Objective To investigate the effect of lateral retinacular release on the clinical outcomes after total knee arthroplasty (TKA) without resurfacing of the patella. Methods A prospective randomized controlled study was performed on 132 patients with unilateral degenerative knee arthritis undergoing TKA bewteen October 2012 and October 2014, who met the selection criteria. During TKA, lateral retinacular release was used in 66 cases (trial group) and was not used in 66 cases (control group). Two patients were excluded from the study due to missing the follow-up in trial group. Four patients were excluded from the study due to lateral retinacular release in control group. Finally, 64 patients and 62 patients were included in the trial group and in the control group. There was no significant difference in gender, age, body mass index, side, disease duration, preoperative patellar morphology, grading of patellofemoral arthritis, grade of patellar cartilage degeneration, patellar malposition, patellar maltracking, patellar score, and Knee Society Score (KSS) between 2 groups (P>0.05). The operation time, postoperative drainage volume, hospitalization time, postoperative complications, and patient satisfaction were recorded. Postoperative anterior knee pain was assessed by visual analogue scale (VAS), and the knee joint function was evaluated by KSS score and patellar score. The femoral angle, tibial angle, femoral flexion angle, and tibial posterior slope angle were measured on the X-ray film for postoperative prosthetic alignment. The postoperative patellar tracking and patellar position, as well as the presence of osteolysis, prosthesis loosening, patellar fracture and patellar necrosis were observed. Results All patients were followed up for 24 months. There was no significant difference in operation time, postoperative drainage volume, hospitalization time, and patient satisfaction between 2 groups (P>0.05). The incidence of anterior knee pain in the trial group was better than that in the control group (P=0.033). KSS score and patellar score were significantly improved in both groups at 24 months after operation when compared with preoperative scores (P<0.05), but no significant difference was found between 2 groups (P>0.05). Complications included hematoma (2 cases in the trial group, and 1 case in the control group), mild wound dehiscence (2 cases in each group respectively), skin-edge necrosis (1 case in the trial group), and superficial wound infection (1 case in each group respectively), which were cured by conservative treatment. No patellar necrosis, patella fracture, or knee lateral pain occurred in 2 groups. There was no significant difference in complication rate between groups (P=0.392). Satisfactory implant alignment was observed in both groups during follow-up. There was no significant difference in femoral angle, tibial angle, femoral flexion angle, and tibial posterior slope angle between 2 groups (P>0.05). No radiolucent line at the bone-implant interface was seen around the tibial components and femoral components in both groups. The patellar maltracking was observed in 3 patients of the trial group and 5 patients of the control group, showing no significant difference (P=0.488). However, the incidence of patellar malposition in the trial group (18.8%) was significantly lower than that in the control group (35.5%) (χ2=0.173,P=0.034). Conclusion Lateral retinacular release during primary TKA without resurfacing of the patella can reduce postoperative knee pain without increasing complications.
ObjectiveTo evaluate the early effectiveness of one-stage total knee arthroplasty (TKA) with tibial stem extender for knee arthritis complicated with tibial stress fractures. MethodsBetween January 2014 and November 2016, 12 patients (12 knees) with knee arthritis and tibial stress fractures underwent one-stage TKA with tibial stem extender. There were 5 males and 7 females with an average age of 71.5 years (range, 60-77 years). There were 8 cases with osteoarthritis and 4 cases with rheumatoid arthritis. The radiographic examination showed the 6 cases of intra-articular fractures and 6 of extra-articular fractures (including transverse fractures in 4 cases and short oblique fractures in 2 cases); 2 cases complicated with middle and upper fibular fractures; 12 cases of varus deformities. Preoperative Knee Society Score (KSS) clinical score was 31.5±8.4 and functional score was 33.3±9.0. The preoperative range of motion (ROM) of the knee was (65.6±9.6)°. ResultsAll incisions healed primarily and no wound infection or skin necrosis occurred. All patients were followed up 36.5 months on average (range, 6-52 months). X-ray films showed that all fractures healed at 3-7 months (mean, 4 months); the position of the prosthesis was good, and no loosening or signs of infection occurred. At last follow-up, the KSS clinical score was 90.5±8.9 and functional score was 92.1±7.8; the ROM of the knee was (115.0±9.8)°. All indexes were significantly improved than those before operation (t=40.340, P=0.000; t=32.120, P= 0.000; t=8.728, P=0.000). ConclusionOne-stage TKA with tibial stem extender for patients with knee arthritis and tibial stress fractures can restore limb alignment, facilitate fracture healing, and obtain the satisfactory early effectiveness.
