Quick Search
  Office Online
  Journal Online
Current Issue
Archive
Advanced Search
Read Articles
Download Articles
2020 Vol. 26, No. 12
Published: 2020-12-25
 
1059 Influence of Patellofemoral Joint Degeneration on the Clinical Outcome of the Oxford Medial Unicompartmental Knee Arthroplasty
Objective  To investigate the effect of patellofemoral joint degeneration on the clinical outcome of Oxford unicompartmental knee arthroplasty.Methods  A retrospective analysis was performed in 500 patients with medial compartment osteoarthritis of the knee treated by Oxford unicompartmental knee arthroplasty between April 2007 and April 2017.There were 176 males and 324 females with an average age of (61.12±8.63)(range：43~91).According to the roentgenographic grading of patellofemoral joint，there were 4 groups.There were 104 cases in grade 0~1 group，179 cases in grade 2 group，182 cases in grade 3 group and 35 cases in grade 4 group.The clinical treatment was evaluated by ROM，KSS and OKS.The long-term survival rate of prosthesis，on survival rate were evaluated by Kaplan-Meier survival analysis.The changes of ROM，KSS and OKS before and after were compared bypaired sample ttest.The changes of ROM，KSS and OKS after operation between differentgroups of patellofemoral joint degeneration were compared by One-way ANOVA. Results  The follow-up time from 2 to 12 years，with an average of (6.27±1.97)years.The KSS score improved from (59.03±5.59)points before operation to (93.80±3.45)points after operation(t＝－116.09，P＜0.05)；the OKS score increased from (23.83±2.45)points before operation to (45.61±3.83)points after operation (t＝－110.23，P＜0.05)；the ROM of knee joint was (110.40±6.84)degrees before operation and (117.11±9.68)degrees after operation (t＝－12.88，P＜0.05).The 10-year survival rate of prosthesis was 96.0%.The survival rate of prosthesis was 98.9% in grade 0~1 group，92.7% in grade 2 group，97.8% in grade 3 group，96.0% in grade 4 group，there was no significant difference；ROM and KSS of patients in all groups were not significantly different；OKS of grade 4 group were significantly decreased，the difference was significant.Conclusion  The Patellofemoral joint degeneration did not affect UKA prostheses survival，should not be regarded as a contraindication for UKA. In grade 4 degeneration of patellofemoral joint, postoperative clinical effect is a bit poor. Patients with severe degeneration of the lateral patellofemoral joint, the selection of UKA surgery still need to be cautious.Preoperative assessment of UKA by patellofemoral joint roentgenographic grading is reliable and efficient.
2020 Vol. 26 (12): 1059-1069 [Abstract] ( 321 ) HTML (1 KB)  PDF (1013 KB)  ( 409 )
1064 Influence of Different Degrees Preoperative Lower Limb Alignment Varus Deformity on the Short-term Efficacy after Unicompartmental Knee Arthroplasty
Li Yakun，Li Hao，Wang Haohao，et al
Objective  To explore the effect of preoperative lower limb alignment in different degrees varus deformity after unicompartmental knee arthroplasty.Methods  A total of 99 patients (131 knees) who underwent unicompartmental knee arthroplasty were selected from March 2018 to September 2019，including 29 males (37 knees) and 70 females (94 knees).The average age was (64.79±7.71).The average body mass index (BMI) was (26.17±4.04)kg／m2.Patients were divided into three groups according to preoperative HKA(hip-knee-ankle angle)，0°<HKA≤5°for mild varus (Group A)，5°<HKA≤10° for moderate varus (Group B)，and 10°<HKA≤15° for severe varus (Group C).The postoperative HKA，preoperative and postoperative Oxford knee score (OKS)，pain visual analogue scale (VAS) and range of motion (ROM) of knee joint results of the three groups were compared，and the correlation between the observation indexes and preoperative HKA were analyzed.Results  All patients were followed up for 12~30 months，an average of (19.01±3.80) months.There were statistically significant differences in OKS，VAS，ROM，the lower limb alignment varus deformity between preoperation and last follow-up(P＜0.05).There were statistically significant differences in preoperative OKS，VAS and ROM(P＜0.05).The postoperative HKA was(2.80±1.82)°in group A，(3.16±1.47)° in group B and (4.79±1.84)°in group C.There was statistically significant difference of postoperative HKA among three groups (P＜0.05).There were no statistically significant differences in postoperative OKS，VAS and ROM at the last follow-up among the three groups (P＞0.05).Preoperative HKA was significantly correlated with postoperative HKA，preoperative OKS and preoperative ROM (P＜0.05).Conclusion  Different degrees of preoperative lower limb alignment varus deformity has a significant correlation with the preoperative knee function and postoperative lower limb alignment，different varus deformity preoperatively do not affect the short-term clinical efficacy after unicompartmental knee arthroplasty (range of 0°~15°).
