon by providing thequantitative information to align the lower limb in extension, equalize the articular spaces in extension and flexion, balance the internal and external forces, and define the femoral component rotation, and by providing the information toplan the releasing of the soft tissues and the rotating of the femoral component. Conclusion The modified robotized hydraulic tensor can enable the surgeon to properly manage the ligament balance in the total knee arthroplasty.
Objective To make a retrospective analysis on an early clinical outcome of total knee arthroplasty (TKA) for the knees with different degrees of flexion-contracture deformities. Methods Ninety-seven knees of 65 patients undergoing total knee arthroplasty with the Scorpio posterior-stabilized knee prosthesis from January 2000 to December 2003 were reviewed, including 51 osteoarthritis patients (74 knees) and 14 rheumatoid arthritis patients (23 knees). Thirtythree patients underwent unilateral TKA, and 32 patients underwent bilateral TKA. The average range of motion (ROM) before operation was 82.8°(range, 5-140°).According to the preoperative flexion-contracture degrees of the knees, these patients were divided into 2 groups, group A and group B. Group A consisted of the patients with flexioncontracture less than 20° (range, 0-15°), and group B consisted of the patients with flexion-contracture not less than 20° (range, 20-60°). In group A, the average flexion-contracture degree, ROM, KSS (knee society score), and function score were 10.7±8.0°, 104.6±20.0°, 29.1±18.0, and 32.6±20.7, respectively. But the corresponding data were much worse ingroup B than in group A, which were 28.2±7.8°, 60.8±26.6°, 12.1±13.2, and 26.8±18.1. All the operations were primary total knee arthroplasty, and they were performed by the same group of surgeons. The time for the prosthesis installed lasted for 25.6 minutes, and the average tourniquet time was 34.7 minutes. Three or four days after operation, the patients began the continuous passive motion (CPM) and active functional exercise of the knee.Results The patients were followed up for an average of 2 years and 7 months(range, 8 mon-3.5 yr). During the follow-up period, the average flexion-contracture degree, ROM, KSS, and function score in group A were 0.4±2.1°, 108.6±19.0°, 82.1±13.8, and 72.3±29.1, respectively; and the corresponding data in group B were 1.3±3.2°, 986±16.4°, 75.9±8.2, and 81.4±26.9, respectively. There was no significant difference between the 2 groups. No revision or deep infection was found. Conclusion The curative effect is mainly determined by the surgeon’s good operational skills, rich clinical experience, and familiarity with the prosthesis, and it is not influenced by severity of the knee flexioncontracture deformity. The knee ROM after TKA, which has a “toward middle ROM”phenomenon, is influenced by many clinical factors. It is very important for the patientto perform a functional exercise of the knee as early as possible after operation.
Objective To analyze the relationship between the collateral ligament attachment and the epicondylar axis with rotational alignment of the femoral component in the total knee arthroplasty(TKA).Methods Twenty normal cadaver knee joints were anatomized and 2 holes were drilled on the distal femur from the deep and superficial insertions of the medial collateral ligaments to the lateral condylar part, respectively. Then, all the knees were scanned by MRI on the sagittal plane, making the drilled hole located relatively to the posterior condylar joint surface on the axial plane, and the posterior condylar angle (PCA) and thecondylar twist angle (CTA) were measured.Results The colateral ligament had the deep and superficial parts, and the deep part was strained during the knee flexing. PCA and CTA were 4.50±1.26° and 7.10±0.30° respectively, and there was a significant difference between them(P＜0.05), which were significantly greater than those reported abroad. On the sagittal plane, there wasno significant difference between the radiuses of the posterior medial and lateral condylar circles (Pgt;0.05). The distance from the center of the posterior condylar circle to the deep insertion of the medial collateral ligament (MCL) (d1) was 4.22±0.20 mm, and the distance to the superficial insertionof MCL (d2) was 7.36±0.13 mm. The difference between d1 and d2 was significant(Plt;0.05). Conclusion The center of the posterior condylar circle passes from the deep insertion of the collateral ligament, which can be regarded as a fixed flexionextension axis of the knee. By releasing the different parts of the collateral ligaments, the balance of the flexion and extension gap canbe obtained, and then varus, valgus or flexed contracture deformity of the kneecan be realigned. Besides, the rotational orientation of the femoral prothesis can be made by a reference to the epicondylar insertion of the collateral ligament.