ObjectiveTo investigate the clinical effect of combined air pressure wave and oral glucosamine in the treatment of knee osteoarthritis. MethodsWe chose 200 patients with knee osteoarthritis treated in the Department of Rehabilitation between April 2013 and March 2015 as our research subjects. The patients were randomly divided into observation group and control group with 100 in each. The control group accepted conventional physical therapy, while the observation group underwent normal physical therapy in combination with air pressure wave and oral glucosamine treatment. We compared the two groups in terms of curative effects. ResultsThe total effective rate was not significantly different between the two groups (P＞0.05) , but in terms of efficiency rate, the observation group (85.0%) was significantly superior to the control group (73.0%) (P ＜ 0.05) . ConclusionCombined air pressure wave and oral glucosamine treatment for knee osteoarthritis is high efficient, which is worthy of being popularized.
ObjectiveTo investigate the clinical effect of arthroscopic microfracture surgery combined with oral glucosamine hydrochloride in the treatment of early knee osteoarthritis. MethodsWe retrospectively analyzed the clinical data of 172 patients with knee osteoarthritis treated between March 2007 and August 2013. The patients were divided into observation group (n=82) and control group (n=90) according to their treatment. Patients in the control group only underwent arthroscopic debridement and cartilage defect microfracture surgery, while those in the observation group underwent arthroscopic microfracture surgery combined with oral glucosamine hydrochloride. The Lysholm knee functional scores, the Lequesne index and X ray image were used to compare the clinical efficacy between the two groups. ResultsThe postoperative symptoms of both the two groups were significantly alleviated. The Lequesne index was not significantly different between the two groups before surgery, and 1 and 3 months after surgery (P>0.05), but it was significantly difference between the two groups 6, 12, 18 and 24 months after surgery (P<0.05). Before surgery, the Lysholm score was not significantly different between the two groups (P>0.05), and the score increased significantly after surgery in both the two groups (P<0.05). One and 3 months after surgery, the Lysholm score was not significantly different between the two groups (P>0.05), but it was significantly higher in the observation group 6, 12, 18 and 24 months after surgery. ConclusionArthroscopic microfracture surgery combined with oral glucosamine hydrochloride is effective in treating patients with early knee osteoarthritis, and the clinical efficacy becomes more significant with the time of treatment.
【Abstract】 Objective To compare the two different techniques determining tibial rotational al ignment in total kneearthroplasty(TKA) to enhance postoperative effect and reduce compl ications. Methods From May 2006 to April 2007, 60 patients(27 males, 33 females, aged 55-78 years ) received TKA and randomly divided into 2 groups(n =30): tibial rotational al ignmentin TKA was determined by medical 1/3 of tibial tubercle in Group A, by medial border of tibial tubercle at 0-9°varus inGroup B, by medical 1/3 of tibial tubercle at 20°or greater varus or by the mean l ine between medial border of tibial tubercle andmedical 1/3 of tibial tubercle at 10-19°varus. The angle of rotation of polyethylene cushion was calculated. Results The angleof rotation of polyethylene cushion in Group A was (8.4±3.8)° at 0-9°varus, (3.5±2.7)° at 10-19°varus and (0 ±2.4)° at 20°varusor over, respectively, and there was significant difference (P lt; 0.05). The angle of rotation of polyethylene cushion in Group Bwas (0 ±2.1)° at 0-9° varus, (0 ±2.0)° at 10-19°varus and (0 ±1.7)° at 20°varus or over, respectively, and there was no significantdifference (P gt; 0.05). The angle of rotation of polyethylene cushion averaged (5.6±2.8)°in Group A and (0±1.9)° in Group B,showing significant difference (P lt; 0.05). Conclusion The range of ideal tibial rotational al ignment in TKA was from medialborder of the tibial tubercle to medical 1/3 of the tibial tubercle, and is decided by the degree of varus deformities and valgus deformities.