2020 Vol. 26 (12): 1064-1069 [Abstract] ( 248 ) HTML (1 KB)  PDF (1503 KB)  ( 383 )
1070 Usage Strategy of Optimized Tourniquet in Unicompartmental Knee Arthroplasty
Zhou Xiaoqiang，Yu Xiao，Xu Renjie，et al

Objective  To investigate the effects of different tourniquet strategies on the perioperative blood loss，postoperative function and complications of unicompartmental knee arthroplasty.Methods  97 patients who underwent primary UKA in our hospital from January 2018 to December 2018 were retrospectively reviewed and divided into the whole process group (12 males and 21 females)，the optimized group (11 males and 19 females) and no tourniquet group (13 males and 21 females)，according to the way of tourniquet use.We recorded the operation time，intraoperative blood loss，postoperative drainage，recessive blood loss，VAS score and swelling rate on the first postoperative day，range of motion at discharge，hospital stays and number of complications and collected knee HSS score at follow-up.Results  The operation time of the whole process group and the optimized group was shorter，and the amount of intraoperative blood loss was less (P＜0.05).However，the postoperative drainage，hemoglobin reduction，recessive blood loss，VAS score swelling rate，range of motion，the number of minor complications，the hospital stay and the HSS score at one month were significantly betterin the optimized group and the no tourniquet group than in the whole process group (P＜0.05).There was no statistically significant difference in the number of severe complications and the HSS score at follow-up between the three groups (P＞0.05).Conclusion  During Unicompartmental Knee Arthroplasty，optimization of tourniquet usage can effectively reduce intraoperative blood loss and reduce the operation time，without affecting the early recovery of the patient and increase the incidence of complications.
2020 Vol. 26 (12): 1070-1078 [Abstract] ( 293 ) HTML (1 KB)  PDF (1615 KB)  ( 303 )
1075 Short-term Clinical Efficacy of Unicompartmental Knee Arthroplasty in the Treatment of Unicompartmental Knee Osteoarthritis with Osteoporosis
Xu Han 1，Lv Bo 2，Zhao Yongzheng 3，et al
Objective  To retrospectively analyze the short-term clinical effect of single condyle replacement in the treatment of anterior medial compartment osteoarthritis of knee combined with osteoporosis in the aged over 70 years.Methods  A retrospective study was conducted on 36 patients with antemedial knee osteoarthritis combined with osteoporosis who underwent unicondylar replacement in the department of Orthopedics of Sichuan People's Hospital from June 2017 to June 2019.According to Kellgreen-Lawrence (K-L) grading scores，there were 25 patients with grade Ⅲ and 11 patients with grade Ⅳ.The changes of tibial femoral angle (FTA)，hip，knee and ankle Angle (HKA)，lower extremity line，active maximum range of motion (ROM)，visual analog score (VAS) and knee joint score (HSS) in hospitals for special surgery，as well as the occurrence of complications were analyzed before and at the last follow-up.Results  All patients were followed up and theaverage follow-up time was (11.5±5.8) months.HKA，FTA，ROM，VAS and HSS were significantly improved in the last follow-up (P＜0.05).No postoperative complications caused by osteoporosis or prosthesis occurred in the last follow-up.Conclusion  The elderly patients with osteoarthritis of the knee combined with osteoporosis is relatively common in clinical，the choice of the knee joint monondylar prosthesis careful，skilled the surgical techniques，postoperative active anti-osteoporosis，monondylar replacement are preferable satisfactory clinical efficacy.