Objective To analyze the effect of the posterior cruciate ligament (PCL) retaining or not on knee-joint proprioception by comparing the proprioceptive difference between PCL retaining and no PCL retaining in total knee arthroplasty (TKA). Methods Between June 2009 and June 2010, 38 osteoarthritis patients meeting the inclusion criteria were divided into PCL retaining group (group A, n=19) and PCL-substituting group (group B, n=19) according to the random number table. There was no significant difference in gender, age, disease duration, the range of motion of the knee between 2 groups (P gt; 0.05). The effectiveness and the knee-joint proprioception were separately assessed by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score and the passive angle reproduction test (30, 60, and 90° of knee flexion) preoperatively and 12 months postoperatively. Results All incisons healed by first intention, without complications of infection, fracture, and deep vein thrombosis of lower limb. The patients were followed up 12-17 months (mean, 14.1 months). The knee function after operation was obviously improved when compared with preoperative one; significant differences were observed in the WOMAC scores and the results of passive angle reproduction test between at preoperation and at 12 months after operation (P lt; 0.05), but no significant difference was found between group A and group B (P gt; 0.05). Conclusion Whether PCL retaining or not in TKA both can improve knee-joint proprioception, and no obvious difference between them.
Objective To analyze the effect of arteriovenous impulse system (AVIS) combined with lowmolecular-weight heparins calcium (LMWHC) for prophylaxis of deep vein thrombosis (DVT) following total knee arthroplasty (TKA). Methods From March 2006 to March 2008, 76 cases of osteoarthritis patients (76 knees) accepted TKA, including 25 males and 51 females with an average age of 66.6 years (range, 58-79 years). The affected knees were left side in 41 cases and right side in 35 cases. They were randomly divided into experimental group and control group before surgery. Then LMWHC and rehabil itation training were routinely given in two groups before and after surgery. However, only experimental group was treated with AVIS continually during the first four days and then two times a day for 30 minutes one time during 5-7 days. At 7 daysd after operation, color Doppler ultrasound was used to detect the occurrence condition of DVT. Results Five cases (13.16%) had thrombosis of calf and recovered after treated with urokinase and salvia in the experimental group. Eleven cases had thrombosis of calf and 3 cases had thrombosis of whole low extremities (36.84%), and improved after treated with urokinase and salvia in the control group. There was significant difference in DVT incidencerate between two groups (P lt; 0.05). No pulmonary embol ism or death was found in both groups. Conclusion AVIScan effectively accelerate the venous blood return velocity, a combination of AVIS and LMWHC has a better effect in theprevention of DVT following TKA.
Objective To develop and validate a nomogram prediction model of early knee function improvement after total knee arthroplasty (TKA). Methods One hundred and sixty-eight patients who underwent TKA at Sichuan Province Orthopedic Hospital between January 2018 and February 2021 were prospectively selected to collect factors that might influence the improvement of knee function in the early postoperative period after TKA, and the improvement of knee function was assessed using the Knee Score Scale of the Hospital for Special Surgery (HSS) at 6 months postoperatively. The patients were divided into two groups according to the postoperative knee function improvement. The preoperative, intraoperative and postoperative factors were compared between the two groups; multiple logistic regression was performed after the potential factors screened by LASSO regression; then, a nomogram predictive model was established by R 4.1.3 language and was validated internally. Results All patients were followed up at 6 months postoperatively, and the mean HSS score of the patients increased from 55.19±8.92 preoperatively to 89.27±6.18 at 6 months postoperatively (t=−40.706, P<0.001). LASSO regression screened eight influencing factors as potential factors, with which the results of multiple logistic regression analysis showed that preoperative body mass index, etiology, preoperative joint mobility, preoperative HSS scores, postoperative lower limb force line, and postoperative analgesia were independent influencing factors for the improvement of knee function in the early postoperative period after TKA (P<0.05). A nomogram model was established based on the multiple logistic regression results, and the calibration curve showed that the prediction curve basically fitted the standard curve; the receiver operating characteristic curve showed that the area under the curve of the nomogram model for the prediction of suboptimal knee function in the early postoperative period after TKA was 0.894 [95% confidence interval (0.825, 0.963)]. Conclusions There is a significant improvement in knee function in patients after TKA, and the improvement of knee function in the early postoperative period after TKA is influenced by preoperative body mass index, etiology, and preoperative joint mobility, etc. The nomogram model established accordingly can be used to predict the improvement of knee function in the early postoperative period after TKA with a high degree of differentiation and accuracy.