Objective To investigate the effect of body mass index (BMI) on the short-term effectiveness of high tibial osteotomy (HTO) in the treatment of varus knee arthritis. Methods The clinical data of 84 patients (84 knees) with varus knee arthritis treated with HTO between May 2016 and August 2020 were retrospectively analyzed. According to BMI, the patients were divided into normal group (32 patients in group A, BMI<25 kg/m2), overweight group (27 patients in group B, BMI>30 kg/m2), and obese group (25 patients in group C, BMI>30 kg/m2). The BMI of groups A, B, and C were (23.35±0.89), (26.65±1.03), and (32.05±1.47) kg/m2, respectively. There was no significant difference (P>0.05) in gender, age, surgical side, disease duration, and preoperative Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, knee range of motion, and hip-knee-ankle angle (HKA) between groups. The operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation were recorded and compared between groups. The improvement of knee joint function and pain status were evaluated by knee joint HSS score, knee range of motion, and VAS score before and after operation, and measuring the HKA of patients on X-ray film. During the follow-up, the X-ray films of the knee joint were reexamined to observe the position of the internal fixator and the healing of osteotomy. Results All patients completed the operation successfully and were followed up 8-40 months (mean, 19.3 months). There was no significant difference in follow-up time, operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation between groups (P>0.05). No operative complications such as severe vascular or nerve injury occurred. After operation, deep venous thrombosis of lower extremities occurred in 1 case in groups A and B respectively, and fat liquefaction of surgical incision occurred in 2 cases in group C. There was no significant difference in the incidence of perioperative complications between groups (3.1% vs. 3.7% vs. 8.0%) (P=0.689). During the follow-up, there was no bone nonunion, plate fracture or loosening. At last follow-up, HSS score, VAS score, knee range of motion, and HKA significantly improved in the 3 groups when compared with those before operation (P<0.05), but there was no significant difference in the differences of the above indexes between groups before and after operation (P>0.05). Conclusion BMI does not affect the short-term effectiveness of HTO in the treatment of varus knee arthritis. HTO can be selected for overweight and obese patients after standard medical treatment is ineffective.
Objective To systematically review the rehabilitation effect of isokinetic muscle training on knee muscle strength, functional walking ability and dynamic balance in post-stroke patients. Methods PubMed, Ovid Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP, and Wanfang databases were searched online for randomized controlled trials on isokinetic muscle training of lower limbs in post-stroke patients. The retrieval time was from inception to October, 2022. Endnote X9 software was used to manage the literature. Cochrane Manual 5.1.0 was used for quality assessment, and RevMan 5.4 software was used for meta-analysis. Results A total of 20 randomized controlled trials were included in the study, with the intervention group using isokinetic muscle training of the lower extremities or combined with conventional rehabilitation training and the control group using conventional rehabilitation training and/or other intervention, with a total of 1448 study subjects. Meta-analysis results showed that the differences in knee flexion peak torque [mean difference (MD)=5.85 N·m, 95% confidence interval (CI) (4.84, 6.85) N·m, P<0.00001], knee extension peak torque [MD=9.09 N·m, 95%CI (4.83, 13.36) N·m, P<0.0001], Time Up Go test [MD=–4.70 s, 95%CI (–6.68, –2.72) s, P<0.00001], 10-meter walking test [MD=–4.71 s, 95%CI (–9.12, –0.31) s, P=0.04], Fugl-Meyer Lower Extremity Motor Function Assessment score [MD=6.61, 95%CI (3.52, 9.70), P<0.0001], and Berg Balance Scale score [MD=5.61, 95%CI (0.91, 10.31), P=0.02] were statistically significant. Conclusion Isokinetic training may improve knee strength and functional walking ability in post-stroke patients, but there is still no strong evidence of improvement in motor function and balance.
Objective To conduct a systematic bibliometric analysis of recent research on robot-assisted orthopedic surgery, in order to reveal the research trends, hotspots, main contributors, and future development directions in this field. Methods On August 27, 2024, WoSCC (Web of Science Core Collection Database) was searched and relevant literature on robot-assisted orthopedic surgery from 2003 to 2023 was included. Excel 2016, VOSviewer (version 1.6.10), and CiteSpace (version 6.2.R6) were used for data collection and analysis. Results The total citation frequency of 1718 retrieved literature was 28978 times, with an average citation frequency of 16.87 times per article. The total citation frequency of articles in 2019 was the highest (4330 times), and the publication volume in 2023 was the highest (315 articles). Among the top 5 countries in terms of publication volume, the United States had the highest publication volume and total citation frequency, while China ranked second in terms of publication volume, but had the lowest average citation frequency per article. Analysis of cooperation between countries showed that the United States, China, Germany, and other countries had the most cooperation. Babar Kayani’s articles were cited the most frequently. Among the top 10 institutions in terms of publication volume, the Hospital for Special Surgery (United States) had the highest publication volume, the Pennsylvania State System of Higher Education (United States) had the highest total citation frequency for publications, and the average citation frequency of each article published by the University of Pittsburgh (United States) was the highest. The dynamic evolution of research hotspots suggested that early research mainly focused on the combination of traditional surgical techniques and navigation, while in recent years, research had mainly focused on computer-aided surgery, augmented reality, and medical robotics technology. Conclusions In recent years, significant progress has been made in the research of robot-assisted orthopedic surgery, with the United States taking a leading position in this field and having extensive global cooperation. Research hotspots show that with the continuous development of computer-aided surgery, augmented reality, and robotics technology, the field of orthopedic surgery is evolving towards more precise, individualized, and minimally invasive directions.