2020 Vol. 26 (12): 1075-1078 [Abstract] ( 318 ) HTML (1 KB)  PDF (679 KB)  ( 391 )
1079 The Finite Element Analysis of the Deviation of Intramedullary Guides in Oxford Unicompartment Knee Arthroplasty
Xu Cheng，Nan Shaokui，Li Haifeng，et al
Objective  To simulate the intramedullary localization process of Oxford unicompartment knee arthroplasty (OUKA) by digital technology，and to analyze the error of intramedullary guide of the rodwith different length by finite element analysis.Methods  The patients underwent OUKA from January 2019 to October 2019 in our department were selected prospectively.The three-dimensional model of femur was established by using the software of mimics and 3-matics，and thepositioning process in OUKA was simulated.Two kinds of intramedullary rods with different lengths (30 cm and 20 cm) were inserted respectively.The finite element analysis was carried out by using the software of Ansys.The swinging of the intramedullary rod in the intramedullary cavity was simulated，and the distance of the rod end moving was obtained.The maximum distance and the maximum displacement of the rod end in the sagittal and coronal plane of the intramedullary cavity were calculated.The data were analyzed statistically.Results  The maximum swing range of 30 cm rod was (1.10±0.72)degrees in sagittal plane of the femoral medullary and (0.85±0.55)degrees in coronal plane，while (4.36±0.95)degrees in the sagittal and (3.77±1.00)degrees in the coronal of 20 cm rod.The maximum swing range of the same rod in sagittal plane was larger than that in coronal plane，and the difference was significant (P＜0.05).On the sagittal and coronal plane，the maximum swing range of 30 cm rod was significantly smaller than that of 20 cm rod (P＜0.05).There was a significant correlation between the swing range of 30 cm and 20 cm rods.Conclusion  In this study，a finite element model of the movement of the rod in the marrow cavity is established.It is proved that the error of the 30 cm rod is significantly less than that of the 20 cm rod，and its positioning is more accurate.However，for patients in small size，it is possible that the intramedullary rod cannot be completely inserted or deformed after insertion.For these patients，we recommend 20 cm rod.
2020 Vol. 26 (12): 1079-1082 [Abstract] ( 272 ) HTML (1 KB)  PDF (1707 KB)  ( 318 )
1135 Clinical Observation of Platelet Rich Plasma in the Treatment of Chondromalacia Patellaeof Knee Joint
Liu Wenbo，Chen Bojian，Lin Yuewei，et al
Objective  To observe the clinical efficacy of Platelet-rich plasma(PRP)in the treatment of chondromalacia patellae of knee joint.Methods  60 patients with patellar malacia disease were randomly divided into two groups，30 patients in each group.The experimental group (group A) was injected with autologous PRP in the joint cavity，while the control group (group B) was injected with cross-linked sodium hyaluronate in the joint cavity.Changes in visual analogue scale (VAS) and Western Ontario and McMaster Universities Arthritis Index(WOMAC) were observed 1 month，3 months，6 months，and 1 year after treatment. Results  After 1 month of treatment，VAS scores in group A and B were significantly lower than those before treatment (P<0.05).VAS and WOMAC scores of group A and B were different after 1 month and 3 months of treatment，but there was no statistical significance.VAS and WOMAC scores after 6 months and 1 year of treatment were significantly better in group A than in group B，with statistically significant differences (P<0.05).During the follow-up，VAS and WOMAC scores in group A continued to decrease，while VAS score and WOMAC scores of group B increased 6 months after treatment.Conclusion  Platelet rich plasma therapy can significantly improve the pain and joint function of patellomalacia，and has a stable short-term effect.
2020 Vol. 26 (12): 1135-1147 [Abstract] ( 269 ) HTML (1 KB)  PDF (726 KB)  ( 336 )
1139 Biomechanical Study of Fibular Osteotomy of Knee Joint
Li Cunxiang 1，Li Desi 2
Objective  To investigate the biomechanics of fibula osteotomy and the mechanism of treating knee osteoarthritis.Methods  Three healthy adult lower limb specimens were obtained，2 male specimens and 1 female specimen，aged 30，33 and 40 years，respectively.Including 2 right knee joints and 1 left knee joint.The pressure load of the four quadrants of the anterior and posterior tibiofemoral compartment of the fibula was measured with a film pressure sensor manufactured by takscan company under a longitudinal load of 800 N.Results  The results showed that the pressure distribution in the knee joint was uneven，but had similar rules.The pressure in the posterolateral quadrant was the largest，followed by the anterior inner quadrant.The total pressure of the lateral platform was greater than that of the medial，and the pressure in the anterolateral and posteromedial quadrants was the smallest.After fibular osteotomy，the pressure in the anterior inner quadrant and the anterior outer quadrant decreased，but the pressure in the posterior outer quadrant was greater，and the pressure in the posterior inner quadrant also increased.Conclusion  Fibular osteotomy can reduce the medial pressure of knee joint and can be used for the treatment of knee varus arthritis.The medial pain of knee arthritis can be relieved or disappear after fibula osteotomy.However，adaptive rehabilitation training should be carried out after operation to make the knee joint adapt to the new load distribution and prevent the disease from repeating or aggravating caused by the increase of tibial load after fibula osteotomy.
2020 Vol. 26 (12): 1139-1142 [Abstract] ( 229 ) HTML (1 KB)  PDF (1198 KB)  ( 276 )
Copyright © Editorial Board of sygkzz
     ���������� 14010702070875��
Supported by:Beijing Magtech