Objective To compare the effectiveness of the traditional center of tibial plateau as the entry point and digital technology in the design of intramedullary tibial nail point positioning method in total knee arthroplasty (TKA). Methods Between October 2011 and October 2012, 60 cases undergoing unilateral TKA and meeting the selection criteria were randomly divided into 2 groups: in group A (30 cases), the tibial plateau center as the entry point of tibial intramedullary positioning was used; in group B (30 cases), Mimics 10.01 software to simulate the guide rod point of tibial intramedullary positioning was used. There was no significant difference in gender, age, etiology, disease duration, sides, and preoperative knee range of motion, Hospital for Special Surgery (HSS) score, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) between 2 groups (P gt; 0.05). Postoperative X-ray films were taken to measure the tibiofemoral angle and tibial angle; knee range of motion, and HSS and WOMAC scores were used to assess the activity of knee. Results The entry point of group B was located in front of the center of tibial plateau, which was inconsistent with the traditional entry point. The incision healed by first intention in all patients of 2 groups. The patients were followed up 6 to 12 months (mean, 8.6 months). The X-ray measurement at 1 week after operation showed no significant difference in tibiofemoral angle between 2 groups (t= — 6.65, P=0.72), but the anteroposterior and lateral tibial angles of group A were significantly lower than those of group B (P lt; 0.05). The knee range of motion, HSS score, and WOMAC score of 2 groups were significantly higher at 3 and 6 months after operation when compared with preoperative values (P lt; 0.05), and the values at 6 months were significantly increased than those at 3 months after operation (P lt; 0.05). HSS score and WOMAC score had no significant difference between 2 groups at 3 months after operation (P gt; 0.05), but the scores of group B were significantly higher than those of group A at 6 months (P lt; 0.05). The knee range of motion of group B was significantly better than that of group A at 3 months after operation (t=2.13, P=0.04), but no significant difference was found between 2 groups at 6 months (t=0.58, P=0.56). Conclusion Compared with the traditional intramedullary guide rod insertion point positioning, digital individualized design of entry point positioning has the advantages of more accurate lower limb force line, better recovery of knee function, and earlier 90°activities, but the long-term effectiveness needs further observation.
Objective To review the advance in the researchand clinical application of the tibial rotational alignment technique in the total knee arthroplasty in China and abroad. Methods The recent literature concerned with the tibial rotational alignment technique in the totalknee arthroplasty was extensively reviewed and briefly summarized. Results According to the literature reviewed, the traditional tibial rotational references for the total knee arthroplasty were affected by many factors, so that the references were not accurate enough. There have been no unified references.ConclusionChoosing the range from the medial border of the tibial tubercle to the medial 1/3 of the tibial tubercle, decided by the degrees of the varus deformities and the valgus deformities, to determine the rotaional alignment of the tibial component will create an optimal tibiofemoral rotational alignment.
Objective To explore the risk factors associated with interleukin 6 (IL-6) level in serum after total knee arthroplasty (TKA). Methods A retrospective study was made on the clinical data of 273 patients underwent primary unilateral TKA between July 2015 and April 2017. There were 50 males and 223 females with an average age of 66.3 years (range, 36-89 years), and the body mass index (BMI) was (25.5±3.7) kg/m2. Of them, 256 patients suffered with osteoarthritis, and the other 17 patients with rheumatoid arthritis. Univariate analysis was made to find the related factors between IL-6 level in serum at 1 day after operation and preoperative data including gender, age, BMI, diagnosis, comorbidities, preoperative American Society of Anesthesiologists (ASA) grade, preoperative varus or valgus deformity, range of motion of the knee, preoperative level of C-reactive protein (CRP) and IL-6 in serum, operation time, intraoperative blood loss, usage of drainage tube and catheter, and dosage of tranexamic acid and dexamethasone used on day of operation. Furthermore, the multiple linear regression analysis was performed to identify the risk factors. Results The operation time was (79.7±15.6) minutes, and the intraoperative blood loss was (107.8±25.3) mL. Drainage tubes were used in 111 patients and catheters were used in 41 patients after operation. The dosage of tranexamic acid and dexamethasone used on day of operation were (3.2±0.8) g and (15.1±6.6) mg, respectively. The levels of IL-6 in serum were (4.48±3.05), (42.65±37.09), and (28.21±26.44) pg/mL before operation and at 1 and 3 days after operation, respectively. Univariate analysis showed that the level of IL-6 in serum at 1 day after operation was significantly higher in variables as follows: age, diagnosis, history of lung infection, range of motion, preoperative levels of CRP and IL-6 in serum, intravenous dosage of tranexamic acid and dexamethasone on day of operation (P<0.05). Multiple linear regression analysis showed that range of motion less than 90°, intravenous dosage of tranexamic acid on day of operation less than 3 g, and dosage of dexamethasone on day of operation less than 10 mg were significant risk factors (P<0.05). Conclusion Range of motion less than 90°, intravenous dosage of tranexamic acid on day of operation less than 3 g, and dosage of dexamethasone on day of operation less than 10 mg were independent risk factors that resulted in increased level of IL-6 in serum at 1 day after TKA.