ObjectiveTo investigate the effectiveness of anterior knee incision by the patellar longitudinal approach for osteotomy in treating type C fractures of the distal femur. MethodsBetween March 2010 and June 2014, 36 patients with type C fractures of the distal femur underwent fracture reduction and internal fixation by patellar longitudinal approach for osteotomy. There were 25 males and 11 females, aged 26-72 years (mean, 49 years). Injury causes included traffic accident injury (19 cases), falling injury from height (8 cases), and crushing injury (9 cases). There were 34 cases of closed fracture and 2 cases of open fracture. Associated fractures included 2 cases of patellar fracture and 4 cases of clavicular fracture; combined injuries included 4 cases of anterior cruciate ligament injury, 1 case of posterior cruciate ligament injury, 12 cases of meniscus injury, and 9 cases of medial and lateral collateral ligament injuries. It was 3-11 days from injury to operation (mean, 6 days). ResultsAmong 36 patients, 29 were followed up 12-24 months (mean, 18 months). Primary healing of incision was obtained, without infection or lower limb deep venous thrombosis. X-ray films showed fracture healing at 12-32 weeks (mean, 16.4 weeks). Neither loosening of screw and plate breakage nor valgus and varus knee occurred. Pain and stiff of the knee joint were observed in 4 and 2 cases, respectively; 4 cases walked with a cane. According to Hospital for Special Surgery (HSS) scoring system, the results were excellent in 21 cases, good in 7 cases, and fair in 1 case; and the excellent and good rate was 96.55%. The internal fixation was removed at 10-14 months after operation, and there was no re-fracture. ConclusionThe patellar longitudinal approach has the advantages of sufficient exposure, easy reduction, short operation time, good internal fixation, less damage of soft tissue, and less complication. So it is the appropriate approach to treat type C fractures of the distal femur.
Objective To assess the feasibility, safety, and validity of the TC-Dynamic posterior stabilized prosthesis implanted in the total knee arthroplasty (TKA). Methods Twelve knees of 10 patients (the TC-Dynamic group) were followed up, who had been implanted with the TC-Dynamic posterior stabilized prosthesis from September 2003 to March 2004. Preoperative KSS knee scores were 16.08±11.58, function scores 13.75±19.79, and the range of motion (ROM) of the knee 75.00±26.46°. Meanwhile, 50 knees of 30 patients (the Scorpio group) werefollowed up, who had undergone TKA with the Scorpio posterior stabilized prosthesis.Preoperative KSS knee scores were 19.48±967, function scores 3.16±19.82,andthe ROM of the knee 80.80±22.82°. The anteroposterior and lateral X-ray filmsof each knee were examined before and after operation. The statistical Z-test was used to analyze the differences between the 2 groups in the improvement of the KSS knee scores, function scores, and ROM after operation. Results The average of the 130 days’ follow-up revealed that the patients implanted with the TC-Dynamic prosthesis had an excellent result. In the TC-Dynamic group, the KSS knee scores were 88.83±4.04 with improved scores of 72.75±14.47 compared with those before operation; function scores were 79.17±5.15 with improved scores of 65.42±19.47; the ROM of the knee was 107.92±11.57° with increased degrees of 32.92±32.22°.Meanwhile, in the Scorpio group, the KSS knee scores were 85.68±7.36 with improved scores of 66.20±10.44 compared with those before operation; function scores were 71.40±12.70 with improved scores of 68.24±25.35; the ROM of the knee was 109.20±11.13° withincreaseddegrees of 28.40±26.41°.There was no significant difference in the improvement of the KSS knee scores, function scores, and ROM after operation between the 2 groups （Pgt;0.01）. All the X-ray films of the knees implanted with both the Scorpio prosthesis and the TC-Dynamic prosthesis were analyzed.No malalignment or lucent line with the prosthesis was seen in all these X-ray films. Conclusion The short-term follow-up indicates that the patients implanted with the TC-Dynamic prosthesis have an excellent result. The TC-Dynamic prosthesis with a scientific and proper design is more suitable for the Chinese. However, the long-term outcome of the patients implanted with the TC-Dynamic prosthesis should be observed in a larger number of TKA operations. The basic surgical principles, including excision of both the cruciate ligaments and correction of thebone deformity with the proper balancing of the soft tissues in flexion and extension, are still crucial to successful TKA and to the longterm high survivalrate of the knee prosthesis.